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Gender parity has been reached in graduation rates from medical school, yet women in medicine continue to face obstacles in promotion, compensation and opportunities, leading to leadership inequity, higher burnout and lower engagement. These complex issues with gender are just one aspect of the wide challenges related to diversity, equity and inclusion among medical professionals. While there are no “one size fits all” approaches, psychologists are well positioned to lead efforts related to promoting leadership equity, reducing burnout and raising engagement because of their training in communication skills, programmatic development and empathetic listening. This paper details several evidence-based efforts in which psychologists can lead in these ongoing issues for women in medicine.

[This is an excerpt.] Before the COVID-19 pandemic and going as far back as the Harvard Medical Practice Study,1 it has been common to hear leaders lament the seemingly tedious discussions about health care worker (HCW) burnout and work-life integration. Fast forward post pandemic and it is hard to imagine a leader who is not routinely discussing workforce well-being. How are leaders supposed to navigate these new well-being responsibilities? In this issue of Mayo Clinic Proceedings, Hurtado and colleagues2 offer some empirical insights to inform well-being leadership efforts, saying that the burden of emotional exhaustion management “often falls back on clinic leaders who desperately need urgent guidance to implement swift, low-effort, practical and meaningful strategies to manage an afflicted workforce.” We agree. This has been our experience at Duke Health and across hundreds of US hospitals in which we have surveyed safety culture and workforce well-being since the start of the global health crisis. What leaders want and need right now are specific actions to help recover from pandemic exhaustion, to rebuild trust—and by the way, whatever that entails, it needs to be quick and fit into increasingly shrinking budgets. Furthermore, this is against a backdrop of growing numbers of frustrated HCWs adopting the refrain “Just fix the system!” as their exhaustion worsens. Meanwhile, frustrated health care leaders manage the combination of financial constraints and workforce challenges as a gordian knot, consuming all energy while too complex to be untied. Currently, there are few system fixes that are broadly applicable across all of health care, but Hurtado et al are shining a light on one with broad potential. [To read more, click View Resource.]

Mental fatigue and burnout are concerns for healthcare organizations, but their effects on leaders have not been thoroughly studied. Infectious diseases teams and leaders are at risk for mental fatigue and burnout due to the increased demands from the coronavirus disease 2019 (COVID-19) pandemic, additive effects of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (omicron) and δ (delta) variant surges, and unique pre-existing pressures. No single intervention can reduce stress and burnout in healthcare workers. Work-hour limitations may have the biggest impact in physician burnout mitigation. Institutional and individual programs focused on mindfulness may improve well-being in the workplace. Leading during times of stress requires a multimodal approach and an understanding of goals and priorities. Greater awareness of burnout and fatigue across the healthcare spectrum and continued research are required to advance healthcare worker well-being.

The COVID-19 pandemic has had an unprecedented impact on the US health care system which was already experiencing higher levels of personal burnout among health care workers than the average US worker. Well-being efforts to support the workforce have become a critical countermeasure during the pandemic. This work was presented at the Thomas Jefferson University, College of Population Health Seminar Series: Clinical Lessons from the Northeast Surge, COVID-19: Spread the Science, not the Virus, held August 18, 2020. The entire series was held virtually from July 21 to September 29, 2020. The authors describe issues impacting health care workers during this early period of the pandemic with two examples of concrete strategies to approach well-being at the organizational level and lessons learned.

This resource is found in our Actionable Strategies for Health Organizations: Establishing Commitment & Shared Governance (Organizational Infrastructure for Well-Being).

BACKGROUND: Burnout continues to impact health care workers and its effect takes a toll on their lives and wellbeing, especially in primary care. Relatively few studies have focused specifically on the perspective of clinicians in Federally Qualified Health Centers (FQHCs), which offer crucial, preventative health care services to vulnerable and underserved patient populations. OBJECTIVE: To examine the perspectives of clinicians working at an FQHC in the Northeast United States after the implementation of a year-long wellness initiative. DESIGN: A qualitative analysis of clinician's discussion during focus groups conducted after the wellness initiative. SUBJECTS AND SETTING/LOCATION: A total of 28 clinicians (primary care physicians and nurse practitioners) in an FQHC in the Northeast United States. INTERVENTIONS: A one-year wellness initiative with programs and activities designed to bolster wellness. OUTCOME MEASURES: Analyzed NVIVO-coded transcripts of focus group discussion to generate codes and used modified grounded theory to extrapolate meaningful themes. RESULTS: Five key themes emerged from the qualitative analysis: (1) clinicians often felt burdened by their workload and personally responsible when they were not able to provide optimal care to patients; (2) burnout was exacerbated by systemic problems at the FQHC; (3) medical assistants, medical scribes, schedulers, and other support staff played a crucial role in the wellness of the entire team; (4) perceived differences in priorities between administration and health care workers may have contributed to burnout; and (5) a communicative and stable team helped clinicians effectively care for their patients. CONCLUSIONS: Clinician burnout is a complex problem at FQHCs with many root causes. Addressing burnout and improving clinician wellness at FQHCs will require a multifaceted approach encompassing systemic, team, and individual components. The perspectives from the clinicians at our FQHC may inform wellness strategies for other safety net, clinical institutions in the primary care setting.

[This is an excerpt.] We know from the literature that residents experience high rates of burnout, the consequences of which include the erosion of empathy, worse patient outcomes, and threatened professional endurance. In their qualitative study of resident thriving, Hyman and Doolittle attempt to broaden our gaze as researchers of physician well-being beyond a disease model of burnout toward a health model of thriving. Much of the research on resident well-being has relied on unidimensional measures, such as life or work satisfaction or overall quality-of-life scales. This approach leaves gaps in our understanding of physician thriving. [To read more, click View Resource.]

PURPOSE: To evaluate lesbian, gay, bisexual, transgender, questioning, and other sexual/gender minority (LGBTQ+) orientation as a burnout risk factor among an international ophthalmologist cohort. METHODS: An anonymous, cross-sectional electronic survey was distributed via an Internet platform to characterize the relationship among demographic factors, including LGBTQ+ orientation, and burnout as measured by the Copenhagen Burnout Inventory (CBI). Univariable data analysis (linear) by sexual orientation was performed and variables with an association with a P value of <0.15 in univariable analysis were included in the multiple linear regression modeling. RESULTS: A total of 403 ophthalmologists participated in the survey. The majority self-identified as "White" (69.2%), were from North America (72.0% United States, 18.6% Canada) and were evenly distributed between age of 30 and 65 years. Overall, 13.2% of participants identified as LGBTQ+ and 98.2% as cisgender. Approximately 12% had witnessed or experienced LGBTQ+-related workplace discrimination or harassment. The personal and work-related burnout scores and confidence limits of persons identified as LGBTQ+ were higher and nonoverlapping compared with those reported as non-LGBTQ+. Multivariable analysis identified significant risk factors for higher personal and work-related burnout scores: LGBTQ+ (11.8 and 11.1, P = .0005 and .0023), female gender (5.36 and 4.83, P = .0153 and .0434), older age (19.1 and 19.2, P = .0173 and .0273). and caretaker stress (6.42 and 5.97, P = .0085 and .0239). CONCLUSIONS: LGBTQ+ orientation is a burnout risk factor among ophthalmologists, and LGBTQ+ workplace discrimination may be a contributing factor. Support from ophthalmology organizations to address LGBTQ+-, gender-, and age-related workplace discrimination may decrease burnout. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

PURPOSE: To identify reasons for burnout, characterize the effect of lifestyle medicine (LM) practice on burnout, and assess the risk of burnout in relation to the proportion of LM practice. DESIGN: Analysis of mixed methods data from a large, cross-sectional survey on LM practice. SETTING: Web-based survey platform. PARTICIPANTS: Members of an LM medical professional society at the time of survey administration. METHODS: Practitioner members of a medical professional society were recruited to a cross-sectional, online survey. Data were collected on LM practice and experiences with burnout. Free-text data were thematically grouped and counted, and the association of burnout with the proportion of lifestyle-based medical practice was analyzed using logistic regression. RESULTS: Of 482 respondents, 58% reported currently feeling burned out, 28% used to feel burned out but no longer do, and 90% reported LM had positively impacted their professional satisfaction. Among LM practitioners surveyed, practicing more LM was associated with a 43% decrease (0.569; 95% CI: 0.384, 0.845; P = 0.0051) in the odds of experiencing burnout. Top reasons for positive impact included professional satisfaction, sense of accomplishment, and meaningfulness (44%); improved patient outcomes and patient satisfaction (26%); enjoyment of teaching/coaching and engaging in relationships (22%); and helps me personally: quality of life and stress (22%). CONCLUSION: Implementing LM as a greater proportion of medical practice was associated with lower likelihood of burnout among LM practitioners. Results suggest that increased feelings of accomplishment due to improved patient outcomes and reduced depersonalization contribute to reduced burnout.

[This is an excerpt.] Nearly every minute in Alberta, paramedics are called to a potential emergency that may require the use of medical and pharmaceutical interventions, as well as a variety of psychosocial skills, to save lives and prevent further illness. Hence, paramedics and the work they do on the streets (in ever-changing and unpredictable environments) and off the streets (in hospitals and other facilities) are central to the provision of health care in Alberta. For many Albertans, paramedics are the first point of contact in the health and social care system in the province. Suffice it to say, paramedics are a key component of this system. Prehospital emergency medical services and the workers central to the system — the paramedics — are in a state of crisis in Alberta. This is evidenced by increased rates of paramedic burnout/moral injury, staff retention issues, increased response times, increased number of code reds/red alerts” (which refers to instances where no ambulances are available for emergency calls for a specific community), and paramedics being “parked”/stuck in emergency departments. While SARS-COV-2 (hereafter COVID-19) and the opioid and overdose crisis (hereafter overdose crisis) have exacerbated the challenges experienced by paramedics in Alberta, the root of the current crisis dates back at least to the amalgamation of emergency medical services in the province in 2009. [To read more, click View Resource.]

Social media usage has drastically increased in recent years. In particular, social media usage among medical providers has become commonplace. It may offer a variety of benefits in the medical arena, with respect to information dissemination, health promotion, and education. However, the implications of social media usage and engagement remain to be seen. This narrative review aimed to describe and highlight the effects of social media usage and engagement and to provide guidance for engaging in social media as a medical professional. Our review demonstrates that active social media engagement unequivocally affords the urologist with meaningful opportunities for selfpromotion, branding, education, networking, research, and enhanced recruitment efforts, but this engagement comes with the risk for burdensome exposure to misinformation and harassment. We encourage adherence with American Urological Association/European Association of Urology (AUA/EAU) social media best practices and provide our own recommendations for social media engagement.

[This is an excerpt.] This toolkit offers a blueprint for crafting a well-organized Listening Campaign, provides a framework to prioritize and execute improvement initiatives, and sheds light on strategies to overcome common challenges in engaging leaders and physicians, fostering active involvement in improvement work. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Worker & Learner Engagement).

Research shows that healthcare providers encounter stress in their workplaces whether in a home or a healthcare facility that results in reduced job satisfaction, burnout, and inadequate care of patients. There is a gap in the literature regarding the lived experiences of nurses caring for children in all work settings, including the home care setting, regarding stress and burnout. The lived experiences of pediatric nurses working in home care settings were explored to discover conditions that contribute to their occupational stress and burnout. The occupational stress model with a major focus on the job demands-resources occupational stress model was used to guide the qualitative, transcendental phenomenological study. Data were collected through semistructured interviews with 17 pediatric nurses from a northeaster U.S. state. Results showed that poor condition of homes causes stress and burnout and that patients’ families, uncooperative parents, fear of losing patients, lack of equipment, patient load, and solo decision making all contributed to stress. Long working hours caused burnout. Nurses should be supported to deal with stress, and self-care is critical in the mitigation of stress and burnout. Implications for positive social change including providing information to healthcare administrators that can lead to creating programs that can help eliminate stress and burnout among pediatric home care nurses and hence improve overall patient quality of care.

INTRODUCTION: Emotional intelligence (EI) as a concept is becoming increasingly relevant in the healthcare industry. In order to examine the relationship between EI, burnout, and wellness, we administered these measures quarterly in resident physicians and analyzed the variables in each subset to gain insights and understanding of their relationship. METHODS: In 2017 and 2018, all residents entering the training programs in year one (PGY-1) were administered The Emotional Intelligence Questionnaire - Short Form (TEIQue-SF), The Maslach Burnout Inventory (MBI), and The Physician Wellness Inventory (PWI). The questionnaires were completed quarterly. Statistical analysis included ANOVA and ANCOVA. RESULTS: The overall combined PGY-1 resident year (n = 80) had an EI global trait mean score of 5.47 (SD: 0.59) at the beginning of their first year. The domains of burnout and physician wellness were examined across four different time points during the resident's first year. Domain scores changed significantly over the four time points during the first year. There was a relative 46% increase in exhaustion (P < .001), 48% increase in depersonalization (P < .001), and an 11% decrease in personal achievement (P < .001). Physician wellness domains also changed significantly between time 1 and the end of the year (time 4). There was a relative 12% decrease in career purpose (P < .001), a 30% increase in distress (P < .001), and 6% decrease in cognitive flexibility (P < .001). Each burnout domain and physician wellness domain were highly correlated with emotional quotient (EQ). Emotional quotient was independently assessed with each domain at baseline and with changes overtime. The lowest EQ group reported their distress increased significantly over time (P = .003) and a decline in career purpose (P < .001) and cognitive flexibility (P = .04). The response rate was 100%. CONCLUSION: Emotional intelligence is associated with well-being and burnout in individual residents; therefore, it is important to identify those who require increased support during residency in order to succeed.

In turbulent times like these, it’s natural for people to hold back and avoid taking risks at work. This can mean a reluctance to report mistakes, ask questions, offer new ideas, or challenge a plan. People, whether they’re aware of it or not, try to protect their reputations and jobs. Unfortunately, the same behaviors that feel risky to individual employees are precisely what their companies need in order to thrive in this uncertain economic climate. To solve this dilemma, we encourage leaders to adopt a “winning formula” for achieving a more psychologically safe workplace and the benefits it provides.

This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Psychological Safety).

Reach new levels of organizational productivity and achievement by redefining the phrase “workplace health” In Make Work Healthy, a team of distinguished organizational transformation professionals delivers an insightful how-to manual for improving organizational performance with a new approach to workforce management. The book offers organizations, leaders, and managers with the knowledge, data, frameworks, and methodologies they need to radically transform how they approach day-to-day operations into a sustainable and resilient business success model. The authors focus on workplace health—in a broad sense—as a way of focusing organizational attention on culture, building work capacity, productivity, and sustainability. They explain the tangible business value that comes from focusing on wellbeing as well as the symbiotic relationship between organizational health and employee health. Make Work Healthy includes: Strategies for moving beyond typical “wellness” initiatives such as just addressing illness and absence reduction to a more holistic understanding of “healthy work” Ways to locate, attract, recruit, and retain talent over the long-term by aligning organizational goals with employee health Tactics to help managers of dispersed, hybrid, and remote teams manage feelings of pressure and isolationAn indispensable, effective, and holistic new take on organizational and employee health, Make Work Healthy will earn a place in the hands of managers, executives, board members, and other business and human resources leaders who seek impressive gains in company productivity and fulfilment.

OUTCOMES: 1. Describe the components of CASE, a US Department of Veterans Affairs clinical ethics consultation tool and opportunities to resolve ethical dilemmas near end of life. 2. Identify resources and collaborative opportunities for inpatient palliative care and ethics consultation teams caring for dying patients and distressed families and healthcare providers. BACKGROUND: Ethical dilemmas commonly complicate care and comfort near end of life. Family members and providers may especially experience ethical dilemmas when surrogates are required for patients without capacity or known wishes. The US Department of Veterans Affairs (VA) aims to improving ethical quality through its implementation of a standardized approach to ethics consultation based on consistent and systematic use of widely accepted ethical standards and norms and by recruiting consultants from the interdisciplinary team. CASE DESCRIPTION: An 87-year-old hospitalized veteran with low blood pressure and hypoactive delirium was identified as seriously ill and at high risk for imminent death. The cosurrogate daughters reported their mother shared no prior preferences for care near her end of life. Despite early palliative care team involvement, the daughters could not reach treatment decisions and reported their own moral distress. After 10 days, concerned nurses called for an ethics team consultation to “help with patient suffering and family disagreement.” The palliative care team and the ethics team together applied the novel VA ethics consultation model and collaboratively addressed the ethical dilemma, aligned care to maximize comfort, and alleviated staff moral injury. DISCUSSION: We will describe the structure and application of the VA Ethics Consultation Program's CASE approach (clarify, assemble, synthetize, explain, support) as a tool with which palliative care teams may effectively resolve surrogate conflict near a loved one's end of life when no prior preferences are known. Through CASE methodology, including review of substituted judgment/best interest standards and specific negotiating techniques, the ethics and palliative care teams supported successful quality outcomes for the patient, family, staff, and the healthcare system. CONCLUSION: A systematic approach of ethical reasoning, such as CASE, can support interdisciplinary palliative care teams to resolve ethical dilemmas while improving quality outcomes when death is expected and imminent.

INTRODUCTION: A New York State initiative requests that Emergency Department (ED) providers document in the electronic health record (EHR) each admitted patient’s employment status and, if applicable, their mode of commute. This initiative diverts them from their primary duties and increases the likelihood they will either disregard the request or input incorrect information to complete the data fields as fast as possible. This study intends to understand how well providers adhere to this regulation, which, while important for society as a whole, has little clinical relevance, especially in the ED, where the focus is to identify and treat emergent conditions. We hypothesized that clinician-collected employment data would contain many more "N/A" responses than registration-collected employment data (the "gold standard"). METHODS: We took a randomly selected convenience sample of 100 patients admitted from the ED and compared each patient’s provider-entered response to the employment data field to the registration-recorded response. The EHR operates such that the "Employment" field must be completed in order to complete the admission electronically. Data fields collected were: last name, first name, date of birth, medical record number, date and time of arrival, date and time of admission, attending physician, resident physician (if there was one), mid-level provider (if there was one), provider-entered employment status, registration-entered employment status, admitting service (eg, Medicine, Surgery, OB/Gyn), and disposition level (eg, ICU). We assessed the percent of employment data that was concordant between the provider's entry and the registration clerk's entry. We also assessed for the potential confounding variable of how busy the ED was at time of admission, as providers may not take ask about employment or enter such data during particularly busy times. Finally, we interviewed providers to elicit reasons they did not enter accurate data. Statistical significance was set a priori at p <0.05. RESULTS: One hundred six patients were screened; six were excluded because one of the authors (MR) was their attending physician. For 92 of the remaining 100 patients, providers recorded employment as “N/A," and for eight patients they recorded “retired." For seven of these eight patients, provider entry matched registration entry (87.5% concordance). To adjust for whether how busy the ED was may have impacted the accuracy of data entry, admissions were categorized according to what time of day the patient was admitted. There was no statistically significant correlation between how busy the ED was and accuracy of data entry. The majority of providers stated they responded "NA" because the employment information was unrelated to the ED visit. CONCLUSION: In New York, for each patient admitted from the ED, the ED provider is requested to enter the patient's job information and, if they commute to work, the method they use. However, this takes providers' attention away from what they should be doing most: diagnosing and treating patients. This study highlights the unintended consequence of requesting data fields that are not clinically relevant and, from the patient and provider perspective, are not good investments of time and energy and distract from the clinical visit. Persons interpreting such clinically irrelevant data should do so with caution, as the results are unlikely to reflect the truth of what the questions intend to determine.

BACKGROUND: Troubled conscience among nurses and other healthcare workers represents a significant contributor to healthcare worker moral distress, burnout and attrition. While research in this area has examined critical care in hospitals, less knowledge has been obtained from long-term care contexts such as nursing homes, despite widely recognised challenges with regard to vulnerable patients, increasing workload and maintaining workforce sustainability among nurses. OBJECTIVE: The aim of this study was to illuminate and interpret the meaning of the lived experience of troubled conscience among registered nurses (RNs) working in nursing homes. RESEARCH DESIGN: This qualitative research employed narrative interviews with eight nurses to obtain essential meanings of their lived experiences of troubled conscience. The interview texts were analysed using a phenomenological hermeneutic approach. ETHICAL CONSIDERATIONS: Participation was voluntary, informed and was conducted with written consent. The Norwegian Centre for Research Data approved the data processing of personal data. FINDINGS: The analysis uncovered two themes: (1) troubled conscience means abandoning ideals, with the subthemes: failing dependent patients; being disloyal to colleagues; being inadequate in the performance of work tasks and (2) troubled conscience means facing realities, with the subthemes: accepting being part of the system; responding to barriers. DISCUSSION: Troubled conscience meant experiencing continuous and simmering tension between one's ideals and realities and feeling a drive to preserve accountability and one's moral integrity. Endangered ideals were often under cross-pressure and included humanistic values, professional values, working life values and the values of the organisation. CONCLUSION: Nurses' troubled conscience refers to a struggle, but also a force that plays out at various levels and arenas in long-term care. Openness and dialogue about how professional values and the welfare state's intentions can be realised within the given framework are important for individual nurses' occupational health as well as the quality of care provided to patients.

INTRODUCTION: EHRs are associated with improved patient outcomes, but the inefficiency of time spent on EHR may contribute to healthcare provider stress, exhaustion and burnout. EHR use associates with higher prevalence of burnout in Neonatal Intensive Care Units (NICUs), but the relationship between EHR use and burnout in other inpatient settings remains unclear. This study sought to identify subjective and objective markers of EHR use associated with provider burnout in the pediatric inpatient setting. METHODS: Attendings, fellows, hospitalists, and nurse practitioners from a quaternary children’s hospital who work primarily in the inpatient setting were included in our study. We collected five months (June-October 2020) of EHR-use and schedule data for these providers. This data was then linked to 2020 annual wellness survey (September-October) data which included a 4-item EHR experience score and the Stanford Professional Fulfillment Index. We evaluated associations using Pearson correlation, lasso regression for variable selection, and mixed effect linear regression. RESULTS: Of 246 eligible providers, 179 (73%) responded to the survey. Average EHR experience score was 2.2±0.8, range 0-4, and average burnout score was 1.1±0.7, range 0-4, with burnout prevalence of 32%. Average number of notes/orders placed was independently associated with the EHR experience scores (coefficient -0.013, p=.04). EHR experience scores were negatively correlated with provider burnout scores (r -0.18, p=.03), but not independently associated after adjustment for work setting and role. EHR task count per patient, division, and role were selected as important predictor variables for burnout via lasso regression. Among these, the Pediatric Intensive Care Unit (PICU) division was independently associated with higher burnout scores (coefficient 0.36, p=.016). None of the EHR use measures were independently associated with burnout. CONCLUSIONS: Burnout is prevalent among inpatient providers, and being a PICU provider was independently associated with burnout. Although routinely collected EHR use measures may associate with negative EHR experience, we did not identify independent associations with burnout among this sample of inpatient pediatric providers. Larger studies are needed to investigate this relationship further.

[This is an excerpt.] Moral distress is indeed distressing for those who experience it and whose sense of integrity can be shaken by exposure to events or situations that test their core values and ethical belief systems. But the meaning of this term—both from a conceptual and an empirical perspective—continues to be a source of contention. [To read more, click View Resource.]