April 8, 2019

EJRC - Job satisfaction and resilience can be learned

A multi-modal programme including theory, role play and debriefing reduces job strain in ICU nurses


In November 2018, JAMA published an article by El Khamali R, et al. in which described how a simulation-based course had been used for ICU nurses to evaluate its effect on job strain.

The study was a randomised clinical trial in 8 French ICUs and evaluated different parameters used on the participating nurses at baseline, after 6 months, and 12 months after the intervention/control.

Nurses working in the participating adult ICUs for at least 6 months were included, whereas nurses planning to leave the ICU, or who were on leave, were excluded.

The simulation course took place over five full days and combined theory and simulation scenarios over two weeks. Participants were voluntary, but the course took place during working hours.

The aim of the intervention was to reduce job strain prevalence by improving the ability of ICU nurses to cope with stressful situations and specific stressors related to work organisation or working conditions.

Specific objectives were to develop expected ICU nursing skills, but also analyse the effects of stress and emotions in daily practice, for participants to learn strategies to reach a professional distance, improve team relationships, and to get to know his/her team.

The study included 198 nurses overall. 101 were randomised to the intervention group and 97 to the control group.

The trial was stopped after the interim analysis, as results were importantly significant.

The intervention group had significantly lower job strain at 6 months and 12 months’ follow-up than the control group (54% and 35% difference, respectively). Moreover, there were also significant decreases in all the other parameters evaluated, related to job strain (iso strain, high psychological demand, low social support, absenteeism and leaving the ICU) and a clear increase in work satisfaction.



This is one of the first studies that demonstrates that simulation is effective in improving nurses’ working environments with such a long follow-up. However, its authors acknowledge several limitations, such as the difficulties to select the proper control intervention, or the need to standardise the intervention to implement it in other countries.

Further research is needed to understand which components of the intervention are effective and also its cost-effectiveness.



Simulation should be used to train more than technical abilities. It can be also used to analyse and improve human factors, work environment and other intangible aspects of patient care and work-related issues.

A visual abstract can be seen here.


This article review was prepared and submitted by Mireia Llauradó Serra, on behalf of the N&AHP Committee.



1) Radia El Khamali; Atika Mouaci; Sabine Valera; et al. Effects of a Multimodal Program Including Simulation on Job Strain Among Nurses Working in Intensive Care Units. A Randomized Clinical Trial. JAMA. 2018;320(19):1988-1997.

Comment on this news