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Correctional officers are shouldered with important responsibilities designed to reinforce institutional security, yet work under hazardous conditions that can jeopardize their wellbeing. Among the myriad dangers they confront, COVID-19 has now presented itself as an additional threat to officer wellness. Presently little is known about how the coronavirus pandemic has affected officers, or their respective institutions. Semi-structured interview data collected from correctional officers working in a large, urban county jail located in the southeastern United States (N?=?21) revealed how COVID-19 significantly disrupted institutional operations, compounded health concerns for officers, and created a climate of confusion over procedures designed to contain spread of the virus. Policy implications are discussed.

Encountering racism is burdensome and meeting it in a healthcare setting is no exception. This paper is part of a larger study that focused on understanding and addressing racism in healthcare in Sweden. In the paper, we draw on interviews with 12 ethnic minority healthcare staff who described how they managed emotional labor in their encounters with racism at their workplace. Data were analyzed using thematic analysis. The analysis revealed that experienced emotional labor arises from two main reasons. The ?rst is the concern and fear that ethnic minority healthcare staff have of adverse consequences for their employment should they be seen engaged in discussing racism. The second concerns the ethical dilemmas when taking care of racist patients since healthcare staff are bound by a duty of providing equal care for all patients as expressed in healthcare institutional regulations. Strategies to manage emotional labor described by the staff include working harder to prove their competence and faking, blocking or hiding their emotions when they encounter racism. The emotional labor implied by these strategies could be intense or traumatizing as indicated by some staff members, and can therefore have negative effects on health. Given that discussions around racism are silenced, it is paramount to create space where racism can be safely discussed and to develop a safe healthcare environment for the bene?t of staff and patients.

[This is an excerpt.] Most readers will recognize the main title of this editorial, a curse of sorts that was apparently coined by a British politician in the 1930s. Of course, the irony is that this curse is actually calling for the recipient to experience dangerous or troubling times. We in the pharmacy profession are currently experiencing “interesting times”, with all the various connotations entailed by the term “interesting”. [To read more, click View Resource.]

The pandemic helped politicize the exam room and exacerbate long-festering systemic problems. Discover how the AMA helps reduce physician burnout.

BACKGROUND: Trainees in graduate medical education are affected by burnout at disproportionate rates. Trainees experience tremendous growth in clinical skills and reasoning, however little time is dedicated to metacognition to process their experiences or deliberate identity formation to create individualized definitions of success and wellbeing. The purpose of this study was to understand the perspectives and experiences of trainees who participated in a 6-month, web-based, group coaching program for women residents in training. METHODS: Better Together Physician Coaching is a six-month, self-paced, online, asynchronous, coaching program with multiple components including live coaching calls, unlimited written coaching, and self-study modules. Semi-structured interviews of seventeen participants of Better Together from twelve GME programs within a single institution in Colorado were conducted from May to June of 2021. All identified as women and had participated in a 6-month coaching program. Both inductive and deductive methods were used in collecting and analyzing the data with an aim to understand learners’ perceptions of the coaching program, including “how and why” the coaching program affected training experiences and wellbeing. RESULTS: Three main themes emerged as benefits to the coaching program from the data: 1) practicing metacognition as a tool for healthy coping 2) building a sense of community, and 3) the value of a customizable experience. CONCLUSIONS: Female trainees who participated in a group coaching program expressed that they found value in learning how to cope with stressors through metacognition-focused coaching. They also described that building a community and being able to customize the experience were positive aspects of the program.

BACKGROUND: Physicians and nurses face high levels of burnout. The role of care teams may be protective against burnout and provide a potential target for future interventions. OBJECTIVE: To explore levels of burnout among physicians and nurses and differences in burnout between physicians and nurses, to understand physician and nurse perspectives of their healthcare teams, and to explore the association of the role of care teams and burnout. DESIGN: A mixed methods study in two school of medicine affiliated teaching hospitals in an urban medical center in Baltimore, Maryland. PARTICIPANTS: Participants included 724 physicians and 971 nurses providing direct clinical care to patients. MAIN MEASURES AND APPROACH: Measures included survey participant characteristics, a single-item burnout measure, and survey questions on care teams and provision of clinical care. Thematic analysis was used to analyze qualitative survey responses from physicians and nurses. KEY RESULTS: Forty-three percent of physicians and nurses screened positive for burnout. Physicians reported more isolation at work than nurses (p<0.001), and nurses reported their care teams worked efficiently together more than physicians did (p<0.001). Team efficiency was associated with decreased likelihood of burnout (p<0.01), and isolation at work was associated with increased likelihood of burnout (p<0.001). Free-text responses revealed themes related to care teams, including emphasis on team functioning, team membership, and care coordination and follow-up. Respondents provided recommendations about optimizing care teams including creating consistent care teams, expanding interdisciplinary team members, and increasing clinical support staffing. CONCLUSIONS: More team efficiency and less isolation at work were associated with decreased likelihood of burnout. Free-text responses emphasized viewpoints on care teams, suggesting that better understanding care teams may provide insight into physician and nurse burnout.

Highlights
• Burnout impacts 50-55% of emergency department nurses; nurse burnout cultural impacts in this setting are under-explored.
• This ethnography revealed an explanatory model of nurse burnout impacts, “The Pathway of Burnout”.
• Cultural clash was identified between pervasive nurse burnout culture and a culture of patient safety.

OBJECTIVE:The objective of this study was to addresses the basic question of whether alternative legislative approaches are effective in encouraging hospitals to increase nurse staffing. METHODS: Using 16 years of nationally representative hospital-level data from the American Hospital Association (AHA) annual survey, we employed a difference-in-difference design to compare changes in productive hours per patient day for registered nurses (RNs), licensed practical/vocational nurses (LPNs), and nursing assistive personnel (NAP) in the state that mandated staffing ratios, states that legislated staffing committees, and states that legislated public reporting, to changes in states that did not implement any nurse staffing legislation before and after the legislation was implemented. We constructed multivariate linear regression models to assess the effects with hospital and year fixed effects, controlling for hospital-level characteristics and state-level factors. RESULTS: Compared with states with no legislation, the state that legislated minimum staffing ratios had an 0.996 (P<0.01) increase in RN hours per patient day and 0.224 (P<0.01) increase in NAP hours after the legislation was implemented, but no statistically significant changes in RN or NAP hours were found in states that legislated a staffing committee or public reporting. The staffing committee approach had a negative effect on LPN hours (difference-in-difference=−0.076, P<0.01), while the public reporting approach had a positive effect on LPN hours (difference-in-difference=0.115, P<0.01). There was no statistically significant effect of staffing mandate on LPN hours. CONCLUSIONS: When we included California in the comparison, our model suggests that neither the staffing committee nor the public reporting approach alone are effective in increasing hospital RN staffing, although the public reporting approach appeared to have a positive effect on LPN staffing. When we excluded California form the model, public reporting also had a positive effect on RN staffing. Future research should examine patient outcomes associated with these policies, as well as potential cost savings for hospitals from reduced nurse turnover rates.

[This is an excerpt.] In 2020, 73.3 million workers age 16 and older in the United States were paid at hourly rates, representing 55.5 percent of all wage and salary workers. Among those paid by the hour, 247,000 workers earned exactly the prevailing federal minimum wage of $7.25 per hour. About 865,000 workers had wages below the federal minimum. Together, these 1.1 million workers with wages at or below the federal minimum made up 1.5 percent of all hourly paid workers.

Data on minimum wage workers for 2020 reflect the impact of the coronavirus (COVID-19) pandemic on the labor market. Comparisons with data on minimum wage workers for earlier years should be interpreted with caution. Large declines in employment in 2020, particularly among low-wage workers, resulted in changes in the hourly earnings distribution. More information on labor market developments in 2020 is available at www.bls.gov/covid19/effects-of-covid-19-pandemic-and-response-on-the-employment-situation-news-release.htm. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards & Recognition (Adequate Compensation) 

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[This is an excerpt.] Addressing clinician well-being has reached a new level of urgency during the COVID-19 pandemic. Record numbers of clinicians are experiencing moral distress from critical resource shortages, emotional distress from delivering care to profoundly ill patients while being socially isolated, and role stress from the loss of child care or other supports. These stressors have been compounded by the deaths of Breonna Taylor, George Floyd, and others, heightening awareness of long-standing, unaddressed structural racism that impacts both clinicians and patients.Work culture heavily influences clinician well-being, and changes that improve organizational work culture and create seamless workflows have been successfully implemented to reduce burnout and increase well-being. Similar arguments can and must be made for health care organizations to adopt antiracist practices that result in sustained meaningful change, because for too many clinicians, racism is a defining component of work culture. [To read more, click View Resource.]

[This is an excerpt.] The field of occupational therapy utilizes a variety of frameworks and models to inform the occupational therapy (OT) process for assessment and goal development, and to provide intervention and guidelines for practitioners. This document applies the Occupational Adaptation (OA) model to address diversity, equity, and inclusion within the field of occupational therapy. The model provides a method to identify areas of need and supports the growth of our students, practitioners, and those in academia. The purpose of this framework is to provide a tool for increasing awareness of the diverse needs of individuals in our professional communities and to provide inclusive occupational therapy practice for all. The occupational adaptational model provides the framework for exploring our own needs as we press for mastery as an occupational therapy practitioner, a student, a fieldwork educator, or a faculty member. This framework guides individuals through understanding their own perspectives as occupational therapy practitioners, fieldwork students, fieldwork educators, or faculty in occupational therapy education. As we press for practice from a perspective of cultural humility, we must recognize the implicit and explicit biases that impact our interactions.The framework also allows understanding the perspective of others and considering the influence of environment and contexts on providing inclusive occupational therapy services. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Relational Strategies (Improving Diversity, Equity, & Inclusion).

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[This is an excerpt.] The first case of COVID-19 was reported in America in January of 2020. In the ensuing months, COVID-19 has taken the lives of more than 200,000 people in the USA and upended our current model of medical education and practice. In the midst of a pandemic, hospitals across the country report millions of dollars in economic losses, healthcare providers face furloughs, and medical students sit at home delaying their training indefinitely. The novel coronavirus threatens to disrupt every facet of our healthcare system, and work surrounding diversity, equity, and inclusion in medicine is not immune. [To read more, click View Resource.]

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

[This is an excerpt.] Member Boards showed their support for the new Standards for Continuing Certification (Standards) following their approval by the American Board of Medical Specialties (ABMS) Board of Directors during its October meeting, with many issuing statements explaining the new Standards, their implications for board certified physicians, and how changes made or those underway are already in alignment with the new Standards. Some boards had already started making substantial changes to their continuing certification programs following the release of the recommendations made by the Continuing Board Certification: Vision for the Future Commission, which met through 2018 to provide strategic guidance to the ABMS Board of Directors and Member Boards. A few of them predate the recommendations. These programmatic changes reflect the Commission recommendations and the new Standards whose release represents the culmination of three years of development and consultation with myriad stakeholders from across the health care spectrum. As an example, the new Standards reinforce the transition to innovative assessment programs that support and direct physician learning. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Operational Strategies (Workloads and Workflows).

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BACKGROUND: Academic service-learning nursing partnerships (ASLNPs) integrate instruction, reflection, and scholarship with tailored service through enriched learning experiences that teach civic responsibility and strengthen communities, while meeting academic nursing outcomes. Objective: This scoping review aimed to identify, appraise, and synthesize evidence of community focused ASLNPs that promote primary health care throughout the Americas region. METHODS: A systematic search of PubMed, CINAHL, Scopus, Google Scholar, and LILACS English-language databases was performed in accordance with PRISMA guidelines. Full-text articles published since 2010 were reviewed using an inductive thematic approach stemming from the "Advancing Healthcare Transformation: a New Era for Academic Nursing Report" and the Pan American Health Organization "Strategic Directions for Nursing." RESULTS: A total of 51 articles were included with the vast majority 47 (92.1 %) representing North America. Structured, established relationships between an academic nursing institution or program and one or more community serving entities resulted in high levels of effectiveness and innovation across settings. Five themes emerged: (a) sustaining educational standards and processes - improving academic outcomes (25.5 %), (b) strengthening capacity for collaborative practice and interprofessional education (13.7 %), (c) preparing nurses of the future (11.8 %), (d) enhancing community services and outcomes (21.6 %), and (e) conceptualizing or implementing innovative academic nursing partnerships (27.4 %). A synthesis of conceptual frameworks and models revealed six focus areas: communities/populations (26.2 %), nursing (26.2 %), pedagogy (19 %), targeted outreach (14.3 %), interprofessional collaboration (11.9 %), and health determinants (9.5 %). A proliferation in US articles, triggered by nursing policy publications, was confirmed. CONCLUSIONS: ASLNPs serve as mechanisms for nurses and faculty to develop and lead change across a wide variety of community settings and healthcare systems, develop scholarship, as well as for students to apply the knowledge and skills learned. Given the lack of geographically broad evidence, successes and challenges across U.S. partnerships should be viewed cautiously. Nevertheless, ASLNPs can play a critical role towards meeting the goal of universal health access and coverage through partnering with the education sector. Further investigation of grey literature as well as Spanish and Portuguese language literature from Latin American and Caribbean countries is highly recommended.

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

Discrimination towards individuals with disabilities is problematic within nursing. There have been calls to increase diversity in nursing and this includes embracing nurses with disabilities. Increasing diversity in nursing requires increasing diversity among nursing students; in this way, nurse educators are gatekeepers to the profession. Clinical education is a crucial element of nursing education, yet there have been very few studies related to the clinical education of nursing students with disabilities. There have been no studies of attitudes of acute care nurse preceptors toward students with disabilities in the United States. This gap is important as the majority of clinical experiences occur in the acute care environment. Utilizing a focused ethnography, semi-structured interviews were conducted with 20 acute care nurses with at least two years’ experience precepting students. While positive feelings about nursing students with disabilities were shared, thoughts and behavioral intentions remained negative. Six themes emerged: safety, barriers, otherness, communicating to meet needs, disclosure, and student versus colleague. Attitudinal barriers are the primary barriers faced by individuals with disabilities in becoming and practicing as nurses. Nurses in practice and education must embrace more inclusive attitudes towards individuals with disabilities.

BACKGROUND: A variety of stressors throughout medical education have contributed to a burnout epidemic at both the undergraduate medical education (UGME) and postgraduate medical education (PGME) levels. In response, UGME and PGME programs have recently begun to explore resilience-based interventions. As these interventions are in their infancy, little is known about their efficacy in promoting trainee resilience. This systematic review aims to synthesize the available research evidence on the efficacy of resilience curricula in UGME and PGME. METHODS: We performed a comprehensive search of the literature using MEDLINE, EMBASE, PsycINFO, Educational Resources Information Centre (ERIC), and Education Source from their inception to June 2020. Studies reporting the effect of resilience curricula in UGME and PGME settings were included. A qualitative analysis of the available studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using the ROBINS-I Tool. RESULTS: Twenty-one studies met the inclusion criteria. Thirteen were single-arm studies, 6 quasi-experiments, and 2 RCTs. Thirty-eight percent (8/21; n = 598) were implemented in UGME, while 62 % (13/21, n = 778) were in PGME. There was significant heterogeneity in the duration, delivery, and curricular topics and only two studies implemented the same training model. Similarly, there was considerable variation in curricula outcome measures, with the majority reporting modest improvement in resilience, while three studies reported worsening of resilience upon completion of training. Overall assessment of risk of bias was moderate and only few curricula were previously validated by other research groups. CONCLUSIONS: Findings suggest that resilience curricula may be of benefit to medical trainees. Resilience training is an emerging area of medical education that merits further investigation. Additional research is needed to construct optimal methods to foster resilience in medical education.

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

[This is an excerpt.] Demographic and policy trends in the United States have combined to create unprecedented demand for home-based, long-term care services for the elderly, with expected growth for decades to come. Home care workers like home health and personal care aides provide most of the care for the increasing elderly population, many of whom have chronic and complex medical and social needs and prefer to age at home. Despite the critical role of those providing this care,home care workers are undervalued, underpaid, and rarely acknowledged as members of client health care teams. This undervaluation contributes to low job satisfaction and high home care worker turnover and attrition, which may negatively affect clients’ health and employers’ bottom lines. As a result, advocates argue that opportunities for skill and career advancement for homecare workers can improve their job quality, satisfaction, and livelihoods while also contributing to positive downstream outcomes for clients, employers, and even health systems. This report, Advancing the Home Care Workforce: A Review of Program Approaches, Evidence,and the Challenges of Widespread Adoption, was commissioned by the Ralph C. Wilson, Jr.Foundation with an objective to examine program approaches to advance the roles of home care workers with a deeper dive into some of the contextual factors that may impact uptake specifically in in Western New York and Southeast Michigan due to the Foundation’s geographic focus in these two regions. Findings emerged from a literature review and interviews with content experts representing a range of stakeholder groups. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards& Recognition (Career Supports and Development)

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OBJECTIVE: The objective of this study was to addresses the basic question of whether alternative legislative approaches are effective in encouraging hospitals to increase nurse staffing. METHODS: Using 16 years of nationally representative hospital-level data from the American Hospital Association (AHA) annual survey, we employed a difference-in-difference design to compare changes in productive hours per patient day for registered nurses (RNs), licensed practical/vocational nurses (LPNs), and nursing assistive personnel (NAP) in the state that mandated staffing ratios, states that legislated staffing committees, and states that legislated public reporting, to changes in states that did not implement any nurse staffing legislation before and after the legislation was implemented. We constructed multivariate linear regression models to assess the effects with hospital and year fixed effects, controlling for hospital-level characteristics and state-level factors. RESULTS: Compared with states with no legislation, the state that legislated minimum staffing ratios had an 0.996 (P<0.01) increase in RN hours per patient day and 0.224 (P<0.01) increase in NAP hours after the legislation was implemented, but no statistically significant changes in RN or NAP hours were found in states that legislated a staffing committee or public reporting. The staffing committee approach had a negative effect on LPN hours (difference-in-difference=-0.076, P<0.01), while the public reporting approach had a positive effect on LPN hours (difference-in-difference=0.115, P<0.01). There was no statistically significant effect of staffing mandate on LPN hours. CONCLUSIONS: When we included California in the comparison, our model suggests that neither the staffing committee nor the public reporting approach alone are effective in increasing hospital RN staffing, although the public reporting approach appeared to have a positive effect on LPN staffing. When we excluded California form the model, public reporting also had a positive effect on RN staffing. Future research should examine patient outcomes associated with these policies, as well as potential cost savings for hospitals from reduced nurse turnover rates.

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

IMPORTANCE: Medical trainee burnout is associated with poor quality care and attrition. Medical students in sexual minority groups report fear of discrimination and increased mistreatment, but the association between sexual orientation, burnout, and mistreatment is unknown. OBJECTIVE: To evaluate whether medical student burnout differs by sexual orientation and whether this association is mediated by experiences of mistreatment. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study surveyed US medical students graduating from Association of American Medical Colleges (AAMC)–accredited US allopathic medical schools who responded to the AAMC graduation questionnaire in 2016 and 2017. Statistical analyses were performed from March 15, 2019, to July 2, 2020, and from November 20 to December 9, 2020. MAIN OUTCOMES AND MEASURES: Burnout was measured using the Oldenburg Burnout Inventory for Medical Students, and sexual orientation was categorized as either heterosexual or lesbian, gay, or bisexual (LGB). Logistic regression models were constructed to evaluate the association between sexual orientation and experiencing burnout (defined as being in the top quartile of exhaustion and disengagement burnout dimensions) and to test the mediating association of mistreatment. RESULTS: From 2016 to 2017, 30 651 students completed the AAMC Graduation Questionnaire, and 26 123 responses were analyzed. Most respondents were younger than 30 years (82.9%) and White (60.3%). A total of 13 470 respondents (51.6%) were male, and 5.4% identified as LGB. Compared with heterosexual students, a greater proportion of LGB students reported experiencing mistreatment in all categories, including humiliation (27.0% LGB students vs 20.7% heterosexual students; P < .001), mistreatment not specific to identity (17.0% vs 10.3%; P < .001), and mistreatment specific to gender (27.3% vs 17.9%; P < .001), race/ethnicity (11.9% vs 8.6%; P < .001), and sexual orientation (23.3% vs 1.0%; P < .001). Being LGB was associated with increased odds of burnout (adjusted odds ratio, 1.63 [95% CI, 1.41-1.89]); this association persisted but was attenuated after adjusting for mistreatment (odds ratio, 1.36 [95% CI, 1.16-1.60]). The odds of burnout increased in a dose-response manner with mistreatment intensity. Lesbian, gay, or bisexual students reporting higher mistreatment specific to sexual orientation had and 8-fold higher predicted probability of burnout compared with heterosexual students (19.8% [95% CI, 8.3%-31.4%] vs 2.3% [95% CI, 0.2%-4.5%]; P < .001). Mediation analysis showed that mistreatment accounts for 31% of the total association of LGB sexual orientation with overall burnout (P < .001). CONCLUSIONS AND RELEVANCE: This study suggests that LGB medical students are more likely than their heterosexual peers to experience burnout, an association that is partly mediated by mistreatment. Further work is needed to ensure that medical schools offer safe and inclusive learning environments for LGB medical students.

Practicing physicians and administrators both rightfully consider themselves to be highly trained, skilled, and knowledgeable team members. However, relationships between frontline physicians and administrators are severely strained in many health care organizations, and trust is at an all-time low. Physicians may feel that administrators don’t understand, or don’t care, about the challenges they face taking care of patients. They may feel as though they are treated as line production workers with little control over their schedules, support team, and even clinical decision-making. At the same time, administrators may think physicians do not understand the challenges of running a complex organization such as a hospital or health system, including the financial and management challenges that ensure long term sustainability.

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