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AIMS AND OBJECTIVES: (1) To investigate the vulnerability of nurses to experiencing professional burnout and low fulfilment across 5 months of the COVID‐19 pandemic. (2) To identify modifiable variables in hospital leadership and individual vulnerabilities that may mitigate these effects. BACKGROUND: Nurses were at increased risk for burnout and low fulfilment prior to the COVID‐19 pandemic. Hospital leadership factors such as organisational structure and open communication and consideration of employee opinions are known to have positive impacts on work attitudes. Personal risk factors for burnout include symptoms of depression and anxiety. METHODS: Healthcare workers (n = 406 at baseline, n = 234 longitudinal), including doctors (n = 102), nurses (n = 94), technicians (n = 90) and non‐clinical administrative staff (n = 120), completed 5 online questionnaires, once per month, for 5 months. Participants completed self‐report questionnaires on professional fulfilment and burnout, perceptions of healthcare leadership, and symptoms of anxiety and depression. Participants were recruited from various healthcare settings in the southeastern United States. The STROBE checklist was used to report the present study. RESULTS: Both at baseline and across the 5 months, nurses working during the COVID‐19 pandemic reported increased burnout and decreased fulfilment relative to doctors. For all participants, burnout remained largely steady and fulfilment decreased slightly. The strongest predictors of both burnout and fulfilment were organisational structure and depressive symptoms. Leadership consideration and anxiety symptoms had smaller, yet significant, relationships to burnout and fulfilment in longitudinal analyses. CONCLUSIONS: Burnout and reduced fulfilment remain a problem for healthcare workers, especially nurses. Leadership styles and employee symptoms of depression and anxiety are appropriate targets for intervention. Relevance to clinical practice Leadership wishing to reduce burnout and increase fulfilment among employees should increase levels of organisational support and consideration and expand supports to employees seeking treatment for depression and anxiety.

OBJECTIVE: During the COVID-19 pandemic, burnout of healthcare workers, including anesthetists, has become a critical issue. This study aimed to provide a practical framework for decreasing and preventing burnout among anesthesiology residents through preserving their good mental health. MATERIALS AND METHODS: Since the onset of the COVID-19 outbreak, anesthesiology residents have been members of medical teams with the attending staff, senior residents, and partner residents. Besides, the following measures were taken to reduce burnout: providing financial support for the attending staff to procure personal protective equipment (PPE), rearrangement of work schedules to reduce the workload, holding training sessions in virtual meetings, and improving the social network system for reducing burnout. RESULTS: The interventional program could help anesthesiology residents to adapt to or cope with the healthcare system status and also prevent burnout. Moreover, development of empathy, integrity, and cohesion in the healthcare system motivated the staff to comply with the principles of medical professionalism. CONCLUSION: During the current health crisis due to COVID-19, it is essential to implement specific interventional and training programs for decreasing or preventing burnout among healthcare workers.

BACKGROUND: Mental illness among physicians is an increasingly recognized concern. Global data on mental health conditions (MHCs) among cardiologists are limited. OBJECTIVES: The purpose of this study was to investigate the global prevalence of MHCs among cardiologists and its relationships to professional life. METHODS: The American College of Cardiology conducted an online survey with 5,931 cardiologists globally in 2019. Data on demographics, practice, MHC, and association with professional activities were analyzed. The P values were calculated using the chi-square, Fischer exact, and Mann-Whitney U tests. Univariate and multivariate logistic regression analysis determined the association of characteristics with MHC. RESULTS: Globally, 1 in 4 cardiologists experience any self-reported MHC, including psychological distress, or major or other psychiatric disorder. There is significant geographic variation in MHCs, with highest and lowest prevalences in South America (39.3%) and Asia (20.1%) (P < 0.001). Predictors of MHCs included experiencing emotional harassment (OR: 2.81; 95% CI: 2.46-3.20), discrimination (OR: 1.85; 95% CI: 1.61-2.12), being divorced (OR: 1.85; 95% CI: 1.27-2.36), and age <55 years (OR: 1.43; 95% CI: 1.24-1.66). Women were more likely to consider suicide within the past 12 months (3.8% vs 2.3%), but were also more likely to seek help (42.3% vs 31.1%) as compared with men (all P < 0.001). Nearly one-half of cardiologists reporting MHCs (44%) felt dissatisfied on at least one professional metric including feeling valued, treated fairly, and adequate compensation. CONCLUSIONS: More than 1 in 4 cardiologists experience self-reported MHCs globally, and the association with adverse experiences in professional life is substantial. Dedicated efforts toward prevention and treatment are needed to maximize the contributions of affected cardiologists.

The aim of this systematic review and meta-analysis study was to estimate the pooled prevalence of burnout among health care workers (HCWs), who worked in health centers during the coronavirus disease (COVID-19) outbreak, based on the Maslach Burnout Inventory (MBI) Questionnaire. A comprehensive search based on specific terms was performed through the online studies of Pubmed, Scopus, Web of Science, and ProQuest, until January 2022. The methodological quality of included studies was assessed using the National Institutes of Health (NIH) tool. Data analysis was carried out through the randomeffects model, and the heterogeneity was investigated by I2 statistic using the software STATA Version 16. In total, seven articles with 5,022 participants were included in the final analysis. Four studies with 4,419 participants reported the prevalence of burnout as percent in moderate and severe types for all three components of burnout syndrome. Our results showed that the 45% of pooled moderate and 37% of severe levels of emotional exhaustion, 49% of pooled moderate and 18% of severe levels of depersonalization, 38% of pooled moderate and 51% of pooled severe levels of reduced personal accomplishment. Whereas six studies with 4,838 sample size reported the mean prevalence of MBI-based burnout syndrome and the mean pooled prevalence of emotional exhaustion, depersonalization, and accomplishment was 21.57, 7.47, and 33.48, respectively. Based on our findings, HCWs who worked in health centers during COVID-19 outbreak, experienced significant burnout. Therefore, it is necessary to design and implement programs to deal with burnout among this populations.

RATIONAL AND OBJECTIVES: To evaluate prevalence and demographic factors associated with both burnout and fulfillment of private practice radiologist leaders within the United States. MATERIALS AND METHODS: The study cohort was the largest coalition of wholly radiologist owned, independently practicing radiology groups within the United States. Two designated leaders within each of the 30 radiology private practices within the organization Strategic Radiology were electronically mailed a weblink to a confidential IRB-approved survey in July 2021. Surveys included questions from the Stanford Professional Fulfillment Index, individual and practice demographics, and self-care. RESULTS: The overall response rate was 67% (40/60). Fulfillment and burnout scores were calculated from the individual questions, and radiologists were classified as being fulfilled or not and burned out or not based upon score cutoffs previously validated from the Stanford Professional Fulfillment Index (PFI). The overall professional fulfillment rate of staff was 43% and the overall burnout rate was 33%. (Cronbach's ??=?0.90 for fulfillment and 0.91 for burnout). The inverse correlation between professional fulfillment and burnout was highly significant (r?=??0.42, p?=?0.007). No statistically significant association was seen between either burnout or fulfillment and age, gender, ethnicity, practice geography or practice size. CONCLUSION: Utilizing the validated Stanford PFI for assessment, the prevalence of burnout in private practice radiologist leaders was 33%. The prevalence of professional fulfillment was 43%, with a mild inverse association between professional fulfillment and burnout. SUMMARY: In private practice leaders, the prevalence of burnout was 33% and the prevalence of professional fulfillment was 43%.

INTRODUCTION/OBJECTIVES: Many health systems screen patients for social determinants of health and refer patients with social needs to community service organizations for assistance. However, little is known about social determinants of health among health system employees. We sought to examine the prevalence of social determinants among employees of The MetroHealth System, a large safety-net health system in Cleveland, Ohio. METHODS: We invited participants in an employee wellness program to answer the same screening questions that patients answer about 9 social determinants of health, including food insecurity, financial strain, transportation difficulty, inability to pay for housing or utilities, intimate partner violence, social isolation, infrequent physical activity, daily stress, and lack of internet access. We then determined the percentage of employees who met pre-defined criteria for being at risk for each social determinant. We also examined how these percentages varied across employee job categories. RESULTS: Of 4191 full-time employees, 1932 (46%) completed the survey. The percentage of employees at risk for each social determinant were: food insecurity (11%), financial strain (12%), transportation difficulty (4%), inability to pay for housing or utilities (10%), intimate partner violence (4%), social isolation (48%), infrequent physical activity (10%), daily stress (58%), and lack of internet access (3%). Being at risk for specific social determinants was more common among support staff compared to staff physicians and nurses. For example, the survey participants included 436 administrative support staff, a job category that includes secretaries and patient service representatives. Among this group, 20% reported food insecurity, 20% financial strain, and 17% inability to pay for housing or utilities. CONCLUSIONS: Social determinants of health are common among health system employees, especially among workers in lower paid job categories. Health systems should routinely screen employees for social determinants and adjust salaries, benefits, and assistance programs to address their social needs.

This resource is found in our Actionable Strategies for Health Organizations: Measurement & Accountability.

AIM: The aim of this study was to design and use a parsimonious survey tool to use in real time to assess moral injury and describe how moral injury relates to burnout and intent to leave the job. The Moral Injury Quotient (MIQ) is derived from this 6-item tool. FINDINGS: The MIQ metric has good performance characteristics and captures a substantiative portion of moral injury. It is related to clinically meaningful changes; each 10-point increase in the MIQ was associated with 125% increased odds of burnout (p < 0.001) and 50% increased odds of intending to leave the job (p < 0.001). CONCLUSIONS: Measuring and addressing moral injury has major workforce implications. This metric is an “off the shelf” tool that may be helpful in busy clinical settings to assess, implement improvements, and reassess for reductions in moral injury.

The introduction of the COVID-19 pandemic has placed additional strain on healthcare workers, inducing immense levels of stress and workplace burnout. Health care professionals are acutely susceptible to COVID-19 exposure, ultimately leading to elevated levels of anxiety and mental illness. For example, dental professionals are at high risk due to their close work with the oral cavity. To provide temporary relief to the stress, some may turn toward substance use, especially if that individual has some form of mental illness. To curb the onset of burnout and its byproduct of substance use disorder, it is crucial to be equipped with proper tools and healthy habits that can counteract extreme levels of stress. In this article, a time-effective, 3-step method is introduced, with each activity proven to lessen the symptoms of burnout. When followed, an individual can navigate burnout’s symptoms through a healthy mind and body approach. Additionally, resources to find resiliencebuilding and mentorship programs are provided. Common substance use support groups and information regarding group meetings and contact information are listed.

INTRODUCTION: Burnout has been recognized as an occupational hazard among health care professionals. The objective of this study was to assess the extent and pattern of burnout in advanced practice providers (APPs) in urology by analyzing American Urological Association Census data. METHODS: The American Urological Association conducts an annual census survey to all providers in the urological care community, including APPs. In the 2019 Census, the Maslach Burnout Inventory questionnaire was included to measure burnout among APPs. Demographic and practice variables were assessed to establish correlating factors to burnout. RESULTS: A total of 199 APPs (83 physician assistants and 116 nurse practitioners) completed the 2019 Census. Slightly more than 1 in 4 APPs experienced professional burnout (25.3% in physician assistants and 26.7% in nurse practitioners). Observed higher burnout rates were seen in APPs who were aged 45 to 54 (34.3%), women (29.6% vs 10.8% in men, p value <0.05), non-White (33.3% vs 24.9% in White), those who had 4-9 years of practice (32.4%) and those who practiced in academic medical centers (31.7%). Except for gender, none of the above observed differences were statistically significant. Using a multivariate logistic regression model, gender remained the only significant factor associated with burnout (women vs men with an odds ratio of 3.2 [95% confidence interval: 1.1-9.6]). CONCLUSIONS: Overall, APPs in urological care reported lower levels of burnout than urologists; however, there was a higher chance of female APPs experiencing higher professional burnout in comparison to their male counterparts. Future studies are needed to investigate possible reasons for this finding.

OBJECTIVE: To determine if individualized professional coaching reduces burnout, improves quality of life, and increases resilience among surgeons. SUMMARY BACKGROUND DATA: Burnout is common among surgeons and associated with suboptimal patient care and personal consequences. METHODS: A randomized controlled trial of 80 surgeons evaluating the impact of 6 monthly professional coaching sessions on burnout (Maslach Burnout Inventory), quality of life (single-item linear analog scale), and resilience (Connor-Davidson Resilience Scale) immediately post-intervention and 6 months later. Participants randomized to the control group subsequently received 6 professional coaching sessions during months 6 to 12 (delayed intervention). RESULTS: At the conclusion of professional coaching in the immediate intervention group, the rate of overall burnout decreased by 2.5% in the intervention arm compared to an increase of 2.5% in the control arm (delta -5.0%, 95% CI -8.6%, -1.4%, P=0.007). Resilience scores improved by 1.9 points in the intervention arm compared to a decrease of 0.2 points in the control arm (delta 2.2 points, 95% CI 0.07, 4.30, P=0.04). Six months after completion of the coaching period, burnout had returned to near baseline levels while resilience continued to improve among the immediate intervention group. The delayed intervention group experienced improvements in burnout during their coaching experience relative to the immediate intervention group during their postintervention period (18.2% decrease vs. 2.9% increase, delta -21.1%, 95% CI -24.9%, -17.3%, P<0.001). CONCLUSIONS: Professional coaching over 6 months improved burnout and resilience among surgeons, with reductions in improvement over the ensuing 6 months.

PURPOSE: Even though physician burnout can negatively impact physical/mental health, ophthalmologists’ quality of life (QOL) is understudied. Although managing high-risk diseases like pediatric glaucoma may lead to compassion satisfaction (CS), the responsibility of caring for very sick, demanding patients has been linked to higher burnout. Burnout and secondary traumatic stress (STS) constitute compassion fatigue, the negative effects resulting from helping those who experience stress. We assessed professional QOL, including CS, burnout, and STS, along with associated factors among pediatric glaucoma providers managing potentially blinding disease in children. DESIGN: Cross-sectional survey study. PARTICIPANTS: Pediatric glaucoma providers in the Childhood Glaucoma Research Network, American Glaucoma Society, and Indian Paediatric Glaucoma Society. METHODS: Participants were sent an electronic survey of a validated instrument (Professional Quality of Life-Version 5) designed to measure burnout, STS, and CS, as well as questions related to demographics, lifestyle, training, and practice. Burnout, STS, and CS scores range from 10 to 50 and are classified into low (? 22), moderate (23–41), and high (? 42) subgroups. MAIN OUTCOME MEASURES: Burnout, STS, and CS. RESULTS: Seventy-six pediatric glaucoma providers completed the survey with resulting burnout (22.6 ± 6.3), STS (22.7 ± 6.1), and CS (42.3 ± 6.7) scores. Most respondents had low burnout (43, 56.6%), low STS (44, 57.9%) and high CS (48, 63.2%), though more than a third reported moderate burnout (33, 43.4%), STS (31, 40.8%), and CS (27, 35.6%). Older age and more years in practice correlated positively with CS, and age correlated negatively with STS (P < 0.05 for all). Frequent workday fatigue correlated positively with burnout and STS and negatively with CS, and frequent caffeine consumption correlated positively with burnout and negatively with CS (P < 0.05 for all). Members of a married or unmarried couple had significantly lower CS scores than single, divorced, or separated respondents (P = 0.022). CONCLUSIONS: Pediatric glaucoma providers derive a high level of professional satisfaction from their work, though many report moderate burnout and STS. To comprehensively address provider QOL, CS, and both components of compassion fatigue must be considered. Initial efforts may be focused on younger, early-career providers as this group had lower professional QOL scores than their older, late-career counterparts.

BACKGROUND: The nursing shortage and the aging of the nursing workforce is a growing concern for health care institutions. Understanding nurses attitudes toward turnover intentions is a crucial step to develop effective policies and maintain nurse staffing continuity. OBJECTIVE: This research aims to study the impact of the Professional Quality of Life and Fear of COVID-19 moderated by perceived Job Market Outlook on South Florida registered nurses by predicting turnover intentions. METHODS: From March to August, 2021, 202 registered nurses from seven South Florida counties completed the self-reporting Professional Quality of Life, Fear of COVID-19, and perceptions of Job Market Outlook surveys when predicting turnover intentions in a quantitative nonexperimental predictive correlational design research study. RESULTS: Results showed that in the professional quality of life, burnout significantly predicted ( p <.001) registered nurses (n=202) turnover intentions during the COVID-19 pandemic. Secondary traumatic stress, compassion satisfaction and fear of COVID-19 did not significantly predict registered nurses’ turnover intentions. Hierarchical regression analysis confirmed burnout is significantly more predictive than no model of turnover intentions accounting for more variance at 15.45% ( p < .001). Perceived job market outlook did not moderate between the independent variables and the dependent variable turnover intentions. CONCLUSION: This research reveals the deleterious impact of burnout in the registered nurses’ professional quality of life and turnover intentions warranting the need for health care institutions and nursing leadership to collaborate on the needs of the nursing workforce on a micro and macro level.

[This is an excerpt.] Although, they represent the lion's share of the American workforce, few articles specifically address the mental health and wellbeing needs and related resources for small employers. In this paper we define small businesses and their share of the U.S. workforce. Next, we review the research on the increasing burden of behavioral health disorders during the COVID-19 pandemic. Finally, we discuss the role of employee assistance programs (EAP) in small businesses to effectively respond to the kinds of worker health and workplace problems exacerbated by the pandemic. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Mental Health).

Prolonged lengths of stay (PLOS) impact patient outcomes, healthcare spending, and bed availability. Many patients stay beyond medical necessity due to complex barriers to discharge, including conservatorship applications and insurance coverage, shifting the provision of care from acute to chronic on medicine wards. We aim to understand the impact of this shift on healthcare staff workflow, interactions, and wellbeing through 23 key informant interviews analyzed using grounded theory. Our findings highlight PLOS as a contributor to burnout, with implications for patient care and staff job satisfaction that necessitate additional support for caring for this vulnerable patient population.

BACKGROUND: Stress is a major risk factor for depression, and both are associated with important changes in decision-making patterns. However, decades of research have only weakly connected physiological measurements of stress to the subjective experience of depression. Here, we examined the relationship between prolonged physiological stress, mood, and explore-exploit decision making in a population navigating a dynamic environment under stress: health care workers during the COVID-19 pandemic. METHODS: We measured hair cortisol levels in health care workers who completed symptom surveys and performed an explore-exploit restless-bandit decision-making task; 32 participants were included in the final analysis. Hidden Markov and reinforcement learning models assessed task behavior. RESULTS: Participants with higher hair cortisol exhibited less exploration (r = −0.36, p = .046). Higher cortisol levels predicted less learning during exploration (β = −0.42, false discovery rate [FDR]–corrected p [pFDR] = .022). Importantly, mood did not independently correlate with cortisol concentration, but rather explained additional variance (β = 0.46, pFDR = .022) and strengthened the relationship between higher cortisol and lower levels of exploratory learning (β = −0.47, pFDR = .022) in a joint model. These results were corroborated by a reinforcement learning model, which revealed less learning with higher hair cortisol and low mood (β = −0.67, pFDR = .002). CONCLUSIONS: These results imply that prolonged physiological stress may limit learning from new information and lead to cognitive rigidity, potentially contributing to burnout. Decision-making measures link subjective mood states to measured physiological stress, suggesting that they should be incorporated into future biomarker studies of mood and stress conditions.

Our healthcare delivery system has accumulated complexity of payment, regulation systems, expectations and requirements. Often these are not designed to align with clinical thinking process flow of patient care. As a result, clinicians are utilizing enormous mental (cognitive) resource to comply with these complexities, over and above the baseline mental effort required to give good care to the patient. Recent studies suggest a significant number of physicians, advanced practice providers and nurses no longer want to stay in healthcare due to difficult work expectations and conditions that have become unreasonable. Technology has benefitted healthcare delivery, but also is a conduit of many expectations that have been grafted upon clinician workloads, exceeding the resources provided to accomplish them. Cognitive load is a measure of mental effort and is divided into Intrinsic, Germane and Extraneous Cognitive Load. Extraneous Cognitive Load (ECL) is what is not necessary and can be removed by better design. High cognitive load is associated with increased risk of both medical error and clinician burnout. Chronic high level occupational stress occurs from dealing with this job/resource imbalance and is showing serious personal health impact upon clinicians and the quality of the work they can provide for patients. Since organizational systems have become more complex, leadership methods, clinician wellbeing and patient safety efforts need to adjust to adapt and succeed. Safety efforts have tended to predominantly follow methods of a few decades ago with predominant focus upon how things go wrong (Safety I) but are now being encouraged to include more of the study of how things go right (Safety II). Human Factors/Ergonomics (HFE) science has been used in many industries to preserve worker wellbeing and improve system performance. Patient safety is a product of good system performance. HFE science helps inform mechanisms behind Safety I and II approach. HFE concepts augment existing burnout and safety interventions by providing a conceptual roadmap to follow that can inform how to improve the multiple human/technology, human/system, and human/work environment interfaces that comprise healthcare delivery. Healthcare leaders, by their influence over culture, resource allocation, and implementation of requirements and workflows are uniquely poised to be effective mitigators of the conditions leading to clinician burnout and latent medical error. Basic knowledge of HFE science is a strategic advantage to leaders and individuals tasked with achieving quality of care, controlling costs, and improving the experiences of receiving and providing care.

Surgery residencies are not adequately structured to support women surgeons who want to have children, which has negative implications for children and patients.

INTRODUCTION: We developed a comprehensive wellness initiative to address burnout with specific interventions targeted at faculty, residents, nurses, administrators, coordinators, and other departmental personnel. METHODS: A department-wide wellness initiative was implemented in October 2020. General interventions included monthly holiday-themed lunches, weekly pizza lunches, employee recognition events, and initiation of a virtual networking board. Urology residents received financial education workshops, weekly lunches, peer support sessions, and exercise equipment. Faculty were offered personal wellness days to use at their discretion at no penalty to their calculated productivity. Administrative and clinical staff were given weekly lunches and professional development sessions. Pre- and post-intervention surveys included a validated single-item burnout instrument and the Stanford Professional Fulfillment Index. Outcomes were compared using Wilcoxon rank-sum tests and multivariable ordinal logistic regression. RESULTS: Among 96 department members, 66 (70%) and 53 (55%) participants completed the pre- and post-intervention surveys, respectively. Burnout scores were significantly improved after the wellness initiative (mean 2.06 vs 2.42, mean difference −0.36, P = .012). An improvement was also observed in the sense of community (mean 4.04 vs 3.36, mean difference 0.68, P < .001). Adjusting for role group and gender, completion of the curriculum was associated with decreased burnout (OR 0.44, P = .025), increased professional fulfillment (OR 2.05, P = .038), and increased sense of community (OR 3.97, P < .001). The highest-rated components were monthly gatherings (64%), sponsored lunches (58%), and employee of the month (53%). CONCLUSIONS: A department-wide wellness initiative with group-specific interventions can help reduce burnout and may improve professional fulfillment and workplace community.

Healthcare organizations across the United States have begun the journey to high reliability as one method for improving patient safety. Being a High Reliability Organization (HRO) requires constant vigilance for ensuring the delivery of system-wide excellence in patient quality and safety. Establishing a foundation for high reliability requires the engagement of personnel across the organization from frontline staff to executive leadership. Staff must feel comfortable voicing concerns in order to be fully engaged. However, we believe this is easier said than done. The purpose of this article is to describe the importance of psychological safety along the journey to becoming an HRO. Additionally, strategies for promoting a psychologically safe work environment are provided.

Military Medicine providers (sometimes referred to as caregivers) not only endure the stress of supporting the medical readiness of operational commands, they take on the continuous demands involved in providing direct care to military beneficiaries. Research shows that occupational stress and burnout impacts the health and wellbeing of providers, increases job turnover, and reduces the quality of patient care. Thus, interventions have aimed to reduce burnout and enhance the wellbeing of military providers. Although these efforts have shown promise, there is much room for improvement. Navy Medicine has implemented the Caregiver Occupational Stress Control (CgOSC) program at its commands, with the objectives to enhance provider wellbeing and resilience, improve retention, and ensure the quality of patient care. This article introduces the Navy Medicine CgOSC program, describes the implementation of the CgOSC program at Navy Medicine commands, and delineates how the program is tracked for program adherence. This tracking method can serve as a model for other healthcare organizations that are establishing programs that aim to promote the wellbeing of their providers.