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OBJECTIVE: Little is known about the scope and role of discriminatory experiences in dentistry. The purpose of this study is to document the experiences that American Indian/Alaska Native (AI/AN), Black, and Hispanic dentists have had with discrimination. METHODS: This study reports data from a 2012 nationally representative study of dentists documenting experiences with discrimination during their dental careers or during dental school by the setting of the discrimination, the providers’ education, and geographic location. This study does not differentiate between levels of discrimination and focuses holisticly on the experience of any discrimination. RESULTS: Seventy-two percent of surveyed dentists reported any experience with discrimination in a dental setting. The experiences varied by race/ethnicity, with 49% of AI/AN, 86% Black, and 59% of Hispanic dentists reporting any discriminatory experiences. Racial/ethnic discrimination was reported two times greater than any other type. CONCLUSIONS: Experiences with racial/ethnic discrimination are prevalent among AI/AN, Black, and Hispanic dentists, suggesting that as a profession work is needed to end discrimination and foster belonging.

AIM: This mixed-methods pilot study aimed to measure the feasibility and acceptability of a psychoeducational group programme and determine its impact on mental well-being. BACKGROUND: The programme was developed to promote self-care, growth and adaptive coping for nurse managers. The programme themes were resilience, insight, self-compassion and empowerment. METHODS: The sample included 19 hospital-based nurse managers. Outcomes included post-traumatic growth, resilience, insight, self-compassion, empowerment, perceived stress, burnout and job satisfaction. Paired samples t tests were conducted to compare outcomes at baseline to follow-up. Qualitative interviews were conducted. Thematic analysis was used to code the qualitative responses by keyword, which were then aggregated into themes. RESULTS: Participants reported higher post-traumatic growth and psychological empowerment after the intervention. The following six themes emerged most consistently from the qualitative interviews: feasibility of the programme, benefits of peer support, sources of stress, barriers to self-care, sources of strength and sustainability of effects. CONCLUSIONS: The results support the acceptability and feasibility of the psychoeducational group programme. Implications for nursing management Health care organizations can support and promote the implementation of programmes to alleviate burnout and improve mental well-being amid the complex demands of nursing management (ClinicalTrials.gov: NCT04987697).

Communication among interprofessional healthcare worker teams is critical to ensure a thriving and resilient workforce. We will evaluate the implementation and effectiveness of the Alda Healthcare Experience (AHE), a novel medical improvisation (improv) workshop designed to improve interprofessional communication skills among healthcare professionals. The AHE workshop includes a two-hour experiential training workshop led by an improv specialist and a clinical co-facilitator. In July 2022 we began implementing the AHE workshop by training 18 clinical co-facilitators who will co-facilitate the workshops for 550 healthcare workers from five hospital departments at Stony Brook University Hospital over the course of a year and a half. Using mixed-methods, we will conduct an Effectiveness-Implementation Hybrid Design project that includes an outcome evaluation (effectiveness) and a process evaluation (implementation).

The burnout literature is replete with burnout score results from quantitative surveys. There is a paucity of qualitative research that seeks to understand the impact of physician stressors on work-life balance and burnout. This study aimed to identify factors that support and disrupt work-life balance, drivers of burnout, and potential solutions among academic dermatologists. The objective was to better understand factors that promote wellness and ameliorate burnout. Concurrent explanatory mixed methods consisted of scores on the Abbreviated Maslach Burnout Inventory and open-ended semi-structured telephone interviews. The results were that positive factors, such as supportive home life and satisfaction derived from academic endeavors, compete with ongoing feelings of exhaustion, frustration, and apathy. Negative stressors include the electronic medical record, insufficient staffing, administrative and clinical task burden, and perceived lack of interest from mid-level and senior health system leadership in addressing clinicians' needs. This was a single-center academic study. As with all qualitative studies, these results may not be generalizable to all dermatologists. In addition, some participants were concerned about their anonymity. Modifiable root causes of burnout require institutional commitment to sustain the pace required by academic dermatologists.

OBJECTIVE: To assess changes to the experiences and wellbeing of urology trainees in the United States (US) and European Union (EU) during the COVID-19 pandemic.

METHODS: A 72-item anonymous online survey was distributed September 2020 to urology residents of Italy, France, Portugal, and the US. The survey assessed burnout, professional fulfillment, loneliness, depression and anxiety as well as 38 COVID specific questions.

RESULTS: Two hundred twenty-three urology residents responded to the survey. Surgical exposure was the main educational concern for 81% of US and 48% of EU residents. E-learning was utilized by 100% of US and 57% of EU residents with two-thirds finding it equally or more useful than traditional didactics. No significant differences were seen comparing burnout, professional fulfillment, depression, anxiety, or loneliness among US or EU residents, 73% of US and 71% of EU residents reported good to excellent quality of life during the pandemic. In the US and EU, significantly less time was spent in the hospital, clinic, and operating room (P <.001) and residents spent more time using telehealth and working from home during the pandemic and on research projects, didactic lectures, non-medical hobbies and reading. The majority of residents reported benefit from more schedule flexibility, improved work life balance, and increased time for family, hobbies, education, and research.

CONCLUSION: The COVID-19 pandemic has resulted in significant restructuring of residents’ educational experience around the globe. Preservation of beneficial changes such as reduction of work hours and online learning should be pursued within this pandemic and beyond it.

Background: The workloads of emergency medical service personnel (EMS) are varied. In the absence of recovery, health consequences can result. The aim of this review was to analyze the literature on the associations between psychosocial or physical work factors on one hand and the well-being outcomes and job satisfaction on the other hand. Methods: A systematic literature review examining the workloads, behavior, and well-being of EMS including emergency physicians, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for the reporting systematic reviews, was performed. The PubMed, Ovid Medline, Cochrane Library, Scopus, Web of Science, PsycINFO, Psyndex, and Embase electronic databases were used. Results: Thirty-three studies were included. These were divided into studies that predominantly focused on the behavior (6), stress and strain (22), and well-being (5) of EMS. Only four studies also examined emergency physicians. The studies indicated a high prevalence of psychological and physical stress factors. Burnout and posttraumatic stress disorders have been the most studied consequences of mismatched stress. The health status variable performs better in conjunction with higher qualifications. Age is not a protective variable in some studies. Conclusions: EMS workloads are varied and must be assessed on an individual basis. Studies on emergency physicians are needed. Organizational and personal measures must become the focus of health promotion and prevention in the workplace.

INTRODUCTION: Resident burnout is highly prevalent in general surgery. Burnout is increasingly recognized as a symptom of an unsupportive workplace. The objectives of this study were to describe resident perceptions of program responsiveness and to identify associated factors. METHODS: We used a convergent mixed-methods design. A cross-sectional survey was administered to all U.S. general surgery residents following the 2020 ABSITE, querying resident perceptions of their learning environment (including program responsiveness), burnout, thoughts of attrition and suicide, and career satisfaction. Multivariable logistic regression models adjusting for program/resident characteristics assessed associations of program responsiveness with aspects of the learning environment and resident wellness. 366 interviews and 27 focus groups with residents and faculty were conducted during in-person visits to 15 residency programs. Transcripts were analyzed thematically using inductive and deductive logics until thematic saturation was achieved. RESULTS: Of the 7233 clinically active residents from 323 programs who completed the survey (85.5% response rate), 5256 had data available for all outcomes of interest. 72.1% (n=3791) reported satisfaction with program responsiveness. These residents were significantly less likely to report 80-hour workweek violations (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.18-0.26), burnout (OR 0.47, 95% CI 0.41-0.53), thoughts of attrition (OR 0.32, 95% CI 0.27-0.38), and suicidality (OR 0.52, 95% CI 0.41-0.65). They were significantly more likely to report satisfaction with career choice, personal life, and work-life balance (all p < 0.001). Factors associated with improved perception of program responsiveness included larger program size (50+ vs. <23 residents; OR 1.48, 95% CI 1.01-2.19), having faculty mentorship (OR 2.64, 95% CI 2.22-3.14), having meaningful input into call and vacation schedules (OR 3.31, 95% CI 2.74-4.00), and feeling comfortable speaking up (OR 4.20, 95% CI 3.47-5.09). We conducted a qualitative analysis to identify the following components of program responsiveness: (1) core values reflecting a shared understanding of the importance of resident voice in shaping the training experience and the program, including mutual trust and respect between residents and faculty, transparency and communication, resident unity, and resident participation in and ownership of program improvement; (2) structural constructs that reflect and support responsiveness; (3) mechanisms for supporting resident agency, including resources and leadership support, faculty advocacy, and resident leadership opportunities. CONCLUSION: Program responsiveness in surgical residency is associated with improved resident wellness. Programs should develop formal channels to elicit and concretely address resident concerns, provide opportunities for resident representation, and entrust residents with the flexibility and autonomy to make decisions that support their own education and wellness.

BACKGROUND: There have been no studies to date of moral distress during the COVID-19 pandemic in national samples of U.S. health workers. The purpose of this study was to determine, in a national sample of internal medicine physicians (internists) in the U.S.: 1) the intensity of moral distress; 2) the predictors of moral distress; 3) the outcomes of moral distress. METHODS: We conducted a national survey with an online panel of internists, representative of the membership of the American College of Physicians, the largest specialty organization of physicians in the United States, between September 21 and October 8, 2020. Moral distress was measured with the Moral Distress Thermometer, a one-item scale with a range of 0 (“none”) to 10 (“worst possible”). Outcomes were measured with short screening scales. RESULTS: The response rate was 37.8% (N = 810). Moral distress intensity was low (mean score = 2.4, 95% CI, 2.2–2.6); however, 13.3% (95% CI, 12.1% - 14.5%) had a moral distress score greater than or equal to 6 (“distressing”). In multiple linear regression models, perceived risk of death if infected with COVID-19 was the strongest predictor of higher moral distress (β (standardized regression coefficient) = 0.26, p < .001), and higher perceived organizational support (respondent belief that their health organization valued them) was most strongly associated with lower moral distress (β = -0.22, p < .001). Controlling for other factors, high levels of moral distress, but not low levels, were strongly associated (adjusted odds ratios 3.0 to 11.5) with screening positive for anxiety, depression, posttraumatic stress disorder, burnout, and intention to leave patient care. CONCLUSIONS: The intensity of moral distress among U.S. internists was low overall. However, the 13% with high levels of moral distress had very high odds of adverse mental health outcomes. Organizational support may lower moral distress and thereby prevent adverse mental health outcomes.

BACKGROUND: Academic gastroenterology (GI) hospitalists are increasing, however the impacts on fellowship training and clinical care are unclear. Motivations for implementation of the GI hospitalist model are uninvestigated. AIMS: We aimed to determine the prevalence of GI hospitalists, explore motivations for and against adoption of a GIH model, and investigate the model's effects on fellowship training. METHODS: Leadership at current general GI fellowships were surveyed about current staffing models, as well as effects and perceptions of the hospitalist model. RESULTS: There was a total of 52 (26%) respondents and 12 (23%) reported having a GI hospitalist at their institution. A majority of respondents stated burnout and reduced time on service for other faculty was a primary reason for hiring a GI hospitalist. DISCUSSION: The largest perceived benefit of a hospitalist is reduced burnout and time on service for outpatient GI faculty. Many respondents also believed a GIH would improve fellowship education and quality of inpatient care.

This JAMA Forum discusses hospital policies that can harm patients, such as aggressively collecting payment on medical bills from those who cannot afford to pay, and provides ways to address current “never event” policies.

Making fair and equitable staffing decisions and patient assignments created complexities and undue nursing dissatisfaction on a 20-bed progressive care unit. Common themes shared by the nursing staff included inadequate staffing ratios, increased workload, and unease for patient safety. On the basis of these concerns, a unit-based needs assessment provided insight into what perceived and actual barriers exist preventing nurses from providing excellent care. Information gathered helped determine what could be done to overcome some barriers, and performing a comprehensive unit profile assessment allowed for better insight into how the unit was currently functioning. A comprehensive review of literature was undertaken to examine articles related to patient acuity utilizing the electronic databases CINAHL, PubMed, and MEDLINE. Key words and phrases included the following: acuity, patient acuity, acuity tools, progressive care acuity, nurse-patient assignment, workload, nursing assignments, and equitable staffing. Utilizing the results of the nurse survey, and information gained from articles gathered during the literature review, a patient acuity tool was created. The tool was believed to be an accurate representation of the patients' acuity, and the majority of charge nurses reported that they utilized the patient acuity tool score when making nurse-patient assignments. Overall staff satisfaction and perceptions of nurse-patient assignment equity were improved.

This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Safe & Appropriate Staffing).

The COVID-19 pandemic has exposed and amplified the longstanding occupational circumstances of nurses. In this article, the authors provide updates to their 2020 institutional recommendations and craft a national plan to tackle burnout and moral suffering.

This qualitative study investigated turnover intention and its influence on the public service motivation of U.S. police officers. The study was completed using a phenomenological design to elicit the lived experience of 21 retired and active police officers using face-to-face and telephonic interviews. The theoretical frameworks of turnover intention and public service motivation supported the research. Deductive thematic analysis was utilized to examine the results using NVivo 12. Furthermore, the findings supported the theoretical frameworks of turnover intention and public service motivation. The results revealed that each participant had different turnover intentions influencing distinct public service motivation characteristics. The turnover intentions that were most common amongst the participants were a lack of perceived organizational support (90%, 19 of 21) and increased stress (90%, 19 of 21). The characteristics of public service motivation that were most influenced were self-sacrifice (33%, 7 of 21), attraction to policy making (90%, 19 of 21), and compassion (33%, 7 of 21). Increased turnover intention did not always change the characteristics of public service motivation. Further research is needed to evaluate police participants, such as examining non-retired individuals who self-terminated and did not return to the profession, different genders to identify variations, longitudinal studies to explore police officers' public service motivation, and mixed research designs to provide a quantitative descriptive dimension with qualitative evidence that offers a holistic perspective.

A psychologically safe environment for healthcare teams is desirable for optimal team performance, team member well-being, and favorable patient safety outcomes. This piece explores facilitators of and barriers to psychological safety across healthcare settings. Future research directions examining psychological safety in healthcare are discussed.

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

PURPOSE: Working in a hospital setting during a global health pandemic can lead to increased levels of anxiety, stress, burnout, and depression. Anecdotal evidence exists, but there is little research utilizing clinically validated tools to measure hospital staff psychological distress. METHODS: In Summer 2021, 771 hospital staff in North Dakota responded to an electronic survey collecting demographic data and employing validated behavioral health screening tools to assess anxiety, depression, emotional distress, and work-related quality of life. FINDINGS: Compassion satisfaction was significantly higher for those who worked in rural areas than urban [t(769) = –1.99, P = .0467]. The burnout rating was significantly higher for those who worked in urban areas than rural [t(769) = 2.23, P = .0261)]. There was no significant geographic variation in stress, anxiety, or depression. Anxiety, depression, burnout, and stress were all significantly higher for those who worked directly with COVID-19 patients than those who did not, regardless of hospital location. CONCLUSIONS: Hospital staff caring for COVID-19 patients experienced equitable (and high) levels of depression and anxiety. However, data indicate that rural providers experienced greater protective factors, resulting in lower rates of burnout and higher compassion satisfaction. Rural communities, hospitals, and health systems may have characteristics that could be duplicated in urban areas to support hospital staff well-being. Support and promotion of mental wellness must also come from the hospital system, and health care and policy leaders. If we do not care for our hospital staff, there will not be hospital staff left to care for the community.

For more than 2 years, the world has been upended by the COVID-19 pandemic. Arguably, no other group has experienced challenges as intense and unrelenting during this time as hospital-based health care workers (HCWs). These individuals have played, and continue to play, a key role in the battle against COVID-19, risking psychological and physical safety in the face of this historic pandemic. Mounting evidence shows that HCWs have experienced acute psychological distress, with alarmingly high rates of anxiety, depression, burnout, and sleep disturbances that are likely to persist beyond these recurring waves of the COVID-19 outbreak.

Nurses are central to health care as the largest professional workforce and the providers of constant, ongoing care. Difficulties retaining enough qualified and motivated nurses presents an ongoing problem that threatens the quality of healthcare delivery. Demands of nursing practice, often resulting in stress and burnout, is a major barrier to retaining nurses. Self-care approaches and techniques have proven effective in reducing stress and burnout, increasing job satisfaction and the likelihood of nurses remaining in the profession. Despite knowing the benefits, nurses frequently do not engage in self-care resulting in negative consequences both personally and professionally. To advance our knowledge in this important area, a review of the literature was conducted to explore nurses’ experience of self-care and how they made sense of their experiences. The literature was analysed critically and synthesised through a phenomenological lens. The identified themes were structured according to phenomenological concerns: selfhood, mood and embodiment, sociality and relatedness, temporality, spatiality, and nursing culture. Understanding self-care from a phenomenological perspective is important to forming a deeper comprehension of nurses’ relationship with self-care, including acceptance and resistance. This new knowledge can be used to develop strategies to encourage self-care. The implications for recruitment and retention within nursing, and ultimately to the quality of healthcare, are significant.

BACKGROUND: We aim to explore the factors related to job satisfaction among pain physicians and identify the reasons why individuals minimize or stop practicing outpatient pain medicine. OBJECTIVES/STUDY DESIGN: This is a survey-based study with the primary goal to identify factors determining job satisfaction and dissatisfaction among pain medicine fellowship graduates who continue to practice and those who are no longer practicing interventional pain. A secondary goal is to elucidate reasons for anesthesiologists trained in pain medicine to leave pain medicine, despite an additional year of training, and to work as general anesthesiologists. METHODS: In this study, all 114 pain program directors listed on the Accreditation Council for Graduate Medical Education (ACGME) website, or their administrative assistants were directly contacted via email. All email addresses were obtained from the ACGME website. The survey opened in September 2021, with reminder emails sent before the closing of the survey in December 2021. A final reminder email was sent 4 weeks prior to the closing of the survey. RESULTS: Of all the respondents, 79 (89.77%) were currently practicing pain medicine, and 9 (10.23%) were no longer practicing pain medicine. LIMITATIONS: Our study has a major limitation as we are unable to determine the response rate and are limited in the data points gathered. CONCLUSION: We hope this study will allow for pain medicine fellowship program directors to improve recruitment and retention of pain fellows in the field while addressing the pros and cons of future career aspirations with anesthesiology residents prior to fellowship selection. A larger, more thorough study with an exact response rate can compare the various outcomes based upon different types of settings, such as private practice, partnership, and academia, as well as geographical locations.

[This is an excerpt.] Despite extensive literature measuring the prevalence and the consequences of burnout among resident physicians, effective interventional controlled trials are lacking.1,2 Mindfulness, therapy, and schedule changes have shown small benefits, but require learning a new skill, significant institutional resources, or organizational change.2 Additionally, ability to safely participate in many group or self-care activities has been limited by the recent COVID-19 pandemic. Gratitude3 and 3 good things3 (G/3GT) journaling are low-cost, individual-level interventions that have been shown to significantly improve measures of burnout, happiness, depression, gratitude, and stress; studies so far have not focused on resident burnout.3,  4,  5,  6 We piloted an app-based G/3GT journaling intervention for four weeks with pediatric residents measuring adherence and burnout as primary outcomes, with gratitude and life satisfaction as secondary outcomes. [To read more, click View Resource.]

OBJECTIVE: Frontline healthcare workers (FHCWs) responding to the COVID-19 pandemic develop posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptoms. Such symptoms are associated with burnout, occupational and relational difficulties. In the current study, we examined the prospective association between acute transdiagnostic COVID-19-related PTSD, MDD, and GAD symptoms at pandemic outset, and burnout and functional difficulties several months later in FHCWs in New York City. METHODS: Wave 1 symptoms of COVID-19-related PTSD, MDD, and GAD, were assessed in 787 FHCWs from April 14 to May 11th, 2020. Burnout and occupational difficulties were assessed at wave 1 and wave 2, approximately 7 months later. RESULTS: After adjusting for wave 1 burnout, wave 1 MDD symptoms, particularly sleep difficulties, loss of interest, and feeling tired/having little energy, collectively explained 42% incremental variance in this outcome. After adjusting for wave 1 work difficulties, MDD and PTSD symptoms, particularly feeling tired/having little energy, loss of interest, and negative expectations of self/world, collectively explained 42% incremental variance in this outcome. After adjusting for wave 1 relationship difficulties, MDD, GAD, and PTSD symptoms, particularly depressed mood, irritability, and appetite disturbance, explained 26% incremental variance in this outcome. CONCLUSIONS: Results highlight psychiatric symptoms assessed during the acute phase of the COVID-19 pandemic that may help predict burnout and work and relationship difficulties in FHCWs. Early interventions aimed at ameliorating transdiagnostic symptoms of MDD, PTSD, and GAD may help mitigate risk for burnout and functional difficulties in this population.