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Resident physician burnout and well-being are increasingly important and salient topics in medical training. Unfortunately, limited research exists regarding the efficacy of various burnout and wellness interventions for resident physicians. Better characterization of the causes of burnout and the components of well-being must necessarily precede implementation and evaluation of interventions. The authors advocate for an increased role for technology in implementing and studying wellness programming for resident physicians. In addition, they describe an intervention under development at the University of Colorado School of Medicine that uses a "Gratitude Journal" smartphone app to support trainee wellness.

Correctional officers are shouldered with important responsibilities designed to reinforce institutional security, yet work under hazardous conditions that can jeopardize their wellbeing. Among the myriad dangers they confront, COVID-19 has now presented itself as an additional threat to officer wellness. Presently little is known about how the coronavirus pandemic has affected officers, or their respective institutions. Semi-structured interview data collected from correctional officers working in a large, urban county jail located in the southeastern United States (N?=?21) revealed how COVID-19 significantly disrupted institutional operations, compounded health concerns for officers, and created a climate of confusion over procedures designed to contain spread of the virus. Policy implications are discussed.

Succinct clinical documentation is vital to effective twenty-first-century healthcare. Recent changes in outpatient and inpatient evaluation and management (E/M) guidelines have allowed neurology practices to make changes that reduce the documentation burden and enhance clinical note usability. Despite favorable changes in E/M guidelines, some neurology practices have not moved quickly to change their documentation philosophy. We argue in favor of changes in the design, structure, and implementation of clinical notes that make them shorter yet still information-rich. A move from physician-centric to team documentation can reduce work for physicians. Changing the documentation philosophy from "bigger is better" to "short but sweet" can reduce the documentation burden, streamline the writing and reading of clinical notes, and enhance their utility for medical decision-making, patient education, medical education, and clinical research. We believe that these changes can favorably affect physician well-being without adversely affecting reimbursement.

BACKGROUND: The COVID-19 pandemic has led to the rapid expansion of telehealth service delivery. We explored the experiences of a multidisciplinary palliative care team delivering telepalliative care for oncology inpatients during a 10-weeks COVID-19 surge in New York City. METHODS/PARTICIPANTS: We conducted semi-structured qualitative interviews with a targeted sample, employing a phenomenological approach with applied thematic text analysis. An interdisciplinary coding team iteratively coded data using a mix of a priori and inductive codes. Team members first independently reviewed each category, then met to reach consensus on recurring themes. The sample (n = 11) included a chaplain (n = 1), social worker (n = 1), pharmacist (n = 1), physicians (n = 3), physician assistant (n = 1), and nurse practitioners (n = 4). RESULTS: Participants described multidimensional clinician distress as a primary experience in delivering telepalliative care during the COVD-19 surge, characterized by competing loyalties (e.g., institutional obligations, ethical obligations to patients, resentment and distrust of leadership) and feelings of disempowerment (e.g., guilt in providing subpar support, decisional regret, loss of identity as a provider). Participants provided explicit recommendations to improve telepalliative care delivery for acute oncology inpatients in the future. CONCLUSION: Palliative care clinicians experienced personal and professional distress providing inpatient telepalliative care during this COVID-19 surge. Clinician strain providing telehealth services must be explored further as the pandemic and utilization of telehealth evolves. Telepalliative care planning must include attention to clinician wellbeing to sustain the workforce and promote team cohesion, and a focus on infrastructure needed to deliver high-quality, holistic care for oncology patients and their families when in-person consultation is impossible.

Encountering racism is burdensome and meeting it in a healthcare setting is no exception. This paper is part of a larger study that focused on understanding and addressing racism in healthcare in Sweden. In the paper, we draw on interviews with 12 ethnic minority healthcare staff who described how they managed emotional labor in their encounters with racism at their workplace. Data were analyzed using thematic analysis. The analysis revealed that experienced emotional labor arises from two main reasons. The ?rst is the concern and fear that ethnic minority healthcare staff have of adverse consequences for their employment should they be seen engaged in discussing racism. The second concerns the ethical dilemmas when taking care of racist patients since healthcare staff are bound by a duty of providing equal care for all patients as expressed in healthcare institutional regulations. Strategies to manage emotional labor described by the staff include working harder to prove their competence and faking, blocking or hiding their emotions when they encounter racism. The emotional labor implied by these strategies could be intense or traumatizing as indicated by some staff members, and can therefore have negative effects on health. Given that discussions around racism are silenced, it is paramount to create space where racism can be safely discussed and to develop a safe healthcare environment for the bene?t of staff and patients.

BACKGROUND: Leadership is a key driver of health care worker well-being and engagement, and feedback is an essential leadership behavior. Methods for evaluating interaction norms of local leaders are not well developed. Moreover, associations between local leadership and related domains are poorly understood. This study sought to evaluate health care worker leadership behaviors in relation to burnout, safety culture, and engagement using the Local Leadership scale of the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey. METHODS: The SCORE survey was administered to 31 Midwestern hospitals as part of a broad effort to measure care context, with domains including Local Leadership, Emotional Exhaustion/Burnout, Safety Climate, and Engagement. Mixed-effects hierarchical logistic regression was used to evaluate the relationships between local leadership scores and related domains, adjusted for role and work-setting characteristics. RESULTS: Of the 23,853 distributed surveys, 16,797 (70.4%) were returned. Local leadership scores averaged 68.8 ± 29.1, with 7,338 (44.2%) reporting emotional exhaustion, 9,147 (55.9%) reporting concerning safety climate, 10,974 (68.4%) reporting concerning teamwork climate, 7,857 (47.5%) reporting high workload, and 3,436 (20.7%) reporting intentions to leave. Each 10-point increase in local leadership score was associated with odds ratios of 0.72 (95% confidence interval [CI] 0.71-0.73) for burnout, 0.48 (95% CI 0.47-0.49) for concerning safety climate, 0.64 (95% CI 0.63-0.66) for concerning teamwork climate, 0.90 (95% CI 0.89-0.92) for high workload, and 0.80 (95% CI 0.78-0.81) for intentions to leave, after adjustment for unit and provider characteristics. CONCLUSION: Local leadership behaviors are readily measurable using a five-item scale and strongly associate with established domains of health care worker well-being, safety culture, and engagement.

One way to increase the number of RNs during a global nursing shortage is to recruit those currently not working in health care to rejoin the workforce. The goal of this project was to assess the attitudes and perceived learning needs of nurses who are not working in health care. An online survey was distributed via social media nursing groups to a self-selected sample of nurses not working in health care for the previous 2 years. Although the response rate was low (n = 18), there was interesting discussion on re-entry to nursing practice. Top reasons stated for not re-entering the workforce included burnout/stress, workplace conditions, lack of education/skills, and pay. Pharmacology, skills, and technology were the top three self-identified learning needs of the participants. Limited programs offer education for re-entry to practice. Nurse educators should develop learning materials to meet the needs of this special population. [J Contin Educ Nurs. 2022;53(11):486-490.].

Self-compassion has previously been shown to buffer healthcare professionals from burnout and other forms of mental distress, yet research is lacking on how self-compassion can be developed and integrated into the healthcare work environment. The purpose of this pilot study was to examine the potential precursors, mechanisms, and outcomes of change regarding how healthcare professionals learned self-compassion from attending a 6-week Self-Compassion for Healthcare Communities (SCHC) training. Social connections at work enhanced the trustworthiness of the program and helped participants learn to apply self-compassion within the healthcare context. Participants described practicing self-compassion with ?small daily gifts? and by offering themselves ?grace.? They felt their relationships with patients, coworkers, and family members had improved as a result of the emotion regulation and self-care skills they had gained. Findings suggest the SCHC program may address HCP burnout and empathy fatigue by providing tools that help individuals replenish their energy throughout the day and emotionally separate from others? experiences of pain. Situating programs within healthcare settings may help to reinforce and contextualize self-compassion concepts and facilitate the implementation and benefits of these tools and skills.

Limited research is available on the COVID-19 response experiences of local, state, and federal public health workers in the United States. Although the response to COVID-19 is still presenting challenges to the public health workforce, public health systems must also begin to consider lessons learned that can be applied to future disasters. During July and August 2021, a random sample of participants from a cross-sectional study of the public health workforce was invited to participate in interviews to obtain information on the current state of public health operations, the ongoing response to the COVID-19 crisis, and takeaways for improving future preparedness and response planning. Interviews were transcribed and inductively coded to identify themes. Twenty-four initial interview invitations were sent, and random substitutions were made until thematic saturation was reached when 17 interviews were completed. Four thematic categories were identified, including challenges related to (1) ongoing lack of political support or policy guidance; (2) fluctuations in, and uncertainty about, future funding and associated requirements; (3) job expectations, including remote work and data-sharing capabilities; and (4) the mental health toll of sustained response and related burnout. As the public health response to the COVID-19 pandemic continues in its third year, it is crucial to identify lessons learned that can inform future investment in order to sustain a public health workforce and a public health preparedness and response system that is resilient to future disasters.

PHENOMENON: Many academic medical centers (AMCs) have a history of separating patients on the basis of insurance status. In New York State, where Black and Latino patients are more than twice as likely to have Medicaid as white patients, this practice leads to de facto racial segregation in healthcare. Emerging evidence suggests that this segregation of care is detrimental to both patient care and medical education. Medical students are uniquely positioned to be change makers in this space but face significant barriers to speaking out about these disparities and successfully advocating for institutional change. APPROACH: The authors designed, piloted, and distributed a 16-item survey on segregated care to third-year medical students at a large academic medical center in New York City. Students were asked both open- and close-ended questions about witnessing separation and differences in patient care on the basis of insurance during their clinical rotations. The survey was shared with 140 students in March 2019 with a response rate of 46.4% (n?=?65). Preliminary findings were presented to school and hospital administrators. FINDINGS: More than half of survey respondents reported witnessing separation of patient care or differences in patient care on the basis of insurance (56.3%, n?=?36 and 51.6%, n?=?33 respectively). Many students reported that these experiences contributed to cynicism and burnout. The authors leveraged these results to advocate for quality improvement measures. In Ob-Gyn, department leadership launched a clinical transformation taskforce and recruited a new Vice Chair of Clinical Transformation/Chief Patient Experience Officer, whose role includes addressing segregated care and disparities in health outcomes. The hospital committed to establishing integrated practices in new clinical spaces and launching a similar survey among house staff. INSIGHTS: Many medical students experience and participate in segregated care during their clerkships and this has the potential to impact their education. Medical students are well-positioned to recognize segregated care across health systems and leverage their experiences for advocacy. A survey-based approach can be a powerful tool enabling students to collect these experiences to address segregated care and other health equity issues.

PURPOSE: The on-going COVID-19 pandemic has drastically impacted healthcare systems worldwide. Understanding the perspectives and insights of frontline healthcare workers caring for and interacting with patients with COVID-19 represents a timely, topical, and important area of research. The purpose of this qualitative action research study was to assist one US healthcare system that has an expansive footprint with the implementation of a needs assessment among its frontline healthcare workers. The leadership within this healthcare system wanted to obtain a deeper understanding of how the COVID-19 pandemic was impacting the personal and professional lives of its workers. Further, the organisation wanted to solicit employees' feedback about what they needed, understand the issues they were facing, and solicit their ideas to help the organisation know where to take action. DESIGN/METHODOLOGY/APPROACH: This qualitative research employed 45 focus groups, referred to as virtual listening calls (LCs) in this organisation, which were held over a four-week period. A total of 241 nursing staff, representing healthcare facilities across the country, attended 26 of the LCs. A total of 19 LCs were held with 116 healthcare workers who are employed in other clinical roles (e.g. therapists) or administrative functions. FINDINGS: Extending beyond the available research at the time, this study was initiated from within a US healthcare system and informed by the frontline healthcare employees who participated in the LCs, the findings of this study include the perspectives of both nursing and other healthcare workers, the latter of which have not received considerable attention. The findings underscore that the COVID-19 pandemic has wreaked havoc on the personal and professional lives of all of these healthcare workers and has exacted an emotional toll as noted in other studies. However, this study also highlights the importance of listening to employees' concerns, but more importantly, their recommendations for improving their experiences. Notably, the organisation is in the midst of making changes to address these frontline workers' needs. ORIGINALITY/VALUE: The study, inclusive of nursing and other healthcare staff, demonstrates how an organisation can adapt to a crisis by listening and learning from its frontline employees.

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

Researchers explored travel nurses' and permanent staff nurses' COVID-19 pandemic work experiences, seeking to understand, “How do these experiences influence nurses' motivation, happiness, stress, and career decisions?” The COVID-19 pandemic took a heavy physical and psychological toll on health care providers. Demand outweighed resources as nurses accepted the monumental task of caring for communities affected by the catastrophe. We aimed to gain insight into nurses' lived pandemic experiences in the United States, while exploring the impact of these experiences on their motives to remain in current positions or alter their career paths. In this descriptive, phenomenological study, interview data collected from 30 nurses were analyzed using qualitative content analysis. Physical and emotional trauma experienced during the early and peak months of the pandemic led nurses to evaluate their current work arrangements and to ponder alternatives. Our results suggest that pandemic work environments contributed to a change in nursing workforce distribution and exacerbated widening nurse shortage gaps. A call to action bids leaders to institute retention measures based on factors influencing nurses' career trajectory decisions in the current environment. Our findings led to recommendations for leadership approaches to promote nurses' emotional healing and mental wellness.

The COVID-19 pandemic has had a considerable impact on the mental health of the general population.Reference Pierce, Hope, Ford, Hatch, Hotopf and John1 However, there is also concern that the mental health of healthcare professionals (HCPs) has been disproportionately affectedReference Hacimusalar, Kahve, Yasar and Aydin2-Reference Luo, Liu, Chen, Huang, Chen and Yang4 because of the stress related to caring and working with patients with COVID-19,Reference Kisely, Warren, McMahon, Dalais, Henry and Siskind5-Reference Siddiqui, Aurelio, Gupta, Blythe and Khanji8 increased exposure to COVID-19, concern regarding infecting family members,Reference Billings, Ching, Gkofa, Greene and Bloomfield9-Reference Han, Choi, Cho, Lee and Yun11 and other unique stressors such as moral injuryReference Williamson, Murphy, Phelps, Forbes and Greenberg12 and stigma.Reference Han, Choi, Cho, Lee and Yun11 This is likely in addition to the mental health impact related to the growing economic insecurityReference Kousoulis, McDaid, Crepaz-Keay, Solomon, Lombardo and Yap13 and financial problemsReference Kwong, Pearson, Adams, Northstone, Tilling and Smith14 faced by the general public, and issues such as staff shortages resulting from cuts to public health services in the UK. The mental health impact is likely to result in increased work absences and significant attrition in some job roles, thus it is a priority to broadly understand the impact, dimensions and severity of the COVID-19 pandemic on the mental health of HCPs.Reference Billings, Ching, Gkofa, Greene and Bloomfield9 Nonetheless, there is conflicting data regarding the relative impact on the mental health of front-line HCPs (those who work with patients) compared with ‘non-front-line’ HCPs, or HCPs compared with non-HCPs, during this pandemic.Reference Alshekaili, Hassan, Al Said, Al Sulaimani, Jayapal and Al-Mawali15-Reference Norhayati, Che Yusof and Azman18 Largely these studies have been cross-sectional only,Reference Hacimusalar, Kahve, Yasar and Aydin2,Reference Li, Ge, Yang, Feng, Qiao and Jiang17-Reference Buselli, Corsi, Baldanzi, Chiumiento, Del Lupo and Dell'Oste19 or, in the case of the few longitudinal studies, have not repeatedly sampled the same population,Reference Mosolova, Sosin and Mosolov20 thereby limiting our understanding of the evolution of mental health changes throughout the pandemic. [...]although there has been great media interest in burnout, this has not been systematically evaluated in the different professional groups described above over time. Aims To address these gaps, we devised the COVID-19 Disease and Physical and Emotional Wellbeing of Health Care Professionals (CoPE-HCP) studyReference Khanji, Maniero C, Siddiqui, Gupta and Crosby21 as an international, observational cohort study assessing mental health, well-being and burnout in HCPs and non-HCPs across three distinct phases for evaluation of multiple domains over time. The validated mental health, burnout and well-being measures asked at all phases were as follows: the nine-item Patient Health Questionnaire (PHQ-9) to measure depression;Reference Kroenke, Spitzer and Williams22 the seven-item Generalised Anxiety Disorder (GAD-7) to measure anxiety;Reference Spitzer, Kroenke, Williams and Lowe23 the seven-item Insomnia Severity Index (ISI) to measure clinical insomnia;Reference Morin, Belleville, Belanger and Ivers24 burnout was measured with single-item indicators of emotional exhaustion and depersonalisation, abbreviated from the Maslach Burnout Inventory;Reference Li-Sauerwine, Rebillot, Melamed, Addo and Lin25 and the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) to measure well-being.Reference Tennant, Hiller, Fishwick, Platt, Joseph and Weich26 These measures were selected because they are widely used and freely available, allowing comparable rates with similar research elsewhere, and have validated cut-off points.

Mental health and wellness is a major concern among trainees, where challenges may be associated with higher perceived stress, burnout, depression, and suicide.1,2 Although struggles with mental health are not new, awareness has been heightened by increasing depression and anxiety among all medical specialties, including oral and maxillofacial surgery (OMS). Stress during residency is something we can all identify with, and the era of grinning and bearing with it, sucking it up, or taking one for the team is a strategy of the past. We can all remember sleepless nights and stressful emergency department encounters, but we must also recognize that not every surgical resident or practicing surgeon handles stress in an identical manner. Making sure oral and maxillofacial surgeons have access to mental health care providers and outlets is imperative, and it all starts during residency. We must foster a culture where senior residents advocate for their juniors, faculty advocate for their residents, and practicing oral and maxillofacial surgeons or senior faculty advocate for their junior colleagues. Only in this way will we reduce the stigma of seeking help for mental health issues. Identifying stress, anxiety, and depression not only is important for the well-being of the surgeon but also optimizes professional effectiveness and limits medical errors, emotional exhaustion, and depersonalization.

[This is an excerpt.] Male physicians consistently earn more than women. For every dollar a man earns, a woman earns only 74 cents. This translates to between $0.9 million and $2.5 million less in career earnings for women physicians compared to men, depending on the type of medicine practiced. The number of women physicians has been consistently increasing; more than half of medical students are women. But despite this growing representation, women continue to make less than men. As part of the focus on addressing discrimination and bias in health care and diversifying the workforce, we should also consider the physician gender compensation gap. The gender pay gap for physicians is substantially wider than in most other occupations in the U.S. While women across occupations earn less than men, often owing to a range of factors including family obligations and fewer opportunities for raises and promotions, how much and how we pay for health care in the U.S. uniquely contributes to the gender compensation gap among physicians. [To read more, click View Resource.]

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

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OBJECTIVE: There is a high prevalance of burnout and mental health illness among trainees. Through structured meetings, Program Directors (PDs) have an opportunity to screen and aid residents that may be affected by mental health concerns. However, barriers to this process exist. This study sought to evaluate the perspectives of PDs regarding mental health screening for trainees. DESIGN: A 13-item survey-based study. SETTING: Electronic distribution of the survey was performed via three individualized requests sent via e-mail to PDs. PARTICIPANTS: PDs of 5 ACGME specialties, including Internal Medicine, Pediatrics, Emergency Medicine, General Surgery, and Psychiatry were invited to participate. RESULTS: In total, 595 PDs responded to the survey (response rate = 40.0%) In general, PDs expressed dissatisfaction with the management of burnout and mental health. Most PDs supported periodic screening of residents for burnout (87.0%) and mental health (73.9%). For a resident that could screen positive for mental illness, most PDs were concerned about the possibility of harm to a patient (70.7%) and implications for future licensing (65.7%). Only 30.2% of PDs currently use some form of standardized screening to identify residents struggling with mental health and burnout concerns. CONCLUSION: The majority of PDs across 5 ACGME specialties support the use of periodic screening of

OBJECTIVE: To describe the association between mistreatment, burnout, and having multiple marginalized identities during undergraduate medical education. DESIGN: Cross sectional survey and retrospective cohort study. SETTING: 140 US medical schools accredited by the Association of American Medical Colleges. Participants 30 651 graduating medical students in 2016 and 2017. MAIN OUTCOME MEASURES: Self-reported sex, race or ethnicity, and sexual orientation groups were considered, based on the unique combinations of historically marginalized identities held by students. Multivariable linear regression was used to determine the association between unique identity groups and burnout along two dimensions (exhaustion and disengagement) as measured by the Oldenburg Burnout Inventory for Medical Students while accounting for mistreatment and discrimination. RESULTS: Students with three marginalized identities (female; non-white; lesbian, gay, or bisexual (LGB)) had the largest proportion reporting recurrent experiences of multiple types of mistreatment (88/299, P<0.001) and discrimination (92/299, P<0.001). Students with a higher number of marginalized identities also had higher average scores for exhaustion. Female, non-white, and LGB students had the largest difference in average exhaustion score compared with male, white, and heterosexual students (adjusted mean difference 1.96, 95% confidence interval 1.47 to 2.44). Mistreatment and discrimination mediated exhaustion scores for all identity groups but did not fully explain the association between unique identity group and burnout. Non-white and LGB students had higher average disengagement scores than their white and heterosexual counterparts (0.28, 0.19 to 0.37; and 0.73, 0.52 to 0.94; respectively). Female students, in contrast, had lower average disengagement scores irrespective of the other identities they held. After adjusting for mistreatment and discrimination among female students, the effect among female students became larger, indicating a negative confounding association. CONCLUSION: In this study population of US medical students, those with multiple marginalized identities reported more mistreatment and discrimination during medical school, which appeared to be associated with burnout.

[This is an excerpt.] Most readers will recognize the main title of this editorial, a curse of sorts that was apparently coined by a British politician in the 1930s. Of course, the irony is that this curse is actually calling for the recipient to experience dangerous or troubling times. We in the pharmacy profession are currently experiencing “interesting times”, with all the various connotations entailed by the term “interesting”. [To read more, click View Resource.]

Meaningful recognition is powerful and tied to purpose. As nurses, we are motivated by our ability to contribute and make a difference in our patients' lives. As leaders, we can buffer the negative effects of burnout, foster a positive work environment, and cultivate a culture of gratitude and trust by creating and sustaining a culture of recognition.

The COVID-19 pandemic created novel patient care circumstances that may have increased nurses' moral distress, including COVID?19 transmission risk and end?oflife care without family present. Well?established moral distress instruments do not capture these novel aspects of pandemic nursing care. The purpose of this study was to develop and evaluate the psychometric properties of the COVID?19 Moral Distress Scale (COVID?MDS), which was designed to provide a short MDS that includes both general and COVID?19?specific content. Researcher?developed COVID?19 items were evaluated for content validity by six nurse ethicist experts. This study comprised a pilot phase and a validation phase. The pilot sample comprised 329 respondents from inpatient practice settings and the emergency department in two academic medical centers. Exploratory factor analysis (EFA) was conducted with the pilot data. The EFA results were tested in a confirmatory factor analysis (CFA) using the validation data. The validation sample comprised 5042 nurses in 107 hospitals throughout the United States. Construct validity was evaluated through CFA and known groups comparisons. Reliability was assessed by the omega coefficient from the CFA and Cronbach's alpha. A two?factor CFA model had good model fit and strong loadings, providing evidence of a COVID?19?specific dimension of moral distress. Reliability for both the general and COVID?19?specific moral distress subscales was satisfactory. Known groups comparisons identified statistically significant correlations as theorized. The COVID?MDS is a valid and reliable short tool for measuring moral distress in nurses including both broad systemic sources and COVID?19 specific sources.