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BACKGROUND: Burnout is costly to the healthcare system and is associated with medical error, absenteeism, and attrition. Emergency medical services (EMS) clinicians endure numerous stressors that predispose them to experience burnout. METHODS: An instrument was administered to licensed EMS clinicians recruited from 16 services across Massachusetts. The anonymous survey consisted of demographics, the Copenhagen Burnout Inventory (CBI) instrument, and 5-possibility Likert scales. Prevalence ratios were calculated to determine which demographic qualities and burnout-related factors were associated with increased CBI scores. RESULTS: In total, 386 EMTs were surveyed (62.2% male). The survey response rate was 21.4%. The mean CBI was 52.97 (SD 17.88). A positive burnout screen (CBI score = >50) was calculated for 55.4% of respondents. Respondents most often reported that inadequate compensation (87.5%) and high call volume (79.2%) contributed to perceived stress at work. Factors most associated with positive burnout screening amongst respondents were inadequate compensation (PR 5.8, CI 2.52–12.38, p < 0.001) and inadequate opportunity to process trauma (PR 2.88, CI 2.14–3.87, p < 0.001). CONCLUSION: Over half of the surveyed EMS population suffers from burnout, based on the CBI assessment tool. Factors contributing most to positive burnout screening include inadequate compensation and lack of opportunity to process trauma.

[This is an excerpt.] Resident-related research is pervasive throughout medical literature. Frequent areas of investigation include physical stress, burnout, and mental health. These critical studies aid in the improvement of curriculums, augmentation of resources, and over-all advancement of training programs. As a go-to convenience sample, residents are routinely approached to participate in a variety of studies during their training. These studies are frequently resident and faculty led, from within their current institution or those of potential future fellowship training or professional positions. Residents’ high-levels of education and in-depth knowledge of scientific practices belies the vulnerability of this captive group. The complexity of resident status within the hierarchy of graduate medical education structures and the factors motivating them to participate in scientific inquiry need to be investigated. Ethical considerations regarding residents’ diminished states of health during these intense years of training and the collection of health-related data should also be examined. In the current literature, issues related to coercion, collection of sensitive data, and participant risk are underdeveloped for resident participants in scientific study. [To read more, click View Resource.]

The COVID-19 pandemic altered work environments of nurses, yielding high rates of stress and burnout. Potential protective factors, including effective sleep, may influence psychological health and wellbeing. Evidence about sleep in nurses may help develop interventions that mitigate burnout and poor psychological outcomes. A cross sectional survey was distributed across three hospitals to nurses in New York City (NYC). During the first wave of the pandemic (March-April 2020), NYC had the highest incidence of laboratory-confirmed COVID-19 cases (915/100 000) and half of all COVID-related deaths nationwide. Multivariable logistic regression was used to determine associations between Pittsburgh Sleep Quality Index (PSQI) global sleep score, PSQI sleep dimensions, and psychological health (burnout, depression, anxiety, and compassion fatigue), unadjusted and then controlling for individual and professional characteristics. More than half of the participants reported burnout (64%), depression, (67%), and anxiety (77%). Eighty percent of participants had PSQI global scores >5 (poor sleep) (mean 9.27, SD 4.14). Respondents reporting good sleep (PSQI less than or equal to 5) had over five times the odds of no burnout (OR: 5.65, 95% CI: 2.60, 12.27); increased odds of screening negative for depression (OR: 6.91, 95% CI: 3.24, 14.72), anxiety (OR: 10.75, 95% CI: 4.22, 27.42), and compassion fatigue (OR: 7.88, 95% CI: 1.97, 31.51). Poor subjective sleep quality PSQI subcomponent was associated with burnout (OR: 2.21, 95% CI: 1.41, 3.48) but sleep duration subcomponent was not (OR: 0.84, 95% CI: 0.59, 1.19). Daytime dysfunction was significantly associated with all psychological outcomes. Sleep disturbances and medications yielded higher anxiety odds. Overall, sleep quality appears more strongly related to burnout than sleep duration in nurses working during the COVID-19 pandemic. Sleep interventions should target individual sleep dimensions in nurses.

INTRODUCTION: Student well-being is a growing area of interest, though existing literature assessing multiple areas of well-being is lacking. This study aimed to evaluate the well-being of pharmacy students corresponding to three well-being domains (physical health, mental health, personal well-being and burnout) and identify characteristics associated with these domains. METHODS: An online survey adapted from various instruments was disseminated to pharmacy students from 11 pharmacy programs. Survey responses were compared using basic descriptive statistics, and Pearson's chi-Square was used for association analyses. RESULTS: Eight hundred thirty-six students from responded to the survey (24.3% response rate). For physical health, 59.3% of students reported sleeping <7  hours per night and 60.4% reported exercising 1 to 5  hours per week. For mental health, 24.8% of students screened positive for depression and 42% screened positive for anxiety. Lastly, 65.9% of students were at risk for decreased well-being and 63.7% for burnout. Based on association analyses, gender and pharmacy year were associated with screening positive for anxiety and burnout, gender was associated with decreased well-being, and relationship status was associated with screening positive for depression. CONCLUSIONS: This study revealed pharmacy students are at risk for lack of sleep and exercise, depression or anxiety, decreased well-being, and burnout. Also, several characteristics were found to be associated with these negative well-being outcomes. Although response rate and participant demographics could impact the generalizability of these findings, findings further increase awareness about student well-being and inform pharmacy programs supporting well-being by better understanding student risks.

BACKGROUND: Research has not explicitly explored differences between male and female microvascular head and neck (MHN) surgeon burnout, which should be identified and addressed to ensure career satisfaction and longevity. OBJECTIVE: To measure and compare the prevalence of burnout among male versus female MHN surgeons. METHODS: A prospective questionnaire based on the Maslach Burnout Inventory (MBI) was distributed through a web-based survey to the American Association of Facial Plastic and Reconstructive Surgeons and American Head and Neck Society in 2021 and 2022. Additional variables collected included demographics, relationship and parental status, academic rank, annual salary, and COVID-19-related questions. RESULTS: One hundred thirteen surveys were collected. Twenty-nine (25.7%) were women and all completed MHN surgery fellowships. Women trended toward more emotional exhaustion than men (2.8 mean MBI vs. 2.3 mean MBI) but reported similar personal achievement (4.8 mean MBI vs. 4.9 mean MBI). Men experienced less workplace sexual harassment (p < 0.001). Women experienced more burnout (69% vs. 39%, p = 0.006) during the COVID-19 pandemic. CONCLUSION: Female MHN surgeons reported in this survey to experience more workplace sexual harassment and higher COVID-19-related burnout than their male counterparts.

OBJECTIVE: To assess associations of adverse childhood experiences (ACEs) and adverse occupational experiences (AOEs) with depression and burnout in US physicians. PARTICIPANTS AND METHODS: We performed a secondary analysis of data from a representative sample survey of US physicians conducted between November 20, 2020, and March 23, 2021, and from a probability-based sample of other US workers. The ACEs, AOEs, burnout, and depression were assessed using previously published measures. RESULTS: Analyses included data from 1125 of the 3671 physicians (30.6%) who received a mailed survey and 6235 of 90,000 physicians (6.9%) who received an electronic survey. The proportion of physicians age 29-65 who had lived with a family member with substance misuse during childhood (673 of 5039[13.4%]) was marginally lower (P <.001) than that of workers in other professions (448 of 2505 [17.9%]). The proportion of physicians age 29-65 who experienced childhood emotional abuse (823 of 5038 [16.3%]) was similar to that of workers in other professions (406 of 2508 [16.2%]). The average physician depression T-score was 49.60 (raw score ± SD, 6.48±3.15), similar to the normed US average. The AOEs were associated with mild to severe depression, including making a recent significant medical error (odds ratio [OR], 1.64; 95% CI, 1.33 to 2.02, P<.001), being named in a malpractice suit (OR, 1.30; 95% CI, 1.07 to 1.59, P=.008), and experiencing one or more coronavirus disease 2019-related AOEs (OR, 1.76; 95% CI, 1.56 to 1.99, P<.001). Having one or more ACEs was associated with mild to severe depression (OR, 1.58; 95% CI, 1.38 to 1.79, P<.001). The ACEs, coronavirus disease 2019-related AOEs, and medical errors were also associated with burnout. CONCLUSION: Assessing ACEs and AOEs and implementing selective primary prevention interventions may improve population health efforts to mitigate depression and burnout in physicians.

PURPOSE/OBJECTIVES: Case management in Veterans Affairs (VA) depends on leadership skills such as effective communication, excellent resource management, self-governance, patient advocacy, and a distinctly professional attitude. VA registered nurses (RNs) and social workers (SWs) also provide case management services, a role and service, which is pivotal to veteran satisfaction and effective health care coordination. The leader-follower framework (LF2) was used to assess and compare the responses of RNs, SWs, and case managers (CMs) on the annual VA All Employee Survey (AES) to provide insight regarding VA case management performance, which has influenced veteran satisfaction. PRIMARY PRACTICE SETTING: VA CMs work in a variety of clinical settings, which, in recent years, includes the use of telehealth modalities because of COVID-19. VA CMs remain flexible working in environments where and when veterans require their services while promoting safe, effective, and equitable health care services. FINDINGS/CONCLUSIONS: RNs and SWs indicated greater agreement and satisfaction scores in 2019 compared with 2018 on questions related to the leadership element of character and questions regarding mutual respect between VA senior leaders and the respondents. In contrast, RNs and SWs indicated less agreement and satisfaction scores on questions related to the leadership elements of competence, context, communication, personal, interpersonal, team, organizational, and greater burnout in 2019 than in 2018. RN response scores in 2018 and 2019 were greater and burnout scores were less than SWs. Additionally, the one-way analysis of variance indicated no difference for RNs and SWs who were performing the duties of a CM. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The responses of RNs indicated greater satisfaction and less burnout than SWs and were consistent whether RNs and SWs were in case management roles or not. These are important findings and concerning trends warranting further discussion and research. © 2023 Lippincott Williams and Wilkins. All rights reserved.

OBJECTIVES: Second victim syndrome refers to the negative mental and emotional after-effects physicians may experience after adverse patient outcomes. We evaluated the impact of second victim status on physician self-efficacy, burnout, perceived stress, and sleep patterns.

METHODS: Physicians at a university hospital voluntarily participated in an anonymous, survey which included second victim status, General Self-Efficacy Scale (GSE), Copenhagen Burnout Inventory (CBI), Perceived Stress Scale (PSS), and Insomnia Severity Index. The total possible survey points were: GSE, 40; CBI, 95; PSS, 40; and Insomnia Severity Index, 28. The Student t test for independent samples and Mantel-Haenszel were used to compare second victim with nonsecond victims.

RESULTS: Of the 115 respondents, 85 (74%) provided second victim status: 48% female, 93% non-Hispanic White, 35% surgeons, and 53% in practice for more than 20 years. There were 24 (28%) self-reported second victims. Demographics were similar between groups. GSE scores were comparable: second victim versus nonsecond victim: 31.4 vs 32.6 (P = .13), but fewer second victims reported that they could accomplish their goals (79.2 vs 88.7%; P = .03). Overall, 56% of physicians had CBI scores consistent with moderate burnout. Mean CBI scores were similar for both groups 56.6 vs 52.4; P = .17). Work-related burnout (22.9 vs 21.9; P = .44) and personal burnout (18.9 vs 17.3; P = .17) were comparable, but second victims more commonly reported patient-related burnout (15.3 vs 12.9; P = .039). Second victims responded often or always more frequently to questions regarding patients being hard to work with (8.3% vs 1.6%; P = .03), frustrating (12.5% vs 3.3%; P = .02), draining energy (16.7% vs 5%; P = .018), or wondering how long they could continue to work with patients (16.7% vs 11.5%; P = .039). There was no difference in mean PSS for lack of control (11.7 vs 10.5; P = .28) or ability to cope with existing stressors (10.0 vs 10.6; P = .34). Mean insomnia scores were comparable (9.4 vs 7.7; P = .22), but second victims experienced problems with waking too early more often (29.2% vs 14.5%; P = .01). Official debriefing and individualized counseling or coaching to cope with the event were top resources desired by second victims (54%). Mandatory time off or mandatory meetings with a psychiatrist or psychologist were least favored (8%).

CONCLUSIONS: More than 25% of physicians have experienced second victim sequalae, which do not distinguish by demographics. Despite high-level GSE, moderate burnout was present in more than 50% of physicians, irrespective of second victim status. Patient-related burnout was particularly evident among second victims. These numbers are alarming and should be addressed promptly by medical societies and hospitals. A valuable starting point may be offering individualized counseling for all physicians.

Work environments and practice structural features are associated with both burnout and the ability of practices to enhance quality of care.To characterize factors associated with primary care practices successfully improving quality scores without increasing clinician and staff burnout.This cross-sectional study assessed small- to medium-sized primary care practices that participated in the EvidenceNOW: Advancing Heart Health initiative using surveys that were administered at baseline (September 2015 to April 2017) and after the intervention (January 2017 to October 2018). Data were analyzed from February 2022 to January 2023.The primary outcome of being a quality and well-being positive deviant practice was defined as a practice with a stable or improved percentage of clinicians and staff reporting burnout over the study period and with practice-level improvement in all 3 cardiovascular quality measures: aspirin prescribing, blood pressure control, and smoking cessation counseling.Of 727 practices with complete burnout and aspirin prescribing, blood pressure control, and smoking cessation counseling data, 18.3% (n = 133) met the criteria to be considered quality and well-being positive deviant practices. In analyses adjusted for practice location, accountable care organization and demonstration project participation, and practice specialty composition, clinician-owned practices had greater odds of being a positive deviant practice (odds ratio, 2.02; 95% CI, 1.16-3.54) than practices owned by a hospital or health system.In this cross-sectional study, clinician-owned practices were more likely to achieve improvements in cardiovascular quality outcomes without increasing staff member burnout than were practices owned by a hospital or health system. Given increasing health care consolidation, our findings suggest the value of studying cultural features of clinician-owned practices that may be associated with positive quality and experience outcomes.

[This is an excerpt.] The prevalence of burnout among physicians increased in parallel with the COVID-19 pandemic. Despite disruptions in medical education, studies suggest that burnout among medical students has remained stable in recent years. We analyzed data from the 2019 to 2021 Association of American Medical Colleges (AAMC) Graduation Questionnaire, which is administered to graduating US medical school students, and data on COVID-19 cases and COVID-19–related deaths in the schools’ surrounding communities to explore the association between COVID-19 intensity in the clinical learning environment and student burnout and residency preparedness. [To read more, click View Resource.]

BACKGROUND: Stressors for health care workers (HCWs) during the COVID-19 pandemic have been manifold, with high levels of depression and anxiety alongside gaps in care. Identifying the factors most tied to HCWs’ psychological challenges is crucial to addressing HCWs’ mental health needs effectively, now and for future large-scale events. OBJECTIVE: In this study, we used natural language processing methods to examine deidentified psychotherapy transcripts from telemedicine treatment during the initial wave of COVID-19 in the United States. Psychotherapy was delivered by licensed therapists while HCWs were managing increased clinical demands and elevated hospitalization rates, in addition to population-level social distancing measures and infection risks. Our goal was to identify specific concerns emerging in treatment for HCWs and to compare differences with matched non-HCW patients from the general population. METHODS: We conducted a case-control study with a sample of 820 HCWs and 820 non-HCW matched controls who received digitally delivered psychotherapy in 49 US states in the spring of 2020 during the first US wave of the COVID-19 pandemic. Depression was measured during the initial assessment using the Patient Health Questionnaire-9, and anxiety was measured using the General Anxiety Disorder-7 questionnaire. Structural topic models (STMs) were used to determine treatment topics from deidentified transcripts from the first 3 weeks of treatment. STM effect estimators were also used to examine topic prevalence in patients with moderate to severe anxiety and depression. RESULTS: The median treatment enrollment date was April 15, 2020 (IQR March 31 to April 27, 2020) for HCWs and April 19, 2020 (IQR April 5 to April 27, 2020) for matched controls. STM analysis of deidentified transcripts identified 4 treatment topics centered on health care and 5 on mental health for HCWs. For controls, 3 STM topics on pandemic-related disruptions and 5 on mental health were identified. Several STM treatment topics were significantly associated with moderate to severe anxiety and depression, including working on the hospital unit (topic prevalence 0.035, 95% CI 0.022-0.048; P<.001), mood disturbances (prevalence 0.014, 95% CI 0.002-0.026; P=.03), and sleep disturbances (prevalence 0.016, 95% CI 0.002-0.030; P=.02). No significant associations emerged between pandemic-related topics and moderate to severe anxiety and depression for non-HCW controls. CONCLUSIONS: The study provides large-scale quantitative evidence that during the initial wave of the COVID-19 pandemic, HCWs faced unique work-related challenges and stressors associated with anxiety and depression, which required dedicated treatment efforts. The study further demonstrates how natural language processing methods have the potential to surface clinically relevant markers of distress while preserving patient privacy.

OBJECTIVE: To examine the relationship of work schedules with nurse turnover across various work settings. METHODS: A cross-sectional study design was used with data collected from 17,046 nurses who participated in the 2018 National Sample Survey of Registered Nurses in the U.S. Multivariate logistic regression was used to examine the effects of work hours and overtime on nurse turnover. RESULTS: Longer weekly work hours increased nurse turnover (OR = 1.104, 95% confidence interval [CI] = 1.006–1.023). A non-linear relationship was observed between overtime and turnover. Compared with nurses with no overtime, the turnover for nurses working 1–11 h overtime per week decreased (OR = 0.893, 95% CI = 0.798–0.999). When nurses worked ≥12 h, turnover increased (OR = 1.260, 95% CI = 1.028–1.545). Earning from the primary nursing position decreased turnover among nurses working in hospitals, other inpatient settings, and clinics. Job satisfaction decreased turnover. CONCLUSIONS: To prevent nurse turnover, it is important to monitor and regulate nurses’ working hours at institutional and government levels. Government support and policy implementations can help prevent turnover.

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This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Support & Ensure Safe Staffing)

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RATIONALE: Burnout is a personal and occupational phenomenon that has been associated with negative physical and psychological outcomes in medical staff. Additionally, there are implications for healthcare organizations, as those staff who are burned out are more likely to have lower productivity or leave the organization. As with the Covid-19 pandemic, future national emergencies and potentially large-scale conflicts will require similar and likely even larger scale responses from the U.S. Military Health System, thus it is important to understand burnout in this population so that the readiness of the staff and the military can remain at a high level. OBJECTIVE: This assessment was designed to examine levels of burnout among United States Military Health System (MHS) staff working at Army installations and the factors that influence the development of burnout. METHODS: Anonymous data was collected from 13,558 active-duty U.S. Soldiers and civilian MHS employees. burnout was measured using the Copenhagen burnout Inventory and the Mini-Z. RESULTS: Results showed nearly half of staff who responded (48%) reported being burned out, an increase since last measured in 2019 (31%). Factors related to increased burnout included concerns about work/life balance and workload, low job satisfaction and feeling disconnected from others. burnout was associated with increases in adverse physical and behavioral health (BH) outcomes. CONCLUSIONS: Results indicate that burnout is a common problem across MHS Army staff and is related to significant adverse health consequences for the individual and reduced retention of staff for the organization. These findings highlight the need to address burnout through policies that standardize health care delivery policies and practices, providing support to leadership to promote a healthy workplace, and individual support to those who experience burnout.

BACKGROUND: Burnout is a growing problem among medical professionals, reaching a crisis proportion. It is defined by emotional exhaustion, cynicism, and career dissatisfaction and is triggered by a mismatch between the values of the person and the demands of the workplace. Burnout has not previously been examined thoroughly in the Neurocritical Care Society (NCS). The purpose of this study is to assess the prevalence, contributing factors, and potential interventions to reduce burnout within the NCS. METHODS: A cross-sectional study of burnout was conducted using a survey distributed to members of the NCS. The electronic survey included personal and professional characteristic questions and the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI). This validated measure assesses for emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). These subscales are scored as high, moderate, or low. Burnout (MBI) was defined as a high score in either EE or DP or a low score in PA. A Likert scale (0–6) was added to the MBI (which contained 22 questions) to provide summary data for the frequencies of each particular feeling. Categorical variables were compared using χ2 tests, and continuous variables were compared using t-tests. RESULTS: A total of 82% (204 of 248) of participants completed the entire questionnaire; 61% (124 of 204) were burned out by MBI criteria. A high score in EE was present in 46% (94 of 204), a high score in DP was present in 42% (85 of 204), and a low score in PA was present in 29% (60 of 204). The variables feeling burned out now, feeling burned out in the past, not having an effective/responsive supervisor, thinking about leaving one’s job due to burnout, and leaving one’s job due to burnout were significantly associated with burnout (MBI) (p < 0.05). Burnout (MBI) was also higher among respondents early in practice (currently training/post training 0–5 years) than among respondents post training 21 or more years. In addition, insufficient support staff contributed to burnout, whereas improved workplace autonomy was the most protective factor. CONCLUSIONS: Our study is the first to characterize burnout among a cross-section of physicians, pharmacists, nurses, and other practitioners in the NCS. A call to action and a genuine commitment by the hospital, organizational, local, and federal governmental leaders and society as a whole is essential to advocate for interventions to ameliorate burnout and care for our health care professionals.

INTRODUCTION: The personality traits of those who become orthopaedic surgeons may also lead to overwork, work-life balance issues, and burnout. Health and wellness practices of orthopaedic surgeons have not been widely explored. This study evaluated the personal health habits, wellness, and burnout of practicing orthopaedic surgeons in the United States. METHODS: An anonymous self-assessment survey was completed by 234 practicing orthopaedic surgeon alumni from two large residency programs. The survey assessed exercise habits according to Centers for Disease Control and Prevention recommendations, compliance with preventive medical care practices according to the United States Preventive Services Task Force, prioritization of occupational wellness strategies, and the presence of burnout via an adapted Maslach Burnout Inventory. Survey responders' mean age was 52 years, 88% were male, and 93% had a body mass index <30 kg/m2. Surgeons were stratified according to practice type, years in practice, and subspecialty. RESULTS: Among orthopaedic surgeons, compliance with aerobic and strength exercise recommendations was 31%. Surgeons in academic practice were significantly (P = 0.007) less compliant with exercise recommendations (18%) compared with private (34%) or employed (43%) practicing surgeons. Most (71%) had seen their primary care provider within 2 years and were up to date on age-appropriate health care screening including a cholesterol check within 5 years (79%), colonoscopy (89%), and mammogram (92%). Protecting time away from work for family/friends and finding meaning in work were the most important wellness strategies. The overall burnout rate was 15% and remained not significantly different (P > 0.3) regardless of years in practice, practice type, or subspecialty. CONCLUSION: This survey study identifies practicing orthopaedic surgeons' health habits and wellness strategies, including limited compliance with aerobic and strength exercise recommendations. Orthopaedic surgeons should be aware of areas of diminished personal wellness to improve quality of life and avoid burnout.

OBJECTIVE: This systematic review and meta-analysis aims to explore overall prevalence of burnout among physicians during early and late COVID-19 pandemic and geographical differences in burnout. METHODS: This review was registered prospectively with PROSPERO (CRD42022327959). A comprehensive search of several databases, including Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, PsycINFO, and Scopus, spanning from December 2019 to May 2022 was conducted. Eligible studies included physicians or medical professionals including physicians that worked directly or indirectly with COVID-19 patients, whilst reporting burnout outcomes using a validated scale. Literature that did not include physicians or did not occur in a hospital setting were excluded. Literature including medical students were also excluded. RESULTS: Forty-five observational studies were included, all of which were cross-sectional studies. The pooled estimate of overall prevalence of burnout was 54.60% (95% CI: 46.7, 62.2). Mean emotional exhaustion, depersonalization, and personal accomplishment was found to be 22.06% (95% CI: 18.19, 25.94), 8.72 (95% CI: 6.48, 10.95) and 31.18 (95% CI: 27.33, 35.03) respectively. Frontline workers displayed higher rates of burnout than second-line healthcare workers (HCW) (OR: 1.64, 95% CI: 1.13, 2.37). Studies from the early pandemic period reported burnout prevalence of 60.7% (95% CI: 48.2, 72) compared to a prevalence of 49.3% (95% CI: 37.7, 60.9) from the late pandemic period. Geographically, burnout was highest amongst Middle East and North Africa (MENA) studies (66.6%, 95% CI: 54.7, 78.5), followed by Europe (48.8%, 95% CI: 40.3, 57.3) and then South America (42%, 95% CI: –0.4, 84.4). Lastly, burnout prevalence overall (OR = 0.77, 95% CI: 0.36, 1.67) emotional exhaustion (MD = –0.36, 95% CI: –4.64, 3.91), depersonalization (MD = –0.31, 95% CI: –1.80, 1.18), and personal accomplishment (MD = 0.55, 95% CI: –0.73, 1.83) were found comparable between physicians and nurses. CONCLUSION: COVID-19 has had significant consequences on HCW burnout. Further research is needed to examine early signs of burnout and to develop effective coping strategies.

BACKGROUND: Weighing implications of multiple intensive cancer-directed therapies over time, oncology nurses are more prone to intrinsic distress compared to nurses in non-oncologic settings. This vulnerability may give rise to moral distress. Yet, little is known about moral distress experiences of oncology nurses. OBJECTIVE: This systematic review and meta-analysis examined the frequency and intensity of moral distress among oncology nurses with an exploratory focus on nurse-level and work-related characteristics. METHODS: We conducted a systematic search of 7 electronic databases (2000–2020) supplemented by hand-search strategy. Means and standard deviations of moral distress scores in the included studies were extracted and pooled in our meta-analysis. RESULTS: Our sample of 8 cross-sectional studies consisting of 2686 participants with 1654 oncology nurses met criteria for inclusion. A random-effects model was used in our meta-analysis given considerable heterogeneity. Our results suggest that moral distress was of low to moderate frequency, but of high intensity. Moral distress among oncology nurses was a significant predictor for burnout, provider communication, decisions surrounding end-of-life care, work conditions (eg, patient assignment, type of unit), and inability to provide compassionate care. CONCLUSION: Moral distress in oncology nurses is associated with burnout syndrome, compassion fatigue, and secondary traumatic stress syndrome, all of which are linked to poor patient care and outcomes. Robust psychological well-being is critical in minimizing unintended consequences of moral distress. IMPLICATIONS FOR PRACTICE: Oncology nurses are at high risk for moral distress due to the nature of their work. Future studies should examine the prevalence among oncology nurses to help inform targeted interventions.

Ambulance services are changing, and the SARS-CoV-2 pandemic has been a major challenge in the past three years. Job satisfaction and work engagement are important characteristics for a healthy organization and success in one’s profession. The purpose of the current systematic review was to evaluate the predictors of job satisfaction and work engagement in prehospital emergency medical service personnel. Electronic databases, such as PubMed, Ovid Medline, Cochrane Library, Scopus, Web of Science, PsycINFO, PSYNDEX, and Embase, were utilized in this review. Predictors (ß coefficient, odds ratio, rho) of higher job satisfaction and work engagement were examined. Only prehospital emergency medical service personnel were considered. The review included 10 studies worldwide with 8358 prehospital emergency medical service personnel (24.9% female). The main predictor for job satisfaction was supervisors’ support. Other predictors were younger or middle age and work experience. Emotional exhaustion and depersonalization, as burnout dimensions, were negative predictors for higher job satisfaction or work engagement. Quality demands for health care systems are a significant challenge for future emergency medical services. The psychological and physical strengthening of employees is necessary and includes constant supervision of managers or facilitators.

This systematic review investigates the association between coping strategies and burnout in emergency workers. Three electronic databases were searched. Eleven eligible articles were extracted, and quality assessed. Findings were integrated through narrative synthesis, highlighting clear methodological issues around conceptualizing, and measuring coping strategies and burnout with agreed upon tools. This review found no convincing evidence to suggest coping strategies have a meaningful relationship with burnout in emergency workers, questioning the evidence base for psychological interventions focusing on modifying coping strategies to target burnout. To understand the true impact of coping strategies on burnout, more longitudinal designs, and an agreed, validated measure for coping is needed.