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RATIONALE: Burnout is a personal and occupational phenomenon that has been associated with negative physical and psychological outcomes in medical staff. Additionally, there are implications for healthcare organizations, as those staff who are burned out are more likely to have lower productivity or leave the organization. As with the Covid-19 pandemic, future national emergencies and potentially large-scale conflicts will require similar and likely even larger scale responses from the U.S. Military Health System, thus it is important to understand burnout in this population so that the readiness of the staff and the military can remain at a high level. OBJECTIVE: This assessment was designed to examine levels of burnout among United States Military Health System (MHS) staff working at Army installations and the factors that influence the development of burnout. METHODS: Anonymous data was collected from 13,558 active-duty U.S. Soldiers and civilian MHS employees. burnout was measured using the Copenhagen burnout Inventory and the Mini-Z. RESULTS: Results showed nearly half of staff who responded (48%) reported being burned out, an increase since last measured in 2019 (31%). Factors related to increased burnout included concerns about work/life balance and workload, low job satisfaction and feeling disconnected from others. burnout was associated with increases in adverse physical and behavioral health (BH) outcomes. CONCLUSIONS: Results indicate that burnout is a common problem across MHS Army staff and is related to significant adverse health consequences for the individual and reduced retention of staff for the organization. These findings highlight the need to address burnout through policies that standardize health care delivery policies and practices, providing support to leadership to promote a healthy workplace, and individual support to those who experience burnout.

BACKGROUND AND OBJECTIVES: Clinician workload is a key contributor to burnout and well-being as well as overtime and staff shortages, particularly in the primary care setting. Appointment volume is primarily driven by the size of patient panels assigned to clinicians. Thus, finding the most appropriate panel size for each clinician is essential to optimization of patient care. METHODS: One year of appointment and panel data from the Department of Family Medicine were used to model the optimal panel size. The data consisted of 82 881 patients and 105 clinicians. This optimization-based modeling approach determines the panel size that maximizes clinician capacity while distributing heterogeneous appointment types among clinician groups with respect to their panel management time (PMT), which is the percent of clinic work. RESULTS: The differences between consecutive PMT physician groups in total annual appointment volumes per clinician for the current practice range from 176 to 348. The optimization-based approach for the same PMT physician group results in having a range from 211 to 232 appointments, a relative reduction in variability of 88%. Similar workload balance gains are also observed for advanced practice clinicians and resident groups. These results show that the proposed approach significantly improves both patient and appointment workloads distributed among clinician groups. CONCLUSION: Appropriate panel size has valuable implications for clinician well-being, patients' timely access to care, clinic and health system productivity, and the quality of care delivered. Results demonstrate substantial improvements with respect to balancing appointment workload across clinician types through strategic use of an optimization-based approach.

Limited research has examined what factors serve as potential barriers and motivators for law enforcement personnel in seeking mental health support. The current study presents findings from a survey of 158 sworn and civilian personnel from a large Southeastern Sheriff's office to shed light on these potential barriers/motivators. We drew on previous literature to create measures related to mental health stigma, confidentiality, burnout, various stressors, and organizational support, among others. The main effects OLS regression models suggest that increased perceptions of stigma and personal stressors significantly lowered employees' willingness to seek mental health support. However, increased burnout and job satisfaction were associated with employees seeking mental health support. Multiplicative models show that as job satisfaction increased within nonwhite respondents, those respondents were significantly more likely to seek mental health assistance. However, as personal stressors increased among nonwhite respondents, those respondents were significantly less likely to seek help. Finally, as overall health increased among white respondents, those respondents were significantly more likely to seek help. Findings indicate that mental health issues experienced by employees vary based on group membership. We discuss several future research directions and policy implications derived from these findings.

[This is an excerpt.] When the coronavirus pandemic hit North America in March of 2020 the medical profession was plunged into a crisis more devastating than any it had faced in the previous century. Trainees and physicians were called to the frontlines to care for extremely ill patients for long hours in the context of inadequate knowledge, skills, and equipment; patients were dying without loved ones to hold their hands and ease their passage. Ethical dilemmas around distribution of limited resources permeated each medical decision and led to moral injury for providers who could not deliver the quality of care that was standard just weeks prior. Healthcare professional burnout and suicide increased from the already significant pre-pandemic rates.1 Many medical schools limited students to virtual learning to protect them from exposure to the virus; yet a byproduct of this prudent decision was that many students found themselves isolated from peers and teachers, and in living situations suboptimal for class attendance and studying. Some questioned whether they were getting an education that would allow them to become good doctors. [To read more, click View Resource.]

Defining burnout and why it has increased among health care providers

When the World Health Organization announced a global pandemic in March of 2020, health care workers across the globe selflessly and tirelessly stood at the frontline. In addition to the clinical challenges an unknown virus brought forth, health care workers were not prepared for the emotional drain and mental health impact. The health care industry is increasingly facing a crisis as frontline workers experience moral distress, emotional trauma, and burnout in high stress health care environments. Debriefing, defined as facilitated interprofessional team reflection after a clinical event, has been shown to improve clinicians’ ability to manage their grief and is associated with lower burnout. A standardized program workshop and intervention, branded as Project Debriefing Event for Analysis and Recovery (D.E.A.R.), was piloted at a pediatric hospital with a multidisciplinary team. These volunteers served as champions to facilitate debriefings following stressful clinical events. The program included education sessions, integration of a standardized debriefing program, and additional resources. Impact of the workshop and educational intervention was evaluated using a pre–post survey design. Data demonstrated increased comfort for the interprofessional facilitators who provided the standardized debriefing. Participants found the sessions highlighted strengths and areas for opportunity. Champions and participants agreed the standardized process improved their emotional wellbeing. Future quality improvement projects are encouraged to standardize debriefing processes addressing the increased need for support to clinicians after a critical incident has occurred.

Burnout of physicians and other medical personnel is a major problem in the economics of healthcare systems, potentially costing billions of dollars. Knowledge of the determinants and costs of burnout at the organization level is sparse, making it difficult to assess the net benefits of interventions to reduce burnout at the level where arguably the greatest change can be affected. In this paper, we use data from a midsize healthcare organization with about 500 clinicians in 2021-22 to advance analysis of clinical burnout in two ways. First, we estimate the costs of clinician burnout beyond the widely studied losses due to turnover. Including hard-to-measure and potentially long-term costs that arise from reduced patient satisfaction and lower productivity of burnt-out clinicians at work, our analysis suggests a much higher cost of burnout per clinician than previous estimates that exclude these costs. Second, we use standard medical billing and administrative operating data to forecast turnover and productivity of clinicians to serve as an early warning system. Accurate estimates of both the cost of burnout now and of likely future costs should help decision-makers be proactive in their approach to solving the burnout crisis currently affecting the healthcare industry. While our empirical analysis relates to a particular healthcare organization, the framework for quantifying the costs of burnout can be used by other organizations to assess the cost-effectiveness of ameliorative policies.

BACKGROUND: The concept of a ‘black cloud’ is a common unfounded perception in the healthcare workforce that attributes a heavier workload to specific individuals or teams. Prior studies in non-surgical disciplines have demonstrated that ‘black cloud’ perceptions are not associated with workload, albeit such perceptions may influence behavior. The influence of ‘black cloud’ perceptions on surgical resident workload and burnout remains to be investigated. This study assesses the associations between ‘black cloud’ self-perception with actual workload and burnout among surgical residents in different specialties. METHODS: A cross-sectional survey study of postgraduate year (PGY) 2 and 3 residents enrolled in different surgical residencies at the Icahn School of Medicine at Mount Sinai was conducted between September–November 2021. RESULTS: The survey response rate was 62.1% (41/66). 46.3% of respondents were female. The majority of subjects were single (61%) and PGY2 trainees (56.1%). In a multivariate regression analysis demographic factors and workload variables, such as the number of pages responded, notes, and amount of sleep, were not significant predictors of a ‘black cloud’-self-perception. A significantly lower Burnout Index Score (BIS) was observed among females (p< .001). A significantly higher BIS was observed among residents who are single (p = .003), training in general surgery (p = .02), and orthopedic surgery (p = .03). There was no significant association between ‘black cloud’ self-perception and BIS. DISCUSSION: The findings demonstrate that a ‘black cloud’ self-perception is not associated with a high workload and burnout among surgical residents. Gender, marriage/domestic partnership, and certain surgical specialties influenced burnout among the study cohort.

BACKGROUND: Emergency Medicine has a high rate of physician burnout. Studies have shown that exercise and social activities have positive impacts on physician wellness. Many residency programs have implemented initiatives aimed to positively impact the emotional, physical, intellectual, and social aspects of wellness. OBJECTIVES: The purpose was to improve EM physician wellness by implementing a voluntary team exercise competition into an EM residency program wellness curriculum over 3 months. METHODS: This study utilized a voluntary survey to compare wellness pre- and post-competition. The population studied included 33 EM residents and 28 EM attending participants. Residents were grouped based on pre-established residency “Houses” and attendings assigned to one of these Houses at random. Participants earned 1 point for every 30 minutes of exercise with the winning team earning a residency funded “House Party” at the end of the 3-month period. Data from the survey was analyzed using a 2 Sample T-Test to assess for significance. The mean values of the pre/post data were compared to determine if an aim of 25% improvement in wellness was met. RESULTS: Resident survey results showed that 100% exercised more during this competition and 100% would participate again. There was improvement in wellbeing (p = 0.026), energy (p = 0.014), and sleep (p = 0.025); these areas all also met the aim of improving by more than 25% after this 3-month competition (25%, 36%, 33% respectively). 80% of residents felt that their increased exercise positively impacted their wellness at work. CONCLUSIONS: EM residents had improvement in wellness, energy, and sleep after implementing a team exercise competition. A majority of participants felt this competition encouraged an increase in their exercise and stated they would participate again. Limitations include confounding variables impacting wellness such as changing weather or rotations, low survey response rate, and survey type.

BACKGROUND: Hospitals and healthcare systems strive to meet benchmarks for the National Database of Nursing Quality Indicator (NDNQI) measures, Centers for Medicare & Medicaid Services (CMS) Core Measures, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) outcome indicators. Prior research indicates that Chief Nursing Officers and Executives (CNOs, CNEs) believe that evidence-based practice (EBP) is important for ensuring the quality of care, but they allocate little funding to its implementation and report it as a low priority in their healthcare system. It is not known how EBP budget investment by chief nurses affects NDNQI, CMS Core Measures, and HCAHPS indicators or key EBP attributes and nurse outcomes. AIMS: This study aimed to generate evidence on the relationships among the budget devoted to EBP by chief nurses and its impact on key patient and nurse outcomes along with EBP attributes. METHODS: A descriptive correlational design was used. An online survey was sent to CNO and CNE members (N = 5026) of various national and regional nurse leader professional organizations across the United States in two recruitment rounds. Data collected included CNO/CNE EBP Beliefs, EBP Implementation, and perceived organizational culture of EBP; organizational culture, structure, personnel, and resources for EBP; percent of budget dedicated to EBP; key performance measures (NDNQI, CMS Core Measures, HCAHPS); nurse satisfaction; nurse turnover; and demographic questions. Descriptive statistics were used to summarize sample characteristics. Kendall's Tau correlation coefficients were calculated among EBP budget, nursing outcome measures, and EBP measures. RESULTS: One hundred and fifteen CNEs/CNOs completed the survey (a 2.3% response rate). The majority (60.9%) allocated <5% of their budget to EBP, with a third investing none. An increase in EBP budget was associated with fewer patient falls and trauma, less nursing turnover, and stronger EBP culture and other positive EBP attributes. A greater number of EBP projects were also associated with better patient outcomes. LINKING EVIDENCE TO ACTION: Chief nurse executives and CNOs allocate very little of their budgets to EBP. When CNEs and CNOs invest more in EBP, patient, nursing, and EBP outcomes improve. System-wide implementation of EBP, which includes appropriate EBP budget allocation, is necessary for improvements in hospital quality indicators and nursing turnover.

INTRODUCTION: Surgeons and perioperative staff experience high rates of burnout manifesting as exhaustion, depersonalization, and lack of achievement. Consequences include increases in errors and adverse patient events. Little data exist regarding the effectiveness of multidisciplinary peer support systems in combatting burnout. We sought to improve staff morale through establishment of a formally trained, multidisciplinary peer support team. METHODS: Selfselected surgeons, anesthesiologists, and nurses were formally trained as Peer Responders as part of an institutional peer support program. All perioperative staff at our pediatric surgery center (n = 120) were surveyed before initiation of the program and then 1-mo and 12-mo after initiation. Primary outcomes were unit morale, unit support, and peer approachability. Kruskal-Wallis tests and Chi-squared tests were used for comparison of primary outcomes among surveys and by position with an alpha value of 0.05 set for significance. Institutional review board approval was waived. RESULTS: The survey response rates were 57.5%, 32.5%, and 37.5% chronologically. After 1 year, there were statistically significant increases in unit support (P < 0.01) and peer approachability (P < 0.001), and a nonstatistically significant increase in unit morale (P = 0.22). On subgroup analysis by staff role, surgeons were least likely to utilize peer support. CONCLUSIONS: A multidisciplinary peer support team is an effective and easily reproducible means of building a culture of support and improving morale among perioperative staff. surgeons were least likely to seek interprofessional peer support. Consequently, surgeon-specific strategies may be necessary. Further investigations are ongoing regarding secondary effects on staff burnout rates, patient safety, and quality of care.

BACKGROUND: Burn-out is a long-standing problem among healthcare workers (HCWs) and leads to poorer quality and less safe patient care, lower patient satisfaction, absenteeism and reduced workforce retention. Crises such as the pandemic not only generate new challenges but also intensify existing workplace stresses and chronic workforce shortages. As the COVID-19 pandemic continues, the global health workforce is burnt-out and under immense pressure, with multiple individual, organisational and healthcare system drivers. METHOD: In this article, we examine how key organisational and leadership approaches can facilitate mental health support for HCWs and identify strategies to support HCWs that are critical for supporting workforce well-being during the pandemic. RESULTS: We identified 12 key approaches at the organisational and individual levels for healthcare leadership to support workforce well-being during the COVID-19 crisis. These approaches may inform leadership responses to future crises. CONCLUSION: Governments, healthcare organisations and leaders must invest and deliver long-term measures to value, support and retain the health workforce to preserve high-quality healthcare.

This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Worker & Learner Engagement).

Fifty-six percent of nurses in a national sample reported burnout symptoms in 2022. Although the nursing literature on burnout dates back to 1978, nurses and other health professionals continue to grapple with this workplace phenomenon that leads to deleterious outcomes, including suicide. The suicide risk among US nurses now surpasses that of physicians. Stories of nurses who have died by suicide or considered it are emerging, and some are similar to this suicide note titled, “A Letter to My Abuser,” which was published as a letter to the editor from the nurse’s parents. More attention is needed to meaningfully address nursing burnout and this can be done by also using an equity lens.

Burnout is a phenomenon characterized by high emotional exhaustion—feelings of energy depletion, high depersonalization (i.e., cynicism) and detachment from the job, and loss of professional efficacy—sense of ineffectiveness and lack of accomplishment. In fact, it has received a certain kind of official imprimatur by having its own ICD-10 code and now it is considered a “syndrome,” although it is not classified as a medical condition. In the ICD-11 classification, burnout appears in the section on problems related to employment or unemployment. Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is not classified as a medical condition. It has to be related to the occupational context, but it’s not just fatigue or even emotional drain that follows a busy night on call, especially when you know all you need is a good night’s sleep. It is also not depression.

BACKGROUND: Nurse faculty burnout is a growing concern in the United States. There are limited studies exploring the level of burnout in nursing faculty. PURPOSE: To assess the prevalence of burnout among nurse faculty in undergraduate and graduate programs and its relationship with specific demographic and organizational variables. METHODS: A descriptive cross-sectional research design was employed to examine the level of burnout of nursing faculty. An internet-based survey was administered to nursing faculty in over 1000 schools of nursing in the United States. Burnout was measured using the Oldenburg Burnout Inventory. RESULTS: A total of 3556 surveys were returned. Among all participants, most of the sample exhibited moderate levels of burnout, exhaustion, and disengagement. Based on the findings from the OBI, a moderate/high exhaustion level was reported in 85.5 % of participants, while disengagement was moderate/high in 84.9 %, and overall burnout was at moderate/high levels in 85.2 % of the nursing faculty. CONCLUSIONS: The nation's nurse faculty population is experiencing a moderate to high level of burnout, exhaustion, and disengagement. Academic nursing leaders are encouraged to identify ways and take action to reduce faculty burnout and promote faculty wellness and resilience.

Physician burnout is increasing in prevalence and has negative implications for the quality of patient care and the health and wellbeing of physicians. Surveys before the COVID-19 pandemic showed high rates of burnout among breast radiologists, and the COVID-19 pandemic has further increased stress. This article summarizes strategies to combat burnout, including improving individual resilience by increasing mindfulness about handling stress, making goals, and noting personal accomplishments. However, more effective change is likely to occur when there is change at both a personal and an organizational level, which includes identifying the stakeholders in a workplace and determining what changes must occur to increase joy and decrease rates of burnout. Despite the increasing rates of burnout, breast radiologists report high rates of personal career satisfaction. Self-reflection and positive steps to increase joy at work are important in maintaining career fulfillment in these challenging times.

OBJECTIVE: Long-term changes in burnout and its predictors in hospital staff during the COVID-19 pandemic were investigated in an international study. METHODS: Two online surveys were distributed to hospital staff in seven countries (Germany, Andorra, Ireland, Spain, Italy, Romania, Iran) between May and October 2020 (T1) and between February and April 2021 (T2), using the following variables: Burnout (emotional exhaustion and depersonalization), job function, age, gender, and contact with COVID-19 patients; individual resources (self-compassion, sense of coherence, social support) and work-related resources and demands (support at the workplace, risk perception, health and safety at the workplace, altruistic acceptance of risk). Data were analyzed using linear mixed models repeated measures, controlled for age. RESULTS: A total of 612 respondents were included (76% women). We found an increase in burnout from T1 to T2. Burnout was high among personnel with high contact with COVID-19 patients. Individual factors (self-compassion, sense of coherence) and work-related factors (support at the workplace, risk perception, health and safety at the workplace) showed associations with burnout. Low health and safety at the workplace at T1 was associated with an increase in emotional exhaustion at T2. Men showed an increase in depersonalization if they had much contact with COVID-19 patients. CONCLUSION: Burnout represents a potential problematic consequence of occupational contact with COVID-19 patients. Special attention should be paid to this group in organizational health management. Self-compassion, sense of coherence, support at the workplace, risk perception, and health and safety at the workplace may be important starting points for interventions.

[This is an excerpt.] As a professor at a school of nursing, I have responded to numerous inquiries from my former students who are interested in changing positions, transferring to nonpatient care areas, or seeking work outside the profession of nursing altogether. They describe relentless demands that exceed their tolerance for occupational stress and report being tired and feeling hopeless as they struggle to cope with the protracted effects of the pandemic and challenges in the workplace. They are concerned about their own physical and mental well-being and fear that their professional obligation to provide quality care is in jeopardy. These distressing personal reports from new graduates in their formative years of training are consistent with recent national reports from media outlets that alert readers to the patient safety risks related to deteriorating working conditions in hospitals and a clinical workforce that is suffering from burnout and on the edge of collapse. What began as a call to duty for U.S. health care professionals to respond to a global emergency has resulted in a parallel pandemic of burnout with personal consequences, job disruptions, and potential risk to patients because of compromised quality of care. [To read more, click View Resource.]

Burnout among nurses is a widespread phenomenon.The wellness of caregivers determines their ability to give patient centred care. Understanding the causes and management of burnout is essential in improving the working life of nurses. This study was aimed at reviewing available evidence systematically on the factors responsible for burnout in intensive care unit (ICU) nurses and to identify the preventive and management strategies in mitigating the menace of burnout.