Resilience reflects the ability to bounce back after adversity (1–3). It is a dynamic process that can evolve over the course of life and vary depending on the circumstances (1, 4).

It correlates with mental health and well-being (5) as well as with work performance (6) and is influenced by both individual factors (such as personality traits and socioeconomic status) (7, 8) and other variable factors. These variable factors, which can be cultivated, encompass demographic characteristics (such as age, marital status, and level of education), practices of relaxation or mindfulness, engagement in physical activity, as well as aspects of well-being such as sleep quality, work-life balance, and the availability of social support (4, 9–17).

In the workplace, effective collaboration and communication within the team, coupled with organizational factors (favorable shifts, adequate staffing, etc.) and opportunities for teaching technical and non-technical skills, are known to foster resilience. This is particularly true for healthcare workers (4, 18–23).

Healthcare workers are a highly at-risk category to adversities and stressful/traumatic condition, both acutely and chronically, due to their constant exposure to people sufferance, necessity of rapidly responding to requests for help, and the possibility of severe adverse disease outcomes (24).

In recent years, there has been a noticeable shortage of healthcare professionals across all high-income nations, primarily due to many doctors and nurses leaving the profession. The trend is primarily driven by high rates of burnout and challenges in balancing work and personal life. While the COVID-19 pandemic and the climate change related events may have exacerbated this situation, early signs of these issues were present prior to their occurrence (24–33).

This has prompted the proposal and development of various interventions aimed at supporting healthcare staff in self-care and also adjustments in medical education programs (25, 29, 34, 35).

For these reasons, resilience emerges as a highly desirable characteristic in healthcare staff, as it may serve as a protective factor against abandoning the profession.

There is limited and fragmented literature on the resilience levels of healthcare personnel, often encompassing only some aspects of this complex construct (4, 19, 20, 22, 23, 33, 36, 37).

Indeed in some healthcare sector a higher level of intrinsic resilience seems to be necessary. For instance, critical care or surgery departments have the highest rates of workers burnout (24, 37–40).

In line with the demand-resources job model (28), these departments entail high demands (night and weekend shifts, highly stressful and emotional situations) while resources remain similar to those available to other healthcare professionals (12).

There is, however, only little information on this topic (37, 41) and there is not a clear understanding of the level of resilience required for these roles. Understanding of clinician resilience has predominantly stemmed from convenience samples of organizations and clinicians, frequently through surveys targeting either physicians or nurses exclusively.

A hospital is a unique environment where various categories of workers, not just healthcare providers, coexist, allowing for potential differences to be assessed based on job type. Within the same setting, there are roles that inherently require the ability to handle extreme situations, while others do not. Despite numerous confounding factors, several variables such as differences in location, administration, and working conditions are eliminated.

Aim of this study was to assess whether there are differences in resilience among various categories of workers within a hospital, and among healthcare providers.

The total sample comprised 1,197 participants, 842 (70.3%) female and 355 (29.7%) male subjects, all collaborators of EOC. The response rate was 28% (1,197/4275 emails sent).

Table 1 describes the responses given with mean CD-RISC score.

The majority of participants were female (70.3%) and were married or in a stable relationship (68%). All ages from 18 to 65 were well represented, as were seniority and hierarchical roles. 38% of the respondents were nurses.

Male subjects, the older ones, with greater seniority and higher hierarchical rank, turned out to be more resilient. Executives seemed to demonstrate higher levels of resilience compared to both managers and workers, regardless of gender.

Regarding the profession practiced, respondents who belonged to the hospitality staff and physicians were found to be more resilient compared to other occupations (Figure 1). Moreover, it was observed that surgical departments and the hospitality sector were more resilient.

In the critical care area (emergency department, anaesthesia, intensive care), the department as a whole did not exhibit higher resilience scores. However, when the emergency department was separated, it showed more elevated levels of highly resilient subjects, comparable to those of the surgery departments and the hospitality sector (Figures 2A,B). By further segregating the various professions, it was observed that emergency department nurses displayed a higher proportion of highly resilient individuals, even after accounting for gender differences (Figures 2C,D). The difference was no longer present when considering physicians.

Analysing the factors contributing to well-being, physical activity and mindfulness were found to be associated with higher resilience scores.

The same was true for subjects who self-identified as highly religious.

Regarding collaboration, communication, and perceived support from colleagues (both within one’s own department and from other departments), as well as the opportunity for training both technical and non technical skills, these elements were also associated with higher scores on the CD-RISC.

All these differences were significant after Bayesian regression (Table 2).

The examination of specific personality traits using the BFI-10 indicated that agreeableness, openness to experience, and conscientiousness were positively linked with higher resilience, whereas for neuroticism and extraversion there was a negative association, more pronounced for neuroticism.

Since the reference values of the BFI-10 differ for subjects ≤35 years and those over 35 years old, calculations were conducted separately for the two age groups. The participants were segregated by gender due to the higher resilience reported in the male group. Figures 3A,B illustrate the distribution of scores for different personality traits in the male (Figure 3A) and female (Figure 3B) populations, correlated with high (CD-RISC 10 score 35–40), medium (CD-RISC 10 score 25–34), and low (CD-RISC 10 score 0–25) levels of resilience.

In this study, we offer comprehensive evidence of difference in terms of score of the CD-RISC 10 scale and proportion of highly resilient individuals among hospital collaborators based on a large sample of respondents.

Being part of the hospitality staff or working as a doctor, was associated to the highest levels of resilience. Surgery and emergency departments had the highest proportion of highly resilient individuals. Male sex, older age, seniority, higher hierarchical rank, engagement in physical activities, relaxation or mindfulness practices, religiosity, perception of good collaboration, communication, social support, and physical activity correlated with higher resilience skills. The examination of specific personality traits using the Big Five Inventory 10 item (BFI-10) indicated that agreeableness, openness to experience, and conscientiousness were positively linked with higher resilience, whereas for neuroticism and extraversion there was a negative association, more pronounced for neuroticism.

To the best of our knowledge, this is the first study assessing resilience skills on a large sample of hospital workers which includes all job categories and finding that physicians, hospitality staff, and people working in the Emergency Department and Surgery Department are the most resilient hospital workers.

Men appear to be more resilient than women and this in agreement with the literature (49, 50). It’s not clear why this occurs, but it’s known that the stress response differs between males and females, and that women have a higher rate of burnout and anxiety (26, 51). The mechanism with which this happen is obscure, as resilience neural circuits have been only partially identified, with the majority of studies performed on male subjects (52). In a study conducted on rodents, the Authors show how neural reactions are different between male and female subjects (51).

Age, seniority and hierarchical role are predictors of superior resilience, as expected (4, 6, 9, 22). Aging is synonymous with adaptation and experience, not only with senescence (49). At the same time, those who have stayed in a specific position for an extended period and those in leadership roles have likely found the resources to do so, and consequently, they are likely self-selected as more resilient.

Interestingly in our sample there was no statistical difference between male and female executives (females being far less numerous than males).

Hospitality staff and physician were found to be more resilient in comparison to other professionals. There are few studies in the literature on healthcare staff, and even fewer deal with hospitality sector. In particular, the hospitality sector has only recently been studied in relation to the forced closures implemented by numerous governments during the COVID-19 pandemic (52). To become a physician and work in a hospital requires many years of study, while working in the hospitality sector of a health facility means doing humble work, often under-appreciated even by the hospital’s own staff. In both cases, a high level of motivation is required, and perhaps this is why these two categories stand out in the resilience ranking.

It’s possible that motivation also plays a significant role in the presence of highly resilient individuals within emergency departments: working 24/7, overcrowding, and highly stressful situations are part of everyday life, and individuals who are unmotivated or less resilient are not easily found in such environments (53). Unfortunately, we did not assess the motivational aspects and work engagement of our respondents.

Well-being, physical activity and mindfulness as well as the perceived presence of good communication, collaboration and social support among co-workers were all factors that were associated to higher levels of resilience: given that resilience can be nurtured (18, 20–23) clinics’ and hospitals’ administrations should be very attentive to these aspects and develop programs that include a caring vision not only for patients but also for the staff (34, 35, 54). This necessitates a cultural shift that is just starting to emerge within the healthcare sector.

In addition, fostering resilience should involve organising an adequate array of technical and non-technical skills training activities, both of which have been linked in this study to higher resilience scores. Even in this field, studies in the literature are scarce. In this 2022 study (55) involving 111 nursing students, the authors were able to identify a correlation between non-technical skills training and increased resilience, but further studies are needed to confirm the validity of these results.

Finally, there is an evident link between personality traits and resilience, already known in the literature (46) and confirmed by this study, notably the negative correlation with neuroticism (or emotional instability). This highlights implications for both the selection of personnel and the provision of psychological support for healthcare workers.

Our study has some limitations:

In conclusion, to our knowledge, this represents the first study that compares various professionals working within the same organization, providing statistically robust data in support of the findings.

The results have implications for enhancing worker resilience, guiding the selection of human resources within a hospital setting, maintaining quality of patients’ care, and stimulating a culture that makes leadership positions accessible to women as well.