Promoting Resilience in Context of Adverse Childhood Articles Paper

A Outline for each article. I need two research outlines, full statements. (sentences)

Experiences of Adversity at Work: Toward an Identity-Based Theory of Resilience
by
Brianna Barker Caza
A dissertation submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
(Psychology)
in The University of Michigan
2007
Doctoral Committee:
Professor Jane E. Dutton, Chair
Professor Richard P. Bagozzi
Professor Christopher Peterson
Professor Kathleen Sutcliffe
Assistant Professor Lisa Kane Low
Clinical Professor Lynn P. Wooten
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UMI N um ber: 3276107
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© Brianna Barker Caza
All rights reserved
2007
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To Grandpa Bob and Grandpa John.
You two began it all.
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ACKNOWLEDGEMENTS
Writing this dissertation was one of the hardest and most fulfilling things I have
ever done. Although I am riding high now that it is all done, there were many bumps in
the road. I am sure I would be wandering around aimlessly somewhere (probably in
whole foods) if I had not had the love, encouragement and support from my advisors,
friends, and family.
First and foremost I want to thank my exceptional committee of mentors for their
guidance, insightful comments, support, and nurturance along the way. All six of my
committee members are incredibly accomplished and busy scholars who consistently
made time for me throughout this journey.
Thank you to Rick, who taught me more about statistics and analysis than I could
have ever learned from the millions of textbooks out there. Your patience and generosity
has been a gift to me.
Thank you to Lisa, who was willing to take me into her world and trusted me to
explore. To me, you epitomize a resilient midwife.
Thank you to Lynn, who has consistently gone out of her way to help me both
personally and professionally. No matter how I felt coming in, I have always left your
office with a smile.
Thank you to Kathie, whose foundational work in organizational resilience helped
pave the way for this research. You always amaze me with your tremendous knowledge
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of seemingly all aspects of organizational theory, and your invaluable insights have
always challenged me to go to new depths in my work.
Thank you to Chris, whose amazing mind can always put things into perspective.
I have always admired your work, and after getting the chance to work with you as a GSI
and on this dissertation, I have also come to admire you as a person. You have not only
been a bottomless source of knowledge, but you have been a vital source inspiration and
support for me over the past few years.
And finally, thank you to Jane, who embodies everything I could every have
hoped for in a mentor, dissertation chair, and friend. Without your love, encouragement,
support, and wisdom, I am not sure I would have finished my second year of graduate
school, much less my dissertation. You are truly a life-giving force. After any meeting
with you (even those in which you had to deliver bad news, like when a complete rewrite
of a chapter was required) I have felt energized and excited to get to work. You have
shaped absolutely every aspect of this dissertation and my graduate career. You have
taught me about good scholarship and about enriching working relationships. Most of all,
you have been a tremendous role model in work and in life.
There are many, many people who have supported me over the past five years,
and made this process not only bearable, but truly enjoyable (well, enjoyable at times).
Thank you to my fellow PhD students who have provided invaluable collegiality and
friendship. A special thank you to Amy and Connie. You two have been so gracious with
your time and knowledge, reading draft after draft of my work and providing me
feedback. You have also been the best friends I could have ever asked for. Thank you to
Emily for taking this journey with me. Thank you to Jose, Brian, Jacoba, Jason, and Barb
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for all that you have done. Thank you to Eric, Molly, Maggie, and Charlie for all the
weekends along the way that have kept me sane and grounded.
Thank you to the big brothers and sisters of Organizational Psychology who made
being and Org. Psych, student a true honor. Thank you to Laura, Mike, Monica, and Amy
for being a source of information and inspiration. I feel lucky to have benefited from your
guidance, and even luckier to call you my colleagues and friends.
This dissertation would not have been possible without the support of the U of M
community. Thank you to Lesley and Kathy for all of your support. I also received very
valuable comments at different points of this process from so many amazing scholars.
Thank you to Lance, Lilia, Gretchen, Mary Ann, and Fiona who have all played a role in
shaping who I have become these past five years.
My friends and family outside of the University of Michigan have always been
incredibly supportive of my endeavors. Thank you to Krysta, for all your emotional
support. Thank you to Noreen, who has made the dissertating process possible.
Thank you to my family, whose intangible love and support has made this
possible. Grandma Rita, you have continually supported and encouraged me. You have
helped me through this process every step of the way. It it was not for your profound
belief in my abilities, I probably would not have even begun this process. Mom, you have
always been and always will be my idol. Thank you for continually setting such a high
bar. Dad, you are the reason I came to Michigan. You epitomize unconditional love and
support. You never cease to amaze me with your generosity and kindness. Ashley, I am
so proud of you, and I feel lucky to have a sister who is also my best friend. Jason, you
have been an incredible source of support for me since I entered graduate school, thank
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you. Thank you to Ryely, and Jenn for putting up with me through this, and always
allowing me to bounce ideas off you.
Finally, I have no words to express the depth of love and gratitude I feel for Arran
and Max. (Fitting, isn’t it?) Thank you for my life. You two make it all worthwhile.
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TABLE OF CONTENTS
ACKNOWLEDGEMENTS
LIST OF TABLES
LIST OF FIGURES
LIST OF APPENDICES
ABSTRACT
iii
viii
ix
x
xi
CHAPTER
1.
Introduction
1
2.
Resilience at Work
3.
Testing a Model of Professional-IdentityBased Resilience at Work
47
4.
Telling Tales of Adversity: A Narrative Study of Identity-based
Response to Adversity at Work
109
Conclusion
174
5.
20
APPENDICES
BIBLIOGRAPHY
192
215
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LIST OF TABLES
3.1. Descriptive Statistics of Study Variables
95
3.2. Goodness of Fit Indices for the Measurement and Structural Models
97
3.3. Proportion of the Variance Accounted for in each Endogenous Variable
97
4.1. Descriptive Summary of Interview Informants
130
4.2. Summary of Types of Adversity
137
4.3. Evidence of Work-Identity Crisis
139
4.4. Evidence of Response Moves
146
4.5. Evidence of Outcomes
151
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LIST OF FIGURES
3.1. Conceptual Model of the Association between Professional Identity and
Resilience at Work
83
3.2. Final Structural Model of the Association between Professional Identity and
Resilience at Work (N= 143)
98
4.1 Model of CNM’s Experiences and Responses to Adversity at Work
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156
LIST OF APPENDICES
A. Description of survey measures
192
B Midwife resiliency survey
194
C. Resilience at work survey scale items
207
D. Sample recruitment e-mail to interview participants
209
E. Semi structured interview protocol
211
F. Nurse-midwifery study information sheet
214
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ABSTRACT
Experiences of Adversity at Work: Toward an Identity-Based Theory of Resilience
by
Brianna Barker Caza
Chair: Jane E. Dutton
This dissertation takes an identity-based approach to understanding how
individuals experience and respond to adversity in the workplace. Prior research has
shown that experiences of adversity in the workplace have negative consequences for
individuals and organizations. However, not all professionals who experience work stress
bum out. In fact, some emerge from stressful situations displaying increased competence,
professional growth, and the ability to handle future challenges. To account for this
discrepancy between theory and reality, this dissertation builds a theory of resilience at
work. This dissertation took an identity-based approach theorizing that an individual’s
work identity provides cognitive, affective, and behavioral resources that shapes the
experience and outcome of adversity at work. A mixture of quantitative and qualitative
methodologies tested this proposition. In study 1 ,1 used structural equation analyses
with a sample of 228 certified nurse-midwives to test whether three components of
professional identity (content, structure, and strength) cultivate individual and social
resources (meaningfulness, creative responding, and social support) and lead to
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resilience. I found that professional identity was associated with resilience at work
through two pathways. First, strength of identification was positively associated with
resilience at work, and this relationship was mediated by affective commitment.
Secondly, I found that structure of identification was associated with resilience at work
through its effect on both energy loss and creative responding. In Study 2 , 1 took a
narrative approach, and analyzed 29 adversity stories gathered in interviews with CNMs
to understand how CNMs perceive, experience, and respond to adversity in the
workplace. Results from this study demonstrated that work identity was an important
global meaning system in work organizations. As a global meaning system, work identity
played an important role in shaping how individuals experience and respond to adversity
at work. Specifically, individuals discussed five different identity-based response moves:
disengagement, stoic coping, switching jobs, identity customization, and job crafting.
Taken together, these two complementary studies demonstrated that experiences of
adversity are not always bad or problematic, and shows that how individuals
conceptualize themselves in their work roles (work identity) influences their experiences
of, responses to, and outcomes from adversity at work.
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CHAPTER 1
Introduction
“There was a window of time, a decade when a few of us had everything:
supportive backup doctors, hospital privileges, affordable malpractice
insurance, and a patient population that wanted exactly what we had to
offer. It was brief, and it may never happen again, so I wanted to
document all that was so wonderful about it.”
(Peggy Vincent, CNM and Author)
“I love my work. Really, this is the best job in the world… If anything, my
dissatisfaction comes from feeling as though I am not doing enough. If I
could, I would live at my job. Nothing is easy; there are a lot of hard
things about my job. But, no one day is the same, which makes it always
exciting. You always have something to learn from, and you can always
improve.”
(Teresa, CNM14, Hospital practice)
These are two statements from Certified Nurse-Midwives (CNMs) reflecting on
their experiences in the profession. The first is from Peggy Vincent, a former CNM, and
the author of a book chronicling her career as a CNM. In her statement, Peggy explains
that her motivation for chronicling her career was because she believes, like many other
CNMs in the United States, that the working climate has become inhospitable to
individuals in the nurse-midwifery profession. In her book, Peggy details the highs and
lows of her experiences as a CNM, concluding that she left the profession because of the
hardships she faced in trying to carry out such physically and emotionally demanding
work in an increasingly difficult work environment. Indeed, the list of grievances from
those in the profession is lengthy: long hours, emotionally and physically laborious work,
low pay, frivolous malpractice suits, constant struggle for respect and legitimacy, difficult
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patients, and, of course, the life and death context of the work itself (Amey, 1987; Rooks,
1997). While it is not uncommon to find people in the modem workforce who find the
demands of their work overwhelming, it becomes a problem when employees in any
profession respond to the stresses of their jobs by simply leaving them, as Peggy Vincent
did. This response to stress on the job is referred to as burnout which entails emotional
exhaustion, depersonalization, and reduced accomplishment (Maslach, 1982). Individuals
who become burned out experience a lack of energy, lack of control, helplessness,
lowered motivation, and negative attitudes toward themselves, their work, and others
(Pines, Aronson, & Kafry, 1981). Burnout also contributes to lowered mental and
physical health of employees (Maslach, Jackson, & Lieter, 2001; Schwab, Jackson, &
Schuler, 1986) and costs work institutions millions each year in health care, missed
workdays, and stress reduction efforts (Maslach & Leiter, 1997). Many articles in the
organizational sciences are devoted to understanding burnout and negative responses to
experiences of adversity at work (for a review see Jackson, Schwab, & Schuler, 1986;
Lee & Ashforth, 1993; Halbesleben & Buckley, 2004; Leiter, 1993; Maslach, Schaufeli,
Leiter, 2001; Pines, Aronson & Kafry, 1981).
Obviously, not all CNMs bum out and leave the profession like Peggy Vincent
did. In fact, statistics from the annual membership survey of CNMs suggest that the
profession of nurse-midwifery is growing in both quantity and quality (ACNM, 1998).
This suggests that there are a number of CNMs who take adversity as an opportunity for
personal growth, and display resilience. The second statement above, which was provided
by a CNM interviewed for this dissertation, Teresa1, illustrates this positive
1 Teresa is not the C N M ’s real name. All participants were assigned a pseudo name to protect their
anonymity.
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developmental trajectory. This CNM works within the same institutional context as
Peggy Vincent did, and has spent approximately the same amount of time in the
profession. Therefore, it is likely that these two CNMs likely faced similar adversities
and performed similar tasks. Yet, while Peggy Vincent chose to leave the profession
because of the adversity inherent in her job, the CNM from City Hospital embraced the
constraints, and viewed them as an opportunity to learn and grow, displaying resilience.
To date, the organizational science literature has not yet accounted for this type
of positive response to adversity at work. In this dissertation, I sought to understand why
some individuals burnout when faced with adversity, as Peggy did, while others display
resilience, as Teresa did. I studied this phenomenon in the context of nurse-midwifery,
but I generalized my findings to all professional workers. In doing so, I expand the study
of organizational behavior beyond the professional burnout phenomenon, and determine
how adversity can foster personal and professional growth through resilience. The
overarching goal in this dissertation was to understand the factors that influence how
individuals respond positively to adversity in their professional work contexts. Although I
study a range of responses to adversity, my specific focus was on trying to uncover the
antecedents and process of resilience at work.
This introduction serves three goals. First, I illustrate the potential of an identitybased approach to understanding responses to adversity in the workplace. Second, I
describe the context of nurse-midwifery, and explain the attractiveness of this particular
context for examining my research questions. Third, I provide an overview of the
dissertation.
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An identity-based approach for understanding responses to adversity at work
Despite the importance of resilience for modem workers and their organizations
(Coutu, 2002), little research has investigated resilience in adult populations (Bonanno,
2004), and even less attention has been paid to resilience in workplace contexts (Sutcliffe
& Vogus, 2003). Therefore, little is known about the nature, antecedents and experience
of resilience at work. My research addressed this gap. In this dissertation, I explored the
mechanisms and processes that shape how individuals respond to experienced adversity
at work. Specifically, I focused on the positive response of resilience.
In this dissertation, I focused on understanding the role of professional identity in
shaping individuals’ experiences of and responses to adversity at work. To date, the
psychological coping and resilience literature has generally overlooked identity processes
(Hansen & Sassenberg, 2006; Mossakowski, 2003; Thoits 1995). I claim that this is a
substantial oversight, and may account for a number of misunderstandings in our current
literature. For example, the current literature does not fully address why some individuals
respond negatively to adversity while others respond positively. Examining identity
processes may help provide insight into these questions. Recent investigations into the
coping strategies of professional psychologists lend support for this assertion by
suggesting that affirmation of professional identity is an important coping resource
(Rupert & Kent, 2007; Rupert & Morgan, 2005; Stevanovic & Rupert, 2004). Building
on and extending this finding, I propose that professional identity plays a key role in
shaping how individuals experience and respond to adversity in the workplace.
Specifically, I assert that an identity lens offers an important theoretical framework for
understanding how individuals are able to achieve professional growth in the context of
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adversity at work. To illustrate the potential usefulness of an identity-based approach, in
this section, I explain the nature of professional identity, and illustrate its importance in
explaining how individuals respond to adversity at work.
Professional Identity
Identity plays an increasingly important role in helping explain individuals’
experiences at work. Gecas (1982) defined identities as the various meanings that are
attached to a person by his/herself and others. Individuals possess a number of personal
and social identities. Personal identities are defined as attributes of the individual (e.g.,
smart, cheerful), whereas social identities are indicative of membership in a particular
social group (e.g., race, gender, occupational) (Tajfel & Turner, 1986). So while personal
identities describe unique characteristics of the person, social identities describe general
characteristics an individual shares with collectives. Individuals derive social identities
from memberships in a variety of social groups, including work groups.
The majority of research on social identities in organizational contexts has
focused on demographically-derived group identities and organizational identification
(e.g., Ashforth & Mael, 1989; Ely, 1994; Tajfel, 1978), but an individual’s social
identities can also derive from membership in occupational groups (Alderfer & Smith,
1982; Fine, 1996; Van Mannan & Barley, 1984). Individuals spend an enormous amount
of their life working, thinking about work, and talking about work. Therefore, who they
are in the context of their work is extremely important. Hughes (1958) argued that
occupational roles are one of the few “master statuses” around which individuals
organize their identity. Individuals use master statuses, such as occupational roles, as a
way to integrate other roles or self-identities (Stryker, 1987). Master statuses are
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identities that override other characteristics of a person in many contexts, or “structurally
based attributes that reflect the features of the social structure in which people’s role
identities are embedded, but because they do not carry specific sets of behavioral
expectations they are not separate components of the s e lf’ (Hogg, Terry, & White, 1995,
p. 257). In this research, I focused on professional work, and how individuals’
identification with their professional or occupational group influence their response to
experiences of adversity at work.
Professionals are defined as people possessing advanced training and unique
skills, which make them essential parts of their organizations and society at large
(Wallace, 1995). A profession is an occupation that requires skill based on technical
knowledge, advanced education and training, formal testing of competence, controlled
admission, admittance to professional associations, codes of conduct and professional
responsibility in serving the public (Goode, 1966). Morrow and Goetz (1988) used the
term “professionalism” to describe the extent to which an individual identifies with his or
her chosen profession and accepts their profession’s values and practices, and the term
“professional” is used to describe an individual operating within a profession.
Professional identity is a type of work identity (Becker & Carper, 1956; 1966). It
encompasses the attributes, groups, roles and professional experiences that individuals
within a profession use to conceptualize themselves as a professional (Ibarra, 1999;
Schein, 1978). Fine (1996) proposed that professional identities are the images that
individuals create of their work roles, and are both mutable and divisible (Fine, 1996). In
his study of chefs, Fine (1996) found that chefs used four occupational rhetorics to
describe their professional identity. One was the artistic rhetoric, which he described as
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contributing a sense of belonging to a glamorous occupation. A second was the rhetoric
of business, which focused on the bottom line (i.e., how to establish and maximize
profit). A third was the rhetoric of labor, which was the most negative and selfdenigrating, and described work as simply labor. The fourth rhetoric was the professional
rhetoric, where little is more important than the work itself. Fine (1996) argued that
occupational rhetorics are an avenue through which individuals are able to justify their
work both to themselves and to the pubic. This research suggested that professionals
devote significant time and attention to understanding who they are at work. In other
words, professional identities play a central role in the lives of all individuals.
Professional identities are formed through training, socialization, and
participation in occupational communities. Van Mannan and Barley (1984, p. 287)
defined occupational communities as “a group of people who consider themselves to be
engaged in the same sort of work; whose identity is drawn from the work; who share with
one another a set of values, norms, and perspectives that apply to but extend beyond work
related matters and whose social relationships meld work and leisure.” Occupational
communities are distinguishable from organizational communities in that the former is
comprised of individuals who share a common approach to a particular type of work;
whereas the later refers to individuals who work within the same organizational
boundaries (Van Mannan & Barley, 1984). Thus, while there is some overlap in an
individual’s occupational and organizational community, it is usually incomplete at best.
As Van Mannan and Barley (1984) explained, “although a position is organizationally
created and sanctioned, the work that comprises such a position often has a history of its
own and, therefore, a context that is not organizationally-limited” (p. 291). In other
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words, one organizational community is likely to contain members from a number of
different occupational communities. In the same light, one organization is comprised of
individuals with varying professional identities.
Professional identity differs in important ways from organizational identity. While
professional identity focuses on the work individuals do, organizational identity is an
indicator of where individuals work (Pratt, Rockmann, & Kaufmann, 2006). An
individual’s professional identity reflects an individual’s cognitive perception of who
they are as a member of a professional occupational community, while their
organizational identity reflects their perception of who they are as a member of an
organizational community. An individual’s professional identity is not simply the role
defined by occupational standards. Rather, professional identities are the images that
individuals create from their work roles, and are both mutable and divisible (Fine, 1996).
In other words, there is not one dominant image that individuals from an occupation
identify with. In this way, an individual’s professional identity is co-created as
individuals interact with their professional environment.
The importance of understanding professional identity in today’s workplace is
paramount, yet our current knowledge is limited (Becker 8c Carper, 1966; Pratt et al.,
2006). Van Mannan and Barley (1984) contend that contemporary organizational
behavior research has failed to properly conceptualize the process of organizing in that
most theories focus purely on the influence of organizations, and fail to account for the
influence of the work itself. They note that the incongruence between ethnographic
accounts of individual’s work and traditional studies of the same topics are the result of
the dominant rational approach to organizations predicated by Weber (1968).
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Elaborating on this, Barley (1996) explained, “work became the intellectual property of
organizational theory’s other discipline, the sociology of work and occupations. Because
early organizational theorists were committed to seeking general principles of organizing,
when they found it necessary to talk about work, they turned to abstraction” (p. 407).
The majority of research on professional identity has been conducted at the macro
level of analysis in professional sociology (e.g., Abbott, 1981, 1988, 1993). This work
builds theory about professional identity at the institutional level, primarily focused on
interoccupational competition and the development and control of professional
jurisdictions (e.g. Abbott, 1981, 1988, 1993). There is significantly less research aimed at
understanding how individuals identify with their professional group (Pratt et al., 2006)
and the implications of this identification for individual action and cognition in
workplace contexts.
Noting the importance of understanding professional identity at the individual
level of analysis, several scholars have aimed to uncover the nature and formation of
professional identity processes (e.g., Becker & Carper, 1956; 1966; Fine, 1996; 2006;
Ibarra, 1999; Pratt et al., 2006; Van Mannan & Barley, 1984). Yet the majority of these
efforts have been focused in particular at understanding how professionals come to form
professional identities during socialization or role transition, and how they negotiate
between personal and professional identities. As a result, we do not yet know much about
the nature or role of professional identity during other times during an individual’s career
(Kreiner, Hollensbe, & Sheep, 2006).
Identity work, or the process of forming, repairing, maintaining, strengthening, or
revising the constructions of identity to form a sense of coherence and distinctiveness
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(Sveningsson & Alvesson, 2003) is ongoing for individuals in work organizations
(Kreiner et al., 2006). Yet, certain events or periods may be especially critical times for
identity work. In other words, certain events can prompt individuals to engage in periods
of intense identity work. I propose that experiences of adversity are critical periods for
identity work in organizations. I elaborate on this proposition in the next section.
The Role of Identity in the Context of Adversity
Understanding how individuals and organizations respond to adversity in the
workplace has been a topic of great interest to organizational scholars (e.g., Meyerson,
1994; Sutcliffe & Yogus, 2003; Gittell, Cameron, Lim & Rivas, 2006; Weick, 1993;
Weick & Roberts, 1993; Weick, Sutcliffe, & Obstfeld, 1999; Worline, Dutton, Kanov,
Lilius, Matlis & Frost, 2006). Individuals in most every work setting are faced with both
large and small crises over the course of their careers. Small, chronic stressors, like
uncivil working conditions, can accumulate over time to produce negative repercussions
(e.g., Andersson & Pearson, 1999; Cortina, Lonsway, Nagley, Freeman, Collinsworth,
Hunter & Fitzgerald, 2002; Cortina, Magley, Williams, & Langhout, 2001; Pearson,
Andersson, & Wegner, 200; Worline et al., 2007).. Meanwhile, unexpected acute events,
like the death of a patient, can instantaneously throw the organization into turbulence and
throw an individual’s professional career off-track (e.g., Gittell, et al., 2006; Weick,
1993; Weick & Roberts, 1993).
In this dissertation, I posit that experiencing adversity at work is likely to be a
time in which individuals are forced to reflect on their professional identity. When faced
with adversity, many individuals attempt to cope by making meaning out of their
experiences and their lives (Park & Folkman, 2004). As a cognitive schema that
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encompasses the individual’s goals, values, and practices at work (Schein, 1978), an
individual’s professional identity becomes salient in order for the individual to make
meaning out of the adversity. As a result, professional identity processes and mechanisms
become important resources in shaping individuals’ responses to experienced adversity.
Identity as a Resource
Past research has demonstrated that understanding identity and identification
provide important insights into cognitions, behaviors, and affect in organizational
contexts (e.g., Ashforth and Mael, 1989; Dukerich et al., 2002; Dutton, Dukerich, &
Harquail, 1994; Elsbach, 1999; Pratt, 1998; Weick, Sutcliffe, & Obstfield, 2005). I argue
that this is likely to be especially true with regard to an individual’s responses to
adversity. While the majority of past work on identification in organizations has focused
on how individuals identify with their organizations, in this dissertation, I examine
professional identity as a resource for resilience at work because professionals are more
likely to identify with their professions rather than with the organization (cf., Dukerich et
al., 2002; Hall, 2004; Scott, 1966; 2003). Professional occupations are viewed as
prestigious because professionals have advanced training and unique knowledge that
allows them to provide an important service to society (Larson, 1977; Wallace, 1995).
Given the high status nature of professional work, it is likely to be an important aspect of
a professional’s self-image (Tajfel & Turner, 1979). Additionally, a growing body of
research has documented an increase in nonstandard, boundaryless, and protean careers,
which has been interpreted to suggest that individuals’ conceptualization of a work
identity is often not linked to a particular organizational context (Arthur & Rousseau
1996; Hall 1967; Hall, 2002). Instead, individuals are likely to define themselves based
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on the type of work that they do, the profession they are a part of. As Collin and Young
explain (1992), in today’s workplace, an individual’s profession provides a “context of
meaning within which a life is lived and through which life is interpreted by others”
(p.8).
The idea that identity can be used as a resource is supported by research in social
psychology and organizational science. For example, work by Callero and colleagues has
demonstrated the utility of conceptualizing roles and identities as resources for both
individuals and organizations (Callero, 1986; 1994; 1998; Pillavin, Grube, & Callero,
2002). Callero (1994) built on Baker and Faulkner’s (1991) concept of role as a resource,
and argued that roles are tools that can be used to help establish routines and structure
work in organizations. Further, he pointed out that human agency is facilitated and
expressed though the use of roles as resources This perspective views roles as changing
and impacting social structures, rather than structures creating roles. Callero (1994)
demonstrated that roles could be used by individuals for thinking, for acting, for creating
structures, and for political ends.
Identity as a Coping Resource
Extending Callero’s role as a resource theory, I assert that individuals’
professional identities are important resources for fostering resilience. Further, building
on research that has demonstrated the importance of identity construction for
sensemaking behavior in organizations (Pratt, 1998; Pratt, Rockmann, & Kaufmann,
2006; Weick, 1995, Weick et al., 2005), I propose that identity processes help individuals
to not only make sense of adversity, but also guides cognitive and behavioral reactions to
the adversity.
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Professional identity can be considered an energy resource according to
Hobfoll’s (1989) Conservation of Resource theory (COR), which is a general
stress theory that has been used to understand responses such as burnout (Hobfoll
& Freedy, 2003). COR is based on the idea that individuals will strive to retain,
protect and build resources at all times. Further, COR posits that the greatest
threat to individuals is the potential or actual loss of valued resources (Hobfoll,
1989, p. 516). According to this theory, resources are defined as “objects,
personal characteristics, conditions, or energies that are valued by individuals or
the means for attainment of those objects” (Hobfoll, 1988, p. 26). Object
resources are tangible goods (e.g., food or shelter), personal resources are
individual-level attributes (e.g., mastery or self esteem), cognitive resources are
states (e.g., job advancement or citizenship), and energy resources are those that
help to gain other resources (e.g., money, social competence). Professional
identity is an energy resource because it can be used to cultivate individual and
social resources that can lead to resilience in the face of adversity.
In summary, this dissertation takes an identity-based approach to
understanding responses to adversity in the workplace. Our growing
understanding of the centrality of identity to individual’s organizational
experiences warrants this approach. Prior research suggests that an individual’s
professional identity is a cognitive schema that can be used to understand and
interpret the organizational environment. I extend this idea to assert that
professional identity may also cultivate and activate important resources that
shape how individuals respond to adversity. Further, I propose that identity
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becomes salient when individuals are faced with adversity, and silently shapes
their responses, which make it an ideal theoretical framework through which the
process of resilience can be viewed.
Empirical context for this dissertation
In this dissertation, I am studying responses to experiences of adversity at work in
the context of nurse-midwifery. In this section, I describe the current workforce of nursemidwives in the US. Then I explain why it is an ideal population for studying response to
adversity in the workplace.
The word midwife literally means “with woman,” and the early use of the word
signified the individual who attended to a woman during childbirth (Aaronson, 1987;
Rooks, 1997). Over time various meanings have been attached to the term, but the
following is the most widely accepted international definition of a midwife: “a midwife is
a person who, having been regularly admitted to a midwifery educational program duly
recognized in the country in which it is located, has successfully completed the
prescribed course of studies in midwifery and has acquired the requisite qualifications to
be a registered and/or legally licensed to practice midwifery” (quoted in Rooks, 1997, p.
6). Midwives are therefore distinguishable from traditional birth attendants who acquire
their skills through apprenticeships; midwifery requires formal training.
There are a number of different types of midwives practicing in the United States
including granny or grand midwives, certified nurse-midwives (CNMs), certified
professional midwives, licensed midwives, and lay or direct-entry midwives (Rooks,
1997). In this research, I focused on the experiences of CNMs. CNMs are distinguishable
from lay midwives and direct entry midwives because they are registered nurses with
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advanced training in midwifery at an institution accredited by the Division of
Accreditation of the American College of Nurse-Midwives (Adams, 1989; Rooks, 1997).
Certified nurse-midwifery is a rapidly growing profession. Currently there are
approximately 6,700 members of the American College of Nurse-Midwifery (ACNM), of
which about 5,700 are currently in clinical practice (www.acnm.org). In 1995,
approximately 3% of all children bom in the U.S. were delivered by CNMs, but it is now
estimated that this number has increased to 10% (Kennedy, Levi, & Low, 2005). Most
CNMs attend deliveries in hospital settings, although some work in free standing birth
centers (about 4%), and even fewer provide home deliveries (Rooks, 1997; Wu, 1995).
The Midwifery Model of Care is based on the fact that pregnancy and
birth are normal life events and that philosophy is usually reflected in CNM ’s
approach to childbirth (Rooks, 1997). CNMs’ scope of practice focuses on lowrisk pregnancies; they are trained to support healthy women with routine
obstetrical care and normal childbirth (Wu, 1995). CNMs approach childbirth as a
normal event with standard variations (Gemmill, 1992; Steiger, 1987), as opposed
to obstetricians who conceptualize it as a state that requires constant and regular
treatment (Rooks, 1997; Wu, 1995). Because CNMs do not perform surgery, they
are not trained in certain advanced medical techniques or technology. If the
pregnancy should deviate from normalcy, they consult with, or refer the patient
to, a certified physician (Baldwin, Hutchinson, & Rosenblatt, 1992; Rooks, 1997).
Although general guidelines for practice are provided by the American College of
Nurse-Midwives, regulations for how certified nurse-midwives may practice vary
greatly from state to state. For example, approximately 75% of states currently
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grant CNMs prescriptive authority (the ability to make diagnosis and treatment
decisions independent of a physician) (Bidgood-Wilson, 1992).
The role of CNMs in the American maternity system has evolved dramatically. In
the past half century, maternity care has been in a state of flux due to changing consumer
demand, regulation, and reimbursement systems (PEW Health, 1999). The most radical
of these changes has been shifts in the institutional logic of maternity healthcare
organizing, such as the increasing collaboration between institutional actors, obstetricians
and certified-nurse midwives. Additionally, changes in the governance system have
influenced these changes in institutional logics. For example, the expansion of managed
care has led to de-institutionalization of physician dominance, and a subsequent
reinsitutionalization of multiprofessional managed health care organizations (Donnison,
1977; Hartley, 1999). For example, in efforts to maximize efficiency and reduce costs,
managed care organizations have begun to provide more autonomy to midwives because
midwives’ time costs less than obstetricians’ (PEW Health, 1999; Scoggins, 1995).
There are a number of characteristics of certified nurse-midwives which make
them an ideal source of data for this dissertation research. First, nurse-midwifery, similar
to other sectors of nursing, is a context that is particularly prone to experiences of stress
and adversity, which is often manifest in bumout and turnover. CNMs are medical
service workers in high stress and emotionally-taxing contexts, which puts them at high
risk for bumout (e.g., Beaver et al., 1986; Jones, 1982; Zellars, Hochwater, & Perrewe,
2000). Evidence has consistently demonstrated that two of the largest complaints CNMs
have regarding their work are also the most common factors that create workplace
bumout: role stress (i.e., role conflict, role ambiguity, and role overload) and poor
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relationships with supervisors or coworkers (see Cordes & Dougherty, 1993 or Maslach,
Schaufeli, & Leiter, 2001 for reviews). Empirical studies have confirmed that medical
professionals particularly vulnerable to bumout because they experience high levels of
role stress and increased interpersonal conflict (Sitkin & Sutcliffe, 1991; Zellars et al.,
2000 ).
As explained earlier, bumout often leads individuals to leave their jobs, which has
created problems in many of the nursing fields. Studies indicate that over 60% of new
graduate RNs leave their first jobs within a year, and that there are over 2.5 million
certified nurses are currently not practicing in the United States (Hodges, Keeley & Grier,
2005). The nursing shortage is expected to strongly affect health care organizations and
the patients they care for over the course of the next decade (Shirey, 2006). By the year
2020, it is projected that the nursing workforce will be at least 20% below our nation’s
requirements, or approximately 800,000 nurses short of sufficient (Buerhaus, Staiger &
Auerbach, 2000; Buerhaus, Donelan, Ulrich, Norman, & Dittus, 2006).
A second reason for using nurse-midwifery as a context for studying adversity at
work is due to the potentially profound impact of stress and adversity on the quality of
their work. Research has demonstrated that experiences of personal distress at work are
linked to medical errors (West et al., 2006). Additionally, a comprehensive analysis of
current research on nursing found that the majority of nurses perceive the nursing
shortage, and its increase stress on the work environment, as having a significant negative
impact on the quality of care they provide to patients (Shirey, 2006). CNMs are at high
risk for bumout (Bekker et al., 1996), and the effects of bumout have particularly
negative implications for the work of CNMs. One of the hallmarks of midwifery care is
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that midwives treat their patients as individuals (Wu, 1995). Their “with women”
approach to health care requires an even greater amount of emotional and psychological
attention than do other health care professions (Davies, 1995; Scoggins, 1995). Malasch
and Jackson (1986) describe bumout as beginning when the individual has emotionally
burdening relationships with clients. Unlike some of the other medical professions,
midwives pride themselves on caring for the “whole” woman (psychological, emotional
and physical health), and also being emotionally involved in the care (www.ACNM.org.
Oakley & Houde, 1991). However, CNMs who are burned out are unable to care for
patients in this way because a consequence of bumout is depersonalization (Malasch,
1982; Malasch & Jackson, 1986). A recent study published in the Journal of Nursing
Education eloquently articulated the need for resilience in the nursing subfields. The
authors professed:
Resilience is an essential element for practice in a chaotic practice world.
As changing health care patterns emerge, expectations shift. New skills, or
at least new perspectives on emerging challenges, are needed to solve
problems. It is not enough to hope new nurses will somehow learn to cope
with chronic work stress and uncertainty; resilience is a vital trait that can
be learned. It is a matter of turning adversity into opportunity and of
staying with chaos until consistent and understandable patterns emerge.
(Hodges et al., 2005, p. 548).
To summarize, in this dissertation, I examine how CNMs respond to adversity at
work for a number of reasons. Individuals within this profession are prone to bumout due
to the increasingly difficult aspects of their work and working conditions. However,
although many individuals within this profession have burned out, other individuals have
displayed resilience by achieving professional growth in the context of adversity at work.
Furthermore, the resilience of CNMs is not just important for the CNMs themselves, but
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also for the millions of patients they care for, making resilience a critically important
aspect of their job.
Dissertation Overview
This dissertation is divided into three parts. In the second chapter, I provide an
overview of the concept of resilience as used in various literatures. Then, I define
resilience at work, and root this definition in several theoretical assumptions. In the third
chapter, I propose and assess a model of resilience at work using structural equation
analyses of survey data from a national sample of 228 CNMs. In the fourth chapter, I
analyzing 29 adversity narratives gathered in interviews with CNMs to understand how
CNMs perceive, experience, and respond to adversity in the workplace. These two
chapters are written as separate empirical papers, each with its own introduction,
methods, results, and discussion. In the fifth and final chapter of this dissertation, I
explore the linkages between these two papers, and discuss their combined contributions.
Together these two studies provide a holistic picture of the identity processes and
mechanisms that shape how individuals respond to adversity at work. While the first
study examines the role of professional identity attributes and their associated roles in
shaping resilience, the second study looks more broadly at the identity processes that
influence a range of responses to adversity. The first empirical study uncovers the
mechanisms by which professional identity can influence resilience in the workplace,
while the second study illuminates the processes by which these mechanisms are
activated. Taken together, these studies propose an identity-based understanding of
responses to adversity in the workplace.
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CHAPTER 2
Resilience at work
Organizational researchers have established that experiencing negative events and
stressors in the workplace can lead to poor personal and professional outcomes, such as
bumout (e.g., Lee, 1993; Maslach, 1982; Maslach, 2001; Pines, Aronson & Kafry, 1981).
Acknowledging these consequences, researchers have devised studies aimed at helping
individuals to cope with negative stressors to minimize the damage, and help prevent
syndromes such as workplace bumout (e.g., Chemiss, 1980,1993; Golembiewski &
Munzenrider, 1984; Golembiewski & Munzenrider, 1988; Jackson, 1986; Lee, 1993;
Leiter, 1988; 1993; Pines et al., 1981; Lee & Ashforth, 1992; Maslach, 1982; Maslach,
1984). However, what much of our current literature has overlooked the fact that not all
individuals bum out when faced with adversity at work. In fact, many individuals
recover, and are able to cope sufficiently with the adversity (e.g., Pines et al., 1981), and
some even thrive in the face of difficult circumstances (Bonanno, 2004, 2005; Tedeschi
& Calhoun, 2004), displaying resilience. Resilience has been defined in a number of
ways, but generally encompasses a dynamic process in which individuals “manifest
competence in the context of significant challenges” (Masten & Coatsworth, 1998, p.
206).
The idea that people can display resilience in the face of adversity has
been a central heroic characteristic in myths, fairy tales, art, and literature for
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centuries (Masten & Reed, 2002). In addition, some of the teachings of major
religions such as Hinduism, Buddhism, and Islam talk about the potentially
transformative power of pain and suffering (Tedeschi & Calhoun, 1995).
However, it is only recently that researchers began a rigorous scientific
investigation of the concept. Writings about resilience emerged in psychology
when researchers who were studying children in high-risk environments realized
that a proportion of the children seemed to be thriving despite extreme adversity
(e.g., Anthony, 1974; Garmezy, 1971, 1974; Murphy & Moriarty, 1976; Rutter,
1979; Werner, 1982, 1989, 1993). For instance, one of the most well-known and
influential studies of resilience was a longitudinal investigation of 698 Kauai
children over the course of five decades. In this study, researchers found that a
subset of this high-risk population did not develop health problems, and were
even deemed successful in their environment (Werner & Smith, 1982; 1992).
This suggested that there was a process at work that mitigated the effects of
exposure to adversity, and perhaps even stimulated growth in the face of the
adversity (Yates, Egeland & Sroufe 2003).
In the past forty years, growing interest has ensured a steady stream of
research on resilience in the field of psychology (for a review see Cicchetti &
Garmezy, 1993; Glantz & Johnson, 1999; Masten & Reed, 2002; Wang, Haertel
& Wahlberg, 1994). However, despite a fair amount of scientific attention, there
are critical debates and significant gaps apparent in the field of resilience
research, and a number of scholars have openly criticized this body of research
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(see Cicchetti & Garmenzy, 1993; Gordon & Wang, 1999; Kaplan, 1999; Luthar,
1993; Luthar & Cushing, 1999; Luthar 2000; Tolan, 1996).
The purpose of this chapter is not to solve all of these debates. Instead, I aim to
provide a theoretical foundation for understanding the concept of resilience at work that
is the focus of this dissertation. I unfold this theoretical framework in four stages. First, I
summarize the history of resilience research, focusing specifically on work in the field of
psychology. In this review, I demonstrate that while we have learned much about
resilience in children, we know far less about resilience in adult populations, and very
little about resilience at work. Then, in the second section, I define resilience at work. In
the third section, I situate this definition within the context of the major debates in the
field by discussing the characteristics and assumptions about resilience at work as used in
t
this dissertation. In the fourth section, I provide empirical support for my definition of
resilience at work using excerpts from my interviews with CNMs that were conducted for
this dissertation research
History of Resilience Research
The psychological study of resilience emerged from studies of individuals’
(primarily children’s) positive adaptation despite extremely difficult circumstances due to
familial mental illness, poverty, or other highly adverse circumstances (Garmezy, 1971;
Luthar, 1999; Luthar, Cicchetti, and Becker, 2000; Masten & Reed, 2002; Werner &
Smith, 1992; 2001). A review of early mental health literature suggests that the idea of
resilience was implicit in many early studies of atypical schizophrenics (see Luthar et al.,
2000). However, conceptual clarification of resilience was limited due the anecdotal
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nature of these studies, and few of these studies actually explicitly addressed the issue of
resilience.
It was not until the 1970s that psychological researchers actually began using the
term “resilience” to describe manifest competence displayed by children in high-risk
circumstances (Rolf, 1999). Garmezy is credited with the first systematic investigation of
resilience when he sought to understand how children of schizophrenic mothers
demonstrated positive growth despite their adverse circumstances (e.g., Garmenzy,
1974). This research demonstrated that some children exposed to extreme adversity in
their environment are able to achieve developmental milestones. This finding ignited
intense research interest in determining what individual and environmental factors lead to
resilience in children (Masten & Reed, 2002). As a result, early research on resilience
was largely dominated by a focus on childhood resilience. Only in the past decade have
researchers turned their attention specifically to understanding resilience in adult
populations. Below, I provide an overview of the dense literature of childhood resilience
as well as the sparse literature on adult resilience, with an eye toward situating my study
of resilience at work within the current theoretical framework of resilience.
Resilience in children
As previously discussed, much of early research on childhood resilience focused
on understanding what differentiated high-risk (i.e., vulnerable to poor developmental
outcomes) children who exhibited positive adaptation patterns from those who did not
(Luthar et al., 2000; Richardson, 2002). To examine this, psychologists conducted
longitudinal investigations to understand how children adapted to a plethora of different
kinds of adverse conditions besides parental mental illness, including socioeconomic
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disadvantage (e.g., Garmenzy, 1991; 1995; Rutter, 1971; Werner & Smith 1982; 1992),
maltreatment (Beeghly & Cicchetti, 1994; Cicchetti & Rogosch, 1997), community
violence (Luthar, 1999), chronic illness (Wells & Schwebel, 1987) and catastrophic life
events (O’Doughherty-Wright, Masten, Northwood, & Hubbard, 1997). The findings
from these studies yielded a list of individual characteristics termed “protective factors,”
that were possessed by children who displayed resilience (Luthar et al., 2000; Masten &
Reed, 2002). These intrapersonal factors consisted mainly of personality traits, cognitive
factors and specific competencies such as optimism (Anthony, 1987; Masten, 1994;
Peterson, 2000; Tusaie-Mumford, 2001), memory (Masten, 1994; Rouse, 2001),
intelligence (Long & Valliant, 1984; Werner, 1993; White, Moffitt, & Silva, 1989),
creativity (Cohler, 1987; Simonton, 2000; Wolin & Wolin, 1993), and a wide range of
coping strategies (Aldwin, 1994; Werner, 1993).
In the 1980s researchers moved away from examining the role of the
individual in his or her own and focused on understanding the role of the child’s
environment in cultivating a resilience trajectory (Masten & Reed, 2002). This
research uniformly demonstrated that the quality of the caregiving environment is
indeed a powerful predictor of the social competence (which is judged as an
important developmental milestone) in children identified as high-risk (e.g., Dyer
& McGuiness, 1996; Garmezy, 1985; Masten, 1989; Radke-Yarrow & Sherman,
1990; Rutter, 1987; Werner, 1993; Werner & Smith, 1982). In a review of the
literature Wang and Gordon (1994) concluded that social support a child receives
from parents and mentors is a key protective factor in children’s resilience.
Supportive social environments are said to contribute to resilience by helping to
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reinforce coping efforts, and by reinforcing personality attributes such as internal
locus of control and high self-esteem. (Brown & Rhodes, 1991; Rutter, 1987).
In the past two decades research on resilience in child development has
progressed from identifying separate risk or protective factors of resilience to building
dynamic models of the process of resilience. This research can be largely classified into
two approaches; variable-focused or person-focused (Masten, 2001; Masten & Reed,
2002). The variable-focused approach examines the linkages among the characteristics of
individuals, environments and experiences in order to understand what leads to good
outcomes on particular indicators of resilience in the face of adversity. The goal of this
approach is to identify specific protective factors that help with specific aspects of
adaptation. These models usually account for the additive, interactive and indirect effects
of risks, assets, and protective factors. Usually, these models are aimed at a particular
form of resilience, such as educational resilience (Masten & Reed, 2002).
An alternative approach is the person-focused model, which identifies resilient
individuals and tries to figure out what makes these individuals different from those who
have not positively adapted to adversity (Luthar et al., 2000). In contrast to the variableapproach models, this approach conceptualizes resilience more globally. In order to be
classified as resilient according to this approach, the individual must excel in more than
one life domain (Luthar et al., 2000).
Although these two approaches differ in many ways both theoretically and
methodologically, their product models are similar in several important ways. Most all of
the resilience models can be classified into three types of models (Luthar et al., 2000).
The first model consists of both salient protective and salient vulnerability processes that
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affect at-risk children on three broad levels (the child, the community, and the family)
(e.g., Garmezy, 1984; Werner & Smith 1982; 1992). The second, more dynamic model
examines how the interchanges between levels shapes the child’s ability to adapt to
adverse circumstances, (e.g., Baldwin, Baldwin, Kasser, Zax, Sameroff, & Seifer, 1993).
The third and most complex model, termed the structural-organizational perspective,
accounts for everything in the dynamic model plus historical and current factors.
Additionally, this theoretical framework emphasizes agentic aspects of the individual in
his/her own development (e.g., Cicchetti & Schneider-Rosen, 1986; Cicchetti & Tucker,
1994; Sroufe, 1979).
To summarize, the study of resilience in children can be credited with generating
intense interest in the concept of resilience, and has greatly advanced our understanding
of the nature and process of resilience. Researchers have progressed from noting it
informally, to rigorously investigating the protective factors leading to resilience in
children (Garmezy, Masten, Tellegen, 1984), to building complex models of the process
of resilience (for a review see Luthar et al., 2000 or Masten & Reed, 2002). While this
research is extremely helpful in aiding researchers to identify children who are at highrisk and in designing interventions to help them achieve positive outcomes despite their
vulnerability, it does not describe or explain resilience in adult populations. Yet, adverse
circumstances are not limited to childhood; individuals face adversities throughout their
lifespan. And, like children, some results display positive outcomes in the face of this
resilience, while others display pathological reactions. Noting the importance in trying to
understand resilience past childhood, researchers are now beginning to also study
resilience in adult populations.
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Resilience in adult populations
Research studies on adult populations have focused on understanding how some
individuals can overcome and even thrive in the face of negative events, while others
display the inability to do so. Resilience has been studied in individuals with chronic
illness and disabilities (Davidson et al., 2005; Farber, Schwartz, Schaper, Moonen &
McDaniel, 2000), chronic pain (Karoly & Ruehlman, 2006; Zautra, Johnson & Davis,
2005); mental health disorders (Deegan, 2005; Tugade & Fredrickson, 2004), and even
learning disorders (Sorensen et al., 2003; Werner, 1993).
A second stream of research interest has been focused on understanding how
individuals cope with disasters such as the loss of a loved one or national tragedies like
9/11 (e.g., Bonanno, 2004; 2005). Bonnano (2004), who has produced a number of
studies on adult resilience, defined it as the individual’s capacity to resist maladaptation
in the face of risky experiences. He conceptualized resilience as the ability of adults, who
are in otherwise normal circumstances, to maintain relatively stable, healthy levels of
psychological and physical functioning after exposure to an isolated and potentially
highly disruptive event, such as the death of a close relation or a violent or lifethreatening situation. Bonanno (2004) focused on three main points in his article. First, he
argued that resilience among adults is a distinct and empirically separable outcome
trajectory than that associated with recovery from trauma. He later supported this claim
with empirical evidence (Bonanno, 2005). Second, he claimed that resilience is more
common than researchers may have previously believed. For instance, a prospective
study examining how individuals cope with the loss of a spouse found that almost half of
the participants (46%) showed evidence of following a resilience trajectory (Bonanno,
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Wortman et al., 2002) Third, Bonanno (2004) theorized that, just as in children, there are
multiple and sometimes unexpected factors that influence adult resilience. However,
despite the similarities, he argued that there are subtle but important differences that
distinguish resilience in adults from resilience in children. For example, he claimed that
adults are more likely to have a broader array of resilience-promoting factors to help
them in times of adversity than do children. This suggests that while studying resilience
in children may be a starting point toward understanding resilience in adults, it may not
cover the complexity of antecedents to resilience in adult populations.
One of the factors that may play an especially important role in resilience in
adults is emotion. Fredrickson and colleagues (Fredrickson et al., 2003; Tugade &
Fredrickson, 2002; Tugade, Fredrickson, & Barrett, 2004) conducted a series of studies
aimed at understanding the connection between resilience and emotions in adults. These
studies indicated that positive emotions mediate the effect of psychological resilience on
both depression and psychological resources (Fredrickson et al., 2003; Tugade &
Fredrickson, 2002). Additionally, this line of research demonstrated that individuals who
are classified as resilient have faster cardiovascular recovery from negative emotional
arousal (Tugade, Fredrickson, & Barrett, 2004).
In summary, the study of resilience in adult populations is still emerging, and
therefore lacks the density of the literature on resilience in children. Nevertheless, studies
of resilience in adult populations have shaped our understanding of the nature of
resilience in the face of traumatic life events in important ways. This research has
suggested that resilience in adults is different than resilience in children, and therefore
needs to be further explored to uncover its protective factors and process (Bonanno,
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2004). For instance, adults often deal with very different stressors, and emotions seem to
play an important role in the resilience process. W ork by Fredrickson and colleagues
have underscored the importance of understanding the role of emotions in the process of
resilience. Yet, there are still significant gaps in our understanding of resilience in adult
populations. One notable limitation is that most of the psychological studies of adult
resilience have focused on how individuals respond to major general life stressors, such
as the death or loss of a loved one. As a result, how individuals deal with stressors in the
workplace is still a largely unexplored area of research.
To date, there have been two different attempts to build an understanding of
resilience at work. First, two psychologists from the hardiness institute published a book
entitled Resilience at Work (Maddi & Khoshaba, 2005). In their preface, the authors
explain that the aim of their book is to “reach out to working adults by teaching the
attitudes and skills we used to find personal and professional satisfaction and success” (p.
viii). Maddi and Khoshaba (2005) insist that the key to resilience is the development of
psychological hardiness. Hardiness is composed of three attitudes: commitment, control,
and challenge (Kobasa, 1979). Thus, in order to help individuals to be resilient in the
face of adversity at work, the authors discuss ways for individuals to develop these three
attitudes.
In addition to this book on resilience at work, a small body of research emerged in
vocational psychology in the 1990’s focusing on a construct in the area of career
motivation termed career resilience (Gordon & Coscarelli, 1996; London, 1983; 1993;
1998; London & Bray, 1984) which has begun to help us understand how individuals
deal with stressors in their work lives. London (1993) defines career resiliency as “the
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ability to adapt to changing circumstances” (p. 55). He posits that career resiliency
consists of self-efficacy, risk-taking and dependency. Individuals who can be classified as
career resilient will be high in both self-efficacy and risk-taking, but low in dependency.
Studies of career resilience have been used mainly to understand how individuals cope
with involuntary job loss. Basically, this research was designed to study adult vocational
adjustment (Gordon & Coscarelli, 1996). Waterman, Waterman and Collard (1994)
described a career resilient workforce as “ a group of employees who not only are
dedicated to the idea of continuous learning but also stand ready to reinvent themselves to
keep pace with change; who take responsibility for their own career management; and
last, but no least, who are committed to the company’s success” (p. 88).
This work on career resilience has contributed to our understanding of
how individuals can be resilient in the face of work adversity. However, career
resilience is focused on how individuals are able to positively adapt to a particular
type of adversity- the loss of a job. Therefore, how individuals respond resiliently
to other types of adversities in the workplace is still largely unknown. And while
Maddi and Khoshaba’s (2005) book is aimed at resilience in the face of more
generalized work stressors, it is practitioner-focused and lacks significant
empirical evidence. Moreover, these researchers stress the importance of
individual attributes, such as hardiness in fostering resilience at work, which is
only one of the many pathways to resilience (Maddi, 2005). This leaves many
other factors that may be associated with increased resilience still largely
unexplored.
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To address these gaps, the focus of the current research on resilience at work
examines how individuals positively adapt to a variety of adversities that occur in the
workplace, which may or may not lead to termination of employment. Specifically, I aim
to look beyond personality attributes to discover other individual level resources
individuals use to become resilient. Individuals face a wide variety of adversities in the
workplace, many of which are typical in their particular profession. Understanding how
individuals respond to these less typical adversities in the workplace is critical, as they
occur much more frequently than termination of employment. For example, if a doctor
loses a patient, despite his or her efforts to keep the patient alive, it is an adversity. Even
though the doctor’s job is not at risk because of this incident, it is still an adversity that
may potentially lead to a pathological response. The goal of this dissertation is to build a
greater understanding of positive responses to this adversity, such as resilience at work.
In the next section, I will define resilience at work and discuss the assumptions inherent
in this definition.
Defining resilience at work
In this dissertation, resilience at work is defined as an individual’s capacity to
emerge from experiences of adversity demonstrating increased competence, professional
growth, and the ability to handle future challenges in the workplace. I conceptualize
resilience at work as a capacity to demonstrate behavioral and psychological
manifestations of positive adaptation and growth within the context of significant
adversity at work. In this dissertation, resilience is not construed as a trait or an attribute
of an individual, but instead as a capacity that occurs as a result of the interaction
between the individual and his or her work environment.
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This definition of resilience at work is aligned with some prior conceptualizations
of resilience, but very different from others. In the recent psychological literature,
resilience has been defined in a number of ways. Unfortunately, there is often little
consistency among these definitions, which has been an area of controversy for resilience
researchers (e.g., Luthar et al., 2002; Masten, 1990; Masten & Reed, 2002). The wide
range of definitions has led to confusion regarding the antecedents, processes, and
outcomes of resilience. For example, critics have pointed out that the prevalence of
resilience in any given population ranges from 15% to 50% depending upon the aspects
of the definition of and operationalization of resilience (Rutter, 1987; Werner, 1993). In
other words, the lack of conceptual clarity is leading to further theoretical confusion
regarding basic aspects of the concept of resilience. Therefore, in order to synthesize andtest the empirical utility of my definition of resilience at work, it is necessary to revisit
prior conceptualizations of resilience
Bridges (1995, p.57) defines resiliency simply, as “the ability to bend and not
break.” Other researchers have developed more complex definitions in an attempt to
articulate the nature of the concept and to differentiate it from other similar concepts
(e.g., positive adaptation, coping, recovery). For instance, resilience has been defined as a
relatively stable personality trait characterized by the ability to bounce back from
negative experience and by flexible adaptation to the ever-changing demands of life
(Block & Block, 1980; Block & Kremen, 1996; Lazarus, 1993), as the positive end of the
distribution of developmental outcomes among individuals at high risk (Rutter, 1987;
1990), as the ability to maintain psychological stability and experience fewer mental
health problems when presented with a threat (Bonanno, Wortman, & Nesse, 2004;
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Fredrickson, Tugade, Waugh & Larkin, 2003), as a dynamic process encompassing
positive adaptation within the context of adversity (Luthar & Chicchetti 2000; Luthar,
Cicchetti & Becker, 2000; Masten, 2001; Masten, Best, & Germanzy, 2001; Werner,
1995), as a family of loosely connected phenomena involving adequate (or better)
adaptation in the context of adversity (Roisman, 2005), as the capacity to rebound from
adversity strengthened and more resourceful (Walsh, 1998), and as an individual’s
capacity to resist maladaption in the face of risky experiences (Bonnano, 2004).
Among these definitions, there are apparent differences, which reflect the major
debates in the field, covered in more detail in the next section, but there are also definite
consistencies. These consistencies are worth noting because they revolve around two
critical conditions of resilience, which are the features that separate resilience from other
similar concepts (Luthar et al., 2000). The first is the presence of some negative stressor,
or exposure to a significant threat. The second is the individual’s achievement of positive
adaptation in the face of this stress or threat (Garmezy, 1990; Luthar, 1999; Luthar et al.,
2000; Masten & Reed, 2002). Positive adaptation is defined in terms of behaviorally
manifested social competence (Luthar & Cicchetti, 2000). In other words, it is the ability
of the individual to meet developmental tasks (Masten, Best & Garmezy, 1990; Masten &
Coatsworth, 1998). For example, research on resilience in children has demonstrated that
positive adaptation for a child of two schizophrenic parents would be to consistently meet
social and cognitive developmental standards as he grows. In other words, resilience is
the ability to follow a positive trajectory. Thus it is not a static concept.
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Characteristics and assumptions of resilience at work
In the current literature on resilience, there are a number of papers focusing on the
status of the resilience field (e.g., Bonanno, 2004; Roisman, 2005). Much of this
discussion has been centered on conflicting definitions of the construct of resilience. As
mentioned before, my goal in this chapter is not to solve these debates, but rather to
establish a position for this dissertation. The inconsistencies within these definitions
reflect ongoing debates regarding the nature of resilience. The most important debates
can be traced to three main issues. One issue focuses on whether resilience is
conceptualized as fixed trait (outcome) or as a developmental process. A second issue
involves determining what counts as adversity. Third, there is variance as to what counts
as positive adjustment. Specifically, while some researchers have stipulated that to
qualify for labels of resilience, at-risk children must excel in multiple adjustment
domains (e.g., Tolan, 1996), other researchers considered resilience excelling in just one
sphere (e.g., Luthar, 1991; Luthar, Doemberger & Zimber, 1993). In reviewing these
debates, I will clarify my definition of resilience by clarifying three key aspects of
resilience at work as used in this dissertation.
Trait vs. process. The distinction between resilience as a trait and resilience a
process is one of the most heated debates in the psychological study of resilience. The
majority of psychological research on resilience has described it as a trait of an individual
(e.g., Fredrickson et al., 2003; Tugade & Fredrickson, 2003). Psychological researchers
often label a person as “resilient” or “invulnerable” which conveys a fixed nature of the
state (Luthar et al., 2000). In fact, psychological resilience is defined in many sources as
a relatively stable personality trait characterized by the ability to bounce back from
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negative experience and by flexible adaptation to the ever-changing demands of life
(Block & Block, 1980; Block & Kremen, 1996; Fredrickson et al., 2003; Lazarus, 1993).
Individuals who are able to bounce back from stressful experiences quickly and
efficiently are considered resilient.
Despite being classified as a trait by some researchers, studies demonstrating the
role of contextual factors suggest that resilience may not be a personality attribute
(Bartlet, 1994). Building on this idea, Luthar and colleagues (2000) argue that resilience
is a dynamic process, which changes over time and situation. The authors argue that the
researchers whose conceptualizing resilience as a trait are subscribing to Block’s (1980)
influential conceptualization of the ego-resilience concept, which is conceptually
different from resiliency. Ego-resilience and resiliency differ on two major dimensions
(Luthar, 1996). First, ego resilience is a personality characteristic of the individual,
whereas resilience is a dynamic developmental process. Second, ego-resilience does not
require exposure to substantial adversity, while by definition resilience does presuppose
prior substantial adversity. Researchers who conceptualize resilience as a developmental
process are adamant about differentiating the terms. For example, researchers have been
cautioned against using the term “resiliency” (Masten, 1994), and against using the term
“resilience” as an adjective (e.g., resilient individual) ( Masten et al., 1990; Wemer,
1984) because both can convey the term as a trait rather than a process.
In this dissertation, I consider resilience to be a dynamic capability of an
individual rather than an individual level trait. I believe that individuals have the ability
to be resilient at some times, and not in others. I believe that it depends on the
intrapsychic, interpersonal, and organizational resources that the individual has in the
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particular time that the adversity occurred. Therefore, since these resources experience a
typical ebb and flow over time, I do not expect resilience at work to be a stable individual
trait.
Definitions of Adversity. Resilience researchers have varied in terms of what
qualifies as adversity. Luthar et al. (2000, p. 534) explains that “adversity conditions
examined have ranged from single stressful life experiences -such as exposure to war—
to aggregates across multiple negative events (e.g., by means of life event checklists)”
While studies of childhood resilience have included both the examination of a single
stressful experience as well as the aggregate of multiple risk factors, the study of adult
resilience has mainly focused on a single critical incident (e.g., death of a spouse or
September 11th, 2001; e.g., Bonanno, 2004, 2005).
In this dissertation, I am considering adverse conditions to be a single stressful
work experience. This critical incident approach allows me to focus on events that are
perceived as extremely threatening, and therefore should evoke some sort of response, be
it bum out, recovery or resilience. While I acknowledge that individuals also need to be
resilient in the face of constant, low-grade stressors (e.g., Caza & Cortina, 2007; Worline
et al., 2006), I specifically focus on the impact of sudden, unexpected major stressors.
Definitions of positive adjustment. Just as there is variability in the conditions
necessary for resilience, there is also a range of ways resilience has been operationally
defined. Definitions of resilience have ranged from the absence of psychopathology in
the child of a mentally-ill parent, to the recovery of function in a brain-injured patient
(Cicchetti and Garmazy, 1993). Additionally, while some researchers claim that resilient
individuals need to excel in only one domain, others argue that resiliency requires above
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normal functioning in multiple domains (Masten & Reed, 2002). Simply put, some
researchers set a higher bar while others have a lower standard, which can be the source
of inconsistent findings and conceptual confusion.
Early work in the area did not measure specific attributes of resilience, but instead
measured resilience by the absence of expected symptoms in various populations (Luthar
et al., 2000). Currently, many researchers who view resilience as a trait utilize Block’s
Ego resilience scale (ER89), which identifies resilient personalities. In addition to this
global measure of resilience, scales have also been developed for specific populations.
For example, the Connor-Davidson Resilience Scale (CD-RISC), measures resilience
among individuals diagnosed with particular types of mental disorders. Benard et al.’s
(1991) resilience scale measures five traits of individuals that he argues make them
resilient (social competency, problem solving skills, autonomy, religious/spiritual
commitment, and a sense of purpose).
As previously mentioned, in this dissertation, I define resilience as an individual’s
capacity to emerge from experiences of adversity demonstrating professional
competence, professional growth, and the ability to handle future challenges in the
workplace. Therefore, my definition of “positive adjustment” requires that the individual
be able to function at work at a higher level than they did pre-adversity
Assumptions about resilience at work
There are three assumptions inherent in my definition of resilience at work,
which speak to the major debates in the field and that should be clarified in order to
situate my definition of resilience within the literature. First, I assume that the concept of
resilience is domain-specific; individuals can display resilience from work stressors, but
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not display resilience from personal stressors. Second, I assume that resilience is a
concept theoretically and empirically distinct from recovery because it involves not just
returning to a state of normal functioning, but exceeding it. Third, I believe that adversity
is an essential part of the resilience process, differentiating it from other concepts like
growth or thriving.
Assumption 1: Resilience is domain-specific. While some researchers have
insisted on a global definition of resilience (e.g., Tolan, 1996), other researchers have
operationalized it as a state that is domain-specific (e.g., Luthar, 1991; Luthar,
Doemberger & Zimber, 1993). In other words, individuals may be resilient in one
domain or sphere of their life, but not in others. Tusaie and Dyer (2004, p. 3) provided
the following example to demonstrate the domain-specificity of the construct: “an
individual from an abusive, impoverished childhood may demonstrate education and
work resilience by obtaining a doctoral degree and a high-paying job, but be unable to
maintain intimate relationships, and demonstrate impairment in the psychosocial
domain.” There is mounting research that supports this notion that resilience is not a uni­
dimensional monolithic phenomenon, but instead consists of multiple domains (e.g.,
Luthar et al., 1993; Werner & Johnson, 1999). For instance, in their attempt to translate
the theory of resilience to practice, Werner and Johnson (1999) point out that domainspecificity is more useful than global resilience in both research and practical applications
because behaviors across domains are not often highly correlated. In fact, Luthar and
colleagues (1993) demonstrated that the degree of resilience in particular domains may
not only vary, but individuals who are resilient in one domain may show signs of
substandard functioning in other domains. Additionally, Luthar and Cushing (1999)
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found that while children may perform well in one area in times of adversity, they may
show serious problems in other domains.
In this research, I concur that the way individuals react to severe adversity is
domain-specific. In other words, I believe that individuals can excel in their personal
lives, but succumb to adversity in their work lives and vice versa. Therefore, my
conceptualization of resilience at work is specific to how individuals respond to negative
stressors in the workplace. While some carry over in resilience across life domains can be
expected, most research evidence suggests that resilience can vary across life domains
(e.g., Luthar & Cushing, 1999). Therefore, this research treats resilience at work and
resilience in one’s personal life as separate constructs. An individual may be able to
demonstrate professional growth in the face of adversity in the workplace, but when
faced with personal stressors they are unable to do so. For instance, a manager may thrive
when she is faced with a sudden, unexpected budget cut by finding new and creative
ways to finish a project. But, when she breaks up with her boyfriend she sinks into
depression, and is unable to function.
Assumption 2: Resilience as different from recovery. In this dissertation, I
distinguish resilience from the concept of recovery. While I believe that resilience
requires individuals to display competence despite risky circumstances, this competence
is not a static phenomenon. Instead, competence grows as the individual develops and
changes and as the context in which the individual is working changes (Masten &
Coatsworth, 1998). As an individual proceeds through their career, they are expected to
grow and change as a professional, becoming more competent with time and experience.
Therefore, competence level should follow a positive developmental trajectory as they
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achieve developmental milestones. An individual who is resilient should be able to
continue to achieve these developmental milestones even in the face of adversity, and
therefore should emerge more competent than they were before the crisis. But not more
competent than they would have been, since they are “able to continue to achieve” In
contrast to this conceptualization of resilience, recovery just indicates that individuals are
at the same level of competence as before the stressor. In other words, they have not
reached a new developmental milestone.
This assumption that resilience is different than recovery fits with Bonanno’s
(2004) argument that there is an important distinction between recovery and resilience.
According to his definition, individuals need to demonstrate growth and learning in order
to be classified as resilient. In contrast, other researchers have looked at resilience as
being able to maintain performance in the face of adversity or simply the absence of
psychopathology when risk factors are present (e.g., Cicchetti and Garmazy, 1993;
Sutcliffe & Vogus, 2003; Werner & Smith, 1982; 1992) Measured in this way, resilience
is essentially recovery or positive adjustment.
Assumption 3: Critical role of adversity. Another notable aspect of my definition
of resilience at work is the importance of adversity. As mentioned earlier, resilience
researchers require that an individual be exposed to significant threat or adversity as a
critical condition of resilience (e.g., Luthar et al., 2000). In fact, it is differentiated from
positive adjustment in that positive adjustment simply examines how individuals adjust to
varying situations, whereas resilience, by definition, presupposes the element of
significant adversity (Cicchetti, 1996; Luthar et al., 2000). In fact, empirical research has
demonstrated that there are different correlates (Luthar, 1998, 1999) and different
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antecedents (Cicchetti & Rogosch, 1997) of positive adjustment patterns when adversity
is present.. However, the current literature has not yet pinpointed the precise role of
adversity in the resilience process. Some researchers have simply defined resilience as
“positive adaptation in the context of significant adversity or risk” (Masten & Reed,
2002, p.75), or the ability to display competence “in the face o f ’ (e.g., Bonanno, 2004, p.
602) or “despite” (Luthar et al., 2000, p. 554) significant adversity. However, other
researchers talk about individuals who emerge from adversity strengthened and even
more resourceful (e.g., Walsh, 1998), suggesting that adversity serves as a catalyst in
some way.
The difference in these three approaches lies in the role of the adversity.
Researchers who talk about resilience “in the context o f ’ or “despite” adversity give
adversity a passive role in the resilience process. It is simply a condition that must be met
in order to differentiate resilience from normal growth. However, there are also
researchers who conceptually assign a more active role to adversity. For example, Roosa
(2000) argues that it is not despite the adversity, but it is because of the experience of the
adversity that individuals emerge with new knowledge, skills, and increased competence.
In other words, the experience of the adversity helped to promote growth in some way. In
this research, I take the second approach to adversity. I believe that individuals who are
resilient at work are able to transform negative stressors into opportunities for learning
and growth. This approach helps to distinguish my conceptualization of resilience at
work from prior research on coping or recovery at work.
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Post-Traumatic Growth
The way resilience at work is conceptualized in this dissertation shares some
similarities with the psychological construct labeled post-traumatic growth. Posttraumatic
growth is defined as a positive psychological change experienced as a result of the
struggle with highly challenging life circumstances (Calhoun & Tedeschi, 1999).
Individuals who experience posttraumatic growth display development that has surpassed
what was present before the crises occurred, at least in some areas (Tedeschi & Calhoun,
2004). Tedeschi, Park, and Calhoun (1998) described posttraumatic growth as a
springboard wherein the individual does not simply learn to live with the effects of
trauma or bounce back to his/her original level of functioning, but instead exceeds
previous functioning through some sort developmental or personal growth catalyzed by
the adverse experience. Therefore, similar to how resilience is conceptualized in this
dissertation, posttraumatic growth is not simply a return to baseline, it is an experience of
improvement in some way. Additionally, similar to this dissertation, the focus of
posttraumatic growth is on conditions of major crises rather than lower level stress, which
differentiates this concept from similar concepts such as stress related growth (Tedeschi
& Calhoun, 2004).
In their review of the concept Tedeschi and Calhoun (2004) differentiated
posttraumatic growth from resilience by claiming that much of the literature on resilience
focuses on helping individuals to return to baseline, while posttraumatic growth refers to
a change in people that goes beyond an ability to resist and not be damaged. While this
conceptualization of resilience may be accurate of some prior studies of the concept, it is
not consistent with others, including my definition of resilience at work. Instead, I agree
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with other researchers, such as Bonanno (2004), who claimed that a return to baseline is
recovery, and surpassing it is resilience. As Tedeschi and Calhoun (2004) noted, “To
some extent, these are semantic choices” and despite whether it is labeled resilience or
posttraumatic growth, it is clear that how individuals grow in the face of adversity is an
important phenomenon to understand.
However, despite the similarities between posttraumatic growth and resilience at
work, there are several important differences. First, like much of the literature on adult
resilience, the work on posttraumatic growth has focused primarily on how people
respond to major life crises including things such as bereavement, HIV infection, cancer,
heart attacks, coping with medical problems of children, house fires, sexual assault,
combat, and being taken hostage (Tedeschi & Calhoun, 2004). In fact, the posttraumatic
growth inventory (PTGI; Tedeschi & Calhoun, 1996) was developed using interviews of
individuals facing major personal stressors such as the loss of a loved one or a physical
disability. To date, this concept has not been studied in the context of work. Therefore, it
is not known whether individuals grow from adversities in the workplace in the same way
that they grow from adversities in their personal life.
A second important differentiation between posttraumatic growth and resilience at
work is the way growth is conceptualized. Tedeschi and Calhoun (2004) talked about
posttraumatic growth as a transformational process. In my dissertation, I investigate the
professional growth individuals exhibit after experiences of adversity. While this growth
may in fact be transformational, it may also be subtler. For instance, the experience of
adversity at work may prompt one individual to completely change how she thinks about
and carries out her work. In contrast, in response to adversity, another individual may
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simply change the order of task procedures to prevent the adversity from occurring again.
I claim that both of these individuals display resilience at work because both demonstrate
professional growth after the adversity. However, the individual who only changed the
task order did not necessarily have a transformational growth experience.
Evidence of resilience in CNMs
My definition of resilience at work is consistent with how the participants of my
research, certified nurse-midwives (CNMs) conceptualize it. One CNM captured the
essence of resilience at work in this statement:
Being resilient in this profession means to positively adapt and grow as a
result of the challenges in our profession. It is not just about survival. That
is certainly a part of it, but we have to ask ourselves, ‘Okay, what can we
do better? What can we do different? What can we take from this tragedy
to serve women better?’” (Nelly, CNM22, Birth Center).
This CNM emphasizes the importance of professional growth by explaining that she is
constantly asking herself what she can do better or different. Rather than trying to
minimize the damage of the adverse experience, she is trying to find ways to benefit from
it and emerge strengthened and better able to deal with future challenges.
Another CNM underscored the importance of conceptualizing resilience as a
process. She defines resilience in the following way:
[Resilience is] a developmental process. If we never had to experience
adversity, we would never become better. I look at the development of the
nurse-midwife, how we are evolving. We are not exactly the same as we
were twenty years ago, or twenty-five years ago. But what are the
differences? They are for the better. We are adapting to the changing
needs of the women we serve in the circumstances in which we serve
them.” (Louise, CNM18, Hospital Practice).
This explanation of resilience at work captures the idea of the process of resilience
allowing individuals to follow a positive developmental trajectory. As the CNM explains,
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resilience is the process that allows the profession to adapt to needs of their clients
because it forces change.
A third CNM working as an independent practitioner talked specifically about
going through the resilience process, and the outcomes she experienced as a result.
I become a better practitioner, I think, after the rough ones. It’s kind of
like boot camp. It makes you have to use your judgment, to be able to
think in adverse situations is in or job, and certainly sleep deprivation and
running around with a chicken with its head cut off is a growth
experience…” (Julie, CNM 10,Hospital practice)
In this statement, the CNM suggests that the experience of adversity enabled her to better
handle significa…