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The outbreak of the COVID-19 pandemic exerted significant mental burden on healthcare workers (HCWs) operating in the frontline of the COVID-19 care as they experienced high levels of stress and burnout. The aim of this scoping review was to identify prevalence and factors associated with burnout among HCWs during the first year of the COVID-19 pandemic. A literature search was performed in PubMed, Web of Science, and CINAHL. Studies were selected based on the following inclusion criteria: cross-sectional, longitudinal, case-control, or qualitative analyses, published in peer-reviewed journals, between January 1, 2020 and February 28, 2021. Studies carried out on other occupations than healthcare workers or related to other pandemics than COVID-19 were excluded. Following the abstract screen, from 141 original papers identified, 69 articles were eventually selected. A large variation in the reported burnout prevalence among HCWs (4.3–90.4%) was observed. The main factors associated with increase/ decrease of burnout included: demographic characteristics (age, gender, education level, financial situation, family status, occupation), psychological condition (psychiatric diseases, stress, anxiety, depression, coping style), social factors (stigmatisation, family life), work organization (workload, working conditions, availability of staff and materials, support at work), and factors related with COVID-19 (fear of COVID-19, traumatic events, contact with patients with COVID-19, having been infected with COVID-19, infection of a colleague or a relative with COVID-19, higher number of deaths observed by nurses during the COVID-19 pandemic). The findings should be useful for policy makers and healthcare managers in developing programs preventing burnout during the current and future pandemics.

Primary care clinicians came under great pressure during the Covid-19 pandemic, exacerbating a long-standing crisis in U.S. primary care. In March 2020, the Larry A. Green Center for the Advancement of Primary Health Care for the Public Good launched a survey series of primary care physicians, nurse practitioners, physician assistants/associates, and other specialists. Analyzing both quantitative and open-ended responses over 2 years of the survey, which drew 32,817 responses from 8,100 respondents in every state, the authors report on clinicians’ concerns and propose a sweeping package of policy reforms to strengthen U.S. primary care practice. The findings showed severe staff shortages, financial stress, difficulty providing accessible care, challenges in sustaining telehealth, and mental exhaustion due to the growing patient burdens in mental health, untreated chronic disease, and acute care delays. These data support the 2021 recommendations on primary care by the National Academies of Sciences, Engineering, and Medicine, including expansion of population-based payment models. The authors also recommend immediate establishment of a Federal Emergency Primary Care Support Fund.

OBJECTIVE: To determine if individualized professional coaching reduces burnout, improves quality of life, and increases resilience among surgeons. BACKGROUND: 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 postintervention 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 with an increase of 2.5% in the control arm [delta: −5.0%, 95% confidence interval (CI): −8.6%, −1.4%; P=0.007]. Resilience scores improved by 1.9 points in the intervention arm compared with 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.

Physician distress and burnout are reaching epidemic proportions, threatening physicians' capacities to develop and maintain competencies in the face of the increasingly demanding and complex realities of medical practice in today's world. In this article, we suggest that coaching should be considered both a continuing professional development intervention as well as an integral part of a balanced and proactive solution to physician distress and burnout. Unlike other interventions, coaching is intended to help individuals gain clarity in their life, rather than to treat a mental health condition or to provide advice, support, guidance, or knowledge/skills. Certified coaches are trained to help individuals discover solutions to complex problems and facilitate decision-making about what is needed to build and maintain capacity and take action. Across many sectors, coaching has been shown to enhance performance and reduce vulnerability to distress and burnout, but it has yet to be systematically implemented in medicine. By empowering physicians to discover and implement solutions to challenges, regain control over their lives, and act according to their own values, coaching can position physicians to become leaders and advocates for system-level change, while simultaneously prioritizing their own well-being.

RATIONALE & OBJECTIVE: High professional fulfillment and low burnout and staff turnover are necessary for a stable dialysis workforce. We explored professional fulfillment, burnout, and turnover intention among US dialysis patient care technicians (PCTs). STUDY DESIGN: Cross-sectional national survey. Setting & Participants: National Association of Nephrology Technicians/Technologists (NANT) members in March-May 2022 (N = 228; 42.6% aged 35-49 years, 83.9% female, 64.6% White, 85.3% non-Hispanic). EXPOSURE: Likert-scale items (range, 0-4) related to professional fulfillment and 2 domains of burnout (work exhaustion and interpersonal disengagement) and dichotomous items related to turnover intention. ANALYTICAL APPROACH: Summary statistics (percentages, means, medians) were calculated for individual items and average domain scores. Burnout was defined by combined work exhaustion and interpersonal disengagement scores of ≥1.3 and professional fulfillment by a score ≥3.0. RESULTS: Most respondents (72.8%) worked ≥40 hours per week. Overall scores for work exhaustion, interpersonal disengagement, and professional fulfillment (median [IQR]) were 2.3 (1.3-3.0), 1.0 (0.3-1.8), and 2.6 (2.0-3.2), respectively; 57.5% reported burnout, and 37.3% reported professional fulfillment. Important contributors to burnout and professional fulfillment included salary (66.5%), supervisor support (64.0%), respect from other dialysis staff (57.8%), sense of purpose about work (54.5%), and hours worked per week (52.9%). Only 52.6% reported that they plan to be working as a dialysis PCT in 3 years. Free text responses reinforced perceived excessive work burden and lack of respect. LIMITATIONS: Limited generalizability to all US dialysis PCTs. CONCLUSIONS: More than half of dialysis PCTs reported burnout, driven by work exhaustion; only about one-third reported professional fulfillment. Even among this relatively engaged group of dialysis PCTs, only half intended to continue working as PCTs. Because of the critical, frontline role of dialysis PCTs in the care of patient receiving in-center hemodialysis, strategies to improve morale and reduce turnover are imperative.

[This is an excerpt.] Mayo Clinic's Program on Physician Well-Being supports the well-being of all members of the health care team to better meet patient needs. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Strengthening Leadership.

OBJECTIVE: To analyze the role of short (<30 minutes) and frequent (quarterly) check-ins between clinic leaders and employees in reducing emotional exhaustion. METHODS: Three interrelated studies were conducted: a 3-year repeated cross-sectional survey at 10 primary care clinics (n=505; we compared emotional exhaustion, perceived stress, and values alignment among employees of a clinic where check-ins were conducted vs 9 control clinics); interviews with leaders and employees (n=10) regarding the check-ins process and experiences; and interviews with leaders and employees (n=10) after replicating the check-ins at a new clinic. RESULTS: Outcomes were similar at baseline. After a year, emotional exhaustion was lower at the check-ins compared with control clinics (standardized mean difference, d, -0.71 [P<.05]). After 2 years, emotional exhaustion remained lower at the check-ins clinic, but this difference was not significant. The check-ins were associated with an increment in values alignment (2018 vs 2017, d=0.59 [P<.05]; 2019 vs 2017, d=0.76 [P<.05]). There were no differences for perceived job stress. Interviews indicated that work-life challenges were discussed in the check-ins. However, employees need confidentiality and to feel safe to do so. The replication suggested that the check-ins are feasible to implement even amid turbulent times. CONCLUSION: Periodic check-ins wherein leaders acknowledge and address work-life stressors might be a practical tactic to reduce emotional exhaustion in primary care clinics.

This resource is found in our Actionable Strategies for Health Organizations: Strengthening Leadership.

Continuity of care is a critical element for delivering quality of care in inpatient units, however it has rarely been considered in nurse-patient assignment (NPA) models. The nursing literature suggests that continuity of care helps reduce medical errors and readmissions and increases patient satisfaction. Balancing patient assignments to nursing staff is also critical to avoid overwork and burnout. This study investigates the relationship between continuity of care and workload balance in NPA decisions in hospital inpatient units. We develop an NPA heuristic to guide continuity-care assignment while addressing the trade-off with workload balance. The heuristic prioritizes higher-acuity patients to the objective of continuity of care, while assignment of lower acuity patients seeks to minimize workload imbalance. A discrete event simulation model of an inpatient hospital unit is used to evaluate how the heuristic addresses the tradeoff between the two objectives under distinct work design scenarios. The heuristic enables significant increases in continuity of care for specific patient segments while limiting the impact on workload balance. We discuss implications for theory and managerial practice.

Healthcare delivery is increasingly complex, with frontline leader roles, especially the nurse manager (NM), pivotal for success. This role is highly stressful, often leading to burnout influencing job satisfaction and leadership effectiveness. A quality improvement project, including preintervention and postintervention assessment with a focused improvement event for NMs, in a large children's hospital was completed. Organization strategies to support professional well-being and enhance support for the NMs were identified and implemented.

Education in self care is a core focus for beginning generalist social work trainees to boost trauma awareness, or the ability to recognize and respond to emotional responses from direct practice with clients with a history of trauma, and oppression, as well as for diminishing worker burnout. This paper presents a description and assessment of an asynchronous teaching module comprised of a video lecture, quiz and assignment piloted with beginning graduate-level social work students in the United States to situate self care as a component of professional development toward trauma-informed and ethical care. The module aimed to translate knowledge and skills in self care directly to practice and framed targets of self care including emotional regulation, and meaning-making. It provided students opportunities to identify self care practices at the individual level on their own, as well as agency-based self care practices in consultation with their field supervisors. The module was piloted with 57 master’s students enrolled in beginning generalist practice courses and the outcomes of a survey and thematic analysis suggests it warrants consideration as a tool for promoting competency regarding self care in an asynchronous, easily transportable format for online or hybrid learning.

This study aims to identify the determinants of burnout in police officers. We considered a wide range of psychosocial risk factors, individual variables that have been previously found to be associated with burnout in police officers (affective and cognitive empathy, self-care), and variables whose unique impact on burnout of police officers needs further clarification (organizational justice and organizational identification). The study was conducted in Portugal, and the sample was constituted by 573 members of the National Republican Guard (GNR—Guarda Nacional Republicana). The participants were invited to answer an online anonymous survey, which included previously validated measures of the following variables: burnout (exhaustion and disengagement), psychosocial risk factors, self-care, empathy (cognitive and affective), organizational justice, and organizational identification. Furthermore, we controlled for the potential impact of demographic variables (age, gender, years of professional experience, religiosity, political orientation, and income). Multiple regression analysis showed that when taken together, only a few of the variables associated with burnout had a unique impact on both exhaustion and disengagement: quantitative demands and affective empathy were burnout risk factors; meaningful work, organizational justice (distributive justice, procedural justice, and interactional justice), and organizational identification were burnout protective factors. Our results highlight the importance of developing theoretical models and planning interventions to prevent burnout in police officers, focusing mainly on the above-mentioned variables.

An experiment reveals interventions that managers can use to increase employees’ comfort with speaking up and raising concerns.

The demanding activity of firefighters has a significant impact on their psychological state. This study aimed to analyse the prevalence of anxiety, Burnout, depression, and post-traumatic stress in firefighters. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used for the systematic literature review. The research was developed in SCOPUS, Web of Science, and Pubmed scientific databases. Fifty-three articles were included in the present study and were distributed in subthemes: Prevalence of Anxiety, Burnout and Depression; Prevalence of post-traumatic stress. Firefighters’ psychological disorders were associated with exposure to traumatic events during activity. Age and years of experience related to the prevalence of post-traumatic stress. It is necessary to develop further studies in this area of research, finding ways to reduce the psychological impacts caused by the activity.

Over the past decades, a growing interest has emerged toward understanding the impact that the exposure to human suffering produces in mental health professionals, leading to the identification of three constructs: vicarious traumatization (VT), compassion fatigue (CF), and secondary trauma (ST). However, little is known about how these conditions affect psychologists. A systematic review and a meta-analysis were conducted to examine the evidence about the effects of occupational exposure to trauma and suffering in studies that included psychologists among their samples. Fifty-two studies were included comprising 10,233 participants. Overall, the results showed that most professionals did not experience relevant distress due to their work, yet some of them developed clinically significant symptoms (i.e., PTSD). However, solid conclusions could not be drawn due to the numerous methodological difficulties found in this research field (i.e., group heterogeneity, lack of comparison groups, and conceptual overlap). Thus, it is necessary to further investigate this topic with scientific rigor to understand these stressors and develop evidence-based interventions.

BACKGROUND: The specific factors that may influence burnout levels in police officers are not yet clear. Our aim was to systematically identify the psychosocial risk and protective factors associated with burnout among police officers. METHODS: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A protocol was registered in PROSPERO. A search strategy was applied to Medline via OvidSP, PsycInfo, Scopus and Web of Science. The quality assessment entailed the use of the CASP checklist for cohort studies. The data was reported through a narrative synthesis. RESULTS: After removing studies based on the selection criteria, 41 studies were included in this review. The findings were synthesized under the following subheadings: socio-demographic factors; organisational factors; operational factors; personality variables and coping strategies. Organisational and operational factors were found to be the most predominant risk factors for burnout. Personality variables and coping strategies appeared as both risk and protective factors. Socio-demographic factors were weak in explaining burnout. LIMITATIONS: Most studies are from high-income countries. Not all used the same burnout measurement tool. All relied on self-reported data. Since 98 % had a cross-sectional design, causal inferences could not be made. CONCLUSIONS: Burnout, despite being strictly defined as an occupational phenomenon, is related to factors outside of this context. Future research should focus on examining the reported associations by using more robust designs. More attention must be paid to police officers' mental health by investing in developing strategies to mitigate adverse factors and maximise the effects of protective factors.

Emergency medical service (EMS) professionals often experience work stress, which escalated during COVID-19. High job demand in the EMS profession may lead to progressive decline in physical and mental health. We investigated the prevalence of psychosocial job stress in the three levels of EMS: basic, advanced, and paramedic, before and during the COVID-19 pandemic. EMS professionals (n = 36) were recruited from EMS agencies following the Institutional Review Board approval. Participants took surveys on demographics, personal characteristics, chronic diseases, and work schedules. Job stress indicators, namely the effort–reward ratio (ERR) and overcommitment (OC), were evaluated from survey questionnaires using the effort–reward imbalance model. Associations of job stress indicators with age, sex, body mass index, and working conditions were measured by logistic regression. Psychosocial work stress was prevalent with effort reward ratio > 1 in 83% of participants and overcommitment scores > 13 in 89% of participants. Age, body mass index, and work hours showed strong associations with ERR and OC scores. The investigation findings suggested that a psychosocial work environment is prevalent among EMS, as revealed by high ERR, OC, and their correlation with sleep apnea in rotating shift employees. Appropriate interventions may be helpful in reducing psychosocial work stress in EMS professionals.

OBJECTIVE(S): To describe PHNs' perceptions and experiences of the COVID-19 pandemic, including training, response activities, and work-related challenges. DESIGN: This was a qualitative study using interpretive description for analysis. SAMPLE: PHN participants who worked in public health departments in Wisconsin were recruited using purposive sampling. A total of 15 PHNs participated in the study, including both general and supervisor-level PHNs. MEASUREMENTS: Data were collected via semi-structured interviews from March to May 2021. Interview questions focused on PHNs' perceptions, experiences, response activities, and burnout in relation to the current pandemic as well as perceptions and experiences of emergency preparedness and response in general. RESULTS: Five themes emerged in the study. These were: (1) experiences and observations of the COVID-19 pandemic, (2) organizational changes and their impacts, (3) public health emergency preparedness and response, (4) public health emergency response activities, and (5) role strain and burnout. CONCLUSIONS: Findings presented here have important implications for PHN training and support in emergency preparedness and response. A wide array of strategies focused on developing and supporting the PHN workforce in response to the public health crisis this area need to be implemented at the organizational, community, and policy levels.

IMPORTANCE: Emergency nurses experience high levels of workplace violence during patient interactions. Little is known about the efficacy of behavioral flags, which are notifications embedded within electronic health records (EHRs) as a tool to promote clinician safety. OBJECTIVE: To explore the perspectives of emergency nurses on EHR behavioral flags, workplace safety, and patient care. DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, semistructured interviews were conducted with emergency nurses at an academic, urban emergency department (ED) between February 8 and March 25, 2022. Interviews were audio recorded, transcribed, and analyzed using thematic analysis. Data analysis was performed from April 2 to 13, 2022. MAIN OUTCOMES AND MEASURES: Themes and subthemes of nursing perspectives on EHR behavioral flags were identified. RESULTS: This study included 25 registered emergency nurses at a large academic health system, with a mean (SD) tenure of 5 (6) years in the ED. Their mean (SD) age was 33 (7) years; 19 were women (76%) and 6 were men (24%). Participants self-reported their race as Asian (3 [12%]), Black (3 [12%]), White (15 [60%]), or multiple races (2 [8%]); 3 participants (12%) self-reported their ethnicity as Hispanic or Latinx. Five themes (with subthemes) were identified: (1) benefits of flags (useful advisory; prevents violence; engenders compassion), (2) issues with flags (administrative and process issues; unhelpful; unenforceable; bias; outdated), (3) patient transparency (patient accountability; damages patient-clinician relationship), (4) system improvements (process; built environment; human resources; zero-tolerance policies), and (5) difficulties of working in the ED (harassment and abuse; unmet mental health needs of patients; COVID-19–related strain and burnout). CONCLUSIONS AND RELEVANCE: In this qualitative study, nursing perspectives on the utility and importance of EHR behavioral flags varied. For many, flags served as an important forewarning to approach patient interactions with more caution or use safety skills. However, nurses were skeptical of the ability of flags to prevent violence from occurring and noted concern for the unintended consequences of introducing bias into patient care. These findings suggest that changes to the deployment and utilization of flags, in concert with other safety interventions, are needed to create a safer work environment and mitigate bias.

[This is an excerpt.] As improvers and leaders of improvement, many of us are very familiar with the three questions of the Model for Improvement, developed by Associates in Process Improvement: What are we trying to accomplish? , How will we know that a change is an improvement? , What change can we make that will result in improvement? [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Aligning Values (Establish a Culture of Shared Commitment).

OBJECTIVES: The goals of this study were to characterize clinical coordinators compared to other Physician Assistant (PA) faculty, and investigate factors associated with intent to leave their position, institution, and academia in the U.S. METHODS: This was a secondary analysis of data obtained from the 2019 Physician Assistant Education Association (PAEA) Faculty and Directors Survey. We examined bivariate associations with faculty role and conducted multiple logistic regression to identify predictors of intent to leave among clinical directors. RESULTS: Clinical directors indicated an intention to leave their position more often than other faculty. Factors influencing intent to leave were a lack of satisfaction with professional development and moderate to high levels of burnout. Clinical directors with severe burnout had 27x the odds of intending to leave academia. CONCLUSIONS: Our results suggest why clinical directors intend to leave and underscore the need for professional development opportunities and faculty mentoring. Faculty-centered work arrangements are needed to reduce burnout among clinical directors.