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[This is an excerpt.] This report presents the results of a survey of 2,212 students from 91 countries and two roundtable sessions with key opinion leaders and faculty in the USA and UK. The aim is to gain a deep understanding of students’ experiences today and their expectations of the future in healthcare, as well as the perspectives of those instructing them. [To read more, click View Resource.]

[This is an excerpt.] In 2017, my husband suffered a critical illness. He is also a physician, and during the course of his short stay at our local hospital, the doctors caring for him—his colleagues—were distant and impassive in the face of his extremis. They delayed his transfer, despite my urgent requests, until his next option for treatment was extracorporeal membrane oxygenation, a therapy not offered at the small facility. They were caring people and not reckless physicians, so their stonewalling and what felt like brinkmanship with my husband’s life seemed out of character. But their inaction stuck with me because of how unsettling and inexplicable it was, given what I knew of them, and of medicine. If asked what was wrong, they might have said they were burned out, because there was no other language for their experience at the time. But to me, their struggle seemed different. It seemed like their hands were tied, as though without accurate language, they were resigned to a situation they couldn’t articulate and therefore could not solve. [To read more, click View Resource.]

BACKGROUND: The aim of this study was to describe clinicians' insights into the quality and safety of patient care delivered to emergency department (ED) boarding patients, as well as clinician safety and satisfaction related to ED boarding. METHODS: This was a single-site, mixed methods sequential explanatory study. Quantitative data were obtained from a cross-sectional survey sent to ED attending physicians, resident physicians, advanced practice providers, and nurses. Semistructured focus group interviews with a subsample of participants sought to add depth to the interpretation of survey data and identify areas of improvement in boarding care. Chi-square and Wilcoxon rank sum tests were used to evaluate for response differences between groups. Qualitative data were thematically coded and analyzed. RESULTS: A total of 94 questionnaires were obtained for a response rate of 34.1%. Clinicians reported that boarding highly contributed to the perception of burnout. All groups reported high rates of perceived verbal and/or physical abuse from boarding patients (86.8% of nurses, 41.1% of providers, p = 0.0002). A total of 39 clinicians participated in focus groups regarding boarding care, and six themes were identified, including patient safety concerns, lack of knowledge/resources/training, and poor communication. Key themes identified as possible solutions to improve care included standardization of care, proactive planning, and culture change. CONCLUSION: Clinicians identified many concerns regarding patient safety and the quality of care delivered to boarding patients and identified several areas for improvement. Clinicians also felt that boarding negatively affected their satisfaction and safety.

[This is an excerpt.] The incidence and impact of burnout among physicians are of ever-increasing concern. Burnout is characterized by emotional exhaustion, depersonalization, and an impaired sense of personal accomplishment caused by work-related stress. The data consistently reveal that among physicians, surgeons are at a substantially increased risk of burnout. Thus, for the benefit of ourselves, our colleagues, our trainees, and our patients, it is paramount that we tackle the subject of burnout, specifically its prevention and management, with thoughtfulness and rigor. [To read more, click View Resource.]

OBJECTIVE: Explore the relevant evidence about stress-related cognitive appraisal and coping strategies among registered nurses in the emergency department (EDRNs) coping with the COVID-19 pandemic. METHODS: This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus electronic databases for related studies from inception through February 2, 2022. This review further conducted study selection based on the PRISMA flow diagram and applied Lazarus and Folkman's Psychological Stress and Coping Theory to systematically organize, summarize, and report the findings. FINDINGS: Sixteen studies were included for synthesis. Most of the studies showed that the majority of EDRNs were overwhelmed by the COVID-19 pandemic. Depression, triaging distress, physical exhaustion, and intention to leave ED nursing were cited as major threats to their wellness. Additionally, comprehensive training, a modified triage system, a safe workplace, psychological support, promotion of resilience, and accepting responsibility may help EDRNs cope with pandemic-related challenges effectively. CONCLUSION: The long-lasting pandemic has affected the physical and mental health of EDRNs because they have increased their effort to respond to the outbreak with dynamically adjusted strategies. Future research should address a modified triage system, prolonged psychological issues, emergency healthcare quality, and solutions facing EDRNs during the COVID-19 or related future pandemics. CLINICAL RELEVANCE: EDRNs have experienced physical and psychological challenges during the pandemic. The ED administrators need to take action to ensure EDRNs' safety in the workplace, an up-to-date triage system, and mental health of frontline nurses to provide high-quality emergency care for combating COVID-19.

Nurses are a critical part of the health care system. Yet the nursing profession continually faces shortages in all specialties. Several causes and issues of concern related to the nursing shortage in nephrology are discussed, including the prevalence of kidney disease and its increasing number of associated comorbidities, which has also heightened the urgent need for nephrology nurses. Data have shown that the lack of nephrology nurses caring for patients with kidney disease impacts patient outcomes and nephrology nurse burnout. Strategies must be implemented to manage these growing needs that affect both patient outcomes and nurse staffing. This article aims to identify methods to combat the nursing shortage, promote recruitment and retention strategies for nephrology nurses, and discuss leadership issues related to the topic.

[This is an excerpt.] Burnout is used to describe the cognitive and emotional responses of practitioners to chronic emotional and interpersonal stress. Operating room nurses are a group engaged in nursing professions in special environments. Due to the long-term high-intensity and fast-paced work, professional mental and physical labour are also required, which can easily lead to job burnout of nurses (Li et al., 2021). We read with great interest a recent article in Journal of Advanced Nursing on burnout in operating room nurses and the relevance of potential traumatic events (Wang et al., 2022). The authors explored and compared the association between potential job-related traumatic events and burnout among operating room nurses under three different statistical approaches. [To read more, click View Resource.]

OBJECTIVE: To determine the effectiveness of communication training and its impact on burnout among healthcare providers (physicians, physician assistants, nurse practitioners), in the setting of the COVID-19 pandemic. METHODS: To evaluate the effectiveness of communication training on burnout during the COVID-19 pandemic, healthcare providers participating in a Communication in Healthcare (CIH) module between October 31, 2019, through February 20, 2020, were identified using a scanned sign-in sheet. A 3-question online survey regarding the utilization of communication skills during the COVID-19 pandemic was sent via email. An ordinal scale was used to rate the effectiveness of the training on subsequent burnout and work satisfaction during the pandemic. RESULTS: Of the 98 surveys distributed via email, a total of 33 participants completed the survey. Seventy-three percent of respondents agreed that communication training helped prevent burnout, and 39% strongly agreed that the modules improved work satisfaction. CONCLUSION: Our study found communication training was effective in reducing burnout in healthcare providers, in the setting of the COVID-19 pandemic. The participants felt the communication tools learned from the training modules were useful in improving work satisfaction and communication with patients during the pandemic.

This case-control study investigates the association between a communication and optimal resolution program to address unexpected adverse patient outcomes and measures of health care worker satisfaction.

BACKGROUND: Nurses have been identified as the most vulnerable health care profession to experience compassion fatigue. Currently, not much is known about the availability and credibility of online compassion fatigue resources for nurses. This systematic review of consumer websites explores the prevalence and quality of compassion fatigue educational resources available online to nurses. METHOD: A descriptive, cross-sectional, nonexperimental design was used. Findings were collected from the websites of the top 20 hospitals in the United States, all professional nursing organizations in the United States, and the top three most used social media platforms. Web-sites were evaluated for quality using the Journal of the American Medical Association (JAMA) benchmarks and Health on the Net Foundation certification. RESULTS: A total of 143 websites were evaluated. Of these, three websites were identified as having the most credible, comprehensive educational resources on compassion fatigue. CONCLUSION: There is a need for more hospitals, professional nursing organizations, and social media websites to provide high-quality compassion fatigue educational resources for nurses.

[This is an excerpt.] I will always remember the first time I interviewed a patient with suicidal ideation. I (P.A.) was a third-year medical student on my pediatrics rotation. The patient was a teenager recently admitted to our service for an intentional overdose. I was a few months into my clinical clerkships, already feeling the exhaustion of perpetually changing services, preceptors, and expectations. [To read more, click View Resource.]

A descriptive study of the impact of the COVID-19 pandemic on non-direct care nurses

PURPOSE: The purpose of this study was to validate the Stanford Professional Fulfillment Index (PFI) for assessment of burnout and professional fulfillment in a study population of pharmacy residents and residency preceptors. SUMMARY: The historical gold standard for assessing professional burnout is the Maslach Burnout Inventory (MBI); there is no established standard for professional fulfillment. The PFI is a 16-question assessment that has previously been validated in medical residents and practicing physicians. In this study, surveys including both PFI and MBI items were sent to active pharmacy residents and residency preceptors. To determine concurrent validity, domains of the PFI were compared to the closest related MBI domain as well as composite burnout rates measured in each portion of the survey. A total of 142 preceptors and 68 residents completed both the PFI and a version of the MBI previously validated in physicians. In assessing indicators of pharmacist burnout and fulfillment, data captured by domains of the PFI closely correlated with data captured by corresponding domains of the MBI (Pearson correlations of 0.683-0.822), with high internal consistency (Cronbach α of 0.866-0.903). CONCLUSION: The PFI is a valid method of assessing burnout in both pharmacy residents and residency preceptors. Additionally, the PFI contributes a reliable system of assessing professional fulfillment while also being highly accessible for both research and residency program monitoring applications.

Research conducted by NACE and The Center for the Study of HBCUs underscores how important it is for companies to conduct audits to assess gaps and inequities in their recruiting efforts.

This resource is found in our Actionable Strategies for Health Organizations: Promoting Diversity, Equity, & Inclusion.

Emergency Medical Services (EMS) clinicians provide patient care within a high-stakes, unpredictable, and complex work environment in which conflict is inevitable. Our objective was to explore the extent to which added stressors of the pandemic exacerbated EMS workplace conflict. We administered our survey to a sample of U.S. nationally certified EMS clinicians during the COVID-19 pandemic in April 2022. Out of 1881 respondents, 46% (n = 857) experienced conflict and 79% (n = 674) provided free-text descriptions of their experience. The responses were analyzed for themes using qualitative content analysis, and they were then sorted into codes using word unit sets. Code counts, frequencies, and rankings were tabulated, enabling quantitative comparisons of the codes. Of the fifteen codes to emerge, stress (a precursor of burnout) and burnout-related fatigue were the key factors contributing to EMS workplace conflict. We mapped our codes to a conceptual model guided by the National Academies of Sciences, Engineering, and Medicine (NASEM) report on using a systems approach to address clinician burnout and professional well-being to explore implications for addressing conflict within that framework. Factors attributed to conflict mapped to all levels of the NASEM model, lending empirical legitimacy to a broad systems approach to fostering worker well-being. Our findings lead us to propose that active surveillance (enhanced management information and feedback systems) of frontline clinicians’ experiences during public health emergencies could increase the effectiveness of regulations and policies across the healthcare system. Ideally, the contributions of the occupational health discipline would become a mainstay of a sustained response to promote ongoing worker well-being. The maintenance of a robust EMS workforce, and by extension the health professionals in its operational sphere, is unquestionably essential to our preparedness for the likelihood that pandemic threats may become more commonplace.

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This resource is found in our Actionable Strategies for Public Safety Organizations: Drivers (Operational Breakdown)

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BACKGROUND: Due to exposure to overwhelming work stressors, approximately half of emergency department (ED) physicians and nurses experience burnout, leading to lower productivity, lower quality of care, higher risk of medical errors, higher rates of absenteeism, and eventually turnover. Growing evidence suggests that the physical environment can be leveraged to support healthcare workers' well-being. OBJECTIVES: This study aimed to identify (1) self-care behaviors that healthcare workers engage in to help them cope with job-related stress, (2) where they engage in those behaviors, (3) attributes of the built environment that may support coping behaviors. METHODS: A mixed-methods study was conducted in three EDs, using online questionnaires (n = 85) and interviews (n = 20). RESULTS: Job-related stress was derived from interruptions, workload and inability to take breaks, insufficient workspace, lack of privacy, unpredictability of EDs, and security concerns. Talking with a colleague, getting something to eat or drink, listening to music, and taking a walk were considered destressing activities. The bathroom was considered a place for destressing by the majority of participants, followed by outside areas, physician-only areas, and care team stations. Supportive environmental features included sufficient workspace, maximized privacy, reduced noise and clutter, controlled temperature and lighting, spaces for decompressing, spaces for documentation, close-by breakrooms with enough eating space and massage chairs, chairs with back support, standing desks, food options, and convenient bathrooms. CONCLUSIONS: Design decisions play an important role in supporting stress reduction among healthcare workers. This study provides several strategies to achieve this aim.

Correctional officers (COs) working in county-level jails are shouldered with important responsibilities designed to maintain institutional order. Despite the invaluable work they perform, an alarming number of officers voluntarily resign from their position shortly following their initial hire date, creating severe problems for the facilities they now leave behind. Although a number of studies have researched factors affecting officer turnover intent, very few have specifically tested whether officers exhibiting signs of mental illness symptoms are more likely to want to resign. Adding to this, currently no study has examined whether resilience confounds the effects of mental illness symptoms on officer resignation intentions. Questionnaire data were collected from a statewide population of county jail officers working throughout TN (N = 1,517) to test whether officers exhibiting symptoms of mental illness were more likely to want to resign and whether these relationships were confounded by resilience. Consistent with hypothesized expectations, officers who scored higher on clinical screening measures for symptoms of mental illness signaled a greater desire to want to quit their job. These relationships were relegated to a statistically non-significant status once resilience was entered into the regression model. Supplementary analyses supported our confounding hypothesis since resilience negatively predicted all five screening measures for mental illness symptoms. Theoretical and policy implications are discussed.

In this narrative medicine essay, a physician recounts her family’s experience with critical illness and death and how she came to appreciate both the health care team’s perspective and the family’s perspective regarding when to have hope and when to let go.

Background: Physician burnout increased during the COVID-19 pandemic. Objective: To evaluate the effectiveness of a multimodal workplace intervention designed to reduce hospitalist burnout. Design: Participants and setting: Our intervention group was composed of internal medicine hospitalists at Providence Portland Medical Center (64 providers including 58 physicians and 6 nurse practitioners). Our control was composed of internal medicine hospitalists at Providence St Vincent’s Hospital (59 physicians and 6 nurse practitioners). Measurements: Two surveys were given during, before, and after a 12-month intervention period (October 2020 and again in October 2021). Surveys included demographics, job satisfaction, the Maslach Burnout Inventory, the Pandemic Experiences Survey, and 2 questions about leaving the job. Interventions: Three hospitalists designated as wellness warriors created weekly COVID group meetings, providing up-to-date information about COVID-19 infection rates, treatments, and work-flow changes. Discussions included coping and vaccine hesitancy, difficult case debriefs, and intensive care unit updates. Individual coaching was also offered. Meeting minutes were taken and sessions were recorded for asynchronous access. Results: No site differences in burnout or job satisfaction were evident pre-intervention. Post-intervention, the intervention group reported 32% burnout while controls reported 56% (p = .024). Forty-eight percent of the intervention group reported high wellness support vs. 0% of the controls (< .001). Intervention participants attributed 44% of wellness support to Providence alone, vs. controls at 12% (< .001). Regressions controlling sex, work hours, experience, race, and children in the home showed the intervention’s positive effects on burnout and job satisfaction remained significant (all p < .02). Limitations: For privacy reasons, all survey responses were anonymous, meaning that individual pre-post changes could not be tracked. Conclusion: We believe the intervention resulted in substantial burnout prevention and is feasible for adoption in most hospitals and clinics.

BACKGROUND: Oncology clinicians are at risk for developing burnout due to work-related factors such as high acuity patients, long work hours, limited autonomy, administrative and documentation demands (Copur, 2019; Eelen et al, 2014). The COVID-19 Pandemic has intensified burnout due to rapid and multiple changes in clinical practice, lack of fulfillment, and heightened moral distress and personal challenges (Hlubocky et al 2021). As a multi-center community cancer care system, an infrastructure was created and operationalized to address the work-related factors contributing to burnout. The purpose of the project was improved identification and prioritization of clinician (physician and APP) needs with subsequent targeted intervention. METHODS: To measure success, a partnership with the American Medical Association (AMA) was formed to deploy the Mini-Z burnout survey. The survey was administered on July 2-August 20, 2021 to all Medical Oncology physicians and Advanced Practice Providers (APPs), n = 60. The survey was re-deployed from July 13-September 2nd, 2022. Data was collated by the AMA and presented back to executive leadership. Through this survey and follow up focus groups, it was identified that physicians tended to struggle more with the EHR and inability to disconnect from work compared to APPs. Our APPs identified several areas of opportunity including onboarding/orientation, mentorship/professional development, pay and scope of practice. An EHR Well-being Committee was established to evaluate EPIC signal reports to address both system and individual clinician needs. To address APP needs, key factors were addressed in the realm of professional development/orientation, compensation and scope of practice. This was approached with the goal of short-term gains and long-term sustainability. RESULTS: The results indicated a 23.8% improvement in job satisfaction, 4.9% improvement in job stress, and 26.3% improvement in employment outlook. A decrease was also noted in EHR Time outside of work (4.5%) and burnout (16.1%). All areas of improvement met or exceeded national benchmarks. Analysis of these results indicate statistical significance for job satisfaction (p = 0.028, CI 2.8-40.4%) and employment outlook (p = 0.033, CI2.4-45.8%). Results that indicated improvement but were not statistically significant were job stress (p = 0.688, CI 17.6-27.4%), burnout (p = 0.191, CI 7.4-37.5%) and EHR time outside of work (p = 0.806). CONLCUSIONS: While the survey data does not account for clinician turnover between 2021 and 2022, initial review indicates a positive impact on job satisfaction and employment outlook which may be an early indication of improved colleague appreciation. Further study, post-pandemic is needed to evaluate effectiveness of care team efficiency and ongoing work to streamline EHR usage.