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[This is an excerpt.] Now 2 years old, the unprecedented coronavirus disease 2019 (COVID-19) pandemic produced a medical response that was equally unprecedented. Starting with nearly no knowledge about diagnosis, transmission, prevention, treatment, or predictors of outcome, physicians and hospitals were forced to develop real time answers for a new and unfamiliar disease. Particularly, challenging medical aspects of COVID-19 included multisystem involvement, extremely high transmissibility, rapid mutation, and an extraordinarily wide spectrum of clinical presentation from asymptomatic carrier to fatal respiratory failure. [To read more, click View Resource.]

Clinicians are reluctant to seek mental health services. They fear loss of livelihood and disciplinary action. The Oregon Wellness Program (OWP) is a state-wide consolidated mental health initiative formally established in 2018 as a physician, physician assistant, acupuncturist, and podiatrist program. OWP is self-referral, not-mandated, strictly confidential, and free. Reporting to oversight bodies is forbidden. Utilization increased from 228 clients to 349 clients (a 53% increase) and 405 visits to 625 visits (a 54% increase) from 2019 to 2020 respectively, coinciding with the first COVID-19 pandemic surge. Between April 2019 and the end of August 2020, 41 of 433 (9.5%) individuals who were provided mental health services returned 77 program evaluation surveys, indicating satisfaction with the program (96%), its helpfulness to them personally (99%), and changes made in their personal lives (80%). The burnout response rate fell with increased visits and reallocation of activities within their practices increased (39%). A survey of mental health professionals corroborated positive results of their clients. The OWP can serve as a model for healthcare professional support programs. Collaboration among healthcare organizations, professional, and oversight bodies is essential. Increasing sustainable funding to pay for expanding services for dentists and nurses, assuring access for rural clinicians, and developing research tools to capture a more robust sample of responses remain priorities.

BACKGROUND: As more women begin to enter the traditionally male-dominated field of orthopaedics, it is critical to examine their experiences in navigating gender-based conflicts in the workplace. METHODS: An anonymous survey was distributed via a web link to approximately 1,100 members of Ruth Jackson Orthopaedic Society (RJOS) and 1,600 members of Women in Orthopaedics (WIO) Facebook group, with an estimated response rate of 50% and 50% respectively and protocols to mitigate duplicate response. Questions included demographics and presented several workplace scenarios. RESULTS: Of the 373 respondents, 72% described experiencing some type of workplace conflict self-attributed to being female. Additionally, 8% reported either being forced out or leaving their previous job due to workplace conflict, leading to depression, anxiety, and burnout. 17% of respondents would not choose the same career again if given the opportunity. CONCLUSIONS: Workplace conflict diminishes a surgeon's career satisfaction and may ultimately contribute to burnout. Understanding the relationship between gender bias and orthopaedic surgery is essential in moving towards change, and addressing these issues will create a more positive working environment for female surgeons.

BACKGROUND: During the COVID-19 pandemic, health care provider well-being was affected by various challenges in the work environment. The purpose of this study was to evaluate the relationship between the perceived work environment and mental well-being of a sample of emergency physicians (EPs), emergency medicine (EM) nurses, and emergency medical services (EMS) providers during the pandemic. METHODS: We surveyed attending EPs, resident EPs, EM nurses, and EMS providers from 10 academic sites across the United States. We used latent class analysis (LCA) to estimate the effect of the perceived work environment on screening positive for depression/anxiety and burnout controlling for respondent characteristics. We tested possible predictors in the multivariate regression models and included the predictors that were significant in the final model. RESULTS: Our final sample included 701 emergency health care workers. Almost 23% of respondents screened positive for depression/anxiety and 39.7% for burnout. Nurses were significantly more likely to screen positive for depression/anxiety (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.11–3.86) and burnout (aOR 2.05, 95% CI 1.22–3.49) compared to attendings. The LCA analysis identified four subgroups of our respondents that differed in their responses to the work environment questions. These groups were identified as Work Environment Risk Group 1, an overall good work environment; Risk Group 2, inadequate resources; Risk Group 3, lack of perceived organizational support; and Risk Group 4, an overall poor work environment. Participants in the two groups who perceived their work conditions as most adverse were significantly more likely to screen positive for depression/anxiety (aOR 1.89, 95% CI 1.05–3.42; and aOR 2.04, 95% CI 1.14–3.66) compared to participants working in environments perceived as less adverse. CONCLUSIONS: We found a strong association between a perceived adverse working environment and poor mental health, particularly when organizational support was deemed inadequate. Targeted strategies to promote better perceptions of the workplace are needed.

BACKGROUND: Reducing burnout is a priority for many organizations. This paper investigates if mentoring has an impact on employee burnout in a large comprehensive cancer hospital. METHODS: Utilizing data from an organizational survey with self-identification of burnout and self-disclosed participation in mentoring relationships, a chi-square test was conducted to analyze the data from 14,500 employees. RESULTS: We found employees participating in a mentoring relationship were significantly less likely to report burnout than employees who were not participating in a mentoring relationship (χ2 (1, 14,500) = 17.204, p < 0.001). This same pattern was found within subsets of employees, examining across gender, ethnicity, generation, and different job classifications. CONCLUSION: Implementing and promoting mentoring programs should be an organizational strategy to help improve overall work satisfaction and professional fulfillment for mentors and mentees. Best practices and institutional mentoring programs are outlined to exhibit the multitude of opportunities for mentoring within the organization that contribute to a reduction of burnout.

BACKGROUND: Substance use (SU) or substance use disorder (SUD) prevalence among U.S. nurses has not been assessed for almost 25 years. PURPOSE: The purpose of this current study, known as the Nurse Worklife and Wellness Study, is to generate population-based prevalence estimates for SU and related problems, including SUDs, among registered nurses and to examine other personal and work characteristics related to nurse SU. METHODS: A mixed-mode survey of a nationally representative sample of randomly selected nurses in nine states, using a cross-sectional design, obtained 1,215 responses (30.6% response rate), with 1,170 usable surveys for analysis. Substance use and problems were assessed based on standardized criteria. RESULTS: Past year illicit drug use was 5.7%, and prescription-type drug misuse was 9.9%, with nurses working in home health/hospice (19%) and nursing homes (15.8%) having the highest rates. Energy drink use was reported by 23.7% of nurses younger than 45 years, with emergency and multi-specialty nurses having three to five times the odds of use versus the reference group. Overall, 18.0% of nurses screened positive for SU problems, with one-third of those (6.6% of the total) screening positive for SUD. Staff, charge nurses/coordinators/nurse managers, and other administrators had 9 to 12 times the odds of having a SUD as opposed to educators and researchers. CONCLUSION: Prescription-type drug misuse rates exceeded the U.S. population rates, and rates varied by specialty. Energy drink use and SUD risk were significantly higher among nurses in certain positions and specialties. Focusing on higher risk groups can help target nurse prevention and treatment efforts and guide policy for identifying and addressing SU problems among nurses.

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The high degree of burnout in physicians, including oncologists, is detrimental to physicians themselves, their families, patients, health care organizations, and the health care systems as a whole. This dire situation has significantly worsened during the COVID-19 pandemic. It is well established that both organizational and individual measures are urgently needed to mitigate the negative consequences of physician burnout. Here, we review the research that has begun to indicate potential evidence-based individual approaches to promote physician well-being. We give an overview of these emerging programs and their importance, provide an example from our own experience, and enumerate considerations for future research. We also discuss the need for developing new approaches that are evidence-based and the best ways in which they can be incorporated in the health care setting. When judiciously combined with organizational approaches, preferentially as an integral part of them, individual wellness programs for physicians are poised to contribute significantly toward the much needed relief from physician burnout.

BACKGROUND: This study investigated the association between fair and supportive leadership and symptoms of burnout and insomnia in police employees. Burnout and insomnia can have negative consequences for health, performance, and safety among employees in the police profession, and risk and protective factors should be thoroughly investigated. METHODS: Data were collected in a police district in Norway through questionnaires administered in October 2018 and May 2019. The sample consisted of 206 police employees (52% males), with an average age of 42 years and 16 years of experience in the police occupation. RESULTS: The results showed that a high degree of fair and supportive leadership was associated with lower levels of burnout and insomnia six months later. Fair and supportive leadership explained a greater amount of variance in burnout compared to insomnia. This finding indicates that fair and supportive leadership is a more important buffer factor against burnout than it is against insomnia. Stress was positively associated with burnout and insomnia, whereas quantitative job demands had no significant association with the concepts. CONCLUSION: Fair and supportive leadership can help protect employees from adverse consequences of stress and contribute to improved occupational health, whereas a low degree of support and fair treatment from leaders can both represent a stressor by itself and contribute to poorer coping of stressful events at work. The important role of leadership should be incorporated in measures aimed at preventing and reducing burnout and sleep problems.

The aim of this cross-sectional study is to investigate the effect of self-esteem on burnout symptoms and depression, using a path analysis approach. A total of 396 Greek police officers, 145 female and 251 male, with a mean age of 37.7 years, participated in the study. The questionnaire included: (a) social?demographic characteristics, (b) Rosenberg's self-esteem scale, (c) Zung's depression scale, and (d) Maslach's burnout scale. Analysis of variance was applied to find whether the demographic variables of gender, age and urban/rural location had a significant effect on the examined psychometric scales. A path model was then tested, aiming to quantify the direct and indirect effects of age, working location and self-esteem on depression and burnout symptoms. Emotional exhaustion and personal accomplishment scores were found to have a direct effect on depression and completely explained the effect of urban area on depression. Self-esteem was found to be a significant regressor on depression and the three burnout subscales, while older and more experienced officers had significantly lower burnout symptoms. The findings of the study confirm the protective role of self-esteem. The findings also confirmed that police officers working in an urban environment are at a greater risk of developing burnout and depression symptoms, while the depressed feelings of police officers in an urban area are completely explained by increased feelings of burnout. The ability of police officers to counteract the psycho-emotional pressure of their profession as they age in service is demonstrated. The need for initiatives aiming to support young officers and police personnel working in large cities is indicated.

OBJECTIVES: The current study aimed to guide the assessment and improvement of psychological safety (PS) by (1) examining the psychometric properties of a brief novel PS scale, (2) assessing relationships between PS and other safety culture domains, (3) exploring whether PS differs by healthcare worker demographic factors, and (4) exploring whether PS differs by participation in 2 institutional programs, which encourage PS and speaking-up with patient safety concerns (i.e., Safety WalkRounds and Positive Leadership WalkRounds). METHODS: Of 13,040 eligible healthcare workers across a large academic health system, 10,627 (response rate, 81%) completed the 6-item PS scale, demographics, safety culture scales, and questions on exposure to institutional initiatives. Psychometric analyses, correlations, analyses of variance, and t tests were used to test the properties of the PS scale and how it differs by demographic factors and exposure to PS-enhancing initiatives. RESULTS: The PS scale exhibited strong psychometric properties, and a 1-factor model fit the data well (Cronbach α = 0.80; root mean square error approximation = 0.08; Confirmatory Fit Index = 0.97; Tucker-Lewis Fit Index = 0.95). Psychological Safety scores differed significantly by role, shift, shift length, and years in specialty. The PS scale correlated significantly and in expected directions with safety culture scales. The PS score was significantly higher in work settings with higher rates of exposure to Safety WalkRounds or Positive Leadership WalkRounds. CONCLUSIONS: The PS scale is brief, diagnostic, and actionable. It exhibits strong psychometric properties; is associated with better safety, teamwork climate, and well-being; differs by demographic factors; and is significantly higher for those who have been exposed to PS-enhancing initiatives.

OBJECTIVE: Faculty development is designed to facilitate career advancement of junior faculty but there is limited empirical evidence on how to design an effective program. METHODS: As a first step in the design of an effective program, a needs assessment was conducted. Participants were faculty members of an academic psychiatry department. Participants completed a quantitative and qualitative survey assessing their experience with mentors, academic self-efficacy, career burnout and satisfaction, academic productivity, and perceived barriers to scholarship. RESULTS: Eighty percent (N = 104) of eligible faculty members completed the study survey (54% female; 81% White, 10% underrepresented in medicine). Less than half of the respondents (44%) reported having a current mentor. Number of mentors (r = .33; p < .01), mentorship meetings (r = .35; p < .01), and mentorship quality (r = .33; p < .01) were significantly correlated to a standardized measure of academic self-efficacy. Self-efficacy was significantly associated with academic productivity (r = .44; p < .001) and career satisfaction (r = .29; p < .05). The top barriers to scholarship productivity were time and lack of access to resources. Faculty members without a mentor endorsed more barriers to scholarship (p < .001) than those with a mentor. Themes that emerged from the qualitative data suggest that mentorship supports career advancement through coaching and professional development, invitations to collaborate and resource share, networking, and active teaching. CONCLUSION: Based on the relationship of mentoring to career outcomes, a robust faculty development program needs a formal academic mentorship program to improve career satisfaction and academic productivity.

Grit, a positive psychological trait comprised of perseverance and passion, has been correlated with physician burnout but has not been extensively studied among medical students. Identification of the relationship between grit and burnout as well as between burnout and other demographics could help to identify students at risk of burnout, while informing educational strategies to increase grit in the medical occupation. For this cross-sectional study, an online, email-based survey including demographic questions, the Maslach Burnout Inventory-Human Services (Medical Personnel) Survey, and the Short Grit Scale was distributed to an entire student body of allopathic medical students via a schoolwide listserv in 2019. The response rate was 39.6% (177/444). Negative correlations were displayed between grit and emotional exhaustion, depersonalization, and overall burnout. Positive correlation was demonstrated between grit and personal accomplishment. Male participants had higher depersonalization than female participants and fourth year medical students had higher depersonalization than other years of training. Fourth year medical students had higher personal accomplishment than other years of training and married students had higher personal accomplishment than those who had never been married. These findings are important not only for potential identification of students at risk of burnout, but also for development of strategies to bolster grit and mitigate distressing experiences in the medical occupation. Future studies are necessary to gauge how this relationship may evolve throughout a medical career.

[This is an excerpt.] The consolidation of hospital systems and physician practices under a single corporate umbrella has resulted in major structural changes to the practice of medicine. In 2012, 60% of practices in the US were physician-owned, 23.4% of practices had some hospital ownership, and only 5.6% of physicians were direct hospital employees.1 After a surge in acquisitions of physician practices over the decade, and in response to the COVID-19 pandemic, the fraction of physicians employed by hospitals or health systems reached 52.1% and 21.8% by other corporate entities in 2022, for a total of an estimated 74% of practicing physicians.2 Many physicians now are employed by consolidated corporate health care systems that span many different communities and increasingly are spread across multiple states. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Workers & Learners

[This is an excerpt.] Since the beginning of the COVID- 19 pandemic, healthcare workers- especially those caring for the acute and critically ill- have faced constant, often unimaginable and unending pressure from working in settings that were all-too-often understaffed, underresourced, and seemingly under siege. Aside from the stress and fatigue of being overworked from taking care of profoundly ill patients with a new and highly contagious virus, clinicians were further burdened by the very real risk of contracting the disease themselves and placing their loved ones at risk illness as well. These pressures are likely worse in the ICU and in related high acuity settings, where the most seriously ill patients are treated and where physicians and other providers already labor under conditions of heightened stress that make them even more prone to burnout, moral distress, and emotional angst. [To read more, click View Resource.]

BACKGROUND: Mental health problems are common in healthcare workers as they are exposed to a variety of risk factors. Healthcare professionals face extraordinary stressors in the medical environment. They demonstrate high levels of stress, anxiety, depression and burnout, and sleep disorders, which inevitably lead to medication errors and lower standards of care. METHODS: We conducted a wide-ranging review to analyze how the use of yoga and mindfulness-based interventions reduce stress, anxiety, and burnout in healthcare workers. The main scientific databases we consulted, such as PubMed, Scopus, Cochrane Library, Web of Sciences, APA PsycInfo, and CINAHL, contain all the systematic reviews present in the literature. No restrictions of year, publication, or language were applied. Based on PRISMA guidelines, 12 reviews were included in this paper. Quality assessment of the systematic reviews included in the research was done using the AMSTAR checklist. RESULTS: In accordance with the literature, the study shows that increasing the use of yoga and mindfulness-based interventions can provide support to healthcare workers in achieving stable psycho-physical well-being, which can enhance their value within their work environment. CONCLUSION: Employers in the healthcare industry should consider implementing workplace wellness programs that integrate these methods to promote the well-being of their staff. MBI and yoga are effective interventions that can help the psychological functioning of healthcare professionals; however, further high-quality research is needed before this finding can be confirmed.

There are more than 160 million people who are a part of the U.S. workforce today.1 Work is one of the most vital parts of life, powerfully shaping our health, wealth, and well-being.2 At its best, work provides us the ability to support ourselves and our loved ones, and can also provide us with a sense of meaning, opportunities for growth, and a community. When people thrive at work, they are more likely to feel physically and mentally healthy overall, and to contribute positively to their workplace.3 This creates both a responsibility and unique opportunity for leaders to create workplace environments that support the health and well‑being of workers. Although the COVID-19 pandemic may have accelerated the evolution of work and the conversation around workplace mental health and well-being, broad recognition and appreciation for the relationship between the work environment, culture, community, and our health preceded the pandemic.4, 5, 6, 7 While many challenges outside the workplace may impact well-being—from economic inequality, food insecurity, and housing insecurity to household, educational, and medical debt—there are still many ways that organizations can function as engines for mental health and well-being.8, 9 Organizational leaders, managers, supervisors, and workers alike have an unprecedented opportunity to examine the role of work in our lives and explore ways to better enable all workers to thrive within the workplace and beyond.

Agitation is a common and potentially dangerous condition requiring rapid recognition and treatment in acute psychiatric units. Prompt intervention can prevent a patient with agitation from harming themselves, harming others, or needing restraints or seclusion. After the review of numerous guidelines, the Modified Agitation Severity Scale (MASS) agitation treatment protocol was developed to identify and manage agitation in an inpatient adult psychiatric setting. This protocol involved modifying an existing agitation scale and pairing scores with a treatment algorithm to indicate which behavioral and medication interventions would be most appropriate. All scoring and interventions were recorded in the electronic medical record (EMR). Three months of data were collected before and after the protocol was implemented. The new, modified scale had high reliability and correlated well with another validated agitation scale. Perceived patient safety was high during both study phases. Nurses’ perceptions of safety trended upward after the protocol was implemented, though these differences were not significant, likely due to insufficient power. Although there was no decrease in seclusion events after implementation of the treatment protocol, there was a 44% decrease in restraint events and average restraint minutes per incident. Despite a potential increase in workload for nursing staff, implementation of the protocol did not increase burnout scores. Physicians continued to order the protocol for 55% of patients after the study period ended. These findings suggest that including a rapid agitation assessment and protocol within the EMR potentially improves nurses’ perceptions of unit safety, helps assess treatment response, reduces time patients spend restrained, and supports decision making for nurses.

The Vitruvian Man is a metaphor for the “ideal man” by feminist posthuman philosopher Rosi Braidotti (2013) as a proxy for eurocentric humanist ideals. The first half of this paper extends Braidotti's concept by thinking about the metaphor of the “ideal nurse” (Vitruvian nurse) and how this metaphor contributes to racism, oppression, and burnout in nursing and might restrict the professionalization of nursing. The Vitruvian nurse is an idealized and perfected form of a nurse with self-sacrificial language (re)producing self-sacrificing expectations. The second half of this paper looks at how regulatory frameworks (using the example of UK's Nursing and Midwifery Council Code of Conduct) institutionalize the conditions of possibility through collective imaginations. The domineering expectations found within the Vitruvian nurse metaphor and further codified by regulatory frameworks give rise to boredom and burnout. The paper ends by suggesting possible ways to diffract regulatory frameworks to practice with affirmative ethics and reduce feelings of self-sacrifice and exhaustion among nurses.

[This is an excerpt.] One recent night a nurse at UC Davis Medical Center in Sacramento, California, awakened a patient to provide anti-seizure medication and got a frightening response. The patient “became verbally aggressive” toward the staff, and when the patient’s roommate said, “Don’t be rude to your nurse,” the patient snapped at him, pushed aside the curtain separating their beds, threw something at him, and resumed resisting the staff. Thus began another assault against health care workers, whom the federal government reports are five times more likely to experience workplace violence than employees in all other industries. In the past, staff options in such confrontations were typically limited to some form of calming the patient on their own or calling security. In this case, the UC Davis staff called the hospital’s new Behavioral Escalation Support Team (BEST), comprising care providers trained in mental health care and de-escalating conflicts. The BEST staff calmed the patient and, with the nurse present, explained that nurses must visit frequently to check vital signs and well-being. The patient quieted and agreed to cooperate with the nurses. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Operational Strategies (Ensuring Physical & Mental Health).

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AIMS: This study assessed the feasibility of delivering three good things (3GTs) practice as part of professional nurse residency program, measured the degree to which it influenced work–life balance, resilience, and burnout, and explored what newly licensed nurses (NLRNs) identified as good things. BACKGROUND: Burnout occurs in response to chronic work-related emotional and interpersonal stress, negatively impacting nurses and patients. However, research shows that 3GT practice can increase positive emotions, enhance resilience, and reduce burnout. METHODS: In this study, 3GT was introduced to a convenience sample of 115 NLRNs during their professional residency program. For 14 days, participants received daily 3GT prompts. Individualized survey links were sent via SMS message at baseline, postsurvey (T1), and 6 months (T2). Survey data were collected about work–life balance, burnout, and resilience, and text data from participants' daily 3GT notations from March through November 2021. RESULTS: Seventy-one participants were recruited. T1 survey results indicated significant improvements in survey measures but only emotional recovery improvement was sustained at T2. Burnout was the only variable that correlated to participants' number of 3GT days practice. Simple joys, reflections about work, self-care activities, and relationships were major identified themes. CONCLUSIONS: The results demonstrate the generalizability, value, and feasibility of implementing a web-based 3GT intervention in a nurse residency program. Additional benefits may be those gained by the reflection that is prompted, thereby facilitating professional development among NLRNs.