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OBJECTIVE: To describe the impact of the COVID-19 pandemic on intensive care nurses personal and professional well-being. RESEARCH METHODOLOGY/DESIGN: A descriptive, qualitative design was used. Two nurse researchers conducted one-on-one interviews via Zoom or TEAMS using a semi-structured interview guide. Setting: Thirteen nurses who were working in an intensive care unit in the United States participated in the study. A convenience sample of nurses who completed a survey in the larger parent study provided an email and were contacted by the research team to participate in interviews to discuss their experiences. MAIN OUTCOME MEASURES: An inductive approach to content analysis was used to develop categories. FINDINGS: Five major categories emerged from the interviews: (1) We are not heroes, (2) inadequate support, (3) helplessness, (4) exhaustion, and (5) Nurses the second victim. CONCLUSION: The COVID-19 pandemic has taken a physical and mental health toll on intensive care nurses. The impact of the pandemic on personal and professional well-being has serious implications for retaining and expanding the nursing workforce. IMPLICATIONS FOR CLINICAL PRACTICE: This work highlights the importance for bedside nurses to advocate for systemic change to improve the work environment. It is imperative for nurses to have effective training including evidence-based practice and clinical skills. There needs to be systems in place to monitor and support nurses’ mental health and encourage bedside nurses to use self-care methods and practices to prevent anxiety, depression, post-traumatic stress disorder and burnout.

BACKGROUND: Evidence suggests that mindfulness training using a phone application (app) may support neonatal intensive care unit (NICU) nurses in their high stress work. If effective, phone apps could improve nurses' professional quality of life (QOL) defined as compassion satisfaction (CS) and compassion fatigue (CF) that includes burnout (BO) and secondary traumatic stress (STS).Purpose: To test the hypothesis that use of a mindfulness phone app will increase NICU nurses' professional QOL. METHODS: Using a single-group, pre/posttest design, investigators invited a convenience sample of 54 NICU nurses from a 377-bed Magnet-recognized, nonprofit hospital to complete a demographic sheet and 2 established scales: the Professional Quality of Life scale, version 5 (ProQOL5), and the Mindfulness Attention Awareness Scale (MAAS). The intervention was nurses' using the mindfulness phone app, Premium Moodfit, for 3 weeks. RESULTS: Response rate was 41% (N = 22). A paired t test for the 9 nurses who returned both pre- and posttest questionnaires showed that their STS fell from moderate to low (P = .003), while their low BO scores (P = .12) and moderate CS scores (P = .4) remained stable. Wilcoxon tests confirmed results: only STS decreased (P =.01). The hypothesis was partly supported. IMPLICATIONS FOR PRACTICE AND RESEARCH: Using the Premium Moodfit mindfulness phone app may improve or maintain NICU nurses' professional QOL even under heightened stress. Individual nurses may independently access Moodfit and the free ProQOL5. Replication studies are warranted to confirm results and establish trends.

PURPOSE: Although intimate partner violence is a type of violence that women are frequently exposed to, its victims are adversely affected by violence at various levels, bio-psycho-socially. This study was conducted to determine the relationship between exposure to spousal violence, communication skills and burnout levels in female nurses. MATERIALS AND METHODS: The study was carried out in a descriptive and cross-sectional research design. The study was conducted in a university hospital in the Black Sea region of Turkey in September 2021. Sample selection was not made in the study, and female nurses who agreed to participate in the study were included in the study. The study's sample size is 165 female nurses. A personal Information Form, Intimate Partner Violence Scale, Communication Skills Scale, and Burnout Scale were used to collect data. FINDINGS: It was concluded that the exposure of female nurses to spouse violence significantly affects their communication skills and there is a significant relationship between nurses' communication skills and burnout levels (P = 0.001). PRACTICAL IMPLICATIONS: The attitudes and behaviors of nurses who are strong in the caregiving process are very important. Personal characteristics, communication styles and body language of nurses who are exposed to partner violence are reflected in nursing care practices and affect the caregiving process. In this context, prevention and intervention approaches for intimate partner violence of female nurses should be known.

IMPORTANCE: There is an abundance of research demonstrating the growing challenge of burnout in healthcare professionals. This has been further exacerbated by the COVID-19 pandemic. The use of meditation using various techniques has shown promising results in the reduction of stress and its sequelae. OBJECTIVE: To determine the efficacy of a mantra-based meditation protocol developed by the American Meditation Institute to reduce caregiver stress by evaluating changes in burnout and secondary traumatic stress (components of compassion fatigue) and compassion satisfaction with the application of the meditation protocol. DESIGN, SETTING, AND PARTICIPATION: This pre–post cohort analysis was conducted on prospective enrollees of the Continuing Medical Education (CME)-accredited American Meditation Institute's annual Heart and Science of Yoga® Conference, a comprehensive training in Yoga Science as Holistic Mind/Body Medicine for physicians and other healthcare providers held in October in Lenox, Massachusetts. Enrollees were trained in mantra-based AMI Meditation at the conference and monitored during the 6-month period following the conference. INTERVENTIONS: The mantra-based AMI Meditation intervention included a 5-day in-person training, a daily practice of a guided mantra-based AMI Meditation using a 20-min CD or MP3 recording, and receipt of a monthly motivational letter. Study participants completed the Professional Quality of Life (ProQOL) Measure (a survey) and a demographic survey at baseline, and the ProQOL Measure and an informational survey at 3 and 6 months. MAIN OUTCOMES AND MEASURES: The primary outcome was a change from baseline in participants’ level of burnout using the ProQOL assessed at baseline and 3 and 6 months. Secondary outcomes included change from baseline in participants’ level of secondary traumatic stress and compassion satisfaction assessed at 3 and 6 months using the ProQOL Measure. Qualitative data were also collected from participant feedback, via the informational surveys, at 3 months and after completion of the program at 6 months. RESULTS: Of the 54 participants who enrolled and completed a baseline survey, 30 completed the follow-up at 3 months and 21 participants completed the follow-up at 6 months. From baseline to 6 months, there were statistically significant improvements in the scores for all three ProQOL scales. Using paired t-test, burnout scores were reduced by 23.2% (p < 0.0001), secondary traumatic stress scores were reduced by 19.9% (p = 0.001), and compassion satisfaction scores improved by 11.2% (p < 0.0001). For secondary traumatic stress and compassion satisfaction scores, most improvements were seen at 3 months. For burnout, the improvements were constant across the 3- and 6-month follow-ups. CONCLUSIONS: In this small cohort of healthcare professionals, the mantra-based AMI Meditation program significantly improved all three domains of caregiver stress with improvements in burnout and secondary traumatic stress as well as improvements in feelings of compassion. This adds to a rapidly growing body of research supporting the critical importance of these tools and skills in the mitigation of caregiver stress.

BACKGROUND: The COVID-19 pandemic demanded exceptional physical and mental effort from healthcare workers worldwide. Since healthcare workers often refrain from seeking professional psychological support, internet-delivered interventions could serve as a viable alternative option. OBJECTIVE: We aimed to investigate the effects of a therapist-guided six-week CBT-based internet-delivered stress recovery intervention among medical nurses using a randomized controlled trial design. We also aimed to assess program usability. METHODS: 168 nurses working in a healthcare setting (Mage = 42.12, SDage = 11.38; 97 % female) were included in the study. The intervention group included 77 participants, and the waiting list control group had 91 participants. Self-report data were collected online at three timepoints: pre-test, post-test, and three-month follow-up. The primary outcome was stress recovery. Secondary outcomes included measures of perceived stress, anxiety and depression symptoms, psychological well-being, posttraumatic stress and complex posttraumatic stress symptoms, and moral injury. RESULTS: We found that the stress recovery intervention FOREST improved stress recovery, including psychological detachment (d = 0.83 [0.52; 1.15]), relaxation (d = 0.93 [0.61, 1.25]), mastery (d = 0.64 [0.33; 0.95]), and control (d = 0.46 [0.15; 0.76]). The effects on psychological detachment, relaxation, and mastery remained stable at the three month follow-up. The intervention was also effective in reducing its users' stress (d = − 0.49 [− 0.80; − 0.18]), anxiety symptoms (d = − 0.31 [− 0.62; − 0.01]), depression symptoms (d = − 0.49 [− 0.80; − 0.18]) and increasing psychological well-being (d = 0.53 [0.23; 0.84]) with the effects on perceived stress, depression symptoms, and well-being remaining stable at the three-month follow-up. High user satisfaction and good usability of the intervention were also reported. CONCLUSIONS: The present study demonstrated that an internet-based intervention for healthcare staff could increase stress recovery skills, promote psychological well-being, and reduce stress, anxiety, and depression symptoms, with most of the effects being stable over three months.

[This is an excerpt.] In this study, 17 key informant experts shared their perspectives on how the emergency medical services (EMS) and community paramedicine (CP) workforces responded to COVID-19 during the first year of the pandemic, 2020. Experts also described how the pandemic has affected EMS and CP. EMS responders provide 9-1-1 emergency services, while community paramedics (CPs), typically drawn from EMS personnel, provide non- emergent public health services and augment primary care services to patients in the community. [To read more, click View Resource.]

BACKGROUND: Job Crafting is a strategy undertaken by highly motivated individuals to modify their own work. Educating individuals about the benefits of this approach has recently been explored in other professions as a wellbeing intervention. OBJECTIVE: We aimed to demonstrate that a Job Crafting intervention for health care leaders would result in improved wellbeing, lower burnout, and enhanced job resources. METHODS: Fourteen health care leaders across 6 departments at one academic medical center participated in a two-part workshop on Job Crafting between January 1, 2019 and December 31, 2020. Participants completed electronic surveys before and 4-6 weeks after the sessions. Pre- and post-intervention scores were compared using Wilcoxon signed rank sum tests. RESULTS: Eighty-six percent of participants stated the sessions were useful and applicable to their jobs, with 93% stating they were a valuable use of time and would recommend sessions to others. Participant Job Crafting behaviors increased following the intervention, with 46% increasing structural and social resources (P = .03) and 85% decreasing Hindrance Demands (P = .02). Increased meaning in work was identified by 38% post-intervention (P = .04). No statistically significant differences were identified in Distress Scores at high risk for burnout pre- and post-intervention (86% for both), but 30% of participants had an absolute improvement (decrease) in their Distress Score. CONCLUSIONS: A Job Crafting intervention was associated with high rates of satisfaction among participants and was successful in increasing Job Crafting behaviors and perceptions of meaningful work, but did not result in a change in risk for burnout in the short follow-up period.

PURPOSE: This project specifically aims to examine (1) the individual impact of coronavirus disease 2019 (COVID-19) on first responders, (2) the organizational impact of COVID-19 on first response agencies and (3) policy and organizational response and support efforts to mitigate potentially harmful effects of the pandemic. DESIGN/METHODOLOGY/APPROACH: The authors' conducted a mixed-methods analysis, including a review of secondary sources (e.g. government documents, organizational policies and news pieces), state-level policies, encompassing surveys, in-depth semi-structured interviews and PhotoVoice focus groups. FINDINGS: COVID-19 compounded many of the inherent risks facing first responders and added new stressors. First responders assumed added responsibilities during the pandemic which increased workloads, job-related stress, burnout, distance from the community and first responders' feelings of frustration. Even with personal protective equipment (PPE), first responders faced greater exposure to individuals with COVID-19 and were primarily concerned with transmitting the virus to family members, or other members of the first responders' support networks. State-level COVID-19 policies that were geared toward first responders aimed to improve the first responders' personal lives outside of work and mitigate burnout within the profession. First response agencies adapted to the pandemic by implementing a wide range of measures. PRACTICAL IMPLICATIONS: First responders also identified several weaknesses in the first responders' agencies' approach to the pandemic. To prepare for the next public health emergency, first response agencies should proactively train employees, build up the first responders' supplies of equipment and PPE, implement policies to strengthen their workforce (e.g. increase hiring for understaffed positions, reduce turnover and mitigate role abandonment), allow for greater employee autonomy, improve communication between leaders and employees and prioritize employees' mental health, as well as other factors relating to departments' informal culture. ORIGINALITY/VALUE: This is one of the largest studies conducted on three types of first responders (police officers, fire firefighters, emergency medical technicians (EMTs) and paramedics) across the United States of America during a public health crisis.

The COVID-19 pandemic disrupted conventional medical education for surgical trainees with respect to clinical training, didactics, and research. While the effects of the COVID-19 pandemic on surgical trainees were variable, some common themes are identifiable. As hordes of COVID-19 patients entered hospitals, many surgical trainees stepped away from their curricula and were redeployed to other hospital units to care for COVID-19 patients. Moreover, the need for social distancing limited traditional educational activities. Regarding clinical training, some trainees demonstrated reduced case logs and decreased surgical confidence. For residents, fellows, and medical students alike, most didactic education transitioned to virtual platforms, leading to an increase in remote educational resources and an increased emphasis on surgical simulation. Resident research productivity initially declined, although the onset of virtual conferences provided new opportunities for trainees to present their work. Finally, the pandemic was associated with increased anxiety, depression, and substance use for some trainees. Ultimately, we are still growing our understanding of how the COVID-19 pandemic has redefined surgical training and how to best implement the lessons we have learned.

Health care providers caring for patients at the end of life (EOL) are faced with a multitude of emotions such as guilt, anger, sadness, and helplessness. Because of the negative impact of initiating EOL care (EOLC) to the pediatric population, organizations must be proactive in instituting education and resources on EOLC. They must also provide advanced skills to nurses who take care of patients at their EOL. Understanding the consequences of providing EOL care to patients in the pediatric intensive care unit allows for better allocation of resources and support services for nurses. This improves patient outcomes and nurse retention.

Burnout is an internationally recognized occupational phenomenon that negatively impacts the healthcare workforce and its recipients. The aim of this pilot study was to test whether positive reinforcement and integrating a language of support among co-workers can enhance resiliency, facilitate psychological wellness, and encourage hope. This embedded mixed methods prospective, behavioral, interventional study evaluated the effects of positive feedback on wellness among intensive care unit clinicians during the COVID-19 pandemic in a single center, quaternary care medical center. The deliberate positive feedback paradigm has the potential to augment resiliency and improve attitudes toward a teamwork climate. The routine use of deliberate positivity may represent a scalable, low-cost initiative to enhance wellness in a healthcare organization.

This study seeks participation from patrol-level officers with at least two years’ experience in the New Castle County Police Department in Delaware (n=134) and requests that they respond to two questionnaires measuring resilience and job burnout: the 25-item Resilience Scale and the Maslach Burnout Inventory. Additionally, participants are asked to self-report their pre-hire fitness scores. Police officers are repeatedly exposed to trauma, which has negative mental and physical consequences, often leading to extreme stress, fatigue, and emotional imbalance. Repeated trauma also impacts physical fitness, which is critical for not only physical and mental health but also work performance, especially for police officers. Two related concepts are used to investigate the relationship between physical and mental health: resilience, which describes an individual’s capacity to recover quickly from difficulties, and burnout, a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. The data generated by the aforementioned scales are compared to pre-hire physical fitness scores to observe the relationship between pre-hire fitness and current levels of burnout and resilience. This study aims to improve the hiring practices of police organizations by identifying characteristics that enable candidates to manage repeated exposure to trauma. Failing to hire resilient police officers can produce physically and mentally exhausted police populations that cannot provide the public with safe and effective policing. The study hypothesizes that pre-hire physical fitness scores influence measures of resilience and burnout in patrol-level police officer populations.

BACKGROUND: Burnout and other psychological comorbidities were evident prior to the COVID-19 pandemic for critical care healthcare professionals (HCPs) who have been at the forefront of the health response. Current research suggests an escalation or worsening of these impacts as a result of the COVID-19 pandemic. OBJECTIVES: The objective of this study was to undertake an in-depth exploration of the impact of the evolving COVID-19 pandemic on the wellbeing of HCPs working in critical care. METHODS: This was a qualitative study using online focus groups (n ¼ 5) with critical care HCPs (n ¼ 31, 7 medical doctors and 24 nurses) in 2021: one with United Kingdom-based participants (n ¼ 11) and four with Australia-based participants (n ¼ 20). Thematic analysis of qualitative data from focus groups was performed using Gibbs framework. FINDINGS: Five themes were synthesised: transformation of anxiety and fear throughout the pandemic, the burden of responsibility, moral distress, COVID-19 intruding into all aspects of life, and strategies and factors that sustained wellbeing during the pandemic. Moral distress was a dominant feature, and intrusiveness of the pandemic into all aspects of life was a novel finding. CONCLUSIONS: The COVID-19 pandemic has adversely impacted critical care HCPs and their work experience and wellbeing. The intrusiveness of the pandemic into all aspects of life was a novel finding. Moral distress was a predominate feature of their experience. Leaders of healthcare organisations should ensure that interventions to improve and maintain the wellbeing of HCPs are implemented.

“Diversity is having a seat at the table, inclusion is having a voice, and belonging is having that voice heard” ( 1 ). Thus, while promoting diversity is important, it is not enough. Diversity is only sustainable through inclusion and belonging. Similarly, having a voice that is heard and a sense of belonging is important for well-being ( 2 ). The recent literature is replete with articles that address diversity and well-being as separate entities. At first glance, these topics may seem unrelated but with a deeper dive, it is evident that they complement and supplement each other. Examples include psychological safety and a sense of belonging, awareness of the minority tax and the potential burden on well-being, family leave and the impact on work-life integration, equal compensation for equal work, and using mindfulness to reduce unconscious bias and improve mental health. This article explores the intersection of diversity and well-being, and proposes strategies to improve physician well-being through the prioritization of diversity, inclusion, and belonging.

This study addresses the link between burnout and job performance. Following a systematic literature review, 45 studies were selected based on the inclusion criteria: (1) set in an organizational environment, (2) including a measure of burnout, (3) including an objective or subjective measure of performance and (4) offering information concerning the link between burnout and job performance. A random-effects model yielded meta-analytic correlations of −.17 for exhaustion (k = 18019 aggregated participants), −.16 for depersonalization (k = 8561 aggregated participants) and −.23 for inefficacy (k = 7281 aggregated participants) and job performance. Four potential moderators were examined: the type of (1) performance measured, (2) performance report, (3) burnout measure, and (4) participant occupation. Our analyses indicate that the burnout measure exerted a moderating effect, but only with respect to exhaustion (r = −.19 for MBI; −.10 for OLBI), but not for depersonalization. Participant occupation was a significant moderator for exhaustion (r =-.21 for corporate roles; −.22 for customer-facing roles), depersonalization (r = −.28 for corporate roles; −.31 for customer-facing roles), and inefficacy (r = −.41 for corporate roles; −.23 for customer-facing roles). The type of performance measure and the type of performance report did not exert any significant moderating effects.

Increasing levels of stress and burnout are aggravating disturbing physician behaviors. Some have changed jobs, others have started new careers, and many have chosen early retirement. For those who remain, stress and burnout have taken their toll on the physician’s physical and emotional health. In some cases, the growing frustration, dissatisfaction, and anger have precipitated unprofessional disruptive behaviors. Although it is difficult to document a cause-and-effect relationship between stress and burnout and disruptive behaviors, the implications are there. In addition to policies and procedures designed to address disruptive behavior, organizations must make a special effort to reduce the triggers that may precipitate these events. Addressing and managing key underlying factors and focusing on enhancing physician well-being is a key part of the solution.

[This is an excerpt.] Throughout the COVID-19 pandemic, Mental Health America (MHA) has witnessed increasing numbers of anxiety, depression, loneliness, and other mental health concerns. COVID-19 has had a profound negative effect on the mental health of the nation, especially among those who are faced with combating the virus. [To read more, click View Resource.]

BACKGROUND: Nurses face many ethical challenges, placing them at risk for moral distress and burnout and challenging their ability to provide safe, high-quality patient care. Little is known about the sustainability of interventions to address this problem. OBJECTIVE: To determine the long-term impact on acute care nurses of a 6-session experiential educational program called the Mindful Ethical Practice and Resilience Academy (MEPRA). METHODS: MEPRA includes facilitated discussion, role play, guided mindfulness and reflective practices, case studies, and high-fidelity simulation training to improve nurses’ skills in mindfulness, resilience, and competence in confronting ethical challenges. A prospective, longitudinal study was conducted on the impact of the MEPRA curriculum at 2 hospitals in a large academic medical system. The study involved surveys of 245 nurses at baseline, immediately after the intervention, and 3 and 6 months after the intervention. RESULTS: The results of the intervention were generally sustained for months afterward. The most robust improvements were in ethical confidence, moral competence, resilience, work engagement, mindfulness, emotional exhaustion, depression, and anger. Some outcomes were not improved immediately after the intervention but were significantly improved at 3 months, including anxiety and empathy. Depersonalization and turnover intentions were initially reduced, but these improvements were not sustained at 6 months. CONCLUSIONS: Many MEPRA results were sustained at 3 and 6 months after conclusion of the initial foundational program. Some outcomes such as depersonalization and turnover intentions may benefit from boosters of the intervention or efforts to supplement the training by making organizational changes to the work environment.

This resource is found in our Actionable Strategies for Health Organizations: Aligning Values (Acknowledge/Address Moral Distress & Moral Injury).

Burnout is a common term in the medical profession, specifically regarding the prevalence among physicians; however, physician assistants have been found to have comparable burnout rates to physicians, but the topic has received less attention. Many techniques have been evaluated in the treatment and prevention of burnout. Mindfulness techniques have reduced burnout among physicians and can be extrapolated to treating burnout with physician assistants. Strategies can be implemented within a busy schedule and have been proven to reduce stress and burnout. However, more research is needed on the direct impact of Mindfulness on physician assistants. This article will highlight the prevalence of burnout in physician assistants, how to identify burnout, and the role of Mindfulness in combating burnout. Recognition of burnout is essential to treat it, and budget constraints often impact programming options. Mindfulness has been proven to reduce burnout and can be implemented time-efficient and cost-effectively.

BACKGROUND: The COVID-19 pandemic worsened the ongoing overdose crisis in the United States (US) and caused significant mental health strain and burnout among health care workers (HCW). Harm reduction, overdose prevention, and substance use disorder (SUD) workers may be especially impacted due to underfunding, resources shortages, and chaotic working environments. Existing research on HCW burnout primarily focuses on licensed HCWs in traditional environments and fails to account for the unique experiences of harm reduction workers, community organizers, and SUD treatment clinicians. METHODS: We conducted a qualitative secondary analysis descriptive study of 30 Philadelphia-based harm reduction workers, community organizers, and SUD treatment clinicians about their experiences working in their roles during the COVID-19 pandemic in July–August 2020. Our analysis was guided by Shanafelt and Noseworthy’s model of key drivers of burnout and engagement. We aimed to assess the applicability of this model to the experiences of SUD and harm reduction workers in non-traditional settings. RESULTS: We deductively coded our data in alignment with Shanafelt and Noseworthy’s key drivers of burnout and engagement: (1) workload and job demands, (2) meaning in work, (3) control and flexibility, (4) work-life integration, (5) organizational culture and values, (6) efficiency and resources and (7) social support and community at work. While Shanafelt and Noseworthy’s model broadly encompassed the experiences of our participants, it did not fully account for their concerns about safety at work, lack of control over the work environment, and experiences of task-shifting. CONCLUSIONS: Burnout among healthcare providers is receiving increasing attention nationally. Much of this coverage and the existing research have focused on workers in traditional healthcare spaces and often do not consider the experiences of community-based SUD treatment, overdose prevention, and harm reduction providers. Our findings indicate a gap in existing frameworks for burnout and a need for models that encompass the full range of the harm reduction, overdose prevention, and SUD treatment workforce. As the US overdose crisis continues, it is vital that we address and mitigate experiences of burnout among harm reduction workers, community organizers, and SUD treatment clinicians to protect their wellbeing and to ensure the sustainability of their invaluable work.