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BACKGROUND: Firefighters are often exposed to occupational stressors that can result in psychological distress (ie, anxiety and depression) and burnout. These occupational stressors have only intensified with the onset of the COVID-19 pandemic and will likely persist in the postpandemic world. OBJECTIVE: To address occupational stressors confronting firefighters, we pilot tested a novel, cost-effective, smartphone app–based meditation intervention created by Healthy Minds Innovations that focused on mindfulness (awareness) training along with practices designed to cultivate positive relationships (connection), insight into the nature of the self (insight), and a sense of purpose in the context of challenge (purpose) with a sample of professional firefighters from a large metropolitan area in southwestern United States. METHODS: A total of 35 participants were recruited from a closed online group listserv and completed the self-guided 10-unit meditation app over the course of 10 days, at 1 unit per day. We assessed anxiety symptoms, depression symptoms, burnout, and negative affect as well as saliva diurnal cortisol rhythm, an objective indicator of stress-related biology, before and after use of the meditation app. RESULTS: This study demonstrated the meditation app was both feasible and acceptable for use by the majority of firefighters. We also found significant reductions in firefighters’ anxiety (P=.01), burnout (P=.05), and negative affect (P=.04), as well as changes in cortisol diurnal rhythm, such as waking cortisol (P=.02), from before to after use of the meditation app. CONCLUSIONS: Our study findings call for future research to demonstrate the efficacy of this meditation app to reduce psychological distress and burnout in firefighters.

Physician health and wellness can be negatively affected by burnout, which in turn can lead to multiple potential professional and personal issues. Burnout issues can start in medical school and progress during residency and fellowship, and throughout a physician’s career. A previous survey of allergists and immunologists reported a burnout rate of 35%. However, there are currently few data regarding health and wellness specifically for fellows-in-training (FIT) in allergy and immunology. This workgroup report was developed to assess health and wellness among FIT in our specialty. The American Academy of Allergy, Asthma & Immunology electronically distributed an anonymous questionnaire using the validated mini-Z survey to a total of 388 allergy and immunology FIT. In addition to the mini-Z items, the survey queried personal and professional demographic characteristics and included open-ended wellness questions. A total of 82 FIT completed the survey, yielding a 24% response rate. The burnout rate was 39%, which is lower than the national average among US physicians. Overall job satisfaction was 82%, and 72% reported satisfactory or better control over workload. Our results identify FIT-specific concerns in our specialty that can be used to develop tailored interventions to improve wellness and minimize burnout among this group. However, future surveys are needed to continue to address allergy and immunology FIT-specific wellness challenges.

While structural change is needed to address the burnout epidemic among healthcare workers, it is important for physicians to avail themselves of the many productivity strategies that can help them succeed in navigating the multiple responsibilities of academic medicine. We present here 5 key strategies within our control that can help increase productivity in the pursuit of work in academic medicine that is meaningful and sustainable: (1) Clarify Priorities, (2) Track Tasks Systematically, (3) Focus and Monotask, (4) Invest in Timesavers, and (5) Celebrate Successes. The specific tools listed under each strategy may help academic physicians feel grounded and maintain our focus on doing meaningful work. While system-wide culture change around expectations, and institutional support for physician wellbeing, is more critical than ever, individual physicians can still benefit from learning strategies to prioritize, track, focus on, delegate and celebrate the work that matters to us in our lives.

[This is an excerpt.] At the beginning of April 2020, the COVID-19 pandemic burned me out. I was ready to quit nursing. I wanted to run as far away as I could, away from dying patients, away from the heartaches. I remember waking up in bed, physically drained from a fitful sleep, emotionally shattered by the friends and the patients we lost. I debated calling out sick that morning just because I dreaded hearing the frequent overhead pages for the code team. The apex of this pandemic that we were preparing for came much too early. Physicians, nurses, and technicians were running around responding to calls for intubations, desperately trying to race against time. We were all covered from head to toe with impervious gowns, face shields, double gloves, boots, and surgical caps; the N95 masks would later leave marks on our faces. The scars in our hearts were unseen, and post-traumatic stress disorder, a real threat. We were protected, we assured ourselves, but how could you be confident about how safe you are when the COVID-19 fatalities keep on rising? The whole hospital (and all of New York City) was in a pandemic chokehold. [To read more, click View Resource.]

This study examined whether firefighters' trust beliefs in co-workers were associated with their psychosocial adjustment and burnout. In the study, 102 firefighters completed measures of trust beliefs in co-workers (honesty, reliability and emotional), psychosocial adjustment, (stress, psychological well-being), and years of service (as an index of burn-out). It was found that firefighters' honesty, reliability, and emotional trust beliefs in co-workers were associated with measures of psychosocial adjustment. Regression analyses confirmed that the firefighters' reliability trust beliefs in co-workers were negatively associated with stress. Also, firefighters' honesty trust beliefs in co-workers were negatively associated with years-of-service which was associated with stress. The findings supported the conclusion that firefighters' trust beliefs in co-workers played a role in psychosocial adjustment and yearsof-service burnout.

Emergency medical technicians (EMT) and firefighters respond to critical incidents and provide emergent care. As the opioid crisis continues and drug overdose rates increase, first responders administer first aid to substance users, including Naloxone, more frequently. This study examined the influence of repeated exposure to drug-related critical incidents and provision of care to substance users on EMTs' and firefighters' secondary traumatic stress (STS) level, world assumptions, and substance use stigma. First responders' world assumptions, STS, burnout, and exposure to drug-related overdoses were analyzed for their power in predicting substance use stigma. Results suggest that occupational burnout, rather than STS, is more predictive of substance use stigma. Also, a firmer belief in the just world assumption was more predictive of substance use stigma than both Benevolence of World and Benevolence of People World Assumption subscales. Analyses point to a potentially useful and harmful function in an overreliance on the just world belief. EMTs with a firmer belief in the just world were found to have lower STS and burnout scores; conversely, they were also found to hold greater negative attitudes toward substance users. Findings have implications for future research, programmatic management, and educational training targeting substance use stigma and mental health concerns.

This chapter looks into detail at the various pathways to build workplace mental health by identifying organizational modifiable risk factors and identifying protective factors and strengths for prevention, growth, and resiliency. Discussion around common mental health conditions, prevention and continuum of care, and risk factors related to moral suffering, compassion fatigue, and burnout is highlighted along with protective factors, including, for instance, resiliency, self-compassion, compassion satisfaction, and psychological flexibility. Practical strategies for leaders are offered for better organizational culture, stigma reduction, and optimizing wellbeing. This chapter brings a unique twist to current debates around mental health and wellbeing, by having the testimonial from a veteran police officer who has been responded to a myriad of critical incidents and shares his narrative of experiences and insights as a veteran police officer. This chapter concludes with the importance of optimizing mental health education, prevention, and interventions to further healthy and more proactive organizational culture and workplace mental health.

Medicine is defined by doing; however, bias, error, and burnout are potential consequences of speed and constant activity. On an individual level, slowing down might reduce bias; resting might reduce error; mindfulness might reduce burnout. Despite its benefits, stillness can be an unattainable privilege for some due to systems of power, including gender, race, and capitalism. In response, institutions must confront these systems and support individual clinicians through radical acts of solidarity because, just as we have fought to make doing-speaking, learning, and working-equal opportunity, so must we ensure that "non-doing" belongs to everyone.

OBJECTIVE: Mistreatment is widespread in graduate medical education, and much attention has been generated on this topic and its relationship to burnout in general surgery residency. In particular, peer-to-peer mistreatment poses a developmental dilemma – as junior residents find themselves mistreated and some turn around and perpetuate that mistreatment. There is a paucity of effective interventions. Forum Theatre (FT) is a novel educational tool to engage participants in solving difficult situations. We present the use of FT as a tool to explore solutions to address peer-to-peer mistreatment in a surgery residency. FT starts with the performance of a culture-specific conflict scenario and then invites the audience to participate in renditions of the situation ending in a collective solution. DESIGN: Stakeholder support was obtained from the general surgery program leadership. Time was protected during two 1-hour scheduled wellness didactic sessions. First, focus groups with each PG year identified the residents’ experience of mistreatment. Themes regarding peer-to peer mistreatment were identified and presented to a group of 3 volunteer actor residents who chose to focus on the unintended consequences of public, corrective feedback with the understanding this would be presented to the residency at large. Following this, they developed a scenario for enactment which was implemented during the second didactic session. The enacted scenario posed a problem with public feedback ending unsatisfactorily. The audience was then invited to engage the actors and participate in replays of the situation until a collective solution was identified. Retrospective pre-post survey and a 6-month post survey were administered. SETTING: General surgery residency at University of Texas Health San Antonio. PARTICIPANTS: General surgery residents. 32 of 66 (48.5%) residents participated. RESULTS: Participants noted an improved understanding of mistreatment, felt more confident in recognizing mistreatment, reported improved confidence in their ability to intervene when witnessing mistreatment and to recognize when they themselves were involved in mistreatment (p < 0.001 for all). In fact, of the residents who reported participating in mistreatment, 100% reported directing it towards peers. After the FT, 89% of residents said they “definitely” or “most likely” recommended participating in a FT to address mistreatment. 85.7% reported that the intervention was moderately to extremely effective for teaching topics in professionalism. These trends remained steady in the survey 6 months after the intervention as well. CONCLUSIONS: We found FT was feasible to implement in a busy general surgery residency and well received with sustained, self- reported behavior change. FT is a novel tool to engage residents to self-evaluate and participate in methods to address mistreatment. FT interventions can be tailored to the local culture to address conflicts specific to that setting.

Psychological safety (PsyS) is an important driver of teams’ performance and organizations are keen to foster it. However, there is little causal evidence on what drives it and how to increase it. This paper implements a randomized control trial with over1000 teams (over 7000 employees) in a global healthcare company to evaluate the impact of individualized attention of the manager to each team member team by encouraging managers to hold frequent 1-to-1 meetings and to focus them on mechanisms expected to increase PsyS. We exogenously vary the content of those meetings: focusing on employees’ needs and aspirations as individuals, or on allowing employees’ to better execute tasks and remove blockers that may hinder their best work. We find that, despite this very non-invasive intervention, the behavior of managers changed as they increased the number of meetings. PsyS also increased as did the relationship to and perceptions of the manager, particularly in the treatment arm that focused on the employees’ individual needs.

The incidence of burnout among radiologists has been increasing exponentially, largely attributed to increased work volumes, expectations for more rapid turn-around times and decreasing interpersonal interactions. While personal wellness activities have been described in the literature, there is little information on the role of cognitive behavioral therapy strategies to mitigate burnout. This manuscript will describe the value of naming automatic negative emotions which can lead to burnout and will provide an overview of strategies that can be used to combat them, using cognitive behavioral therapy techniques.

AIMS: We aim to evaluate the frequency and outcomes of workplace incivility in healthcare for nursing management. BACKGROUND: Incivility in the workplace is a significant problem that is important to nurse managers, as it goes directly against the fundamental values and ethics of providing high-quality care to patients. The Joint Commission (2021) and the American Nurses Credentialing Center have called on healthcare organizations to identify and intervene in the problem of workplace incivility. Evaluation Studies included in this scoping review were those that measured and analysed the frequency and outcomes of workplace incivility in healthcare. Four databases were searched, and 28 articles were reviewed. Evaluation was based on general quality, including study characteristics, instruments, and statistical analyses. Key issues Studies used a quasi-experimental design, and most focused on the Registered Nurse population. The Workplace Incivility Scale was the most commonly used instrument to measure workplace incivility frequency. The most frequently studied work-related outcomes were burnout, satisfaction, and turnover. CONCLUSIONS: Although the frequency of workplace incivility in healthcare is not clear, its consequences are substantial. Multiple studies have revealed significant relationships between workplace incivility and work-related outcomes that are important to nurse managers. Research is needed on non-nursing healthcare professionals, and validation studies are needed on instruments used to measure workplace incivility frequency. Implications for Nursing Management The findings of this review can help nurse managers better understand the phenomenon, frequency, and impact of workplace incivility in the healthcare setting and move toward addressing the problem of workplace incivility among nurses and other healthcare professionals.

BACKGROUND: Nurse educators are challenged to bridge the gap between academia and the health care environment to provide nursing students with the knowledge and skills to ensure their readiness to practice. With limited traditional clinical experiences, many new graduate nurses begin their careers in high-stress environments such as emergency departments. METHODS: A convenience sample of 66 emergency department nurses completed two qualitative survey questions related to their experiences working with new graduate nurses during the coronavirus disease 2019 (COVID-19) pandemic. RESULTS: Respondents reported lack of clinical skills was the biggest weakness observed in new graduate nurses. Four themes were identified: protection and unpreparedness, thirst for knowledge, burnout, and support and self-care; these themes built the foundation for the overarching theme of resilience. CONCLUSION: Nurse faculty must be able to support students' transition into a rapidly changing health care environment. Student preparation should focus on skill building, communication, self-care strategies, and resilience. [J Nurs Educ. 2022;61(12):711–715.]

Labor-Management Partnerships, a new system for structuring hospital care, are based on the recognition that hospitals are complex organizations requiring multiple levels of communication and exchange, and on the premise that front-line workers are best able to identify and pose solutions to problems in their units and departments. They are structured to form creative problem-solving teams of managers and staff supported in their work together to improve their hospital within both in individual areas and systemically. Four extensive examples of such teams are provided from two different hospital settings, one public and one not-for-profit. Their work is then assessed through the lens of organizational and group psychoanalytic theories.

INTRODUCTION: The COVID-19 pandemic created new and exacerbated existing stressors for frontline healthcare workers. Despite being disproportionately affected by COVID-19, little is known about the experiences of frontline healthcare workers serving marginalized populations in community settings. DESIGN: We used qualitative descriptive methods to understand the experiences of 12 frontline healthcare workers (HCWs) supporting primarily underserved populations in outpatient settings during COVID-19. Interviews were conducted from March to April 2021. METHODS: Interviews were held virtually via Zoom using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and uploaded into NVivo 12 qualitative data analysis software. The transcripts were dually coded by members of the research team and a thematic analysis was conducted. RESULTS: Four major themes from the interviews were identified: stressors and burnout, coping strategies, organizational support, and recommendations. HCWs described how the early adjustment period to the pandemic created new challenges as they attempted to navigate changes in the workplace and altered responsibilities at home. HCWs felt largely unsupported by their organizations as they attempted to cope with stressors. Organizational support programs and resources often did not meet frontline workers' needs, and sentiments of unappreciation from leadership contributed to feelings of burnout and frustration as pandemic-related challenges persisted and evolved. CONCLUSION: Despite encountering numerous stressors at work and home, resulting from pandemic-related disruptions, frontline HCWs continued to provide care for their clients while navigating emerging challenges. Health organizations should include HCWs in decision-making processes when implementing support systems for workers during times of crisis.

It probably won’t surprise you to learn that incivility on the front lines of business is on the rise. After all, as the pandemic wore on, we saw in real time how frontline workers went from being seen as “essential” to being seen as, essentially, punching bags. What might not be obvious is that incivility doesn’t affect only workers who experience it directly — it also affects those who witness it, with consequences for businesses and society. Christine Porath has studied incivility for more than 20 years, looking at the experiences at work of people around the world. Her research shows that business leaders have the power to improve things, both for workers and for society as a whole.

Important findings pertaining to burnout in physicians and nurses have been published over the past year. New findings occur in the context of significant cultural changes, ecological dangers, new financial trends, and evolution in the way organizations measure performance. These changes may provide an opportunity for organizations to focus on priorities that transcend profit. One way healthcare leaders can address burnout is by attending to what matters most to healthcare workers. The authors, all psychiatrists who work with business leaders, review what is currently recommended for burnout and then offer guidance. The importance of leaders thinking beyond financial materiality to psychological materiality as well as leaders and employees exploring meaning and connection at work are emphasized as antidotes to burnout.

BACKGROUND: The emotional nature of midwifery practice has been described by several researchers and midwives have reported extremely high burnout levels. Burnout is dynamic and effects individual midwives differently, depending on individual coping abilities and demographic and contextual factors. However, midwives themselves can reduce burnout at an individual level. AIM: This study aimed to explore the concept of burnout with midwives and to ascertain their perspectives on how burnout can be reduced. This paper presents findings in relation to individual midwives' responsibilities for the reduction of burnout. METHODS: This was a Participatory Action Research study. A total of 5 co-operative inquiry meetings were held with practising midwives (n = 21) over a six-month period (October 2018 - March 2019), in a large, urban teaching maternity hospital in Ireland. Data was analysed using Thematic Network Analysis. FINDINGS: Midwives explored in detail the emotional nature of midwifery practice and how this contributes upon midwives' burnout levels. Recommendations were made for individuals to reduce their own burnout levels. These include self-awareness and basic self-care skills. Some specific individual characteristics were suggested as increasing the risk of burnout such as younger, less experienced midwives. CONCLUSION AND RECOMMENDATIONS: Midwives require high levels of self-awareness to identify external demands, which make them more susceptible to burnout, and utilise their own positive coping mechanisms. Basic self-care is also necessary for midwife well-being. However, without commitment from healthcare systems to reduce chronic excessive workload, burnout levels will remain high, which impacts negatively on midwives and the women in their care.

OBJECTIVES: Burnout occurs frequently in emergency medicine (EM) residents and has been shown to have a negative impact on patient care. The specific effects of burnout on patient care are less well understood. This study qualitatively explores how burnout may change the way EM residents provide patient care. METHODS: Qualitative data were obtained from a sample of 29 EM residents in four semistructured focus groups across four institutions in the United States in early 2019. Transcripts were coded and organized into major patient care themes. RESULTS: Residents described many ways in which feelings of burnout negatively impacted patient care. These detrimental effects most often fit into one of four main themes: reduced motivation to care for patients, poor communication with patients, difficult interactions with health care colleagues, and impaired decision making. CONCLUSIONS: According to EM residents, burnout negatively impacts several important aspects of patient care. Resident engagement with clinical care, communication with patients and colleagues, and clinical care may suffer as a result of burnout.

BACKGROUND: Promoting residents' wellbeing and decreasing burnout is a focus of Graduate Medical Education (GME). A supportive clinical learning environment is required to optimize residents' wellness and learning. OBJECTIVE: To determine if longitudinal assessments of burnout and learning environment as perceived by residents combined with applying continuous quality Model for Improvement and serial Plan, Do, Study, Act (PDSA) cycles to test interventions would improve residents' burnout. METHODS: From November 2017 to January 2020, 271 GME residents in internal medicine, general surgery, psychiatry, emergency medicine, family medicine and obstetrics and gynecology, were assessed over five cycles by Maslach Burnout Inventory (MBI), and by clinical learning environment factors (which included personal/social relationships, self-defined burnout, program burnout support, program back-up support, clinical supervision by faculty, and sleep difficulties). The results of the MBI and clinical learning environment factors were observed and analyzed to determine and develop indicated Institutional and individual program interventions using a Plan, Do, Study, Act process with each of the five cycles. RESULTS: The response rate was 78.34%. MBI parameters for all GME residents improved over time but were not statistically significant. Residents' positive perception of the clinical supervision by faculty was significantly and independently associated with improved MBI scores, while residents' self-defined burnout; and impaired personal relations perceptions were independently significantly associated with adverse MBI scores on liner regression. For all GME, significant improvements improved over time in residents' perception of impaired personal relationships (p?