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The COVID-19 pandemic, and the responses to it that were required from frontline healthcare providers and others working in healthcare settings including environmental, clerical, and security staff, has challenged our healthcare systems in unprecedented ways. The threats to the financial, physical, and psychological well-being of healthcare professionals – many of whom entered the field due at least in part to a deep commitment to caring for and helping others – will have profound and long-lasting personal and professional impacts. Early in the pandemic response, healthcare professionals knew little about the risks they, their patients, and their loved ones faced from COVID-19 as they operated under crisis standards of care and without adequate supplies of personal protective equipment. As the pandemic response progressed, the lack of clear, science-based guidance, and the politicization of the pandemic presented new medical, ethical, and moral dilemmas. New psychological support mechanisms, including crisis counseling and evidence-based interventions, are needed for all workers in healthcare settings, regardless of their job role.

BACKGROUND: The first goal of this study was to assess longitudinal changes in burnout among psychotherapists prior to (T1) and during the COVID-19 pandemic (T2). The second objective was to assess the effects of job demands, job resources (including organizational support for evidence-based psychotherapies, or EBPs) and pandemic-related stress (T2 only) on burnout. METHOD: Psychotherapists providing EBPs for posttraumatic stress disorder in U.S. Department of Veterans Affairs (VA) facilities completed surveys assessing burnout, job resources, and job demands prior to (T1; n = 346) and during (T2; n = 193) the COVID-19 pandemic. RESULTS: Burnout prevalence increased from 40 % at T1 to 56 % at T2 (p < .001). At T1, stronger implementation climate and implementation leadership (p < .001) and provision of only cognitive processing therapy (rather than use of prolonged exposure therapy or both treatments; p < .05) reduced burnout risk. Risk factors for burnout at T2 included T1 burnout, pandemic-related stress, less control over when and how to deliver EBPs, being female, and being a psychologist rather than social worker (p < .02). Implementation leadership did not reduce risk of burnout at T2. LIMITATIONS: This study involved staff not directly involved in treating COVID-19, in a healthcare system poised to transition to telehealth delivery. CONCLUSION: Organizational support for using EBPs reduced burnout risk prior to but not during the pandemic. Pandemic related stress rather than increased work demands contributed to elevated burnout during the pandemic. A comprehensive approach to reducing burnout must address the effects of both work demands and personal stressors.

BACKGROUND: Nurse managers are at risk for experiencing stress and burnout. The peer support program was implemented to increase resilience among nurse managers. METHODS: A one-group pretest and posttest design was employed to examine the impact of peer support on nurse manager resilience. The nurse managers participated in bi-weekly 30-minute peer sessions over 12 weeks. The Connor-Davidson Resilience Scale was utilized prior to and following the intervention along with demographic and satisfaction surveys. RESULTS: There were six nurse managers who participated in the peer support program; however, only four completed both the pre- and post-survey. The peer support program intervention did not yield a significant result in increasing resilience levels among nurse managers (p = 0.832). CONCLUSION: Although the peer support intervention did not yield significant results, it shows promise as a needed intervention to address resilience in the nursing manager workforce. Based on the prevalence of stress and burnout among nurse managers, there is a continued need to utilize resilience as a mechanism to provide support. Further research would benefit with a larger sample size, a structured peer session format, and a controlled educational environment.

BACKGROUND: This clinical pharmacy on-call program (CPOP) is a 24-hour, in-house service provided by pharmacy residents. During shifts, challenging situations may arise, which may correlate with depression, anxiety, and stress. OBJECTIVE: This pilot study aims to describe the implementation of a debriefing program and characterize mental-health patterns of residents in the CPOP. METHODS: A structured debriefing process was developed to provide support to residents in the CPOP. Over a 1-year period, twelve outgoing pharmacy residents and ten incoming pharmacy residents completed a modified Depression Anxiety Stress Scale (mDASS-21) questionnaire and received a stress perception score (SPS) during debriefing. Data from first and final on-call shifts were compared via a paired Wilcoxon signed-rank test. Residents were referred to an Employee Assistance Program (EAP) based on mDASS-21 and SPS results. Scores from final on-call shifts were compared between residency classes via a Wilcoxon rank sum test. RESULTS: Following successful implementation, 106 debriefing sessions were completed. Pharmacy residents responded to a median number of 38 events per shift. Significant reductions in anxiety and stress scores were observed from the first and final on-call shifts. Six residents were referred to EAP. A lower incidence of depression, anxiety, and stress was observed in pharmacy residents who received debriefing compared to previous residents. CONCLUSION: The debriefing program provided emotional support to pharmacy residents participating in the CPOP. Implementation of debriefing demonstrated a reduction of anxiety and stress from the beginning to the end of the academic year and in comparison to the previous year.

Emergency medicine training is associated with high levels of stress and burnout, which were exacerbated by the COVID‐19 pandemic. The pandemic further exposed a mismatch between trainees' mental health needs and timely support services; therefore, the objective of our innovation was to create an opportunity for residents to access a social worker who could provide consistent coaching. The residency leadership team partnered with our graduate medical education (GME) office to identify a clinical social worker and professionally‐trained coach to lead sessions. The project was budgeted at an initial cost of $15,000 over 1 year. Residents participated in 49 group and 73 individual sessions. Post implementation in 2021, we compared this intervention to all other wellness initiatives. Resident response rate was 80.88% (n = 55/68) and median interquartile range (IQR) score of the initiative was 2 (1 = detrimental and 4 = beneficial) versus 3.79 (3.69–3.88) the median IQR of all wellness initiatives. A notable number, 22%, rated the program as detrimental, which could be related to summary comments regarding ability to attend sessions, lack of session structure, loss of personal/educational time, and capacity of the social worker to relate with them. Summary comments also revealed the innovation was useful, with individual sessions preferred to group sessions. Application of a social worker coaching program in an emergency medicine residency program appears to be a feasible novel intervention. Lessons learned after implementation include the importance of recruiting someone with emergency department/GME experience, orienting them to culture before implementation and framing coaching as an integrated residency resource.

PURPOSE: The COVID-19 pandemic significantly increased work-related stress and anxiety in healthcare workers worldwide, increasing their potential for burnout. Rural hospitals experienced additional challenges as they often provided care with limited resources and staff. Efforts are made by rural hospitals to mitigate employees’ work-related stress and anxiety, but few studies or projects have been published that highlight these efforts. Our evidence-based practice project aimed to answer the question, does the use of a “Zen” or recovery room influence rural healthcare staff stress and anxiety levels during their shift? SAMPLE: The project’s convenience sample included 36 healthcare workers and hospital staff in an acute care facility, solely servicing a rural county in north-central Texas. METHOD: Following the IOWA Model, a literature search was conducted, and IRB review of the project was obtained. A private, restful space was created in a room with soft lighting, a massage chair, aromatherapy, and other various tools for relaxation. From June 2021 – January 2022, all staff were invited to use the room and complete a brief voluntary anonymous survey when they entered and exited the room. An additional short-answer survey was conducted in March 2022 to explore employees’ perceptions of the project. FINDINGS: On average, participants reported significantly lower levels of stress and anxiety after using the Zen room. Pre-room anxiety scores significantly predicted participants’ post-room stress levels. Barriers to room use included employee’s perception of available time and enough staff during the shift to step away from their duties. CONCLUSION: The availability of private, uninterrupted space decreased staff stress and anxiety and allowed them to return to work with a renewed sense of energy. Rural hospitals would benefit in implementing such a space and conducting further research on the effects of stress and anxiety levels, even as COVID-19 shifts to an endemic disease.

INTRODUCTION: Reported burnout rates among qualified healthcare professionals (QHP) are alarming. Systematic reviews evaluating the effectiveness of burnout interventions for QHP exist; however, findings are contradictory. In addition, to date, there is no indication of how these interventions work and what specific intervention elements mitigate burnout. This review aims to explain how burnout interventions work and the contextual factors that mediate the intended outcomes. Our ultimate goal is to formulate actionable recommendations to guide the implementation of complex burnout interventions for QHP working in the hospital setting. METHODS AND ANALYSIS: In light of the heterogeneity and complexity of the interventions designed to address burnout, we will conduct a realist review using Pawson’s five iterative stages to explore and explain how burnout interventions work, for whom, and in what circumstances. We will search PubMed, CINAHL, Scopus, PsycINFO and Web of Science from inception to December 2022. Grey literature sources will also be considered. The results will be reported according to the Realist and Meta-Narrative Evidence Syntheses—Evolving Standards quality and publication standards Ethics and dissemination Findings will be disseminated in a peer-reviewed journal, conference presentations and through the development of infographics and relevant educational material to be shared with stakeholders and key institutions. This study is a secondary data analysis; thus, a formal ethics review is not applicable. PROSPERO registration number CRD42021293154.

An issue brief provides background on federal and state paid family leave policies (PFL), highlights domestic and international research that shows PFL provides a range of benefits, and lays out principles for a universal paid family leave program.

OBJECTIVE: To conduct an integrative review of existing literature evaluating burnout and stress to identify reliable, valid, psychometrically sound survey instruments that are frequently used in published studies and to provide best practices in conducting burnout and stress research within academic pharmacy. FINDINGS: We reviewed 491 articles and found 11 validated reliable surveys to be most frequently cited in the literature that can be used in future burnout and stress research. We also noted frequent misunderstandings and misuse of burnout and stress terminology along with inappropriate measurement. Additionally, we identified a variety of useful websites during the review. Lastly, we identified a relative dearth of published research evaluating organizational solutions to burnout and stress beyond personal factors, i.e., resilience. SUMMARY: Burnout and stress among student pharmacists, faculty, and staff is an important research area that necessitates more robust, rigorous evaluation using validated reliable surveys with appropriate con-textualization within psychological frameworks and theory. Future research evaluating organizational-level attempts to remedy sources of burnout and stress is also needed.

This Viewpoint discusses the need for clinicians to be involved in every stage of the development of patient safety interventions in order to not only improve patient care, but also maximize the interventions’ effectiveness and ensure clinician well-being and buy-in.

BACKGROUND: The environment in which clinicians provide care and think about their patients is a crucial and undervalued component of the diagnostic process. CONTENT: In this paper, we propose a new conceptual model that links work conditions to clinician responses such as stress and burnout, which in turn impacts the quality of the diagnostic process and finally patient diagnostic outcomes. The mechanism for these interactions critically depends on the relationship between working memory (WM) and long-term memory (LTM), and ways WM and LTM interactions are affected by working conditions. SUMMARY: We propose a conceptual model to guide interventions to improve work conditions, clinician reactions and ultimately diagnostic process, accuracy and outcomes. OUTLOOK: Improving diagnosis can be accomplished if we are able to understand, measure and increase our knowledge of the context of care.

BACKGROUND: Drivers of physician burnout include an intricate interplay between health care organizational structures, societal influences, and individual-level factors. In the traditional workforce, peer-to-peer recognition programs (PRPs) have reduced burnout by building a sense of community and effectively creating a “wellness culture.” We implemented a PRP in an emergency medicine (EM) residency and determined its impact on subjective symptoms of burnout and wellness. METHODS: This was a prospective, pre- and postintervention study conducted in a single residency over a 6-month period. All 84 EM residents of the program were sent a voluntary anonymized survey that included a validated instrument on wellness and burnout. A PRP was initiated. After 6 months, a second survey was distributed. The outcome of the study was to examine whether the addition of a PRP reduced burnout and improved wellness. RESULTS: There were 84 respondents to the pre-PRP survey and 72 to the post-PRP survey. Respondents reported an improvement after the inception of the use of the PRP in two factors that contribute to a physician's wellness: feeling recognized for accomplishments at work, which improved from 45% (38/84) affirmative to 63% (45/72; 95% confidence interval [CI] 2.3%–32.4%, p = 0.025) and a comfortable and supportive work environment, which improved from 68% (57/84) to 85% (61/72; 95% CI 3.5%–29.3%, p = 0.014). There was no significant effect in the Stanford Professional Fulfillment Index (PFI) as a result of this intervention over the 6 months. CONCLUSIONS: A PRP initiative resulted in improvements in several factors that drive physician wellness but overall burnout measured by the Stanford PFI did not show any improvement over the 6-month period. A future longitudinal study examining the continuous assessment of PRP on the EM residents throughout the entire course of 4 years of residency training would be beneficial to determine if it could change burnout from year to year.

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

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Post-Traumatic Stress Disorder (PTSD) affects many healthcare providers who worked during the COVID-19 pandemic. Identifying the symptoms, precipitating factors, and available treatments is essential to mitigate long term effects on personal, patient, and organizational outcomes. PTSD may lead to chronic health conditions, poor patient care, and contribute to the nursing shortage. The purpose of this article is to discuss PTSD and its factors, identify tools to improve nurses’ resilience, and discuss administrative strategies for creating a healthy workplace during times of pandemic stress.

BACKGROUND: Like other facilities nationwide, our healthcare system is dealing with a shortage of infection preventionists (IP) especially with the surges and threats of emerging infectious diseases like Mpox, Ebola, and COVID-19. Most facilities follow the traditional Monday-to-Friday schedule, but to prevent burnout and improve retention of staff, it is essential for us to consider innovative methods such as alternative work schedules (AWS) and hybrid work models.
METHODS: There were several options for AWS, such as “four 10’s” or “5/4/9”, so it was important to be aware of the advantages and disadvantages in order to select one that would accommodate most of the staff. Implementation was the most extensive step, especially when trying to identify critical IP responsibilities and establishing appropriate cross-coverage for hospitals where there was only one IP assigned. Collaboration with the IP team, executive leadership, and human resources made it possible to achieve. RESULTS: The majority of the IPs in our system switched to an AWS, primarily the 5/4/9 format, and managed to fit in a work-from-home day every other week as well. There were concerns with coverage, but by utilizing a time management system, shared calendar tool, and paging system, we were able to organize the schedule to ensure each hospital was supported. Productivity was measured with the number of tracers, rounds, and special projects completed. CONCLUSIONS: Throughout the past few years, we have worked on improving the culture of our team which provided the perfect environment to trial an AWS. Implementation involves reassessment of priorities, structured cross-coverage, and transparency of challenges and opportunities. Ultimately, the benefits of a better work-life balance, increased productivity, and boosted morale outweighed the slightly longer work day.

BACKGROUND: The prevalence of burnout and depression among abdominal transplant surgeons has been well described. However, the incidence of early-career transplant surgeons leaving the field is unknown. The objective of this study was to quantify the incidence of attrition among early-career abdominal transplant surgeons. METHODS: A custom database from the Organ Procurement and Transplantation Network with encrypted surgeon-specific identifiers was queried for transplant surgeons who entered the field between 2008 and 2019. Surgeons who experienced attrition, defined as not completing a subsequent transplant after a minimum of 5, were identified. Surgeon-specific case volumes, case mix, and recipient outcomes were modeled to describe their association with attrition. RESULTS: Between 2008 and 2018, 496 abdominal transplant surgeons entered the field and performed 76,465 transplant procedures. A total of 24.4% (n = 121) experienced attrition, with a median time to attrition of 2.75 years. Attrition surgeons completed fewer kidney (7 vs 21, P < .01), pancreas (0.52 vs 1.43, P < .01), and liver transplants (1 vs 4, P < .01) in their first year of practice. Attrition surgeons completed a smaller proportion of their transplant center’s volume (9% vs 18%, P < .01) and were less likely to participate in pediatric transplants (26.5% vs 52.5%, P < .01) and living donor kidney transplants (64.5% vs 84.5%, P < .01). On multivariable analysis, performing fewer kidney (odds ratio: 0.98, 95% confidence interval: 0.98–0.99) and liver transplants (odds ratio: 0.98, 95% confidence interval: 0.97–0.98) by year 5 and completing a smaller proportion of their centers’ volume (odds ratio: 0.96, 95% confidence interval: 0.94–0.98) were associated with attrition. Furthermore, attrition surgeons had worse allograft and patient survival for liver transplant recipients (both log-rank P < .01). CONCLUSION: This investigation was the first to quantify the high incidence of attrition experienced by early-career abdominal transplant surgeons and its association with surgeon-specific case volumes, case mix, and worse recipient outcomes. These findings suggested the abdominal transplant workforce is struggling to retain their fellowship-trained surgeons.

It is well-established that medical students and practicing physicians alike continue to suffer from extreme burnout, despite growing efforts to attend more closely to wellness. This often takes the form of mindfulness practices, community activities, transparency around work expectations, mentor and support groups, and the like. However, less attention is paid to how efforts towards inclusive learning experiences can themselves support wellness. This chapter will explore how to build a truly inclusive and justice-oriented environment in the service of student wellness by looking at three key moments of the medical education journey, exploring where things often go awry, and offering possible solutions to enhance them. Specifically, the cases will leverage the didactic experience as a student, clinical encounters as a resident, and physician educator encounters with colleagues to illustrate how enhancing inclusive dialogue, environments, and practices in these spaces can also support practitioner wellness.

Health care professionals are chronically overworked due to structural workplace demands and institutional challenges. During the COVID-19 pandemic, US biomedical health care professionals experienced additional environmental strain. Health care professionals who occupy socio-politically minoritized identities are more likely to report symptoms of distress and workplace overburden than their counterparts. While minority stress and identity formation theories explain the relationship between socially constructed identity and environmental strain, these theories remain largely unexplored in LGBTQ+ health care professional populations. Furthermore, contemporary investigations into health care professional burnout and mental distress fail to include differential impacts of identity-based stress, particularly within LGBTQ+ groups. This paper proposes a theoretical explanation for differential stress experiences by health care professionals and calls for research to investigate identity congruence as a key aspect of professionalization in medical schools. Health professions researchers need to attend to identity-based stress models to address discriminatory experiences with burnout and mental distress.

With increasing societal awareness about the adverse impacts of poor mental health on individual and community well-being, there has been a proliferation of scholarship on the need for criminal justice practices that are informed by evidence-based behavioral health. The primary focus of this work examines the need for incorporating evidence-based practices in law enforcement responses to vulnerable groups, such as individuals experiencing mental illness or substance use disorders. A lesser focus of the literature has examined the effects of poor behavioral health among criminal justice workers themselves—despite an increased concern to address such issues, both to protect the health and wellbeing of workers as well as the performance and functioning of agencies.

BACKGROUND: Healthcare workers can suffer from work‐related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational‐level interventions. OBJECTIVES: To evaluate the effectiveness of stress‐reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress‐reduction intervention or another type of stress‐reduction intervention in reducing stress symptoms. SEARCH METHODS: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022. SELECTION CRITERIA: We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms. DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one’s attention on the (modification of the) experience of stress (thoughts, feelings, behaviour); 2. focus one’s attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise); 3. alter work‐related risk factors on an individual level; and ones that 4. combine two or more of the above. The crucial outcome measure was stress symptoms measured with various self‐reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow‐up (> 12 months after the intervention ended). MAIN RESULTS: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised. The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants. Focus on the experience of stress versus no intervention/wait list/placebo/no stress‐reduction intervention - Fifty‐two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) ‐0.37, 95% confidence interval (CI) ‐0.52 to ‐0.23; 41 RCTs; 3645 participants; low‐certainty evidence) and medium term (SMD ‐0.43, 95% CI ‐0.71 to ‐0.14; 19 RCTs; 1851 participants; low‐certainty evidence). The SMD of the short‐term result translates back to 4.6 points fewer on the MBI‐emotional exhaustion scale (MBI‐EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low‐certainty evidence) about the long‐term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress‐reduction intervention - Forty‐two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD ‐0.55, 95 CI ‐0.70 to ‐0.40; 35 RCTs; 2366 participants; low‐certainty evidence) and medium term (SMD ‐0.41 95% CI ‐0.79 to ‐0.03; 6 RCTs; 427 participants; low‐certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI‐EE. No studies reported the long‐term effect. Focus on work‐related, individual‐level factors versus no intervention/no stress‐reduction intervention - Seven studies studied an intervention in which the focus is on altering work‐related factors. The evidence is very uncertain about the short‐term effects (no pooled effect estimate; three RCTs; 87 participants; very low‐certainty evidence) and medium‐term effects and long‐term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low‐certainty evidence) of this type of stress management intervention. A combination of individual‐level interventions versus no intervention/wait list/no stress‐reduction intervention - Seventeen studies studied a combination of interventions. In the short‐term, this type of intervention may result in a reduction in stress symptoms (SMD ‐0.67 95%, CI ‐0.95 to ‐0.39; 15 RCTs; 1003 participants; low‐certainty evidence). The SMD translates back to 8.2 fewer points on the MBI‐EE. On the medium term, a combination of individual‐level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD ‐0.48, 95% CI ‐0.95 to 0.00; 6 RCTs; 574 participants; low‐certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low‐certainty evidence). Focus on stress versus other intervention type Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar. AUTHORS' CONCLUSIONS: Our review shows that there may be an effect on stress reduction in healthcare workers from individual‐level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long‐term effects of individual‐level stress management interventions remain unknown. The same applies for interventions on (individual‐level) work‐related risk factors. The bias assessment of the studies in this review showed the need for methodologically better‐designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better‐designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work‐related risk factors.

[This is an excerpt.] “Where are you really from?” When I tell patients I am from Casper, Wyoming—where I have lived the majority of my life—it’s met with disbelief. The subtext: YOU can’t be from THERE. I didn’t used to think much of comments like this, but as I have continued to hear them, I find myself feeling tired—tired of explaining myself, tired of being treated differently than my colleagues, and tired of justifying myself. My experiences as a woman of color sadly are not uncommon in medicine. [To read more, click View Resource.]