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PURPOSE: While police culture typically refers to the culture among sworn police personnel, there are internal cultural differences between subgroups. This has been documented among sworn personnel, such as the difference between street cops and management cops (Reuss-Ianni, 1983). The divide between professional and sworn staff in a law enforcement context has also been discussed at length (Maguire, 1997; Reiss, 1992), specifically the “us versus them” mentality that stems from feelings of isolation among professional and sworn staff. The relationship between dispatchers and officers is vital to public and officer safety; it is imperative that cultural barriers preventing effective collaboration between two of the most critical components of policing are identified, and recommendations to bridge the gap are provided. DESIGN/METHODOLOGY/APPROACH: The authors use semi-structured interview data from a sample of peer-nominated top dispatch de-escalators (TDDs) considered highly skilled at de-escalation with callers and officers. Reflexive coding techniques were used to identify key themes in an area largely unexamined by research. FINDINGS: The authors find that the police culture creates friction between sworn officers and dispatchers in a number of contexts. This diminishes organizational commitment and increases burnout and frustration. PRACTICAL IMPLICATIONS: There are several policy recommendations for both communications centers and sworn staff to foster understanding and increase collaboration, all of which may result in improved outcomes for community members, dispatchers and officers. ORIGINALITY/VALUE: The authors use qualitative methods to explore the implications of the sworn-civilian divide for police practice, such as more effective de-escalation and incident resolution, as well as the conceptualization of police culture writ large.

[This is an excerpt.] It was a typically busy Wednesday night. We had 22 people in the waiting room, with admitted patients boarding in the emergency department (ED) due to difficulties with bed availability and staffing. At 3:40 a.m. an 80-year-old woman arrived from a skilled nursing facility after staff found her unresponsive. Emergency Medical Services (EMS) discovered her to be pulseless and in asystole, and after 4 rounds of epinephrine in the field, she arrived in room 2 of my ED. As she was a “full code,” I intubated her and initiated resuscitation measures. A bedside echo revealed cardiac standstill and after 2 more rounds of epinephrine, calcium chloride, and bicarbonate infusion, she was pronounced dead. After a moment of silence, I attempted to contact family members, called the medical examiner and the organ bank, and began entering data required by our electronic health record (EHR). [To read more, click View Resource.]

BACKGROUND: Limited data exists to guide strategies that reduce risks of burnout amongst pharmacy residents. OBJECTIVE: The primary objective of this analysis was to characterize wellbeing, burnout, and resiliency among pharmacy residents. The secondary objective was to assess the impact of a resident-run wellbeing committee on wellbeing, burnout, and resiliency. PRACTICE DESCRIPTION: In 2018, a wellbeing committee was developed at an academic medical center with the aim of promoting wellbeing and resilience amongst pharmacy residents. PRACTICE INNOVATION: The wellbeing committee functions through 3 workgroups focused on resources, engagement, and advocacy. Collectively, these workgroups aim to facilitate wellbeing discussions, plan mindfulness events, and advocate for policies to enhance the wellbeing of residents. EVALUATION METHODS: Pharmacy residents were invited to participate in an electronic survey aimed at characterizing resident wellbeing and assessing the impact of a resident-led wellbeing committee on wellbeing, burnout, and resiliency. The Resident & Fellow Wellbeing Index (RFWI) and Brief Resilience Scale (BRS) were utilized to assess burnout and resiliency, respectively. Continuous and categorical endpoints were assessed utilizing student t tests and chi-square tests, respectively. RESULTS: A total of 16 of 38 residents participated in this analysis. Scores for RFWI and BRS remained stable throughout the 16-week period. RFWI scores demonstrated that up to 50% of residents scored as "at risk" at any point during the study period, while over 80% of respondents maintained high levels of resilience. More than 50% of respondents reported a positive impact of the wellbeing committee on their wellbeing, burnout, and resilience. CONCLUSION: A resident-led wellbeing committee demonstrated favorable impact on wellbeing, burnout, and resilience for majority of pharmacy residents. While this data suggests that such a committee may serve to protect residents from the negative impacts of burnout, future studies are necessary to further elucidate strategies to promote resident wellbeing.

OBJECTIVE: This study sought to determine the feasibility of collecting physiologic data in thoracic surgery residents and whether it would correlate with burnout and burnout with performance. METHODS: This was a prospective study of thoracic surgery residents over a 5-month period. Participants were evaluated with a wearable biometric device (heart rate variability and sleep) and the Maslach Burnout Inventory. Resident performance was quantified using Accreditation Council for Graduate Medical Education Milestones (scale, 1-5) normalized to program-designated targets (3 for postgraduate year 6 or lower residents and 4 for postgraduate year 7 residents). RESULTS: The cohort consisted of 71% female participants (5/7) with 86% of residents having 1 or more children. High levels of emotional exhaustion (median, 30 [interquartile range, 20-36], where>26 is high) and high levels of depersonalization (median, 16 [interquartile range, 14-22], where>12 is high) were common, but personal accomplishment was also uniformly high (median, 43 [interquartile range, 41-46], where >38 is high). There was a significant correlation between heart rate variability and emotional exhaustion (r(12) ¼ 0.65, P ¼ .01) but not depersonalization (P ¼ .28) or personal accomplishment (P ¼ .24). Depersonalization and personal accomplishment did not correlate with resident performance (P ¼ .12 and P ¼ .75, respectively); however, increased emotional exhaustion showed a significant correlation with higher resident performance during periods when burnout was reported (r(6) ¼ 0.76, P ¼ .047). CONCLUSIONS: Dynamic measurement of resting heart rate variability may offer an objective measure of burnout in thoracic surgery residents. Thoracic surgery residents who report high levels of burnout in this cohort maintained the ability to meet program-designated milestones at or above the level expected of their postgraduate year.

OBJECTIVE: Evaluate the effect of a virtual coaching program offered to women surgery residents in a surgical society. SUMMARY BACKGROUND DATA: Randomized controlled experiments evaluating the effect of coaching on trainee well-being and burnout is lacking. METHODS: Women surgery residents in the Association of Women Surgeons were recruited to participate in a randomized controlled trial of the effects of a virtual coaching program on trainee well-being. Attending surgeons served as coaches after completing in-person training. Residents (n=237) were randomized to intervention (three 1:1 coaching sessions over 9 mo) or control (emailed wellness resources). Participants were surveyed at baseline and post-intervention using validated measures of well-being, burnout, and resilience. Changes in outcome measures between pre- and post-survey were compared between study arms. RESULTS: Survey response rates were 56.9% (n=66) in the control group and 69.4% (n=84) in the intervention group (P=0.05). The intervention group showed significant improvement in professional fulfillment (P=0.021), burnout (0.026), work exhaustion (0.017), self-valuation (0.003), and well-being (P=0.002); whereas the control group showed significant improvement in self-valuation (P=0.015) and significant decline in resilience (P=0.025). The intervention group had a significant improvement in well-being (P=0.015) and intolerance of uncertainty (P=0.015) compared to controls. CONCLUSIONS: Women surgery residents who participated in a remote coaching program offered by a surgical society demonstrated improvement in aspects of well-being relative to peers who did not receive coaching. Therefore, remote coaching offered by a professional society may be a useful component of initiatives directed at trainee well-being.

AIM: This study aimed to investigate the effect of COVID-19 pandemic on nurses' burnout and related factors. BACKGROUND: Nurses at the frontlines in every field of the health system and composed most of the health service industry closely experience all negative events during the pandemic. METHODS: This study is a rapid systematic review. RESULTS: A total of 751 studies were selected, of which 13 studies were compatible with the inclusion criteria. The sample size ranged from 107 to 12.596. The studies determined that nurses' burnout levels were generally moderate level and above during the COVID-19 pandemic. Sociodemographic, occupational, psychological, and COVID-19-related factors affected this burnout. CONCLUSION: The results of this review may use to make implications that would ease the effect of the pandemic on nurses and develop strategies to protect nurses from burnout in similar possible situations. The protocol information is included here for blind peer review. Prospero registration number (ID) CRD42021244849. Registration and protocol Prior to undertaking the review, we registered the protocol in the International Prospective Register of Systematic Reviews (PROSPERO). The registration number is CRD42021244849. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244849. The changes made during the review process were registered in PROSPERO with an update.

OBJECTIVE: To examine how perceived leadership behaviours affect burnout, professional fulfilment and intent to leave the organisation among physicians. Design Anonymous cross-sectional survey study from November 2016 to October 2018. Setting 12 036 attending and resident physicians at 11 healthcare organisations participating in the Physician Wellness Academic Consortium (PWAC) were surveyed to assess burnout and professional fulfilment and their drivers. Participants A sample of 5416 attending physicians with complete data on gender, specialty, leadership, burnout and professional fulfilment. MAIN OUTCOMES AND MEASURES: The leadership behaviour of each physician’s supervisor was assessed using the Mayo Clinic Participatory Management Leadership Index and categorised in tertiles. Multivariable logistic regression analyses examined the effect of leadership behaviour rating of each physician’s supervisor on burnout, professional fulfilment and intent to leave controlling for gender and specialty. RESULTS: The response rate was 45% across 11 institutions. Half of the respondents were female. Professional fulfilment increased with increasing tertiles of leadership behaviour rating (19%, 34%, 47%, p<0.001). The odds of professional fulfilment were 5.8 times higher (OR=5.8, 95% CI: 5.1 to 6.59) for physicians in the top tertile compared with those in the lowest tertile. Physicians in the top tertile were also 48% less likely to be burned out (OR=0.52, 95% CI: 0.45 to 0.61) and reported 66% lower intent to leave (OR=0.34, 95% CI: 0.26 to 0.44). Individuals who rated their supervisor’s leadership in upper tertiles relative to lower tertiles exhibited lower levels of burnout (18% vs 35% vs 47%, p<0.001), and intent to leave (16% vs 24% vs 50% p<0.001). CONCLUSION: Perceived leadership behaviours have a strong relationship with burnout, professional fulfilment and intent to leave among physicians. Organisations should consider leadership development as a potential vehicle to improve physician wellness and prevent costly physician departures.

BACKGROUND: Peer-support programs in medical school can buffer feelings of inadequacy, anxiety, social isolation, and burnout, drawing upon the benefits of near-peer-support resources. This study examined the effects of providing support to students in a medical school peer-support program. METHODS: Using a pre-post, quasi-experimental study design, the investigators surveyed medical students who were peer supporters in their second through fourth years of medical school with four measures assessing (1) empathy, (2) self-efficacy, (3) mental health stigma, and (4) likelihood to assist peers with mental health problems to examine if serving as a volunteer peer supporter had any effect. Participants included 38 medical students that were actively enrolled peer supporters during the 2020-2021 year at a United States allopathic medical school. RESULTS: Medical students who participated as peer supporters were found to have higher ratings of empathy scores (Z = -1.964, p = 0.050, r = 0.34) and self-efficacy scores (Z = -2.060, p = 0.039, r = 0.35) after participation in the program. No significant changes were noted for mental health stigma or likelihood to assist peers with mental health problems. DISCUSSION: Peer-support programs present a low-cost, sustainable modality to promote wellbeing in medical students. There is a growing body of literature documenting the benefits of peer-support services. This brief, novel study examined the effects of providing peer support on the peer supporters and found higher self-reported ratings of empathy and self-efficacy after participation. These findings underscore peer-support programs as a valuable wellness resource not only for medical students who use the services but for those who provide them as well.

The COVID-19 pandemic drastically impacted medical student experiences. Little is known about the impact of the pandemic on student well-being and protective factors for burnout.

GOAL: Administrative burden is one of many potential root causes of physician burnout. Scribe documentation assistance can reduce this burden. However, traditional in-person scribe services are challenged by consistent staffing because the model requires the physical presence of a scribe and limits the team to a single individual. In addition, in-person scribes cannot provide the flexible support required for virtual care encounters, which can now pivot geographically and temporally. To respond to these challenges, our health network implemented an asynchronous virtual scribe model and evaluated the program’s impact on clinician perceptions of burnout across multiple outpatient specialties.

[This is an excerpt.] Residency training presents a unique combination of factors affecting well-being. Studies suggest that mental/emotional distress is pervasive among residents, caused by contextual factors affecting emotional resilience (eg, sleep deprivation) and abrupt, stressful triggers (eg, patient deaths). Interventions including positive psychology coaching, peer support, mindfulness curricula, and web-based cognitive behavioral therapy have demonstrated modest but inconsistent improvements in well-being; however, they may be considered burdensome. By contrast, mobile phone-based interventions are less onerous and have been well-accepted. No interventions, however, address abrupt or acute distressing events. [To read more, click View Resource.]

INTRODUCTION: Resilience bundles are designed to work within and enhance existing routines. In the wake of COVID-19, nurses are reporting high levels of burnout and are leaving the field at an alarming rate. Hospital system leaders across the country are working to develop wellness programs to improve nurse morale, decrease burnout, and enhance resilience. Resilience can help mitigate nurse burnout, and using a bundle of tools to help nurses develop resilience is more effective than a single strategy. METHODS: Using the Connor-Davidson Resilience Scale-10 and the Perceived Stress Scale 4, emergency nurses were surveyed to measure resilience and stress before and after implementation of a 3-strategy resilience bundle. We surveyed at baseline, phase 1 (6 weeks after implementation), and phase 2 (15 weeks after implementation). RESULTS: A statistically significant increase in the Connor-Davidson Resilience Scale-10 scores was identified between the baseline and phase 1 surveys. A measurable decrease in the Perceived Stress Scale 4 was found between the baseline survey and the phase 1 and phase 2 postintervention surveys. DISCUSSION: Although evidence suggests a multifocal approach to improving resilience, use of resilience bundles is new. To enhance nurse resilience and mitigate burnout, nurse leaders may consider resilience bundles to prioritize the mental health and wellness of their staff.

BACKGROUND: Documentation burden associated with electronic health records (EHR) is well documented in the literature. Usability and functionality of the EHR are considered fragmented and disorganized making it difficult to synthesize clinical information. Few best practices are reported in the literature to support streamlining the configuration of documentation fields to align clinical workflow with EHR data entry elements.

OBJECTIVE: The primary objective was to improve performance, reduce duplication, and remove nonvalue-added tasks by redesigning the patient assessment template in the EHR using best practice approaches.

METHODS: A quality improvement approach and pre-/postdesign was used to implement and evaluate best approaches to redesign standardized flowsheet documentation workflow. We implemented standards for usability modifications targeting efficiency, reducing redundancy, and improving workflow navigation. The assessment type row was removed; a reassessment section was added to the first three flowsheet rows and documentation practices were revised to document changes from the initial assessment by selecting the corresponding body system from the dropdown menu. Vendor-supplied timestamp data were used to evaluate documentation times. Video motion-time recording was used to capture click and scroll burden, defined as steps in documentation, and was analyzed using the Keystrok Level Model.

RESULTS: This study's results included an 18.5% decreased time in the EHR; decrease of 7 to 12% of total time in flowsheets; time savings of 1.5 to 6.5 minutes per reassessment per patient; and a decrease of 88 to 97% in number of steps to perform reassessment documentation.

CONCLUSION: Workflow redesign to improve the usability and functionality decreased documentation time, redundancy, and click burden resulting in improved productivity. The time savings correlate to several hours per 12-hour shift which could be reallocated to value-added patient care activities. Revising documentation practices in alignment with redesign benefits staff by decreasing workload, improving quality, and satisfaction.

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

Maintaining the resilience of healthcare workers (HCWs) during the protracted COVID-19 pandemic is critical as chronic stress is associated with burnout, inability to provide high-quality care, and decreased attentiveness to infection prevention protocols. Between May and July 2020, we implemented the ICARE model of psychological first aid (PFA) in a novel online (i.e., telehealth) format to address the psychological support needs of HCWs during the COVID-19 pandemic. We found that HCWs needed psychological support related to obtaining clear information about pandemic policies and guidelines, navigating new rules and responsibilities, and processing overwhelming and conflicting emotions. The HCWs in our program repeatedly expressed appreciation for the support we provided. Future directions include establishing online discussion forums, increasing opportunities for individual support, and training HCWs to provide peer support using PFA. This program has far-reaching potential benefit to HCWs and to society at large in the context of a pandemic.

OBJECTIVE: To determine the prevalence of imposter phenomenon (IP) experiences among physicians and evaluate their relationship to personal and professional characteristics, professional fulfillment, burnout, and suicidal ideation. PARTICIPANTS AND METHODS: Between November 20, 2020, and February 16, 2021, we surveyed US physicians and a probability-based sample of the US working population. Imposter phenomenon was measured using a 4-item version of the Clance Imposter Phenomenon Scale. Burnout and professional fulfillment were measured using standardized instruments. RESULTS: Among the 3237 physician responders invited to complete the subsurvey including the IP scale, 3116 completed the IP questions. Between 4% (133) and 10% (308) of the 3116 physicians endorsed each of the 4 IP items as a “very true” characterization of their experience. Relative to those with a low IP score, the odds ratio for burnout among those with moderate, frequent, and intense IP was 1.28 (95% CI, 1.04 to 1.58), 1.79 (95% CI, 1.38 to 2.32), and 2.13 (95% CI, 1.43 to 3.19), respectively. A similar association between IP and suicidal ideation was observed. On multivariable analysis, physicians endorsed greater intensity of IP than workers in other fields in response to the item, “I am disappointed at times in my present accomplishments and think I should have accomplished more.” CONCLUSION: Imposter phenomenon experiences are common among US physicians, and physicians have more frequent experiences of disappointment in accomplishments than workers in other fields. Imposter phenomenon experiences are associated with increased burnout and suicidal ideation and lower professional fulfillment. Systematic efforts to address the professional norms and perfectionistic attitudes that contribute to this phenomenon are necessary.

The long term effects of the covid-19 pandemic on healthcare staff have been considerable, with at least one third of critical care staff experiencing burnout and two fifths showing symptoms of post-traumatic stress disorder.1 But has resilience, a term that has gained much traction in recent years, made any difference? Resilience is the capacity to recover quickly from difficulties or toughness.2 Healthcare professionals (HCPs) had already shown this trait before the pandemic—their training requires hours of study and work experience and regular interaction with ill health, disability, and death. Medical …

[This is an excerpt.] Though the United States is an increasingly racially and ethnically diverse and multicultural society, the health care workforce lacks corresponding diversity. Studies demonstrate that a diverse health care workforce can improve patients’ access to and satisfaction with care and health outcomes, and that shared identities between providers and patients may improve health equity (HHS Advisory Committee on Minority Health 2021).

Despite long-standing efforts to increase diversity, health care professions have not achieved equitable representation of Black/African American and Hispanic/Latinx people (HHS Bureau of Health Professions and Office of Minority Health 2009; Morris et al. 2021). To identify promising policies and practices for sustainably increasing diversity in the physician and nursing workforces, the Urban Institute examined pathway programs (also known as pipeline programs) in medicine and nursing. These programs provide academic, financial, and social supports to encourage more students from systemically and structurally excluded groups to enter and remain in health care professions. This study adopts the term systemically and structurally excluded to call attention to the ways that Black/African American and Hispanic/Latinx students and professionals in particular have been locked out of equitable educational and professional opportunities (see box 2). [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Promoting Diversity, Equity, & Inclusion.

New graduate nurses (NGN) often have an idealistic view of nursing compared to the reality of providing complex patient care. NGNs may lack communication and collaborations skills needed to effectively interact with challenging patients, families, and interdisciplinary teams, leading to stress and burnout. This evidence-based quality improvement project provided NGNs an opportunity to practice communication and collaboration techniques within a nurse residency program (NRP). Two scenarios with role-playing and debriefing were developed to practice communication techniques to enhance NGNs’ confidence. Results indicate the NRP improved these skills in NGNs. NRPs may assist NGNs transition to practice and successful integration into the registered nurse (RN) role.

The eight health system teams that participated in IHI's Pursuing Equity initiative share strategies, examples of specific improvements tested, lessons learned, challenges and mitigation strategies, and tools and resources for improving health equity.

BACKGROUND: New graduate nurse job satisfaction persistently decreases at 6 months postgraduation. To prepare future nurses for career resilience, schools of nursing are implementing resilience into their curriculum. METHOD: A large Midwestern school of nursing developed and instituted small group discussions, individual assignments, and online simulations to foster career resilience in a required specialty course. The course, offered in the last year of nursing school, included 93 nursing students and a comparison group of 93 nursing students. RESULTS: The intervention showed an increase in Connor-Davidson Resilience Scale (CD-RISC) scores. Online simulations were useful for classroom learning, helped students discover new ways of thinking, and increased understanding of course content. Differences in simulation techniques were found, and students reported benefitting more from faculty-guided simulations than self-guided simulations. CONCLUSION: Nurse educators implementing resilience simulation programs can increase new graduate nurse resilience using online simulation, which is an effective technique for teaching nursing students. [J Nurs Educ. 2022;61(6):348-351.].