Resource Library

[This is an excerpt.] The incidence and impact of burnout among physicians are of ever-increasing concern. Burnout is characterized by emotional exhaustion, depersonalization, and an impaired sense of personal accomplishment caused by work-related stress. The data consistently reveal that among physicians, surgeons are at a substantially increased risk of burnout. Thus, for the benefit of ourselves, our colleagues, our trainees, and our patients, it is paramount that we tackle the subject of burnout, specifically its prevention and management, with thoughtfulness and rigor. [To read more, click View Resource.]

OBJECTIVE: Explore the relevant evidence about stress-related cognitive appraisal and coping strategies among registered nurses in the emergency department (EDRNs) coping with the COVID-19 pandemic. METHODS: This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus electronic databases for related studies from inception through February 2, 2022. This review further conducted study selection based on the PRISMA flow diagram and applied Lazarus and Folkman's Psychological Stress and Coping Theory to systematically organize, summarize, and report the findings. FINDINGS: Sixteen studies were included for synthesis. Most of the studies showed that the majority of EDRNs were overwhelmed by the COVID-19 pandemic. Depression, triaging distress, physical exhaustion, and intention to leave ED nursing were cited as major threats to their wellness. Additionally, comprehensive training, a modified triage system, a safe workplace, psychological support, promotion of resilience, and accepting responsibility may help EDRNs cope with pandemic-related challenges effectively. CONCLUSION: The long-lasting pandemic has affected the physical and mental health of EDRNs because they have increased their effort to respond to the outbreak with dynamically adjusted strategies. Future research should address a modified triage system, prolonged psychological issues, emergency healthcare quality, and solutions facing EDRNs during the COVID-19 or related future pandemics. CLINICAL RELEVANCE: EDRNs have experienced physical and psychological challenges during the pandemic. The ED administrators need to take action to ensure EDRNs' safety in the workplace, an up-to-date triage system, and mental health of frontline nurses to provide high-quality emergency care for combating COVID-19.

Nurses are a critical part of the health care system. Yet the nursing profession continually faces shortages in all specialties. Several causes and issues of concern related to the nursing shortage in nephrology are discussed, including the prevalence of kidney disease and its increasing number of associated comorbidities, which has also heightened the urgent need for nephrology nurses. Data have shown that the lack of nephrology nurses caring for patients with kidney disease impacts patient outcomes and nephrology nurse burnout. Strategies must be implemented to manage these growing needs that affect both patient outcomes and nurse staffing. This article aims to identify methods to combat the nursing shortage, promote recruitment and retention strategies for nephrology nurses, and discuss leadership issues related to the topic.

[This is an excerpt.] Burnout is used to describe the cognitive and emotional responses of practitioners to chronic emotional and interpersonal stress. Operating room nurses are a group engaged in nursing professions in special environments. Due to the long-term high-intensity and fast-paced work, professional mental and physical labour are also required, which can easily lead to job burnout of nurses (Li et al., 2021). We read with great interest a recent article in Journal of Advanced Nursing on burnout in operating room nurses and the relevance of potential traumatic events (Wang et al., 2022). The authors explored and compared the association between potential job-related traumatic events and burnout among operating room nurses under three different statistical approaches. [To read more, click View Resource.]

OBJECTIVE: To determine the effectiveness of communication training and its impact on burnout among healthcare providers (physicians, physician assistants, nurse practitioners), in the setting of the COVID-19 pandemic. METHODS: To evaluate the effectiveness of communication training on burnout during the COVID-19 pandemic, healthcare providers participating in a Communication in Healthcare (CIH) module between October 31, 2019, through February 20, 2020, were identified using a scanned sign-in sheet. A 3-question online survey regarding the utilization of communication skills during the COVID-19 pandemic was sent via email. An ordinal scale was used to rate the effectiveness of the training on subsequent burnout and work satisfaction during the pandemic. RESULTS: Of the 98 surveys distributed via email, a total of 33 participants completed the survey. Seventy-three percent of respondents agreed that communication training helped prevent burnout, and 39% strongly agreed that the modules improved work satisfaction. CONCLUSION: Our study found communication training was effective in reducing burnout in healthcare providers, in the setting of the COVID-19 pandemic. The participants felt the communication tools learned from the training modules were useful in improving work satisfaction and communication with patients during the pandemic.

This case-control study investigates the association between a communication and optimal resolution program to address unexpected adverse patient outcomes and measures of health care worker satisfaction.

[This is an excerpt.] I will always remember the first time I interviewed a patient with suicidal ideation. I (P.A.) was a third-year medical student on my pediatrics rotation. The patient was a teenager recently admitted to our service for an intentional overdose. I was a few months into my clinical clerkships, already feeling the exhaustion of perpetually changing services, preceptors, and expectations. [To read more, click View Resource.]

BACKGROUND: Nurses have been identified as the most vulnerable health care profession to experience compassion fatigue. Currently, not much is known about the availability and credibility of online compassion fatigue resources for nurses. This systematic review of consumer websites explores the prevalence and quality of compassion fatigue educational resources available online to nurses. METHOD: A descriptive, cross-sectional, nonexperimental design was used. Findings were collected from the websites of the top 20 hospitals in the United States, all professional nursing organizations in the United States, and the top three most used social media platforms. Web-sites were evaluated for quality using the Journal of the American Medical Association (JAMA) benchmarks and Health on the Net Foundation certification. RESULTS: A total of 143 websites were evaluated. Of these, three websites were identified as having the most credible, comprehensive educational resources on compassion fatigue. CONCLUSION: There is a need for more hospitals, professional nursing organizations, and social media websites to provide high-quality compassion fatigue educational resources for nurses.

A descriptive study of the impact of the COVID-19 pandemic on non-direct care nurses

PURPOSE: The purpose of this study was to validate the Stanford Professional Fulfillment Index (PFI) for assessment of burnout and professional fulfillment in a study population of pharmacy residents and residency preceptors. SUMMARY: The historical gold standard for assessing professional burnout is the Maslach Burnout Inventory (MBI); there is no established standard for professional fulfillment. The PFI is a 16-question assessment that has previously been validated in medical residents and practicing physicians. In this study, surveys including both PFI and MBI items were sent to active pharmacy residents and residency preceptors. To determine concurrent validity, domains of the PFI were compared to the closest related MBI domain as well as composite burnout rates measured in each portion of the survey. A total of 142 preceptors and 68 residents completed both the PFI and a version of the MBI previously validated in physicians. In assessing indicators of pharmacist burnout and fulfillment, data captured by domains of the PFI closely correlated with data captured by corresponding domains of the MBI (Pearson correlations of 0.683-0.822), with high internal consistency (Cronbach α of 0.866-0.903). CONCLUSION: The PFI is a valid method of assessing burnout in both pharmacy residents and residency preceptors. Additionally, the PFI contributes a reliable system of assessing professional fulfillment while also being highly accessible for both research and residency program monitoring applications.

Research conducted by NACE and The Center for the Study of HBCUs underscores how important it is for companies to conduct audits to assess gaps and inequities in their recruiting efforts.

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

Emergency Medical Services (EMS) clinicians provide patient care within a high-stakes, unpredictable, and complex work environment in which conflict is inevitable. Our objective was to explore the extent to which added stressors of the pandemic exacerbated EMS workplace conflict. We administered our survey to a sample of U.S. nationally certified EMS clinicians during the COVID-19 pandemic in April 2022. Out of 1881 respondents, 46% (n = 857) experienced conflict and 79% (n = 674) provided free-text descriptions of their experience. The responses were analyzed for themes using qualitative content analysis, and they were then sorted into codes using word unit sets. Code counts, frequencies, and rankings were tabulated, enabling quantitative comparisons of the codes. Of the fifteen codes to emerge, stress (a precursor of burnout) and burnout-related fatigue were the key factors contributing to EMS workplace conflict. We mapped our codes to a conceptual model guided by the National Academies of Sciences, Engineering, and Medicine (NASEM) report on using a systems approach to address clinician burnout and professional well-being to explore implications for addressing conflict within that framework. Factors attributed to conflict mapped to all levels of the NASEM model, lending empirical legitimacy to a broad systems approach to fostering worker well-being. Our findings lead us to propose that active surveillance (enhanced management information and feedback systems) of frontline clinicians’ experiences during public health emergencies could increase the effectiveness of regulations and policies across the healthcare system. Ideally, the contributions of the occupational health discipline would become a mainstay of a sustained response to promote ongoing worker well-being. The maintenance of a robust EMS workforce, and by extension the health professionals in its operational sphere, is unquestionably essential to our preparedness for the likelihood that pandemic threats may become more commonplace.

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This resource is found in our Actionable Strategies for Public Safety Organizations: Drivers (Operational Breakdown)

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BACKGROUND: Due to exposure to overwhelming work stressors, approximately half of emergency department (ED) physicians and nurses experience burnout, leading to lower productivity, lower quality of care, higher risk of medical errors, higher rates of absenteeism, and eventually turnover. Growing evidence suggests that the physical environment can be leveraged to support healthcare workers' well-being. OBJECTIVES: This study aimed to identify (1) self-care behaviors that healthcare workers engage in to help them cope with job-related stress, (2) where they engage in those behaviors, (3) attributes of the built environment that may support coping behaviors. METHODS: A mixed-methods study was conducted in three EDs, using online questionnaires (n = 85) and interviews (n = 20). RESULTS: Job-related stress was derived from interruptions, workload and inability to take breaks, insufficient workspace, lack of privacy, unpredictability of EDs, and security concerns. Talking with a colleague, getting something to eat or drink, listening to music, and taking a walk were considered destressing activities. The bathroom was considered a place for destressing by the majority of participants, followed by outside areas, physician-only areas, and care team stations. Supportive environmental features included sufficient workspace, maximized privacy, reduced noise and clutter, controlled temperature and lighting, spaces for decompressing, spaces for documentation, close-by breakrooms with enough eating space and massage chairs, chairs with back support, standing desks, food options, and convenient bathrooms. CONCLUSIONS: Design decisions play an important role in supporting stress reduction among healthcare workers. This study provides several strategies to achieve this aim.

Correctional officers (COs) working in county-level jails are shouldered with important responsibilities designed to maintain institutional order. Despite the invaluable work they perform, an alarming number of officers voluntarily resign from their position shortly following their initial hire date, creating severe problems for the facilities they now leave behind. Although a number of studies have researched factors affecting officer turnover intent, very few have specifically tested whether officers exhibiting signs of mental illness symptoms are more likely to want to resign. Adding to this, currently no study has examined whether resilience confounds the effects of mental illness symptoms on officer resignation intentions. Questionnaire data were collected from a statewide population of county jail officers working throughout TN (N = 1,517) to test whether officers exhibiting symptoms of mental illness were more likely to want to resign and whether these relationships were confounded by resilience. Consistent with hypothesized expectations, officers who scored higher on clinical screening measures for symptoms of mental illness signaled a greater desire to want to quit their job. These relationships were relegated to a statistically non-significant status once resilience was entered into the regression model. Supplementary analyses supported our confounding hypothesis since resilience negatively predicted all five screening measures for mental illness symptoms. Theoretical and policy implications are discussed.

OBJECTIVE: The aim of the study is to increase understanding regarding healthcare provider experiences with psychological trauma, moral injury, and institutional betrayal, both over the lifetime and during the COVID-19 pandemic. METHODS: The study employed a cross-sectional design to understand traumatic experiences, moral injury, and institutional betrayal among medical and mental health providers. Participants were asked to identify an index trauma, and experiences were coded qualitatively using categories for traumatic events, moral injury, and institutional betrayal. RESULTS: Results revealed that experiences of trauma, moral injury, and institutional betrayal were common in relation to the pandemic, as were prepandemic histories of traumatic exposures. Findings indicate that trauma exposure was a work hazard for healthcare providers during the pandemic, which could result in negative long-term mental health outcomes. CONCLUSIONS: Future research is needed to explore potential long-term negative outcomes among healthcare providers.

Healthcare workers are highly regarded for their compassion, dedication, and composure. However, COVID-19 created unprecedented demands that rendered healthcare workers vulnerable to increased burnout, anxiety, and depression. This cross-sectional study assessed the psychosocial impact of COVID-19 on U.S. healthcare frontliners using a 38-item online survey administered by Reaction Data between September and December 2020. The survey included five validated scales to assess self-reported burnout (Maslach Summative Burnout Scale), anxiety (GAD-7), depression (PHQ-2), resilience (Brief Resilience Coping Scale), and self-efficacy (New Self-Efficacy Scale-8). We used regression to assess the relationships between demographic variables and the psychosocial scales index scores and found that COVID-19 amplified preexisting burnout (54.8%), anxiety (138.5%), and depression (166.7%), and reduced resilience (5.70%) and self-efficacy (6.5%) among 557 respondents (52.6% male, 47.5% female). High patient volume, extended work hours, staff shortages, and lack of personal protective equipment (PPE) and resources fueled burnout, anxiety, and depression. Respondents were anxious about the indefinite duration of the pandemic/uncertain return to normal (54.8%), were anxious of infecting family (48.3%), and felt conflicted about protecting themselves versus fulfilling their duty to patients (44.3%). Respondents derived strength from their capacity to perform well in tough times (74.15%), emotional support from family/friends (67.2%), and time off work (62.8%). Strategies to promote emotional well-being and job satisfaction can focus on multilevel resilience, safety, and social connectedness.

To explore the mental health impacts of the COVID-19 pandemic on healthcare workers in Massachusetts and identify potential strategies to maintain the healthcare workforce we conducted a sequential exploratory mixed methods study. Fifty-two individuals completed interviews from April 22nd - September 7th, 2021; 209 individuals completed an online survey from February 17th - March 23rd, 2022. Interviews and surveys asked about the mental health impacts of working in healthcare during the COVID-19 pandemic, burnout, longevity in the workplace, and strategies for reducing attrition. Interview and survey participants were predominantly White (56%; 73%, respectively), female (79%; 81%) and worked as physicians (37%; 34%). Interviewees indicated high stress and anxiety levels due to frequent exposure to patient deaths from COVID-19. Among survey respondents, 55% reported worse mental health than before the pandemic, 29% reported a new/worsening mental health condition for themselves or their family, 59% reported feeling burned out at least weekly, and 37% intended to leave healthcare in less than 5 years. To decrease attrition, respondents suggested higher salaries (91%), flexible schedules (90%), and increased support to care for patients (89%). Healthcare workers’ experiences with death, feeling unvalued, and overworked resulted in unprecedented rates of burnout and intention to leave healthcare.

Through a national survey, researchers identified prevalent work overload, burnout, and intent to leave health care professions among nurses, clinical staff, and non-clinical staff, including housekeeping, administrative staff, lab technicians, and food service workers.

INTRODUCTION: Acute care surgeons can experience posttraumatic stress disorder (PTSD) due to the cumulative stress of practice. This study sought to document the potential impact of the COVID-19 pandemic on PTSD in acute care surgeons and to identify potential contributing factors. METHODS: The six-item brief version of the PTSD Checklist-Civilian Version (PCL-6), a validated instrument capturing PTSD symptomology, was used to screen Eastern Association for the Surgery of Trauma members. Added questions gauged pandemic effects on professional and hospital systems-level factors. Regression modeling used responses from attending surgeons that fully completed the PCL-6. RESULTS: Complete responses from 334 of 360 attending surgeons were obtained, with 58 of 334 (17%) screening positive for PTSD symptoms. Factors significantly contributing to both higher PCL-6 scores and meeting criteria for PTSD symptomology included decreasing age, increased administrative duties, reduced research productivity, nonurban practice setting, and loss of annual bonuses. Increasing PCL-6 score was also affected by perceived illness risk and higher odds of PTSD symptomology with elective case cancellation. For most respondents, fear of death and concerns of illness from COVID-19 were not associated with increased odds of PTSD symptomology. CONCLUSIONS: The prevalence of PTSD symptomology in this sample was similar to previous reports using surgeon samples (15%-22%). In the face of the COVID-19 pandemic, stress was not directly related to infectious concerns but rather to the collateral challenges caused by the pandemic and unrelated demographic factors. Understanding factors increasing stress in acute care surgeons is critical as part of pandemic planning and management to reduce burnout and maintain a healthy workforce.

In this narrative medicine essay, a physician recounts her family’s experience with critical illness and death and how she came to appreciate both the health care team’s perspective and the family’s perspective regarding when to have hope and when to let go.