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The COVID-19 pandemic was a fertile ground for nurses’ exposure to self- and otherPotentially Morally Injurious Events (PMIEs). Our study explored the effects of nurses’ memories of self- and other-PMIEs on occupational wellbeing and turnover intentions. Using an experimental design on a convenience sample of 634 Romanian nurses, we tested a conceptual model with PLSSEM, ?nding adequate explanatory and predictive power. Memories of self- and other-PMIEs were uniquely associated with work engagement, burnout, and turnover intentions, compared to a control group. These relationships were mediated by the three basic psychological needs. Relatedness was more thwarted for memories of other-PMIEs, while competence and autonomy were more thwarted for memories of self-PMIEs. Perceived supervisor support weakened the indirect effect between type of PMIE and turnover intentions, through autonomy satisfaction, but not through burnout. Self-disclosure weakened the indirect effect between type of PMIE and turnover intentions, through autonomy satisfaction, and both burnout and work engagement. Our ?ndings emphasize the need for different strategies in addressing the negative long-term effects of nurses’ exposure to self- and other-PMIEs, according to the basic psychological need satisfaction and type of wellbeing indicator.

OBJECTIVES: Hospitalists, comprising PAs, NPs, and physicians, manage patients hospitalized with COVID-19. To guide the development of support programs, this study compared the psychologic wellness of hospitalist PAs, NPs, and physicians during the COVID-19 pandemic. METHODS: We surveyed hospitalists in 16 hospitals at Mayo Clinic, from May 4 to 25, 2020. We used PROMIS surveys for self-reported global well-being (two single-item measures), anxiety, social isolation, and emotional support, before and during the pandemic. Linear and logistic regression models were adjusted for personal and professional factors. RESULTS: The response rate was 52.2% (N = 154/295). In adjusted linear regression models, the change in scores (before minus during pandemic) for anxiety, social isolation, and emotional support was similar for PAs and NPs compared with physicians. In adjusted logistic regression models, physicians, compared with PAs and NPs, had a higher odds of top global well-being for mental health (adjusted odds ratio [95% confidence interval]: 2.82 [1.12, 7.13]; P = .03) and top global well-being for social activities and relationships (adjusted odds ratio 4.08 [1.38, 12.08]; P = .01). CONCLUSIONS: During the COVID-19 pandemic, global well-being was lower for PAs and NPs compared with physician hospitalists. These results can guide support programs for hospitalists.

The impact of the novel coronavirus disease 19 (COVID-19) has overburdened the anesthesia fraternity both physically and mentally. The academic and training schedule of the medical residents in the last year was also disrupted. Since we are in the early phase of the second peak of the COVID-19 pandemic, it is time to reconsider the causes of stress in anesthesia residents and methods to mitigate them. In this non-systematic review, authors have included articles from PubMed, Medline, and Google scholar with keywords “identify strategies” “preventing and treating psychological disorders,” and “medical students” from year 2010 onwards were included. Apart from these keywords, we have included the coping strategies and early psychiatric consultation methods. This review article aims at early identification, workplace environment changes, and implementation of early coping strategies in anesthesia residents during this second peak of COVID-19.

Burnout, depression, and anxiety are prevalent among healthcare workers (HCWs) during the COVID-19 pandemic and have been previously shown to contribute to poor health outcomes and reduced quality of care. Positive psychological constructs such as positive affect and meaning and purpose are related to resilience in the face of significant stress. No studies have examined these associations among a cohort of HCWs during this pandemic. The purpose of this study was to examine the association of depression, anxiety, positive affect, and meaning and purpose with burnout among HCWs during the COVID-19 pandemic. We utilized data from a cross-sectional survey conducted between September 29-December 8, 2021, among a cohort of 2,411 HCWs from a large, tertiary academic health care system in the Chicago area. We employed the Patient-Reported Outcomes Measurement Information System (PROMIS) measures for depression, anxiety, positive affect, and meaning and purpose and burnout was measured by the Oldenburg Burnout Inventory (OLBI). The majority (80.88%) of HCWs in this study identified as White, Non-Hispanic race/ethnicity, female sex (82.37%), and roughly one third were between ages 30–39 years old (30.98%). Registered nurses (26.96%) accounted for the largest single occupation group. The mean burnout score was 36.87 (SD = 7.65), with 53.38% of participants classified as having burnout, and registered nurses demonstrating the highest proportions of burnout (63.54%). Higher depression (coef = 0.15, SE = 0.03, p < 0.001) and anxiety (coef = 0.25, SE = 0.02, p < 0.001) scores were associated with higher burnout in multivariable linear regression models. Increased positive affect (coef= −0.19, SE= 0.02, p < 0.001) and meaning and purpose (coef= −0.12, SE= 0.01, p < 0.001) scores were significantly associated with reduced burnout. Positive affect and meaning and purpose were inversely associated with burnout among a cohort of HCWs during the COVID-19 pandemic. Previous studies of positive affect and meaning and purpose suggest the potential buffering effect that these indices may have on burnout. Future research is needed to examine the effect of positive affect and meaning and purpose on mitigating the negative impacts of burnout, depression, and anxiety among HCWs as they cope with the stress of the COVID-19 pandemic and beyond.

BACKGROUND: The quality indicators program has intended and unintended consequences that may affect nurses' professional performance and organisational outcomes. AIMS: To explore public health nurses' knowledge, attitudes, and perceptions of the nursing-sensitive quality indicators applied in mother-child health clinics and their associations with organisational quality outcomes: quality of care, burnout, and communication. METHODS: A cross-sectional study with a convenience sample. In total, 177 public health nurses completed a self-administered questionnaire measuring their knowledge, attitudes, and perceptions of the quality indicators regarding their performance and organisational outcomes. A structural equation modelling analysis was performed to describe the associations between the variables and to identify the mediating variables. FINDINGS: The structural equation modelling analysis revealed that the intended (positive) impact on the nurse's professional level was the mediating variable between the nurses' knowledge and attitudes towards the National Health Quality Measure program, their seniority, and the unintended (negative) impact on the nurse's professional level, and the organisational outcomes. DISCUSSION AND CONCLUSION: Public health nurses perceive quality indicators as contributing to and improving their professional work, with a positive impact on organisational outcomes. Nursing leaders and policymakers may promote good organisational outcomes by developing methods that will emphasise the importance of quality indicators in nursing practice.

The emotional and mental health of public safety personnel has been a topic that is continuing to receive attention. Being exposed to multiple traumatic events takes a mental and emotional toll on those who place their lives in harm’s way to help others. The study was based on social cognitive theory which focused on self-efficacy through social influences and environment. The purpose of this study was to understand the experience of public safety personnel’s training regarding their perceptions to mitigate emotional stress; the experience of public safety personnel with seeking mental health services; experience of public safety personnel with the stigma of receiving mental health services; the experience of public safety personnel’s use of online social networks for emotional support; and the experience of peer-to-peer online support for mental health and receiving mental health services. The research design was basic qualitative with an open-ended questionnaire through a link placed into public safety Facebook groups. Nvivo software was used to code and identify themes for interpretation. The results showed inadequate initial and ongoing mental health training along with negative experiences when seeking mental health services. Mental health stigma has changed, but some participants still felt there was a stigma with seeking mental health services. Peer-to-Peer online support had positive results toward mental health when participants felt stigma amongst coworkers. Findings may be used for positive social change by providing adequate initial mental health training needs. Online peer-to-peer support may be the first step if a person is not ready to seek professional help and public safety personnel need specialized mental health due to the type of traumas they are exposed to each shift.

On the same day in March 2020 that President Donald Trump declared the COVID-19 pandemic a national emergency, researchers at the Larry A. Green Center in Virginia launched an ongoing survey of COVID-19’s effects on primary care practices. Over the past 2 years, more than 36?000 survey responses from clinicians across the country have painted an alarming picture of a workforce that’s increasingly burned out, traumatized, anxious, and depressed. As Green Center codirector Rebecca S. Etz, PhD, summed up her survey’s findings in a recent interview with JAMA, “It’s been bad for primary care over the pandemic and it’s getting worse.”

Mental health in the workplace is gaining increasing attention from employers, policy makers and politicians. Since the average economically active person spends a large amount of waking time working, it should be no surprise that our work contributes to our mental health. For example, people on low incomes are up to three times more likely to suffer with anxiety and depression. More recently, research has shown that exposure to Covid-19 in work led to a higher risk of anxiety and depression in essential frontline workers.

OBJECTIVE: The purpose of the current study was to examine governmental public health employee experiences during the COVID-19 pandemic. DESIGN AND SETTING: A total of 5169 responses to a PH WINS 2021 open-ended question were qualitatively coded. The question asked employees to share their experiences during the COVID-19 response. The 15 most common themes are discussed. PARTICIPANTS: Responses from governmental public health employees in state health agencies (SHAs), big cities (Big City Health Coalition or BCHC agencies), and local health departments (LHDs) across all 50 states were included. RESULTS: The most frequently identified theme was pride in public health work and/or the mission of public health (20.8%), followed by leadership (17.2%), burnout or feeling overwhelmed (14%), communication (11.7%), and overtime/extra work (9.7%). Among the top 15 themes identified, comments about pride in public health work and/or the mission of public health (95.9%), teamwork (81.5%), and telework (61%) were predominantly positive. Co-occurring themes for responses that expressed pride in public health work and/or the mission of public health were often countered with explanations of why respondents remain frustrated, including feeling burned out or overwhelmed, disappointment with the community's sense of responsibility or trust in science, and feeling unappreciated either by the community or their agency. All of these co-occurring themes were predominantly negative. CONCLUSIONS: Employees are proud to work in public health and value teamwork but often felt overworked and unappreciated during the COVID-19 pandemic. Reviewing existing emergency preparedness protocols in the context of lessons learned during the COVID-19 pandemic and listening to employees' experiences with teleworking and task sharing may better prepare agencies for future challenges. Creating channels for clear communication during a period of changing information and guidelines may help employees feel more prepared and valued during an emergency response.

BACKGROUND: Awareness of burnout and its implications within the medical field has been growing. However, an understanding of the prevalence and consequences of burnout among underrepresented minority (URM), specifically underrepresented minority in medicine (UiM) populations, is not readily available. OBJECTIVE: To examine literature investigating burnout among UiM compared to non-UiM, with particular attention to which measures of burnout are currently being used for which racial/ethnic groups. METHODS: The authors identified peer-reviewed articles, published in English through systematic examination using PubMed, PsycINFO, Countway Discovery Medicine, and Web of Science databases. Studies meeting the inclusion criteria were summarized and study quality was assessed. RESULTS: Sixteen studies assessing racial/ethnic differences in burnout were eligible for inclusion. Nearly all studies were cross-sectional (n = 15) in design and conducted among populations in North America (n = 15). Most studies examined burnout among medical students or physicians and used the Maslach Burnout Inventory. Differences in burnout among UiM and non-UiM are inconclusive, although several studies have nuanced findings. CONCLUSION: Increased focus on burnout measurement, conceptualization, and mitigation among UiM populations may be useful in improving recruitment, retention, and thriving.

Public health officials played a critical role in COVID-19 mitigation and response efforts. In Kansas, 51 local health department (LHD) administrators and/or local health officers left their positions due to the pandemic between 15 March 2020 and 31 August 2021. The purpose of this study was to identify factors that led to turnover of Kansas local public health officials during the COVID-19 pandemic. Those eligible to participate in this study included former LHD administrators and/or health officers who were employed at or contracted by a Kansas LHD on 15 March 2020 and resigned, retired, or were asked to resign prior to 31 August 2021. Researchers used a demographic survey, a focus group, and key informant interviews to collect data. Twelve former LHD leaders participated in this study. Four themes emerged from phenomenological analysis: politicization of public health; a perceived lack of support; stress and burnout; and the public health infrastructure not working. The findings of this study can guide the Kansas public health system to address the issues leading to turnover of leadership and prevent future turnover. Future research must explore strategies for mitigating leadership turnover and identify alternative public health structures that could be more effective.

Even before RaDonda Vaught was found guilty of criminally negligent homicide, nurses were fearful of being held individually accountable for systemic errors. Leaders are now faced with repairing the loss of faith in just culture. This article provides an understanding of the erosion of just culture and interventions needed to improve trust.

Caring for patients with substance use disorder (SUD) can be challenging. Lack of knowledge of SUD treatment may add to nurses' feelings of burnout and intent to leave the workplace. This article describes a novel program for patients with SUD admitted for long-term antibiotic treatment and its impact on the nurses' work environment, particularly burnout.

Police, firefighters, and emergency medical technicians and paramedics are frequently exposed to potentially traumatic events (PTE) in their work as public safety personnel (PSP). PTE are a risk factor for posttraumatic stress disorder, depression, anxiety, substance abuse, and suicidal ideation. This systematic rapid scoping review summarizes evaluation research on psychosocial interventions to reduce the negative consequences of exposure to work-related PTE on the mental health of PSP. Articles were identified using PubMed and PsycInfo. Publications from January 1, 2013, to December 1, 2020, were retained because the research published before 2013 was covered by other reviews. We identified 601 unique documents; 30 met preliminary eligibility criteria; and 18 were retained. Most studies were limited to police officers and firefighters. Participants exposed to prevention measures reported improvements of symptoms of depression, burnout, anxiety, sleep problems, and well-being. Most articles identified factors that may hinder or facilitate the use of program components. Studies on ways to support PSP recently affected by a PTE are lacking. There are little data on the efficacy of prevention programs in reducing the prevalence of mental disorders associated with PTE. More studies should focus on identifying participant characteristics and intervention components that influence program use, adherence, and efficacy. Realistic evaluations combined with participatory research could help address important knowledge gaps.

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This resource is found in our Actionable Strategies for Public Safety Organizations: Actionable Strategies (Providing a Continuum of Support)

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BACKGROUND AND OBJECTIVES: Given their broad scope of training, family medicine residents were uniquely situated to care for the American public throughout the COVID-19 pandemic, yet little has been written about their experiences. The objective of this report is to capture the diversity of experiences and contributions of family medicine residents across the United States to the care of the American public during the COVID-19 pandemic. METHODS: Investigators recruited resident interviewees from four residencies throughout the United States via convenience sample. These residencies represented a diversity of geography, rurality, and structure (hospital based vs community based). Investigators conducted 30 to 60-minute, semistructured interviews with family medicine residents. Interviews were recorded and examined for themes. RESULTS: Three major themes emerged through the interview process. First, family medicine residents were a critical component of the inpatient response to COVID-19 in a variety of geographies from urban centers to rural towns to Native American reservations. Second, family medicine residents continued to provide expanded outpatient care to include telehealth, immunization clinics, and public health campaigns to meet the needs of the community. Finally, not only did these residents have an immense impact in the response to COVID-19, but the pandemic also had an immense impact on them, both personally and professionally. CONCLUSIONS: The story of family medicine contributions to the care of the public during COVID-19 reflects the history of COVID-19 in the United States, and the critical role trainees and family medicine physicians have in the US health care system.

PHENOMENON: While part-time clinical work options are popular for physicians, part-time residency training is uncommon. Some residency training programs have offered trainees the option to complete their training on a modified schedule in the past. These part-time tracks often involved extending training in order to complete equivalent hours on a part-time basis. Having experience with trainees in such programs, we sought to explore the impact of completing residency training part-time on the professional and private lives of physicians. APPROACH: Between 2019 and 2020, we conducted interviews with physicians who completed portions of their residency training part-time between 1995 and 2005 in our institution’s pediatrics, combined medicine-pediatrics, and family medicine programs. FINDINGS: Seven female physicians who completed at least some portion of residency part-time were interviewed. To better characterize their experiences, we chose phenomenology as our analytic framework. Members of the research team independently coded each interview and met to resolve conflicts. Codes were then combined and discussed to determine four overarching themes as reasons and benefits of part-time training: The pursuit of extended-time training, logistics, effects on career trajectory, and wellness. These themes highlighted the utility of part-time training and the need for programmatic support to ensure their success. INSIGHTS: Based on our findings, adaptability for training and a sense of agency from their part-time experiences persisted throughout interviewees’ careers. Each felt empowered to make career choices that fit their personal and professional needs. These findings suggest further investigation into the benefits of offering time-variable training in residency programs.

An innovative program for nurse leaders offered virtually by the American Organization for Nursing Leadership to build resilience and combat burnout was implemented and evaluated. It consisted of strategies to build a community of support. The evaluation plan included analysis of preintervention and postintervention results of the Maslach Burnout Inventory – General Survey and open-ended questions for qualitative analysis. Participants' burnout levels remained consistent throughout the program. Resiliency practices learned and implemented are reported. Strategies nurse leaders can use to impact nurse burnout are described.

Clinicians in acute care hospitals experience highly stressful situations daily. They work long, variable hours, complete complex technical tasks, and must also be emotionally engaged with patients and families to meet the caring demands of this profession, which can lead to burnout. In response to these challenges, a multi-disciplinary team from Virginia Tech collaborated with Steelcase to study the impact of medical workspaces on the clinician experience and how those workspaces could be improved to reduce some of the sources of burnout. The team sought to identify conditions that could either aid or hinder clinician workflow and affect burnout rate, then based on interviews and in-situ ethnographic studies, generated design concepts for nurse stations, both centralized and mobile. Using digital and physical full-scale prototypes, we enacted clinical care scenarios to seek feedback and reflect on the design.

BACKGROUND: Burnout is a “normal” albeit concerning response to workplace stress, whereas Major Depressive Disorder (MDD) is a serious illness associated with impairment and suicide risk. Because of symptomatic overlap between the two conditions and MDD-associated stigma, individuals reporting work-related stress and depression often are “diagnosed” with burnout at the expense of recognizing and treating MDD. Our study aimed to leverage organizational implementation of the American Foundation of Suicide Prevention's Interactive Screening Program to elucidate relationships among burnout, depression, and other suicide risk factors. METHODS: 2281 of about 30,000 (~7.6 %) medical trainees, staff, and faculty responded to an anonymous online stress and depression questionnaire. Respondents were grouped into four cohorts: screened positive for burnout alone (n = 439, 19 %), depression alone (n = 268, 12 %), both conditions (n = 759, 33 %), or neither condition (n = 817, 36 %), and compared on multiple measures of distress and other suicide risk factors. RESULTS: Burnout alone and depression alone each predicted greater distress and suicide risk compared with neither condition. Depression was a stronger predictor than burnout and demonstrated a consistent association with other suicide risk factors regardless of whether burnout was present. In contrast, burnout was not consistently associated with other suicide risk factors when depression was present. Limitations The sample was limited to one state-supported academic medical center; to individuals who elected to take the online survey; and relied on a single item, non-validated measure of burnout. CONCLUSION: When emotional distress is reported by healthcare workers, attention should not stop at “burnout,” as burnout frequently comingles with clinical depression, a serious and treatable mental health condition.

BACKGROUND: Reducing nurse turnover is a top priority for nursing management globally. While evidence has demonstrated that working in a favorable environment with greater interprofessional teamwork is essential in increasing nurse retention, few studies have explored the mechanism underlying this relationship. AIM: To examine the direct and indirect effects of interprofessional teamwork on nurses' intentions to leave their jobs via the intermediary roles of job satisfaction and burnout. METHODS: A cross-sectional study was conducted to collect data from 2113 nurses working in 21 hospitals in Oman. Data were collected using a survey questionnaire measuring teamwork, job satisfaction, burnout, and intention to leave. Logistic regression was used to investigate the direct effect of teamwork on intent to leave. A sequential mediation model was conducted to examine the mediating role of job satisfaction and burnout. RESULTS: Interprofessional teamwork was directly associated with nurses' intentions to leave. The influence of teamwork on intention to leave was indirectly mediated by both job satisfaction and job burnout. CONCLUSION: Findings illustrate the potential benefits of enhancing interprofessional teamwork in reducing nurses' intentions to leave. Interventions intended to foster teamwork could create satisfying workplaces, reduce perceived burnout, and ultimately contribute to organizational strategy for reducing nursing shortages.

This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Safe & Appropriate Staffing and Optimizing Teams).