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In response to a high turnover rate and staggering orientation costs for new nurses in the cardiothoracic ICU, leaders at one organization developed a dual-role initiative that decreased overall turnover and nurses' desire to leave and increased overall job satisfaction.

BACKGROUND: As the practice of cardiothoracic surgery continues to evolve, the optimal training model represents an area of uncertainty. We sought to describe and to compare the early career experiences of cardiothoracic surgery graduates from the 3 training models. METHODS: An anonymous survey with questions pertaining to an individual's demographic characteristics, training model, first employment experience, experience as junior faculty, career satisfaction, and personal reflection was sent to graduates from US cardiothoracic surgery training programs between 2012 and 2020. Respondents completed a traditional fellowship (2-3 years), a 4+3 model, or an integrated 6-year (I-6) residency. RESULTS: Of the 670 graduates who received the survey, there were 267 (40%) respondents. Of these, 209 (78%) respondents graduated from a traditional fellowship, 27 (10%) respondents graduated from a 4+3 pathway, and 31 (12%) respondents graduated from an I-6 residency. There was no difference in overall satisfaction, major case volume, operative autonomy, burnout, and lifestyle satisfaction between the models (P>.05). When respondents were asked about the ideal model, the 4+3 and I-6 models were favored by its graduates, regardless of the surgeons’ field of practice. CONCLUSIONS: Important early career outcomes were not different between graduates of traditional, 4+3, or I-6 models. Most graduates of the 4+3 and I-6 models believe these are the ideal training models, regardless of their field of practice.

PURPOSE: A successful surgical residency program prepares graduates not only in technical skills and patient care, but also in teamwork and communication. The daily demands on faculty and residents create challenges in making time for discussion and reflection, to enhance and improve residency training and work culture. Organized departmental retreats provide a forum to address different facets of training. METHODS: To provide time to cultivate discussion and longitudinally improve the surgery residency experience, the authors’ program created an annual half-day education retreat for surgical residents and faculty. Clinical activities were limited during this time to allow for attendance. Each retreat focused on a particular topic and consisted of a guest speaker lecture, breakout discussion sessions, and final debriefing as a department. Surgical education retreat objectives and content focus on core pillars of professional development including but not limited to technical skills, building knowledge base, feedback, and teamwork. RESULTS: Since 2003, annual surgical education retreats have been organized at the authors’ institution. In particular, the retreat focusing on wellness in 2016 resulted in the establishment of a formal wellness program consisting of a variety of departmental efforts to mitigate resident burnout and promote wellness. CONCLUSION: Structured retreats support discussions within the department to promote education and collaboration. The positive impact of these events can provide long-term improvements in surgery residency programs, and can be applied to any training specialty.

BACKGROUND: Physician burnout impacts all levels of medical education and has a relatively unknown impact on those responsible for medical student education, particularly in paediatrics. This study examines the prevalence of burnout among paediatric undergraduate medical educators and explores the impact of roles in medical education on medical educator burnout. METHODS: This cross-sectional mixed-methods study utilised a binational survey of paediatricians involved in undergraduate medical education. Respondents answered demographics, standardised questions about burnout and attitudes towards students, and an open-ended probe about interactions between medical student education and wellness. FINDINGS: Of 445 possible, 120 (26.9%) responded to demographic and burnout questions. Of these, 23.3% endorsed burnout, 21.7% high emotional exhaustion (EE) and 10.8% high depersonalisation (DP). High levels of student-related burnout symptoms were reported by fewer than 5% of respondents and were correlated with overall EE and DP. Content analysis revealed four emergent themes: positive effect of student-related role, need to balance medical education and clinical roles, impact of protected time and medical education-related autonomy on educator well-being, and the burden of the administrative portion of educational roles. DISCUSSION: Participating paediatric educators had low rates of burnout compared with paediatricians as a whole in prior studies. The vast majority found working with students rewarding and described the overall positive impact of their medical education role on wellness. CONCLUSION: Physician involvement in rewarding non-clinical activities may improve their overall well-being. Providing dedicated time for these activities may ameliorate the difficulty that many medical educators described in balancing their clinical and educational roles. Future studies should continue to explore how we can better support medical educators and the impact of this support on burnout.

We examine how the Affordable Care Act Medicaid expansion affected the insurance coverage and the sources of coverage among low-income nursing home aides using the 2010–2019 American Community Survey data. Insurance coverage for low-income nursing home aides increased from about 60% to nearly 90% in expansion states but rose to only about 80% in nonexpansion states. Using a difference-in-differences regression design, we find that Medicaid expansion was associated with a 5.1 percentage-point increase in overall insurance coverage. Expansion states had a 12.2 percentage-point gain in Medicaid that was partially offset by a 6.4 percentage-point reduction in private insurance coverage. Our results show that ACA Medicaid expansion increased insurance coverage for low-income nursing home aides; however, there was substantial crowd-out of private insurance coverage in this population. Policymakers should consider expanding Medicaid while incentivizing affordable private health insurance options for low-income nursing home aides to improve insurance coverage.

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This resource is found in our Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Strengthen Worker Compensation and Benefits).

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BACKGROUND: Nursing students experience higher stress and burnout compared to students in other health professions, with a prevalence rate of as high as 20%. More recently, they have been affected by changes in nursing education due to the COVID-19 pandemic, such as requirements for social isolation and distance learning. Although there are existing studies on interventions that address academic burnout among nursing students, there is no synthesis of randomized trials on this topic. Aim This study aimed to systematically synthesize studies of interventions for academic burnout among nursing students. METHODS: A systematic search for randomized controlled trials was performed in PubMed, CINAHL, CENTRAL, Web of Science, and Scopus. Eligibility criteria were based on study directness in relation to the Patient, Intervention, Comparison, and Outcome (PICO) question. Two review authors independently screened articles for inclusion, collected data from the included studies, and performed risk of bias assessments using the Cochrane Risk of Bias Tool 2.0. A narrative synthesis was performed. This review was registered a priori in PROSPERO (CRD42022350196). RESULTS: Six papers were included in this review. Various interventions were studied: Qigong exercises, progressive muscle relaxation, autogenic therapy and laughter therapy, didactic behavioral sessions focusing on personal and professional development, and coping skills enhancement. The effects of these interventions on academic burnout, depression, and stress among nursing students were short term and their benefits over time remain uncertain. LINKING EVIDENCE TO ACTION: Progressive muscle relaxation and cognitive behavioral interventions demonstrated short-term positive effects on academic burnout, depression, and stress among nursing students. These findings may support the development of individual-level and organizational-level initiatives for nursing students aimed to lessen or prevent academic burnout. Large-scale, high-quality studies on the effect of interventions on academic burden in various settings and cultures are needed.

OBJECTIVES: Professional burnout has been a significant problem for the US healthcare workforce for years, and particularly during the COVID-19 pandemic. It is known that mindfulness-based interventions (MBIs) can reduce stress and symptoms of burnout in healthcare workers. We aimed to assess the effectiveness of group mindfulness-based interventions on individuals who attended prior to the COVID-19 pandemic, and those who attended intra-pandemic. METHODS: Validated survey instruments were administered to participants before and after the courses to assess stress, mindfulness and burnout. Mean scores were compared between groups at baseline. Pre- and post-course responses were gathered and compared within both the pre-pandemic and intra-pandemic cohorts, and within-group effect sizes were calculated. Finally, the change in effect size was calculated between the pre-pandemic and intra-pandemic conditions. RESULTS: Mindfulness groups were associated with significant score changes on specific mindfulness skills (Observe, Act with Awareness, Non-Judge) within both the pre-pandemic and intra-pandemic time periods. The effectiveness of mindfulness skill acquisition varied between these conditions. Mindfulness courses were more effective at reducing stress and burnout during COVID-19, compared with the pre-pandemic time. CONCLUSIONS: Our results demonstrate the adaptability and effectiveness of mindfulness-based interventions in reducing symptoms of stress and burnout among healthcare workers during adverse circumstances.

AIMS AND OBJECTIVES: The aim of this study was to investigate the effectiveness of mindfulness-based interventions on psychological well-being, burnout and post-traumatic stress disorder symptoms among working registered nurses. BACKGROUND: Nurses account for nearly half of the global healthcare workforce and are considered significant contributors in multi-disciplinary healthcare teams. Yet, nurses face high levels of psychological distress, leading to burnout and post-traumatic stress disorder. Mindfulness-based training is a strategy that has been introduced to foster a state of awareness of present physical, emotional and cognitive experiences to regulate behaviour. DESIGN: This systematic review of randomised controlled trials was designed according to PRISMA guidelines. Eligible studies were screened and extracted. Methodological quality was evaluated by two researchers, independently. RevMan 5.4 was used to conduct the meta-analysis. Results: Fourteen studies including a total of 1077 nurses were included, of which only eleven were included in the meta-analysis as the remaining had missing or incomplete data. Meta-analysis revealed that MBI was more effective than passive comparators in reducing psychological distress, stress, depression and burnout—personal accomplishment. When compared to active comparators, MBI was also found to be more effective in reducing psychological distress and was as effective in reducing stress, anxiety, depression and burnout. Evidence on the effects of MBIs on PTSD was scarce. CONCLUSION: Mindfulness-based interventions can effectively reduce psychological distress, stress, depression and some dimensions of burnout. However, evidence remains scarce in the literature. There is a need for more methodologically sound research on mindfulness-based training among nurses. Relevance for clinical practice An important aspect that relates to the success of mindfulness-based interventions is the continued and dedicated individual practice of the skills taught during mindfulness training amidst demanding clinical work environments. Therefore, relevant support for nurses must be accounted for in the planning, design and implementation of future mindfulness-based interventions.

Behavioral technicians (BT) within the field of applied behavior analysis may be at greater risk for experiencing burnout and stress due to the nature of their clients, job demands, and work environments. Burnout and stress may negatively impact BT’s work performances, more specifically, their treatment integrity. Acceptance and Commitment Training (ACT) may be a useful tool to address the private events as well as the covert and overt behaviors associated with burnout and stress. The purpose of this study was to investigate the effects of an ACT intervention on improving treatment integrity and reducing work-related burnout and stress amongst BTs. Four BTs participated in an ACT workshop, and their treatment integrity as well as their burnout and stress levels were measured prior to and following the ACT workshop. Treatment integrity increased for all participants, suggesting that ACT-based interventions may be an effective approach to improving work performance (i.e., treatment integrity) amongst BTs who may experience workplace burnout and stress.

PURPOSE: The aim of this study was to examine the effects of death anxiety and perceived end-of-life care competencies on the fear of terminal care among clinical nurses. METHODS: This correlational study was conducted from June to July 2021. The study included 149 clinical nurses employed at a tertiary hospital and seven other hospitals. The measurement tools used in this study were the Thanatophobia Scale (Cronbach’s α=0.87), the Death Anxiety Scale (Cronbach’s α=0.80), and the Scale of End-of-life Care Competencies (Cronbach’s α=0.94). These instruments were chosen to assess the levels of fear of terminal care, death-related anxiety, and competencies in end-of-life care. RESULTS: The mean score for fear of terminal care was 3.32±1.32. Differences in fear of terminal care were observed based on the working unit, position, number of patients requiring terminal care, and experience with end-of-life care education. Fear of terminal care was significantly positively correlated with death anxiety and significantly negatively correlated with end-of-life care competencies. In multiple regression analysis, the factors influencing fear of terminal care were attitudes toward end-of-life care competencies (β=-0.39, P<0.001), death anxiety (β=0.24, P<0.001), knowledge of end-of-life care competencies (β=-0.22, P=0.005), and behaviors related to end-of-life care competencies (β=-0.16, P=0.021). These factors explained 64.6% of the total variance (F=25.54, P<0.001). CONCLUSION: This study suggests that developing nurses’ end-of-life care competencies and reducing death anxiety are crucial for managing the fear of terminal care. Therefore, providing end-of-life care education and psychological support programs is important.

BACKGROUND: There is extensive literature on physician burnout showing that it correlates with individual mental and physical illness, leads to adverse patient outcomes, and is financially costly to health systems. Further, understanding physician burnout is a step towards improving physician wellness. Investments in physician wellness nationwide have occurred in a broad assortment of ways; however the literature does not present wellness funds to residents as a previously studied approach. OBJECTIVE: Our goal was to study the impact of wellness credits on resident burnout and assess residents’ overall perspective of the intervention on their daily wellness. We hypothesize a decrease in burnout and an overall positive assessment of the program by involved residents. METHODS: In the Fall of 2021, the University of Chicago EM Residency program began to give financial stipends during the most difficult rotations as a novel approach to mitigating resident burnout. This was a quasi-experimental, prospective study investigating the impact of stipends on EM resident burnout. Following the intervention, a post-intervention survey was sent to residents to assess perspectives on the initiative. RESULTS: 36/49 residents (73%) responded to the survey. Over half of residents “often” or “always” (42%, 8%, respectively) had difficulty completing daily chores, and 72% of residents used more than half or all of the gift cards for such chores. In turn, 74% of residents “agree” or “strongly agree” that the initiative benefits their overall wellness.” Finally, 100% of respondents would like to see the initiative continue. CONCLUSIONS: All respondents felt that the gift card initiative should continue; the majority of residents used this help with daily chores that they had difficulty fulfilling. Further, residents reported an increase in wellness after this initiative. We plan on investigating this intervention in relation to individuals’ Maslach Burnout Inventory.

INTRODUCTION: Use of the electronic health record (EHR) has become increasingly widespread. Higher EHR burden is associated with burnout, but this has not been specifically investigated among gastroenterology (GI) providers. METHODS: We retrospectively collected measures of EHR use for outpatient GI providers during a 6-month period. We compared metrics across provider sex, sub-specialty, and training (physicians vs non-physician providers [NPPs]). RESULTS: Data collected represented over 16,000 appointments from 41 providers across the Division of Gastroenterology and Hepatology. Inflammatory bowel disease (IBD) and hepatology specialists spent more time per appointment in the EHR, clinical review, and outside regular hours compared to other sub-specialists. NPPs spent more EHR time than physicians. CONCLUSION: IBD and hepatology specialists and NPPs may have disproportionally high EHR burden. More work is needed to understand differences in provider workload to combat burnout.

INTRODUCTION: Resident duty hour restrictions have resulted in improved resident safety with mixed results on patient safety. There are limited data about 24-hour shifts in obstetrics and gynecology. This project studies resident wellness and performance after eliminating 24-hour call shifts. METHODS: This is a preliminary analysis of a quality improvement project. Physicians were surveyed before and after implementation of a call schedule that reduced 24-hour shifts to 14-hour shifts. Resident performance was assessed by self-reported and attending-reported ability to perform tasks. RESULTS: At preintervention survey, 13 out of 16 residents and 8 out of 17 attendings favored eliminating 24-hour call shifts. Attendings had more confidence in residents' performance on 24-hour shifts than residents did (P<.02) when stratified by task and residency year. At 3-month follow-up, all residents (19/19) preferred 14-hour shifts. Residents reported improvements in wellness (13/13), sleep (13/13), and burnout (10/13). Residents felt more confident in their ability to perform a vaginal delivery (11/13), cesarean birth (12/13), or communicate effectively (11/13) with 14-hour compared to 24-hour shifts. Thematic analysis showed that residents felt happier and better able to care for patients. Two residents cited improved ability to learn, while only one resident cited lost learning opportunities. CONCLUSION: Data suggest that obstetrics and gynecology residency programs should eliminate 24-hour shifts to improve resident wellness and performance, while decreasing burnout. Final follow-up data (to be collected March 2023) will assess whether attendings see a change in resident performance.

INTRODUCTION: Exposure to patient death places healthcare workers at increased risk for burnout and traumatic stress, yet limited data exist exploring exposure to death among emergency medical services (EMS) clinicians. Our objective was to describe changes in EMS encounters involving on-scene death from 2018 to 2021. METHODS: We retrospectively analyzed deidentified EMS records for 9-1-1 responses from the ESO Data Collaborative from 2018 to 2021. We identified cases where patient dispositions of death on scene, with or without attempted resuscitation, and without EMS transport. A non-parametric test of trend was used to assess for monotonic increase in agency-level encounters involving on-scene death and the proportion of EMS clinicians exposed to one or more on-scene death. RESULTS: We analyzed records from 1109 EMS agencies. These agencies responded to 4,286,976 calls in 2018, 5,097,920 calls in 2019, 4,939,651 calls in 2020, and 5,347,340 calls in 2021. The total number of encounters with death on scene rose from 49,802 in 2018 to 60,542 in 2019 to 76,535 in 2020 and 80,388 in 2021. Agency-level annual counts of encounters involving death on scene rose from a median of 14 (interquartile range [IQR], 4–40) in 2018 to 2023 (IQR, 6–63) in 2021 (P-trend < 0.001). In 2018, 56% of EMS clinicians responded to a call with death on scene, and this number rose to 63% of EMS clinicians in 2021 (P-trend < 0.001). CONCLUSION: From 2018 to 2021, EMS clinicians were increasingly exposed to death. This trend may be driven by COVID-19 and its effects on the healthcare system and reinforces the need for evidence-based death notification training to support EMS clinicians.

BACKGROUND: Emergency medicine (EM) clinician well-being has been negatively impacted throughout the COVID-19 pandemic. Resident physicians are particularly vulnerable yet less is known about their perspectives. METHODS: The objective of this study was to use qualitative methods to understand EM residents’ perspectives on well-being during COVID-19. EM residents at an urban, academic institution in the USA were recruited via email and participated in virtual, semi-structured interviews between November 2020 and February 2021. Interviews were conducted by a trained qualitative researcher, recorded, transcribed and de-identified by a third party vendor. All transcripts were double coded by two trained study team members using thematic analysis to identify the themes and interviews were stopped when no new themes emerged. RESULTS: Seventeen semi-structured interviews were conducted until thematic saturation was reached with residents in their first 4 years of training: 6 postgraduate year (PGY)-1 (35%), 6 PGY-2 (35%), 2 PGY-3 (12%) and 3 PGY-4 (18%). Five themes were identified: (1) isolation from peers in training contrasting with a collective call to action, (2) desire for increased acknowledgement and structured leadership support, (3) concerns about personal needs and safety within the clinical environment, (4) fear of missed educational opportunities and lack of professional development and (5) need for enhanced mental and physical health resources. CONCLUSIONS: This qualitative study elucidated factors inside and outside of the clinical environment which impacted EM resident well-being. The findings suggest that programme and health system leadership can focus on supporting peer-to-peer and faculty connections, structured guidance and mentorship on resident career development and develop programmes which bolster resident on-shift support and acknowledgement. These lessons can be used by training programmes to better support residents, but the generalisability is limited due to the single-centre design and participation.

INTRODUCTION: Few studies have examined emergency nurses who have left their job to better understand the reason behind job turnover. It also remains unclear whether emergency nurses differ from other nurses regarding burnout and job turnover reasons. Our study aimed to test differences in reasons for turnover or not currently working between emergency nurses and other nurses; and ascertain factors associated with burnout as a reason for turnover among emergency nurses. METHODS: We conducted a secondary analysis of 2018 National Sample Survey for Registered Nurses data (weighted N = 3,004,589) from Health Resources and Services Administration. Data were analyzed using descriptive statistics, chi-square and t-test, and unadjusted and adjusted logistic regression applying design sampling weights. RESULTS: There were no significant differences in burnout comparing emergency nurses with other nurses. Seven job turnover reasons were endorsed by emergency nurses and were significantly higher than other nurses: insufficient staffing (11.1%, 95% confidence interval [CI] 8.6-14.2, P = .01), physical demands (5.1%, 95% CI 3.4-7.6, P = .44), patient population (4.3%, 95% CI 2.9-6.3, P < .001), better pay elsewhere (11.5%, 95% CI 9-14.7, P < .001), career advancement/promotion (9.6%, 95% CI 7.0-13.2, P = .01), length of commute (5.1%, 95% CI 3.4-7.5, P = .01), and relocation (5%, 95% CI 3.6-7.0, P = .01). Increasing age and increased years since nursing licensure was associated with decreased odds of burnout. DISCUSSION: Several modifiable factors appear associated with job turnover. Interventions and future research should account for unit-specific factors that may precipitate nursing job turnover.

[This is an excerpt.] The Emergency Service Provider Wellness Commission (Commission) within the Agency of Human Services was established in 2021 by 18 V.S.A. § 7257b. The purpose of the Commission is to “consider the diversity of emergency service providers on the basis of gender, race, age, ethnicity, sexual orientation, gender identity, disability status, and the unique needs that emergency service providers who have experienced trauma may have as a result of their identity status.” [To read more, click View Resource.]

The effects of the COVID-19 pandemic have exponentially increased stress, anxiety and burnout levels for all healthcare professionals and students. The psychological effects of working with COVID-19 patients and the physical stress of working under distressing conditions exacerbate an already stressed workforce. Working long hours, shift work, short staffing, demanding workloads, dealing with death and dying and conflicts with management, other staff and disciplines and poor communication between disciplines are among the issues that can lead to burnout, anxiety and depression. Emotional Freedom Technique (EFT) or tapping is a holistic practice that is easy to learn and apply to self and produces relief from stress, anxiety and the symptoms of burnout within in minutes. There are many websites, videos, and tutorials which can teach and support the healthcare practitioner in the practice of EFT.

The COVID-19 pandemic led to an unprecedented need for mental health support for hospital employees. To address these rising needs, members of the Psychiatry Department of Weill Cornell Medicine/NewYork-Presbyterian Hospital created a brief, behavioral skills-based mental health crisis intervention program termed “CopeNYP.” Due to the success of CopeNYP’s treatment model in reducing anxiety and depression, NewYork-Presbyterian adopted and expanded this model as its Employee Assistance Program (EAP). This EAP provides access to short-term counseling for over 38,000 employees and their household members. We describe the transition from a brief intervention to an expanded internal EAP. We report on user characteristics including client demographics and work-related variables. Our program yielded a utilization rate of 4.25% from July 2021 to March 2022. Nurses, administrative staff, and professional and allied health staff were the top three employee groups to utilize the services. The most prevalent presenting problem was Anxiety/Stress. Creating an internal EAP to support healthcare worker needs, including high quality mental health interventions, is feasible. We found that our EAP utilization rates were on par with other internal EAPs. In the era of healthcare burnout, internal EAPs can be beneficial for frontline staff who seeks intervention for mental health and relational issues.

Over the past decade, hundreds of studies have been published on employee voice and silence. In this review, I summarize that body of work, with an emphasis on the progress that has been made in our understanding of when and why employees choose to speak up or remain silent, as well as the individual and organizational implications of these choices. I identify underexplored issues, limitations in how voice has been conceptualized and studied, and promising avenues for future research. Although there has been notable progress in our knowledge of voice and silence, numerous key questions remain, and there are opportunities for the literature on voice to adopt a broader view of that construct. One of the objectives of this review is to motivate and guide research that will address those questions and explore that broader view.