Resource Library

With nursing burnout on the rise, effective self-care interventions such as gratitude journals are needed to help nurses cope with symptoms of burnout. Gratitude journals can support nurses' emotional health by improving stress management and offering an opportunity for overall self-reflection.

OBJECTIVE: The aim of this study was to obtain novel perspectives regarding the effects that surgical training has on the well-being of trainees. SUMMARY BACKGROUND DATA: Improving trainee well-being is a national concern given high rates of burnout, depression, and suicide among physicians. Supporters of surgical trainees may offer new perspectives regarding the effects of surgical training and point to strategies to optimize trainee wellness. METHODS: This qualitative study employs semi-structured interviews of 32 support persons of trainees at a single tertiary care center with multiple surgical training programs. Interviews focused on perspectives related to supporting a surgical trainee. Interview transcripts underwent qualitative analysis with semantic and conceptual coding. Themes related to effects of training on trainee wellness are reported. RESULTS: Four themes were identified: Who Can Endure the Most Hardship?—trainee attributes and programmatic factors contribute to trainees feeling the need to constantly endure the most hardship; Consequences of Hardship—constantly enduring hardships has significant negative effects on wellness; Trainees are Humans—trainees are people with basic human needs, especially the need for worth; Research Time as Refuge—dedicated research time is treated as an oasis away from clinical hardships. CONCLUSIONS: Perspectives from support persons can offer valuable insight into the wellness needs of surgical trainees. According to support persons, surgical training profoundly negatively impacts trainee wellness. Unlike during clinical training, dedicated research time is a period during which wellness can be prioritized. Programs should provide greater attention to mitigating the negative ramifications of surgical training and promoting wellness in a longitudinal fashion throughout training.

Moral injury (MI) describes the intense feelings of shame, guilt, anger, and betrayal that individuals may experience after violating their own moral codes or witnessing the moral transgressions of others. While MI is not a diagnosable mental health disorder, it has been associated with elevated symptoms of depression and anxiety, suicidal ideation, and am substance misuse. MI overlaps with some of the diagnostic properties of posttraumatic stress disorder (PTSD) but has been proposed as a distinct phenomenon. Originally identified in military contexts, moral injuries have also been observed in civilian populations. Healthcare workers (HCWs) are at risk of encountering potentially morally injurious events (PMIEs) in the workplace. During the COVID-19 crisis, HCWs forced to provide care with limited resources reported self-blame after losing patients and while fearful of infecting loved ones. As vaccine roll-out continues, it is essential that we encourage healing among the very population that serviced the ill in their time of need.

This important new book provides the first comprehensive compilation of strategies for promoting physical and mental wellbeing, specifically for nurses and midwives. Written by experts on workforce health and wellbeing in conjunction with the Florence Nightingale Foundation, the book emphasises the importance supporting the wellbeing of self and others, even during times of extreme stress such during winter or when dealing with COVID-19. It covers multiple aspects of self-care, including how to tackle shift work, prevent dehydration and cope with moral injury and guilt – all illustrated with real-life case studies from nurses and midwives working at the coalface. Health and Wellbeing at Work for Nurses and Midwives is suitable for students right through to Chief Nursing Officers and is applicable to readers from all countries. It is sure to stand the test of time as a trusted guide to this crucial aspect of the professional lives of nurses and midwives. Authentic case studies bring concepts to life Written in a conversational and accessible style – suitable for readers of all levels Contributions from across the nursing and midwifery workforce speak directly to the nursing/midwifery experience Key recommendations for translating theory to practice Reflective exercises used throughout to allow readers to engage deeply with the strategies and ideas Edited by experts in their fields and based on evidence

OBJECTIVE: To estimate the excess health care expenditures due to US primary care physician (PCP) turnover, both overall and specific to burnout. METHODS: We estimated the excess health care expenditures attributable to PCP turnover using published data for Medicare patients, calculated estimates for non-Medicare patients, and the American Medical Association Masterfile. We used published data from a cross-sectional survey of US physicians conducted between October 12, 2017, and March 15, 2018, of burnout and intention to leave one’s current practice within 2 years by primary care specialty to estimate excess expenditures attributable to PCP turnover due to burnout. A conservative estimate from the literature was used for actual turnover based on intention to leave. Additional publicly available data were used to estimate the average PCP panel size and the composition of Medicare and non-Medicare patients within a PCP’s panel. RESULTS: Turnover of PCPs results in approximately $979 million in excess health care expenditures for public and private payers annually, with $260 million attributable to PCP burnout-related turnover. CONCLUSION: Turnover of PCPs, including that due to burnout, is costly to public and private payers. Efforts to reduce physician burnout may be considered as one approach to decrease US health care expenditures.

Our nation’s healthcare facilities were dangerously understaffed prior to the pandemic. And for nearly three years, health professionals have worked through unprecedented challenges. This has compounded the strain on an already exhausted workforce, leaving most emotionally drained and far too many in mental health distress. Today’s staffing crisis is really a shortage of staff willing to endure the current working conditions, and it’s a crisis of the healthcare industries’ own making.  As a result, frontline healthcare workers have been leaving and are continuing to leave the health professions in record numbers.

In response, delegates to the American Federation of Teachers’ biennial national convention in July 2022 passed a pointed resolution, “Addressing Staffing Shortages in the Healthcare Workforce.” This resolution called for the convening of a national task force composed of local leaders and frontline members, and that task force produced the Healthcare Staffing Shortage Task Force Report.

While the consequences of the chronic understaffing of our nation’s healthcare facilities can be deadly, the problem is solvable. Our nation’s healthcare employers must invest in the workforce, improve the working conditions, make healthcare facilities a safe place to work, and engage frontline workers in collaborative decision-making. Prioritizing patients over maximizing revenue means recruiting and retaining the workforce needed to deliver high-quality care.

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This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Operational Strategies (Workloads and Workflows).

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Health care has been the second largest sector hit by the Great Resignation of last fall, following only food service and hospitality.

[This is an excerpt.] A new Surgeon General’s Advisory highlights the urgent need to address the health worker burnout crisis across the country. Workers providing health services face many on-the-job challenges that can lead to work-related stress. For many of the 20 million health workers in the U.S., the COVID-19 pandemic has led to new and worsening mental health concerns, including burnout, compassion fatigue, depression, anxiety, substance use disorders, and suicidal ideation. These concerns affect each worker’s overall health, job performance, and ultimately, patient care and safety. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Government: Empowering Workers & Strengthening Leadership and Governance (Invest in Programs and Evidence).

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The Covid-19 pandemic brought new challenges for employees and employers all over the world. Drawn upon the JD-R model, a multilevel approach is conceptualised where the reduced resources (e.g., social support) and increased demands imposed by the pandemic (e.g., work/home spillover, social distancing, adoption of remote work and new technologies), improved the frequency of burnout. The framework of conservation of resources theory (COR) is adopted to explain that the lack of resources brought by demands to acquire and protect employee's resources during the pandemic (e.g., job security, well-being) exacerbated burnout behaviour and under certain circumstances allowed employees to hide their burnout symptoms. Moreover, the lack of social support, cultures and climates of presenteeism, and perceptions of stigmatisation that health problems are not culturally valued in the workplace, moderate at different levels the role of burnout in explaining the burnout shame phenomenon. In the current study the model presented is conceptualised as a dynamic spiral where higher levels of burnout shame lead people to hide and seek fewer resources (e.g., social support), which in turn tends to boost burnout levels and consequently, reduce the levels of well-being and job performance.

[This is an excerpt.] The first step is to raise awareness of the potential barriers that new female PDs may face. The data provided by Hughes et al. indicate that many of the current female PDs are recent graduates from surgical training and are relatively new to their residency leadership position. Having an important role and being younger than male colleagues may lead to difficult power differentials, especially when unpopular decisions must be made to improve resident education. [To read more, click View Resource.]

Healthcare professionals have battled physically, mentally, and emotionally overwhelming workforce pressures for years. The COVID-19 pandemic exacerbated this burnout substantially since its onset in 2020. Recently implemented federal initiatives aim to assist in the development of moral resiliency against a morally distressing workplace environment. But is this enough? Meeting the immediate need for substantial mental health resources in the healthcare field is essential and will be a long-lasting endeavor.

OBJECTIVES: Most emergency medicine (EM) residency programs have orientation curricula to guide interns through the transition from medical school to residency, although no standard components are required. This transition is recognized as a challenging time for young physician learners; however, there is no current understanding of the perspective of incoming interns as they enter residency. We sought to identify themes, examine the current literature, and reflect on the experiences of our residency leadership to inform the creation of orientation activities that foster positive experiences, as well as directly address intern fears and anxieties. METHODS: This qualitative study collected free text responses on the first day of EM orientation regarding areas of high excitement and high fear as interns entered residency. Data were collected from 2011 to 2019 in a 4-year EM residency program and a 6-year combined EM-Anesthesia residency program in the Mid-Atlantic. An inductive approach was used to code intern responses and develop themes within each category, and a frequency analysis was performed. RESULTS: A total of 112 interns participated. Thematic analysis of coded responses yielded 11 themes around “most excited” and 13 themes around “most scared.” The most frequent themes for “most excited” were: (1) Forming new relationships, (2) Building and applying knowledge, and (3) Being responsible for the care and education of others. For “most scared,” the most frequent themes were: (1) work–life balance and burnout, (2) making harmful mistakes, and (3) knowledge wealth and retention. CONCLUSIONS: We identified themes of high excitement and high fear for interns entering residency orientation. Based on the themes developed and current literature, recommendations for residency programs regarding intern orientation are provided, specifically that programs intentionally address opportunities for professional identity formation, building relationships with new people/places, emphasizing wellness, and mitigating burnout.

AIMS: To explore factors associated with nurses' moral distress during the first COVID-19 surge and their longer-term mental health. DESIGN: Cross-sectional, correlational survey study. METHODS: Registered nurses were surveyed in September 2020 about their experiences during the first peak month of COVID-19 using the new, validated, COVID-19 Moral Distress Scale for Nurses. Nurses' mental health was measured by recently experienced symptoms. Analyses included descriptive statistics and regression analysis. Outcome variables were moral distress and mental health. Explanatory variables were frequency of COVID-19 patients, leadership communication and personal protective equipment/cleaning supplies access. The sample comprised 307 nurses (43% response rate) from two academic medical centres. RESULTS: Many respondents had difficulty accessing personal protective equipment. Most nurses reported that hospital leadership communication was transparent, effective and timely. The most distressing situations were the transmission risk to nurses' family members, caring for patients without family members present, and caring for patients dying without family or clergy present. These occurred occasionally with moderate distress. Nurses reported 2.5 days each in the past week of feeling anxiety, withdrawn and having difficulty sleeping. Moral distress decreased with effective communication and access to personal protective equipment. Moral distress was associated with longer-term mental health. CONCLUSION: Pandemic patient care situations are the greatest sources of nurses' moral distress. Effective leadership communication, fewer COVID-19 patients, and access to protective equipment decrease moral distress, which influences longer-term mental health. IMPACT: Little was known about the impact of COVID-19 on nurses' moral distress. We found that nurses' moral distress was associated with the volume of care for infected patients, access to personal protective equipment, and communication from leaders. We found that moral distress was associated with longer-term mental health. Leaders should communicate transparently to decrease nurses' moral distress and the negative effects of global crises on nurses' longer-term mental health.

OBJECTIVES: To evaluate the effects of state community health worker (CHW) certification programs and Medicaid reimbursement for CHW services on wages and turnover. METHODS: A staggered difference-in-differences design was used to compare CHWs in states with and without CHW certification or CHW Medicaid reimbursement policies. Data were derived from the 2010 to 2021 Current Population Survey in the United States. RESULTS: CHW wages increased by $2.42 more per hour in states with certification programs than in states without programs (P = .04). Also, hourly wages increased more among White workers, men, and part-time workers (P = .04). Wages increased by $14.46 in the state with the earliest CHW certification program adoption (P < .01). Neither of the policies assessed had an effect on occupational turnover. CONCLUSIONS: CHW wages are higher in states with certification programs. However, wage gaps exist between Whites and non-Whites and between men and women. PUBLIC HEALTH IMPLICATIONS: Federal, state, and employer-based strategies are needed to establish and sustain effective CHW programs to meet the needs of communities experiencing health and access disparities.

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This resource is found in our Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Support Career Development).

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Prior research suggests that individuals react negatively when they perceive they are underpaid. Moreover, individuals frequently select pay referents who share their race and gender, suggesting that demographic similarity affects one’s knowledge of pay differences. Leveraging these insights, the authors examine whether the gender and racial composition of a work unit shapes individuals’ reactions to pay deprivation. Using field data from a large health care organization, they find that pay deprivation resulting from workers receiving less pay than their same-sex and same-race coworkers prompts a significantly stronger response than does pay deprivation arising from workers receiving less pay than their demographically dissimilar colleagues. A supplemental experiment reveals that this relationship likely results from individuals’ propensity to select same-category others as pay referents, shaping workers’ information about their colleagues’ pay. The study’s findings underscore the need to theoretically and empirically account for how demographically driven social comparison processes affect reactions to pay inequality.

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This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards& Recognition (Adequate Compensation)

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[This is an excerpt.] Unpredictable and challenging circumstances make the nursing profession extremely demanding and stressful. A survey conducted just before the COVID-19 pandemic showed that job pressure, leading to stress and poor mental health, is the main reason nurses leave the profession. The pandemic exacerbates the nurse retention problem in the global healthcare system, as higher psychological pressure is placed on nurses. The concept of stress in nursing may refer to the physiological state resulting from the lack of proper experience and knowledge in uncertain situations. Such stress is harmful to nurses and patients. Nurses' emotional and psychological state is a critical factor affecting their performance, risk of errors, healthcare delivery quality, patient care, recovery, and death. Hospitals worldwide allocate funds to address stress-related issues among nurses to identify and adopt stress-alleviating measures. [To read more, click View Resource.]

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

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[This is an excerpt.] The first part of the solution and thus the first enabler of psychological safety in virtual teams is consciously accepting the team’s challenges. When we say “accepting” these challenges, we do not mean surrendering to their inevitability but rather proactively identifying the specific challenges the team is facing and building a willingness to address them as a team. [To read more, click View Resource.]

OBJECTIVE: The taxing nature of surgery residency is well-documented in the literature, with residents demonstrating high rates of burnout, depression, suicidal thoughts, sexual harassment, and racial discrimination. Mentoring has been shown to improve camaraderie, address challenges of underrepresentation in medicine, and be associated with lower burnout. However, existing formal mentoring programs tend to be career-focused and hierarchal without opportunity to discuss important sociocultural issues. An innovative approach is needed to address these cultural and anthropological issues in surgery residencies while creating camaraderie and learning alternative perspectives across different levels of training. We sought to describe the framework we used to fill these needs by creating and implementing a novel mentoring program. DESIGN: A vertical, near-peer mentoring system of 7 groups was created consisting of the following members: 1 to 2 medical students, a PGY-1 general surgery resident, a PGY-4 research resident, and a faculty member. Meetings occur every 3 to 4 months in a casual setting with the first half of the meeting dedicated to intentional reflection and the second half focused on an evidence-based discussion regarding a specific topic in the context of surgery (i.e., burnout, discrimination, allyship, and finding purpose). SETTING: Program implementation took place at the University of Michigan in Ann Arbor, MI. PARTICIPANTS: Medical students, general surgery residents, and general surgery faculty were recruited. CONCUSIONS: We have successfully launched the pilot year of a cross-spectrum formal mentoring program in general surgery. This program emphasizes camaraderie throughout training while providing opportunities for evidence-based discussion regarding sociocultural topics. We have included increased opportunities for community inclusivity and mentoring while allowing trainees and faculty members to discuss sensitive topics in a supportive environment. We plan to continue developing the program with robust evaluation and to expand the program to other surgical specialties and to other institutions.

Actions on H.R.9200 - 117th Congress (2021-2022): Stop Nurse Shortages Act