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Anger is an emotional state that occurs when unexpected things happen to or around oneself and is “an emotional state that varies in intensity from mild irritation to intense fury and rage.” It is defined as “a strong feeling of displeasure and usually of antagonism,” an emotion characterized by tension and hostility arising from frustration, real or imagined injury by another, or perceived injustice. It can manifest itself in behaviors designed to remove the object of the anger (e.g., determined action) or behaviors designed merely to express the emotion. For the Roman philosopher Seneca anger is not an uncontrollable, impulsive, or instinctive reaction. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It seems that the year 2022 was a year when many Americans were plainly angry. “Why is everyone so angry?” the New York Times asked in the article “The Year We Lost It.” We believe that Seneca is correct in that anger is unacceptable. Anger is a negative emotion that must be controlled, and Seneca provides us with the tools to avoid and destroy anger. Health care professionals will be more effective, content, and happier if they learn more about Seneca’s writings about anger and implement his wisdom on anger from over 2000 years ago.

BACKGROUND: Nurses experienced physical and mental exhaustion during the COVID-19 pandemic. Understanding the impact of the pandemic on nurses and effective strategies to support them is critical for increasing nurse resilience and reducing burnout. AIMS: The aims of this study were (1) to synthesize the literature examining how factors associated with the COVID-19 pandemic affected the well-being and safety of nurses (2) and to review interventions which may promote nurse mental health during crises. METHODS: Using an integrative review approach, a comprehensive search of the literature was conducted in March 2022 using the following databases: PubMed, CINAHL, Scopus, and Cochrane. We included quantitative, qualitative, and mixed-method primary research articles published in English in peer-reviewed journals from March 2020 through February 2021. Included articles focused on nurses caring for COVID-19 patients and addressed psychological factors, supportive hospital leadership strategies, or interventions to support well-being. Studies were excluded if they focused on professions outside of nursing. Included articles were summarized and appraised for quality. Findings were synthesized using content analysis. RESULTS: Of the 130 articles initially identified, 17 were included. Articles were quantitative (n = 11), qualitative (n = 5), and mixed methods (n = 1). Three themes were identified: (1) loss of life, hope, and professional identity; (2) lack of visible and supportive leadership; and (3) insufficient planning and response. These experiences contributed to increased symptoms of anxiety, stress, depression, and moral distress in nurses.

Frontline clinicians responding to the COVID-19 pandemic are at increased risk of burnout, but less is known about the trajectory of clinician burnout as caseloads increase and decrease. Personal and professional resources, including self-efficacy and hospital support, can attenuate the risk of burnout. Yet, empirical data documenting how burnout and resources changed as the pandemic waxed and waned are limited. This intensive longitudinal prospective study employed ecological momentary assessment methods to examine trajectories of burnout and resources over the pandemic’s first year in a New York City hospital. A 10-item survey was emailed every 5 days to frontline clinicians (physicians, nurses, and physician assistants). The primary outcome was a single-item validated measure of burnout; predictors included daily hospital COVID-19-related caseloads and personal and professional resources. Clinicians (n = 398) completed the initial survey and an average of 12 surveys over the year. Initially, 45.3% of staff reported burnout; over the year, 58.7% reported burnout. Following the initial COVID peak, caseloads declined, and burnout levels declined. During the second wave of COVID, as caseloads increased and remained elevated and personal and professional resource levels decreased, burnout increased. This novel application of intensive longitudinal assessment enabled ongoing surveillance of burnout and permitted us to evaluate how fluctuations in caseload intensity and personal and professional resources related to burnout over time. The surveillance data support the need for intensified resource allocation during prolonged pandemics.

PURPOSE: The purpose of this investigation was to develop, describe, and evaluate burnout curricula using meditation as a burnout reduction strategy. METHOD: The Maslach Burnout Inventory was the survey method used to assess PA student’s levels of burnout after completing developed burnout curricula. RESULTS: The results showed no relationship between burnout curricula completion and rates of student burnout. However, the findings showed burnout differences across the three cohorts of student classes. CONCLUSION: While limited by only the three cohorts of students, the study affirmed the need for faculty to stay attuned to aspects of student burnout.

PROBLEM DEFINITION: Moral distress (MoD) is a vital clinical indicator linked to clinician burnout and provider concerns about declining patient care quality. Yet it is not routinely assessed. Earlier, real-time recognition may better target interventions aimed at alleviating MoD and thereby increase provider well-being and improve patient care quality. INITIAL APPROACH AND TESTING: Combining two validated MoD instruments (the Moral Distress Thermometer [MDT] and the Measure of Moral Distress for Healthcare Professionals [MMD-HP]), the authors developed a novel mobile and Web-based application environment to measure and report levels MoD and their associated causes. This app was tested for basic feasibility and acceptability in two groups: graduate nursing students and practicing critical care nurses. RESULTS: The MDT app appears feasible and acceptable for future use. All participants (n = 34) indicated the MDT app was satisfying to use, and 91.2% (n = 31) indicated the app was "very appropriate" for measuring MoD. In addition, 84.2% (n =16) of practicing nurses indicated the app fit either "somewhat well" (47.4%, n = 9) or "very well" (36.8%, n = 7) into their typical workday, and 68.4% (n = 13) said they were either "extremely likely" or "somewhat likely" to use the app daily in clinical practice. KEY INSIGHTS AND NEXT STEPS: Education about moral distress and its associated causes proved important to the MDT app's success. It is ready for future validity and reliability testing, as well as examining usability beyond nursing, longitudinal data monitoring, and possible leveraging to pre- and postintervention evaluation studies.

The American Organization for Nursing Leadership (AONL) led a nationwide strategic initiative during 2022 to cull best practices and strategies for nurse leaders. Two key objectives were targeted: 1) to gain keen insights from nurse leaders through 2 nationwide surveys; and 2) to collect practice-led initiatives, which often are not included in searchable peer-reviewed literature. These practices were gathered in a compendium, organized into 7 sections, which is now available on the AONL website at aonl.org/compendium.

[This is an excerpt.] Workforce, specifically workplace violence, emotional health, and well-being continue to be top issues faced by nursing leaders every day. These were also the common themes I heard recently from nurses at the 2023 International Council of Nurses Congress in Montreal, Quebec, Canada. Through the isolation of the past few years, it was sobering to learn the United States is not alone in dealing with this workforce crisis. As we look at healthcare globally, we share more common challenges than differences. Although our health-systems and payment models vary from coun try to country, we are united in our workforce struggles. [To read more, click View Resource.]

[This is an excerpt.] We were pleased to read the article by Davis et al examining the association between burnout and professional milestone attainment for family medicine resident physicians.1 We were very surprised by the finding that, in their study of over 2500 family medicine residents, Black, Latinx, and Asian family medicine residents experience burnout at lower rates than their White peers. It defies logic that residents who identify as Black, Indigenous, or a Person of Color (BIPOC) experience lower levels of burnout when they are differentially and systematically burdened by experiences of discrimination, microaggressions, and inequitable access to mentorship and structured opportunity and lack of belonging compared to their non-BIPOC colleagues.2- 4 In the discussion, the authors did not have room to explore why burnout trends show the opposite of what we would expect to see. We offer the following insights as to why these findings might be valid, and we would welcome discussion from the authors on this finding. [To read more, click View Resource.]

BACKGROUND: Vaccination is an important component of the public health response to the pandemic, and a large health care system such as UCLA Health must optimize mechanisms to address questions from patients to expedite vaccine acceptance and administration. Local Problem In 2020-2021, COVID-19 vaccines were developed, studied, and approved at unusual speed, leading to both vaccine hesitancy and requests for urgent availability. This required up-to-date responses from physicians to questions through the online patient portal in the UCLA health care system. There was the additional risk of physician burnout due to the large number of questions. INTERVENTION: We developed a physician strike team that enabled accurate and timely dissemination of vaccine information in response to patient queries. The strike team served a dual purpose of answering patient questions quickly with accurate information, and reducing the workload for other physicians. Using a strike team of 10 early career physicians responding to a collection of patient messages, this large community-based health system was able to provide timely, high-quality responses to COVID-19 vaccine-related questions. RESULTS: After the introduction of the physician strike team program in late January 2021 through April 2021, there was a significant reduction in the average number of messages and calls received by covered providers per month compared to the adjusted number of messages and calls they would have received had the pool not existed. The strike team provided a service with high satisfaction scores from both the participating strike team members and the physicians being covered by the strike team. CONCLUSIONS: The success of this small physician strike team to impact inbasket patient messages and calls in our institution suggests that a similar mechanism can be developed to centralize the replies to certain messages, which may reduce the workload and burnout of physicians.

PURPOSE: Rates of burnout are high during medical training including psychiatric residency. This study examined the impact of improvisational theater training on psychiatry residents’ experiences of burnout and on several outcomes associated with improv training: tolerance of uncertainty, playfulness, and self-compassion. METHODS: Fourteen psychiatry residents with minimal background in improvisational theater participated either in an improv (N = 9) or comparison group (N = 5). The improv group met weekly in 2020 for four weeks in person and two additional weeks online. Surveys were administered before the program, after the first four weeks, and following the complete program. RESULTS: Nine residents participated in the improv program. Eight completed all follow up surveys (100%) as did all five non-participants (100%). Initial results indicated that improv contributed to residents’ self experienced well-being, either through reduced burnout or tolerance of uncertainty, increased playfulness, self-compassion, or some combination thereof. Residents reported that improv affected their work and life in general and that it differed substantially from other types of coursework in their psychiatric curriculum. CONCLUSIONS: This study, utilizing a relatively low-cost six-week program, suggests that improv can help psychiatry residents overcome burnout, increase tolerance of uncertainty, and enhance their playfulness, self- compassion, sense of joy, and connection to others.

RATIONALE AND OBJECTIVES: Few studies have examined what constitutes effective interventions to reduce burnout among radiologists. We compared self-reported burnout among academic medical center radiologists before and after a series of departmental initiatives intended to increase wellbeing and professional satisfaction. MATERIALS AND METHODS: This Institutional Review Board-approved, prospective study took place 2017-2019 in a tertiary academic medical center. In pre- (2017) and post-intervention (2019) periods, we administered the previously-validated Stanford Physician Wellness Survey to faculty in our 11-division radiology department. Faculty rated their burnout level across 8 domains (professional fulfillment, emotional exhaustion, interpersonal disengagement, sleep difficulties, self-compassion, negative work impact on personal relations, organizational/personal values alignment, perceived quality of supervisory leadership). Between the two surveys, departmental initiatives focusing on culture, team building, work-life balance, and personal well-being were implemented (e.g., electronic medical record training, shorter work hours). Pre- and post-survey results were compared, using Whitney-Mann U test to calculate Z scores. RESULTS: Faculty members rated lower professional fulfillment (Z-3.04, p=0.002), higher emotional exhaustion (Z=2.52, p=0.012), increased sleep-related impairment (Z=2.38, p=0.012), and reduced organizational/personal values alignment (Z=-4.10, p<0.0001) between the two surveys. No significant differences were identified associated with interpersonal disengagement (Z=1.82, p=0.069), self-compassion (Z=1.39, p=0.164), negative impact of work on personal relationship (Z=0.89, p=0.372) and perceived supervisory leadership quality (Z=0.07, p=0.942). CONCLUSION: Despite numerous departmental initiatives intended to improve culture, workplace efficiency, work-life balance, and personal wellness, self-reported burnout was unchanged or worsened over time.Physician and employee wellness embedded into institutional culture maybe more effective than departmental improvement initiatives.

BACKGROUND: The purpose of this work was to describe the experiences of EMS personnel in responding to drug overdose-related calls and the impact the pandemic has had to help better inform current response and treatment efforts. METHODS: Semi-structured interviews were conducted with 99 EMS personnel across 18 areas throughout the United States that were designated as Early Warning Network sentinel sites by the National Institute on Drug Abuse-funded National Drug Early Warning System. Participants were asked about topics including the potential burdens from the pandemic and the opioid crisis. We coded the interview responses and identifed themes through qualitative analysis. Multiple cycles of descriptive coding, recoding, subcoding, pattern-coding, and thematic coding of responses were conducted. RESULTS: Responses were categorized into the following themes: 1) being over-worked from increased call volume; 2) increased risk for personal harm when responding to patients; 3) compassion fatigue due to long hours and repeat calls for the same people; 4) conflicting perceptions of the utility of naloxone; 5) the need for better treatment options to respond to opioid crisis on top of COVID-19. CONCLUSIONS: The burden of the substance use disorder (SUD) crisis on EMS personnel has been compounded by the COVID-19 pandemic. These reports from EMS personnel throughout the US can help inform policy and procedures to better protect the mental health of EMS personnel and to ensure better care for patients with SUD. These experiences and recommendations may be of use for other countries as substance use and COVID-19 are global health issues.

OBJECTIVE: The primary objective of this qualitative study was to describe key themes discussed by student pharmacists and preceptors related to recognizing burnout and maintaining wellbeing during an experiential assignment. METHODS: This qualitative study used directed content analysis to examine themes that emerged from discussions between student pharmacists and preceptors as part of a required lifelong learning interview during Introductory Pharmacy Practice Experiences that took place between August 2019 and May 2020. Iterative axial coding was used to develop and redefine codes systematically until consensus was reached and a final codebook was established. All responses were coded using the consensus categories. RESULTS: From the 228 interviews analyzed, 3 overarching themes emerged: causes of burnout, manifestations or symptoms of burnout, and strategies to manage stress and burnout. Preceptors identified the mechanics of the job and feeling extreme pressure or worry as 2 major causes of burnout, which manifest as physical exhaustion, mental exhaustion, and poor work performance. To manage stress, preceptors reported using personal and work-positive coping strategies. CONCLUSION: The major themes derived from the analysis—causes of burnout, manifestations of burnout, and strategies to manage stress—align with what is already known about health care provider wellbeing. Although it remains unknown if this type of wellness intervention is effective at changing student stress management habits, results indicate that the intervention sparked conversations that could assist students in establishing a baseline of knowledge on the topic and supply students with a toolkit of resiliency strategies.

During recent years, police have suffered from job dissatisfaction, exhaustion, stress, and burnout; this issue has led to shortages of sworn police across the country. A high percentage of police officers leave the job in the first 5 years of service. A goal of this study was to discover how police investigators build resiliency to those challenging factors so that the individual can remain resilient despite exposure to adverse incidents and conditions that lead to severe stress and burnout. A generic qualitative method was used so that police investigators could share their lived experiences during their interviews and describe their beliefs, reflections, and opinions about their exposure to adversities on the job, and how they built resilience to those experiences. The target population for this study was police investigators who had more years of experience on the job than the less experienced sworn police members who were reportedly quitting the job from job-related dissatisfaction and burnout. The sample consisted of seven sworn police investigators from a small urban police department in the northeast region of the United States. I conducted semi-structured interviews of the seven participants, recorded the interviews using a Sony digital voice recorder, and used Descript transcription software to transcribe the audio recorded interviews to text. A thematic analysis approach was taken to find repeating patterns to identify five common themes from the collected data. These emerging themes were: (a) alcohol consumption used as a temporary coping strategy; (b) setting emotions aside; (c) family and nonlaw enforcement friends were perceived as not understanding: (d) exercise used as self-care method of effective coping; and (e) talking and venting to fellow law enforcement members as an effective coping method. During the interviews, the participants discussed several critical adverse incidents and conditions that caused stress and hardship for them. Through those shared experiences, I learned from the participants how they coped with those adversities and what helped them build resiliency.

Pharmacy residents are especially vulnerable to burnout given the professional and personal stressors associated with postgraduate training. Residency programs need to prioritize burnout reduction strategies to support resident health and well-being. This commentary describes a resident-preceptor collaborative approach to encourage wellness and reduce burnout within a large residency program at an academic medical center. Strategies that have been utilized include (1) fostering collaboration among residents and preceptors; (2) assessing resident interests and needs to ensure alignment; (3) leveraging available institutional and community resources; and (4) integrating initiatives within the existing residency program structure. This commentary aims to provide suggestions that can be implemented to address resident burnout for other residency programs, regardless of resource availability.

Women represent almost half of all practicing surgeons in the USA; however, women continue to struggle with achieving equity in compensation, recruitment, promotion, and work-life balance. A review of recent literature about gender disparities in medicine, with focus on trauma surgery, was performed to better understand the issues and seek solutions.

[This is an excerpt.] Sahni and Carrus (July 27 issue) assert that benefits of artificial intelligence (AI) in health care are unquestionable and that adoption has been too slow. They provide anecdotes and cite several single-institution, preliminary, or case studies but do not cite any of 39 randomized, controlled trials that were identified in a 2022 systematic review. Moreover, they do not discuss ethical concerns about the use of patient data to inform AI or such risks as displacing clinicians as the locus of health care decision making, despite expert acknowledgment of these problems. [ To read more, click View Resource.]

Burnout in the medical workforce is a growing global concern. Visual arts–based interventions can be a novel way to mitigate burnout and bolster resilience in medicine. Improving tolerance of ambiguity and uncertainty has been associated with decreased rates of burnout in clinicians. No known systematic review exists summarizing the evidence behind the use of visual arts–based interventions to mitigate burnout in clinicians. The authors conducted a systematic literature review of PubMed, EMBASE, and CINAHL in November 2022 using the terms: art, medicine, burnout, and uncertainty. The authors review the evidence for the effects of visual arts–based interventions on clinician burnout. The search identified 58 articles, of which 26 met study inclusion criteria and were assessed by 2 reviewers. These studies reported mixed methods assessments of changes in burnout, empathy, and stress. Overall, visual arts–based interventions promoted empathy, connectedness, and tolerance of ambiguity and had positive effects on burnout; however, some results were mixed. Visual arts–based interventions to mitigate burnout show promise, and additional research should focus on feasibility and longer-term outcomes.

Training and practicing physicians continue to experience burnout, poor job satisfaction / engagement, high stress, and even depression and suicide. With an understanding of effective and ineffective methods to improve wellness, our team aimed to collect publications with data on the effectiveness of physical activity interventions to address burnout and well-being in physicians. Comprehensive searches for articles related to the impact of exercise on physicians’ well-being were undertaken in March 2022 in PubMed, PsycINFO, and EMBASE. Of 2496 records identified in the databases, the team screened 1,287 and finalized 12 papers for inclusion and review. This study reviews the overall positive benefits of physical activity and exercise interventions in physicians. Despite the wide-ranging utility of an exercise prescription and despite clear evidence that physicians' personal exercise habits affect their patient counseling about exercise, this review shows that (often overburdened) physicians have insufficient physical activity, and are rarely included in studies targeting exercise. Many of the included studies had small sample sizes, leaving possibilities for future research aiming to augment physician wellness.

PURPOSE: Results of the 2022 ASHP National Survey of Pharmacy Practice in Hospital Settings are presented. METHODS: Pharmacy directors at 1,498 general and children’s medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. IQVIA supplied data on hospital characteristics; the survey sample was drawn from IQVIA’s hospital database. RESULTS: The response rate was 23.7%. Inpatient pharmacists independently prescribe in 27.1% of hospitals. Advanced analytics are used in 8.7% of hospitals. Pharmacists work in ambulatory or primary care clinics in 51.6% of hospitals operating outpatient clinics. Some level of pharmacy service integration is reported in 53.6% of hospitals. More advanced pharmacy technician roles are emerging. For health systems offering hospital at home services, 65.9% of pharmacy departments are involved. Shortages of pharmacists and technicians were reported but are more acute for pharmacy technicians. Aspects of burnout are being measured in 34.0% of hospitals, and 83.7% are attempting to prevent and mitigate burnout. The average number of full-time equivalents per 100 occupied beds is 16.9 for pharmacists and 16.1 for pharmacy technicians. CONCLUSION: Health-system pharmacies are experiencing workforce shortages; however, these shortages have had limited impact on budgeted positions. Workforce challenges are influencing the work of pharmacists and pharmacy technicians. Adoption of practice advancement initiatives has continued the positive trend from past years despite workforce issues.