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STUDY OBJECTIVE: The influence of workplace mistreatment on the well-being and career satisfaction of emergency medicine residents is unknown. This study examined the relationships between burnout, career choice regret, and workplace mistreatment in a national sample of emergency medicine residents. METHODS: This was a secondary analysis of a survey study on the prevalence of workplace mistreatment among emergency residents. Residents who reported emotional exhaustion or depersonalization at least once per week were considered to have burnout. Residents who reported dissatisfaction with their decision to become an emergency physician were considered to have career choice regret. Respondents also reported the type (discrimination, abuse, sexual harassment) and frequency of mistreatment over the academic year. Multivariable logistic regression, adjusting for program characteristics, was used to examine resident characteristics associated with burnout and career choice regret, with the frequency of mistreatment as a covariate. RESULTS: Of the 8,162 eligible residents, 7,680 (94.1 %) participated. About a third of respondents reported burnout (2,188 of 6,902, 31.7%), whereas a minority (224 of 6,923, 3.2%) reported career choice regret. Of the 7,087 responses on mistreatment frequency, 2,117 (29.9%) reported “a few times per year,” and 1,296 (18.3%) reported “a few times per month or more.” Compared with residents who never experienced mistreatment, residents who reported increasing frequencies of mistreatment were associated with having burnout—from mistreatment a few times per year (OR [odds ratio],1.6; 99% CI [confidence interval], 1.3 to 1.9) to a few times per month or more (OR, 3.3; 99% CI, 2.7 to 4.1). Compared with residents without burnout, residents who reported burnout were associated with having career choice regret (OR, 11.3; 99% CI, 7.0 to 18.1). After adjusting for burnout, there were no significant relationships between the frequency of mistreatment and career choice regret. CONCLUSIONS: Workplace mistreatment is associated with burnout, but not career choice regret, among emergency medicine residents. Efforts to address workplace mistreatment may improve emergency medicine residents’ professional well-being.

This paper explores the issue of Moral Injury in firefighters and how it can affect their mental and spiritual health, both in and out of the firehouse. Moral Injury (MI) refers to experiences/situations that go against an individual’s internal moral compass such as lack of fairness or the inability todo what is right and just. Its symptoms are similar to those of Post-traumatic Stress Disorder(PTSD), and like PTSD, MI can be addressed and healed. We surveyed 479 firefighters across nine fire/EMS agencies using the Moral Injury Outcomes Scale (MIOS). Of our 479 responses, 276 (57.6%) reported having experienced a morally-injurious event such as mass shootings, car accidents, injured children, evidence of abuse, or their own failure to call out colleagues making mistakes on the job. Write-in comments indicated themes such as management/leadership failures,toxic organizational culture, lack of access to mental health resources, and adverse working conditions caused by personnel shortages, abuse of the 911 system for non-emergency medical calls, and department policies. A third of our sample responded affirmatively to items from The Primary Care PTSD Screen for DSM-5 regarding nightmares, intrusive thoughts, avoidance,hypervigilance, and guilt. Almost half of our sample responded affirmatively to the question about detachment/isolation. Furthermore, our results suggest that firefighters may not understand the definition of Moral Injury, nor its distinction from PTSD. Regardless of the label, even though the fire service culture is changing, more attention needs to be paid to reducing the stigma of behavioral health, implementing mental wellness programs, and improving access to mental health treatment.

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This resource is found in our Actionable Strategies for Public Safety Organizations: Status of Burnout & Moral Injury

AND Drivers (Relational Breakdown) AND Drivers (Operational Breakdown) AND Outcomes

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STUDY OBJECTIVES: Increased rates of suicide and suicidal thoughts amongst Emergency Medical Service (EMS) professionals continue to be reported in literature which has directed attention to potential causative factors. Burnout is one of the factors most discussed as being associated with this increase. There are limited studies of factors that correlate with increased burnout. Our objective was to conduct a survey of a statewide population of emergency services providers to evaluate their rate of burnout in addition to identifying both work and personal factors that may contribute to their burnout level. We also looked at self-reported burnout prior to the Covid 19 pandemic and during. METHODS: A voluntary, anonymous electronic survey was distributed to all registered emergency medical providers in the state of Louisiana through the Louisiana Bureau of EMS and the Louisiana Ambulance Alliance from 5/18/2020 to 7/24/2020. These participants represented paid and volunteer providers from a variety of systems to include; fire based, private, third city and air medical services. Data was analyzed utilizing descriptive statistics. RESULTS/FINDINGS: We received a total of 1,505 responses from the 24,000 EMS providers licensed with the Louisiana Bureau of EMS. The overall response rate when factoring all active Louisiana providers was 6.09% However, the response rate increases with increasing level of provider with more 50% of responses from paramedic and advanced emergency medical technicians (AEMT) The paramedic response rate was 22.39%. The advanced EMT response rate was 28.74% The EMT response rate was much lower at 9.03%. Burnout level increased with number of years of EMS experience, increased years at current EMS provider level and more advanced levels of provider. Shift length of 12-24 hours showed the highest level of burnout (2.8, IQR 2-4). Decreased amounts of sleep correlated with increasing burnout levels. Supervisory positions correlated with higher levels of burnout. Services that did transfers only showed the lowest burnout levels (1, IQR 0-2) and those who did scene calls with and without transfer and special events showed the highest levels of burnout (2.75, IQR 2-3.5). Burnout level for pre-COVID (at 2.1) was statistically lower than burnout during COVID (2.7, p=3.15x10- 24). Burnout level pre-COVID was highest when respondents were contemplating leaving the profession and expected their profession to end within less than 1.75 years (135 individuals fall into this category). Burnout during COVID was highest not only with those two categories influencing it, but also with the perception of unfair compensation, typical shift length and years of experience. Unfair compensation had a greater impact for the COVID burnout measurement than years of expected continued service. CONCLUSIONS: Pressures resulting in high burnout changed in this time; although contemplating leaving was still the greatest factor contributing to burnout, the second-most important decision changed from predictions about continued employment to concerns regarding fair compensation. Burnout was significantly higher during COVID and was subject to more variables than pre-COVID burnout.

This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Reducing Administrative Burdens).

Grit is a personality trait that is defined as passion and perseverance for a long-term goal. Resilience is defined as the ability to recover or adjust to misfortune or change. The 2 concepts are inexorably intertwined. Surgery residents demonstrate higher average grit scores than the general population. Increased levels of grit predict success in many areas of life and are positively correlated with satisfaction in surgery residency. Decreased levels of grit correlate with burnout, attrition, and suicidality in resident surgeons. Personal grittiness can be increased by a focused interest in an area, deliberate goal-directed practice, finding a calling in life, and cultivating hope and resilience. Resilience, like grit, can be nurtured over time with deliberate steps. Grit and resilience are important in residency training, and training programs can be tailored to promote a wise environment, with demanding, yet supportive, departments. Organizational grit can be boosted by seeking to maximize successful attributes of dynamic organizations.

Two years into a global pandemic, healthcare team members are in crisis. Leaders are bombarded with competing messages about how to support them and address workforce shortages. A group of experts in collaboration with the National Academy of Medicine identified the top five actions leaders should take to support team members now. These evidence-based actions can be initiated within 3 months and build a foundation for a long-term system well-being strategy.

The National Domestic Worker’s Bill of Rights Act aimed to remedy nearly a century of labor and health inequities facing a majority of the home health workforce—including home health workers, personal care aides, and professional caregivers—who are women of color and immigrants. Although the bill did not pass, the National Domestic Workers Alliance and its affiliates continue to organize a new labor movement inclusive of home care workers that supports federal legislation and adequate labor protections for their members, particularly in right-to-work states like Texas and in municipalities where hazardous working conditions and low wages contribute to the perceived disposability and devaluation of care labor. Home care workers require federal labor protections that will hold states accountable for the health and well-being of this essential workforce.

[This is an excerpt.] On July 1, 2022, new institutional requirements went into effect mandating Sponsoring Institutions to have leave policies that include a minimum of six paid weeks off for medical, parental, and caregiver leave. The establishment of this requirement is part of the ACGME’s commitment to resident and fellow well-being. Since discussions about codifying these types of leave in the Requirements began, and now that the final requirement is in effect, we receive questions and see some confusion about what is actually required. We recognize this particular area of the resident/fellow contract can be confusing. This post attempts to provide clarification. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Operational Strategies (Rewarding & Recognizing Workers and Learners).

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This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Relational Strategies (Measuring Well-Being & Accountability).

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The purpose of this study was to explore perceptions of mental health among police officers and correctional officers within rural Appalachia. The main goal of this research was to better understand how the occupational demands of working in the criminal justice field can impact one’s mental health over time. Several research questions were explored, including the prevalence of various mental health problems, associated stressors, the structure of support among officers, and the perceptions of mental health treatment services. Data were gathered through semi-structured interviews with 21 police and correctional officers located in rural Appalachia. Results provided a better understanding of the mental health of rural officers as well as the associated stressors and protective factors. Findings also further explored the perceptions and utilization of the available treatment services.

INTRODUCTION: Healthcare teams include both leaders and followers, with followers making up the majority of the healthcare team. There are five followership styles which have been described by Kelly (1992) based on critical thinking and active engagement. We aim to explore if a relationship exists between followership style and burnout, and also with job satisfaction of followers within the critical care setting. Additionally, we aim to quantify the distribution of followership types amongst followers within the critical care setting. METHODS: Participants were recruited in person at random to participate in a single centered, cross sectional, four-part survey to determine their followership type (Kelly followership type), burnout (Maslach Burnout Inventory) and job satisfaction (Brayfiled-Rothe Survey and Work and Meaning Inventory). Correlations between followership type and burnout as well as followership type and job satisfaction were then determined. RESULTS: A total of 64 participants (27 residents and 37 critical care nurses) took part in the study. There was a weak-moderate correlation between independent critical thinking and personal accomplishment (R = 0.297), and moderate correlation to meaningful work (R = 0.390), and job satisfaction (R = ?0.300). Active engagement was moderately correlated with personal accomplishment (R = 0.302), meaningful work (R = 0.448) and job satisfaction (R = ?0.418). Neither independent critical thinking nor active engagement showed significant correlation with depersonalization and emotional exhaustion subscales. Most participants were characterized into effective/exemplary followership type with no statistically significant differences between nurses and residents. CONCLUSION: This research shows that by creating an environment which promotes critical thinking and active engagement, nurses and residents may display less burnout, and enhanced job satisfaction.

Occupational stress is a crucial risk factor for the development of somatic and mental disorders and for the reduction of overall well-being. Acceptance and Commitment Therapy (ACT) is an established treatment in clinical practice and its use as a non-clinical workplace intervention proliferated in recent years. This study provides an up-to-date meta-analysis on how face-to-face ACT interventions affect occupational stress as well as psychological distress, psychological flexibility, and well-being. Random-effects meta-analyses were conducted exploring ACT's efficacy concerning the four constructs. Sub-group analyses and meta-regressions were performed to investigate individual, workplace-related, and treatment effects. A total of 17 studies including 860 participants allocated to ACT conditions and 736 participants allocated to control conditions were extracted. ACT outperformed control conditions (passive and active control) regarding psychological distress (Hedges' g = −0.38, 95% CI [-0.57; -0.19]) psychological flexibility (g = 0.33, 95% CI [0.13; 0.54]); and well-being (g = 0.24, 95% CI [0.02; 0.47]) at post-treatment, and regarding stress (g = −0.22, 95% CI [-0.41; −0.04]), psychological flexibility (g = 0.31, 95% CI [0.16; 0.47]), and well-being (g = 0.26, 95% CI [0.03; 0.49]) at follow-up. Additional analyses revealed ACT to be most effective for office employees while showing little to no effect for health care workers. Findings demonstrate ACT to be an effective treatment to reduce psychological distress and stress, and to increase psychological flexibility and general well-being in a non-clinical, workplace setting. An application for employees working in an office setting appears to be most promising.

Burnout is a complex issue resulting from chronic workplace stress. It encompasses:
• Exhaustion—feeling depleted, overextended, and fatigued
• Depersonalization—being detached from oneself and emotionally distant from one’s clients and work
• Feelings of inefficacy—having a reduced sense of professional accomplishment

Burnout has physical and emotional consequences for individuals and impacts their work with clients and within an organization. To fully address burnout, organizations need to adopt strategies that improve their organizational culture and climate to modify the six drivers of burnout: workload, control, reward, community, fairness, and values. This guide highlights organization-level interventions to prevent and reduce burnout among behavioral health workers.

[This is an excerpt.] Our health depends on the well-being of our health workforce. Even before the COVID-19 pandemic, the National Academy of Medicine found that burnout had reached “crisis levels” among the U.S. health workforce, with 35-54% of nurses and physicians and 45-60% of medical students and residents reporting symptoms of burnout.4 Burnout is an occupational syndrome characterized by a high degree of emotional exhaustion and depersonalization (i.e., cynicism), and a low sense of personal accomplishment at work. People in any profession can experience burnout, yet it is especially worrisome among health workers given the potential impacts on our health care system and therefore, our collective health and wellbeing. Burnout is associated with risk of mental health challenges, such as anxiety and depression—however, burnout is not an individual mental health diagnosis. While addressing burnout may include individual-level support, burnout is a distinct workplace phenomenon that primarily calls for a prioritization of systems-oriented, organizational-level solutions. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Workers & Learners AND What Workers & Learners Can Do AND What the Public Can Do AND Actionable Strategies for Government: Empowering Workers & Strengthen Leadership and Governance (Invest in Programs and Evidence) AND Aligning Values & Improving Diversity, Equity & Inclusion (Aligning Values and Improving Diversity, Equity & Inclusion) AND Advancing Measurement & Accountability (Establish Health & Public Safety Workforce Analysis and Planning Bodies) AND Strategies for Other Private Organizations

[This is an excerpt.] Mental health and substance use disorders in the United States were on the rise even before the pandemic and COVID-19 exacerbated many behavioral health conditions. In 2020, 21 percent of adults (52.9 million) reported having a mental illness in the past year and 15 percent (37.9 million) reported having a substance use disorder in the past year, with almost 7 percent of adults having both conditions. Recently released Centers for Disease Control and Prevention (CDC) provisional data suggests that the rate of suicides in the U.S. increased 4 percent from 2020 to 2021, after two consecutive years of decline in 2019 and 2020. Behavioral health conditions begin early in childhood, with 1 in 6 children aged 2-8 being diagnosed with a mental, behavioral, or developmental disorder. Children experienced significant increases in diagnoses of anxiety and depression between 2016 and 2020. Youth have experienced substantial disruption to their development during COVID-19, as have those who are underserved – such as people from certain racial and ethnic groups, the LGBTQI+ community, people with disabilities, children and families involved with the child welfare system, and low-income individuals. [To read more, click View Resource.]

[This is an excerpt.] Much of the clinician well-being movement has focused on physicians and nurses.1 But as the May 2022 Surgeon General’s Advisory Addressing Health Worker Burnout and ongoing deliberations of the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience highlight, the coronavirus pandemic has underscored the need to attend to the well-being of the entire health care workforce, including nursing assistants, transport personnel, clerical staff, and others. [To read more, click View Resource.]

BACKGROUND: Workplace violence (WPV) in health care is an important public health issue and a growing concern in the ED. According to the 2018 Bureau of Labor Statistics, health care and social service industries workers experience the highest rates of injuries caused by WPV; 5 times as likely to suffer a WPV injury as compared to the all-worker incidence rate of 2.1, creating harm and work-related stress and burnout. According to American Nurses Association, “A health care culture that considers workplace violence as part of the job” is the number one barrier to reporting WPV. OBJECTIVE: Define WPV, create a multidisciplinary team, increase awareness, formalize reporting process, improve database, and track actionable trends. METHODS: Study data was abstracted retrospectively from 1/2019-12/2021 at an 80K visits ED, 750 bed quaternary hospital; the following variables: unit/department, persons involved (employees, patients, visitors), nature of violence, and time of day. Descriptive statistics and Wilcoxon rank sum test were used. Our Health system and committee adopted the OSHA definition of WPV: any act or threat of physical violence, harassment, intimidation, verbal abuse, or other threatening disruptive behavior that occurs at work. The multidisciplinary team includes Physicians, Nursing, Security, Quality Management, Human Resources, Safety, Patient and Family Centered Care, Patient Care Services, Case Management and Social Work, as well as close collaboration with the System Workforce Safety team. Increased WPV incident reporting was encouraged by embracing a culture of transparency. WPV events were reported to Security, Quality Management, and HR, and collected in an internal database. Data collection processes were improved and drilled down on indicators that could impact the ED specifically. RESULTS: From 1/2019-12/2021, there were a total of 445 WPV incidents, 85 in the ED (19%) (graph ED incidents/quarter and year). The median number of ED WPV incidents from 2019, 2020, and 2021 was significantly different across the 3 years (the Wilcoxon rank sum test p-value¼ 0.0317). The rate of ED WPV incidents per 1000 ED visits was: 2019, 0.13; 2020, 0.27; 2021, 0.76; ED volume 84,889, 66,652, and 74,121, respectively. In 2021, 243 WPV incidents reported at the hospital level, and 56 ED incidents (23%), greater than any other location in the hospital. Of the ED WPV incidents in 2021: 78.6% occurred between patients and employees, 19.6% between visitors and employees, and 1.8% between an unknown person and an employee. The nature of violence of ED WPV incidents as follows: 21.4% physical abuse, 25% physical abuse with injury, 30.4% harassment, 17.9% verbal abuse/ threats/harassment, and 5.4% sexual harassment. Most WPV incidents occurred between 2am – 4am and 3pm – 11pm. CONCLUSIONS: There was a significant increase of ED WPV incidents reported from 2019 to 2021. We concluded this increase was a result of a combination of factors related to data collection, emphasis on reporting, and factors related to crowding, restrictive visitation policies due to Covid-19, and patient factors. The ED was identified as having a disproportionate number of WPV incidents leading to the decision to place security posts 24/7. The ED WPV committee has also developed a formal debrief process for instances of WPV as well as “Proactive Rounding” with a combination of security and clinical teams.

BACKGROUND: In July 2003, an 80-h work week restriction for residencies was mandated. This was met with skepticism regarding its potential impact on operative training. We hypothesized no difference in outcomes for pediatric surgeons who trained under duty hour restrictions compared to historical complication rates. METHODS: Dual-institutional review of pediatric patients who underwent five of the most common operations (2013–2018) by first-year pediatric surgeons who trained under duty hour restrictions was performed. Tests of proportions were used to compare complication rates to published rates on data collected prior to 2003. RESULTS: Patient mean age was 10.1 years. No significant differences (p values > 0.05) were found in laparoscopic appendectomy rates of infection, bleeding or intra-abdominal abscess compared to previously published rates. Pyloromyotomy rates of infection or duodenal perforation were not different. No differences were detected in rates of infection, recurrence or testicular atrophy for inguinal hernia repair. Umbilical hernia rates of infection, bleeding, and recurrence were also not different. There was no difference in CVC rates of hemopneumothoraces; significantly more bleeding events were detected (1.2% vs. 0.1%; p value = 0.04). CONCLUSION: In this study, first-year complication rates of pediatric surgeons who trained under duty hour restrictions were not significantly different when compared to published rates.

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

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Globally, the health workforce has long suffered from labour shortages. This has been exacerbated by the workload increase caused by the COVID-19 pandemic. Major collapses in healthcare systems across the world during the peak of the pandemic led to calls for strategies to alleviate the increasing job attrition problem within the healthcare sector. This turnover may worsen given the overwhelming pressures experienced by the health workforce during the pandemic, and proactive measures should be taken to retain healthcare workers. This review aims to examine the factors affecting turnover intention among healthcare workers during the COVID-19 pandemic.

Firefighters work in an environment in which they are constantly exposed to stressful situations. Exposure to acute and chronic stress have shown to have dire effects on firefighters, including an increased risk of cardiovascular disease (Cardiovascular related health problems are the largest cause of death in firefighters), as well as burnout. Burnout is becoming a prominent issue in the fire service, as increasing emergency responses and decreasing participation make the job much more demanding. There is evidence in the literature to support mental toughness as an effective factor in combatting the physical and psychological consequences of stress, as well as increased organizational performance. However, no current research evaluates the effectiveness of mental toughness on these factors in a population of firefighters. The present study examined the effectiveness of a three-week, six session mental toughness intervention on stress perception and burnout in 15 firefighters located in the Eastern United States. The Mental Toughness Index (Gucciardi et al., 2015) was used to assess mental toughness, the Firefighter Assessment of Stress Test (Schuhman et al., 2021) was used to assess firefighter stress 3 perception, and the Oldenburg Burnout Inventory (Demerouti et al., 2003) was used to assess burnout. Participants were asked to perform a self-report questionnaire assessing their organizational performance, defined by reported absenteeism. Creating an effective mental toughness training program for firefighters can help address two major issues in the fire service, burnout and stress while also potentially increasing organizational performance, helping firefighters become prepared to successfully handle the physical and mental stressors faced while performing their job. Preliminary analysis showed no significant differences in mental toughness, burnout, perceived stress, or work performance between groups at baseline. Repeated Measures ANOVA analyses supported the effectiveness of the mental toughness intervention on mental toughness (p < .001), burnout symptoms (p = .002), perceived stress (p < .001), and work performance (p = .008). Correlational analyses yielded significant relationships between mental toughness and burnout ( r = -.573). No significant relationship was found at baseline between mental toughness and stress perception. However, a significant relationship was found postintervention between mental toughness and stress perception (r = -.507). Similarly, no significant relationship was found between mental toughness and work performance at baseline. However, a marginally significant relationship was found between mental toughness and work performance post-intervention ( r = -.354). Implications for this study support the efficacy for utilizing mental toughness interventions to address burnout, stress perception, and work performance in a firefighter population.