Nurses are the backbone of the healthcare system, comprising 59% of the healthcare
workforce (Salmond, 2021); however, research indicates that 32.8% of newly hired
Registered Nurses (RNs) voluntarily terminate their positions within the first year and
must then be replaced (NSI Nursing Services, 2023). The turnover problem among nurses
threatens the delivery of adequate, safe, and timely patient care, the health and
well-being of nurses and other healthcare professionals, and the sustainability of the
organizations for which they work.
High job turnover among nurses is a problem that has inspired the design, implementation,
and study of numerous organization/system-driven interventions over at least the past
sixty years. Numerous researchers have identified the first year of practice as the most
stressful time in a nurse's career (Chesak, 2019), with the highest levels occurring
at four and eight months of employment (Fang, 2022). These nurses can experience a
phenomenon known as 'transition shock,' comprising cognitive, psychological, and
emotional distress (Duchscher, 2009). Transition shock can lead to nurses feeling
overwhelmed by the stark and unanticipated realities of nursing practice, especially if
that reality conflicts with previously held ideals, beliefs, and expectations. In
addition to experiencing elevated stress levels and transition shock, exposure to
healthcare-related psychological trauma plays a key role in why nurses have left and
continue to leave their positions and the profession in droves (Foli, 2019).
Burnout is a common phenomenon among nurses. Key contributors to the development of
burnout among healthcare workers include exposure to traumatic events such as witnessing
death and suffering, the psychological and physical demands of the job, shift work, low
autonomy, inadequate social support, incivility in the workplace, low staffing, and poor
communication and collaborative relationships with other healthcare professionals
(Chesak, 2019).
Despite the significant human and financial resources invested in solutions that attempt
to mitigate nurse turnover, there is surprisingly little evidence in the published
literature on the use of integrative mind-body self-care interventions to help individual
nurses cope with prolonged or toxic levels of stress, burnout, traumatic stress, and
somatic symptoms.
Self-care deficits are common among nurses, who typically focus on helping and serving
others. While altruism, compassion, and a commitment to help others draw many people to a
career in nursing, the desire to help others deal with their health problems can
sometimes overshadow a nurse's motivation or ability to care for themselves (Crane,
2016). A 2017 survey by the American Nurses Association (ANA, 2017) found that 68% of
nurses put their patients' safety, health, and wellness ahead of their own. Furthermore,
although nurses are well-educated and often teach patients about the importance of
health-promoting behaviors, that knowledge does not always translate into engagement in
healthy lifestyle behaviors among nurses themselves (Albert, 2014).
In the wake of the COVID-19 pandemic, when nurses are more traumatized, stressed, and
spread thinner than ever (American Nurses Foundation, 2021), some are resorting to
employing maladaptive coping strategies, such as substance or alcohol abuse, to cope with
stress and negative emotions (Foli, 2021). This highly problematic engagement in
maladaptive coping strategies highlights and underscores the need for safe,
cost-effective, accessible, and acceptable self-care options for nurses.
Mind-body psychoneuroimmunology-based interventions, such as Tai Chi, have been used for
centuries by people all over the world and may be a feasible self-care intervention for
new graduate nurses. Mind-body therapies are defined as those that emphasize using the
brain in conjunction with the body to harness innate healing powers. Mind-body exercise
often includes multiple components, such as breathing practices, focused attention,
meditation, and gentle physical movements (Bower, 2016). Numerous conceptual models
propose that the primary mechanism by which mind-body therapies produce their effects is
through self-regulation, which has a top-down effect on numerous physiological processes
that impact health and health behaviors (Bower, 2016). Mind-body modalities can improve
nurses' general health and well-being and may help prevent or reduce burnout by
reducing psychological stress and alleviating somatic symptoms (Jung, 2021) through
alterations in inflammatory processes (Irwin, 2015).
Tai Chi Easy™ (TCE) is a safe, cost-effective, non-pharmacological intervention developed
by Dr. Roger Jahnke. TCE is a simplified and streamlined practice that draws from the
four main recognized styles of tai chi (Ward, 2023). According to Jahnke (2003), the
deliberate attention to breathing, movement, and meditation in tai chi integrates the
nervous, endocrine, cardiovascular, digestive, and immune systems with the psyche.
TCE practice comprises four baskets: Self-applied massage, mindful movement, breathing
exercises, and meditation exercises (Ward, 2023). TCE is appropriate for people of all
ages and health conditions because it is easy to learn and perform and is extremely
adaptable (Ward, 2023).TCE is a cost-effective and sustainable mind-body intervention
that does not require any special clothing, footwear, or equipment and can be practiced
virtually anywhere, at any time. Therefore, TCE is the ideal behavioral intervention for
this study to help new nurses cope with stress and improve their overall health and
well-being.
Offering TCE in an asynchronous, virtual format will allow nurses (who often work the
night shift and may need to sleep when in-person classes would typically be offered) to
allow for greater flexibility and opportunities to access the intervention.
The purpose of this study is to a) gain a deeper understanding of factors contributing to
high turnover among nurses, including past exposure to adverse childhood experiences and
adverse life events, b) determine whether virtual TCE training is a feasible, acceptable,
safe, and appropriate mind-body self-care intervention among NGNs, and c) explore whether
changes in stress, transition shock, posttraumatic stress symptoms, and transition shock
occur after participation in a six-week asynchronous virtual TCE training intervention.
The specific aims of this study are as follows:
Aim 1: Feasibility
- Evaluate whether Tai Chi Easy™ is a feasible, acceptable, and appropriate self-care
intervention for registered nurses. Recruitment, retention, intervention adherence,
and safety data will also be obtained.
Aim 2: Changes in Symptoms of Distress
- Explore whether changes in stress, transition shock, burnout, somatic symptoms,
posttraumatic stress symptoms, and intention to quit occur post-intervention.
The results of this study will 1) fill an important knowledge gap in the nursing
literature, 2) inform future studies regarding the use of virtual Tai Chi Easy™ as a
safe, acceptable, cost-effective, and sustainable intervention for nurses who may be
experiencing the phenomena of interest, and 3) provide information with potential utility
for the academic and healthcare industry sectors. There is a demonstrated need to better
prepare nurses for the tumultuous and highly stressful entry to professional practice and
to guide the design and implementation of programs to help new nurses adjust and remain
in their roles.