Resource Library

[This is an excerpt.] The Forum for Shared Governance, founded more than 20 years ago, is the only clearing house that  identifies, promotes, and disseminates evidence-based information about shared governance within a professional governance continuum and through organizational innovations that empower nurses and other healthcare professionals.

The Forum believes that innovations, such as shared governance, that allow front-line professionals, managers, and patients to share control and influence together over practice and the resources that support it in healthcare organizations can enhance patient, professional, and organizational outcomes. The Forum further believes that staff and managers need ongoing support and education to effectively participate in the governance of their practice. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Establishing Commitment & Shared Governance (Shared Governance).

‍

A revolutionary academic-practice partnership model was implemented at the University of Maryland Medical System (UMMS) with the University of Maryland School of Nursing, through which the preparation and transition to practice of new graduate nurses were reimagined, resulting in intentional support for staffing the nursing workforce. Groups of nursing students were paired with a UMMS-funded clinical instructor to take a full patient assignment for one 12-hour shift in a UMMS hospital each week. This instructor-led cohort is equivalent to one UMMS nurse and was included in the staffing numbers of participating units.

Despite professional commitment to wellness, supporting and addressing clinician mental health and professional sustainability has not been historically prioritized or well-understood within the occupational therapy profession. This paper discusses how to build a mentally strong, resilient, sustainable current and future occupational therapy workforce at the personal and systemwide levels to prioritize practitioner mental health. Specific barriers to and support for practitioner occupational balance and mental health as well as systemwide professional sustainability are discussed highlighting a Model of the Interplay of Occupational Balance and Professional Sustainability.

BACKGROUND: Staff working in people-oriented professions are vulnerable to burnout which is negatively associated with professional well-being and service-user care. AIM: To investigate if interventions based on Acceptance and Commitment Therapy (ACT) are effective in reducing staff burnout. METHOD: Systematic database and reference list searches were conducted resulting in the inclusion of 14 quantitative papers. A narrative synthesis, including extraction of individual effect sizes, was performed. RESULTS: All studies were controlled trials. The settings for ACT delivery were varied across health, social care, and public services. The ACT interventions demonstrated statistically significant effects in favour of ACT on the outcome measure subscales across the majority of studies (n = 9). Thirteen studies demonstrated an effect in favour of ACT in at least one outcome measure subscale. Positive aspects of work engagement varied according to a professional role. CONCLUSIONS: The findings suggest that ACT-based interventions using a wide range of formats may have the potential to decrease burnout across a range of professional groups. However, samples were small in the studies reviewed and the interventions were not always defined. Further research would benefit from larger studies, incorporating process measures, with explicit protocols.

The prevalence of suicidal ideation is unknown and limited information exists about depression and anxiety among physician associates/assistants (PAs). We set out to understand the degree of depression, anxiety, and suicidal ideation in PAs and PA students. In total, 728 PAs and 322 PA students took an online survey. Risk of depression and anxiety were present at higher levels in PA students compared with employed PAs. PA students indicated higher levels of suicidal ideation compared with clinically active PAs. One-third of those with suicidal ideation did not reveal it to anyone; among those who did, 16.2% feared the results of disclosure. This study establishes that PAs and PA students are at risk for suicidal ideation and often bypass help. The COVID-19 pandemic may have led to elevated rates of emotional distress, and longitudinal studies are needed to understand the basis for such ideation and if it is transitory.

BACKGROUND AND PURPOSE: To better understand the effects of an intervention, Mindfulness for Healthcare Professional (MIHP), and how it may improve healthcare professional student (HCP) functioning, a constructivist grounded theory exploration was conducted. MATERIALS AND METHODS: Ten participants with the lowest or highest changes on quantitative measures of burnout and perceived stress at the end of MIHP were interviewed at a long-term follow-up. A theoretical framework was developed from the resultant themes to describe the mechanisms by which MIHP had effects on work-relevant functioning. RESULTS: Three overarching themes emerged as mechanisms of change both from their presence in those participants reporting an improvement in stress and their missingness from those participants who reported no change: developing a mindfulness practice, integrating practice into daily life, and enhanced awareness. These mechanisms led to optimized work-relevant functioning: 1) emotional competencies, including nonjudgement, emotion regulation, and burnout prevention; and 2) patient-centered care, including improved listening, patience, and efficiency at work. CONCLUSION: The resultant framework is discussed in the context of previous literature on MIHP and mindfulness theory more broadly. Implications for future disseminations of MIHP encourage the use of group interventions with emphasis on developing at-home practice and informal mindfulness integrated into daily work.

PURPOSE: The objective of this study was to investigate the effect of work stress on job burnout and quality of life and the effect of moderating group factors (transformational leadership and group member interactions) on the relationship between work stress, job burnout, and quality of life. This study takes front-line border police as the research object, adopts a cross-level perspective, and takes work stress as a key factor affecting work efficiency and health indicators. METHODS: It collected data through questionnaires, with questionnaires for each research variable adapted from existing research scales, such as multifactor leadership questionnaire developed by Bass and Avolio. A total of 361 questionnaires were filled out and collected in this study, including 315 male participants and 46 female participants. The average age of the participants was 39.52. Hierarchical linear modeling (HLM) was used to test the hypotheses. RESULTS: First, it was found that work stress has a significant impact on job burnout and quality of life. Secondly, leadership style and group member interactions have a direct, cross-level effect on work stress. Third, it found that leadership style and group member interactions have an indirect, cross-level effect on the relationship between work stress and job burnout. However, these are not indicative of quality of life. The results of this study highlight the particular impact of the nature of police work on the quality of life, and further enhance the value of this study. CONCLUSION: The two major contributions of this study are: 1) it shows the original characteristics of the organizational environment and the social context of Taiwan’s border police and, 2) in terms of the research implication, it is necessary to re-examine the crosslevel impact of group factors on individual work stress.

BACKGROUND: Nationwide nursing shortages have led to higher patient-to-nurse ratios, nursing burnout, and decreased quality of care. LOCAL PROBLEM: Staffing challenges and nursing burnout were becoming growing concerns and success was contingent upon efficient use of existing resources. METHODS: Direct observation current state assessment was completed on medical-surgical specialty units to better understand work activities of registered nurses (RNs) and unlicensed assistive personnel (UAPs). RESULTS: RNs spent more time performing indirect care (eg, documentation) than direct patient care. Interruptions and problems consumed 17.4% and 5.6% of their time, respectively. UAPs performed more direct patient care but had a higher proportion of downtime. RNs underdelegated nonclinical tasks. CONCLUSIONS: Direct observation current state assessment offers a better understanding of workflow and workload inefficiencies. This information is critical to provide informed, evidence-based recommendations to develop future patient care models with more capacity to deliver high-quality care with greater efficiency and lessen nursing burden and burnout during the nursing shortage crisis.

INTRODUCTION: Physician burnout has been described as more common among women than men.  Even if there are no gender-based differences in prevalence, risk factors, such as work/home integration/conflict and gendered biases, likely differ.  Prior administrations of an annual resident wellness survey at a single urban academic institution confirmed that rates of burnout were higher among women, especially during the PGY-2 year.

METHODS: A series of focus groups of women PGY-3 residents across specialties were organized in 2019 at a single urban academic medical center.  Given the number of participants, demographics were not collected to maintain participant anonymity.  The moderator for all groups used a discussion guide consisting of eight open-ended questions based on a review of the literature.

RESULTS: Ten residents agreed to participate in one of four, hour-long focus group discussions.  While the residents identified some factors that were not gender-specific, they also discussed issues that they faced as women in medicine, including needing to work harder to prove themselves and unconscious gendered biases from faculty and patients.  The residents thought that their wellbeing would be improved if their training programs better understood the experiences and needs of women residents and recommended a series of interventions, including improved mentoring and networking opportunities.

CONCLUSIONS: Interventions to improve wellbeing need to consider gender-based differences.  While mentoring and networking can help all residents, these may be especially useful for women and should be considered as a component of an overarching plan to improve diversity, equity, inclusion, and belonging.

BACKGROUND: Significant progress has been made in understanding the factors associated with oncology (onc) PA burnout. However, little is known about what PAs need to mitigate burnout, the availability of resources, and barriers to interventions. METHODS: A national survey of onc PAs was conducted in 2022. PAs completed a quantitative needs assessment to determine the importance of and their perceived skills in topics of self-care, clinical care, and professional development. For importance, “high importance” included ratings of ‘Essential’ or ‘Very Important’; for perceived skill, “high skill” included ratings of ‘Excellent’ or ‘Good’. Engagement with employee assistance programs (EAPs) was examined. Resiliency & Burnout were assessed using the Connor-Davidson Resilience Scale & the Maslach Burnout Inventory. RESULTS: PAs (n = 171) were mostly practicing in medical oncology (66%) and outpatient (66%). The high importance topics most often identified were dealing with difficult patients (93%), dealing with difficult providers (89%), delivering bad news (88%) and coping with death / patient suffering and personal grief (86%). Topics less often reported as high importance included opportunities to be a mentor (61%), professional coaching (59%) and mindfulness skills (53%). PAs frequently reported high skills in dealing with difficult patients (75%), delivering bad news (72%), and resiliency skills (59%). Fewer PAs reported high skills for debriefing following significant events (49%) and mindfulness skills (42%). Burnout (BO) rates were higher for those with lower perceived skills in resiliency (p = 0.03) and dealing with difficult providers and staff (p = 0.03) but did not differ based on importance of any topics. Resiliency significantly increased with increasing levels of reported importance for the mindfulness skills training, cognitive skills training, and debriefing after significant events topics. Resiliency significantly increased with increased levels of perceived skill for all topics explored. Common barriers to well-being EAP participation were lack of time (58%) and concerns about confidentiality and stigma (26%). For PAs with concerns about stigma, resiliency scores were lower (6.4 vs 7.0; p < 0.001) and BO rates were higher (73% vs 47%; p = 0.005). CONCLUSIONS: Perceived deficiencies in resiliency training and managing difficult work relationships correlate with higher rates of burnout in onc PAs. Barriers to participation in EAPs, which may help address these deficits, are common and when present are associated with an alarming rate of burnout and lower resiliency. Cultural change in medicine is needed to reduce perceived and experienced stigmatizing experiences to address burnout. These findings suggest that burnout interventions which focus on building resiliency and managing work relationships are crucial and may be best implemented outside of the workplace.

Physician burnout is an epidemic and there are unique aspects of surgery that dictate rates of burnout among general surgeons and surgical trainees. This review characterizes the scope of burnout and its drivers within the field of surgery and advocates for strategies to address burnout at the individual, institutional, and national levels.

[This is an excerpt.] “Some people just don’t know when to quit.” It might be time to retire this old cliché. As it turns out, people do know when to quit, and they’re quitting their jobs by the millions. “The Great Resignation,” a term coined in May 2021, is an economic trend in which millions of workers are quitting their jobs, switching industries, moving into nontraditional roles, retiring early, and reinventing their ideal career. The numbers are staggering. According to the U.S. Bureau of Labor Statistics, more than 47 million Americans left their jobs in 2021. The trend doesn’t seem to be slowing down either, as a McKinsey report published in July 2022 found that 40% of employees are currently considering leaving their jobs. [To read more, click View Resource.]

BACKGROUND: Prior to the novel coronavirus (COVID-19) pandemic, nurses died by suicide more frequently than the general population. Antecedents prior to death include known job problems, such as disciplinary action; diversion of medications; inability to work due to chronic pain; and physical and mental illness. AIM: The aim of this study was to explore the suicide experience of nurses who died with known job-related problems during the early phase of the COVID-19 pandemic compared to what has been previously described. METHOD: Deductive reflexive thematic analysis was used to analyze narratives of nurses with known job problems who died by suicide from the Centers for Disease Control and Prevention's National Violent Death Reporting System. RESULTS: Forty-three nurses with known job-related problems completed suicide between March and December 2020. Factors associated with death were similar to previous findings with notable exceptions, increased prevalence of suicidal ideation and post-traumatic stress prior to the event. Pandemic-specific issues were noted including reduction in hours, fear of disease transmission, civil unrest, and grief-related trauma. LINKING EVIDENCE TO ACTION: Suicide prevention programs need to address both institutional and individual factors associated with nurse suicide. As previously recommended, transitions into retirement and job loss are vulnerable times warranting psychological support. Further, strategies to reduce the impact of stressors and increase support for nurses are needed at the organizational level. A systems level approach to hardwire coping strategies is indicated pre-licensure and throughout nurses' careers. A new focus on how to process personal and professional grief is warranted. Resources are needed for nurses traumatized by life (rape, childhood trauma) or work-related experiences.

Mental health professionals working in the juvenile justice system work with clients who have complex mental health needs putting them at increased risk of burnout and vicarious trauma. Clinical supervision can help beginning counselors provide competent services and, at the same time, protect them from burnout. This article shows how supervisors can use an Adlerian-informed supervision method that integrates the Respectfully Curious Inquiry/Therapeutic Encouragement (RCI/TE) framework with the discrimination model of supervision to increase the supervisee’s experience of the Crucial Cs. Supervisors can protect supervisees from burnout and vicarious trauma by increasing feelings of connection, significance, competence, and courage. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Occupational burnout has become widespread. The syndrome can be especially harmful in health care settings, affecting clinicians, organizational effectiveness, and patient safety. Certain approaches have proven helpful in some cases in combatting the syndrome. The coronavirus pandemic presented physicians with unique challenges, which appeared to have magnified work stress This national survey specifically explored interventions used by health care leaders to reduce burnout and whether these interventions proved effective during a pandemic. We also discuss effective and appropriate organizational measures to reduce physician burnout and its associated risks during crises.

Advanced Practice Providers (APPs) are critical to the hematology workforce. However, there is limited knowledge about APPs in hematology regarding specialty-specific training, scope of practice, challenges and opportunities in APP-physician interactions, and involvement with the American Society of Hematology (ASH). We conducted APP and physician focus groups to elucidate major themes in these areas and used results to inform development of two national surveys, one of APPs and one of physicians who work with APPs. The APP survey was distributed to members of the Advanced Practitioner Society of Hematology and Oncology (APSHO) and the physician survey was distributed to physician members of ASH. 841 APPs and 1334 physicians completed the surveys. APPs reported most hematology-specific knowledge was obtained via on-the-job training, and felt additional APP-focused training would be helpful (as did physicians). Nearly all APPs and physicians agreed that APPs were an integral part of their organizations and that physician-APP collaborations were generally positive. 42.1% of APPs and 29.3% of physicians reported burnout, and over 50% of physicians felt that working with APPs had reduced their burnout. Both physicians and APPs reported interest in additional resources including "best practice" guidelines for APP-physician collaboration, APP access to hematology educational resources (both existing and newly developed resources for physicians and trainees), and greater APP integration into national specialty-specific professional organizations including APP-focused sessions at conferences. Professional organizations such as ASH are well positioned to address these areas.

Law enforcement and child welfare professionals experience ongoing exposure to work-related traumatic events as a natural part of their occupation. This exposure results in a higher level of vicarious trauma in these professions. Many professionals in these professions have also experienced a statistically higher number of adverse childhood experiences. As a result, they are exposed to more cumulative trauma over time. Also associated with other high-stress and high- stakes work environments, like military service members, is moral injury. Adverse childhood experiences, vicarious trauma, and moral injury are correlated with post-traumatic stress symptoms, negative emotions and behaviors, and suicidality. This research examined the relationship between adverse childhood experiences, vicarious trauma, and moral injury in professionals serving in law enforcement and child welfare. The presence of early positive childhood experiences was considered as a buffer from these variables. The association of moral injury and cumulative trauma experiences was examined using the following measures: the Adverse Childhood Experiences Questionnaire (ACE), Vicarious Trauma Scale (VTS), Moral Injury Assessment for Public Safety Personnel (MIA-PSP), and Positive Childhood Experiences Questionnaire (PCE). Data on age, sex, type of profession, size of the organization, military service status, and total years of service experience were collected and analyzed as other potential predictor variables. Individuals currently serving as law enforcement or child welfare professionals were recruited through the distribution of online surveys, with the necessary minimum sample size being 76 participants. The results from the screening measures were analyzed utilizing a Pearson correlation and multiple linear regression analyses to determine the relationship between adverse childhood experiences, vicarious trauma, and moral injury and how they are moderated by positive childhood experiences.

BACKGROUND: Moral injury (MI) has become a research and organizational priority as frontline personnel have, both during and in the years preceding the COVID-19 pandemic, raised concerns about repeated expectations to make choices that transgress their deeply held morals, values, and beliefs. As awareness of MI grows, so, too, does attention on its presence and impacts in related occupations such as those in public safety, given that codes of conduct, morally and ethically complex decisions, and high-stakes situations are inherent features of such occupations. OBJECTIVE: This paper shares the results of a study of the presence of potentially morally injurious events (PMIEs) in the lived experiences of 38 public safety personnel (PSP) in Ontario, Canada. METHOD: Through qualitative interviews, this study explored the types of events PSP identify as PMIEs, how PSP make sense of these events, and the psychological, professional, and interpersonal impacts of these events. Thematic analysis supported the interpretation of PSP descriptions of events and experiences. RESULTS: PMIEs do arise in the context of PSP work, namely during the performance of role-specific responsibilities, within the organizational climate, and because of inadequacies in the broader healthcare system. PMIEs are as such because they violate core beliefs commonly held by PSP and compromise their ability to act in accordance with the principles that motivate them in their work. PSP associate PMIEs, in combination with traumatic experiences and routine stress, with adverse psychological, professional and personal outcomes. CONCLUSION: The findings provide additional empirical evidence to the growing literature on MI in PSP, offering insight into the contextual dimensions that contribute to the sources and effects of PMIEs in diverse frontline populations as well as support for the continued application and exploration of MI in the PSP context.

‍

This resource is found in our Actionable Strategies for Public Safety Organizations: Drivers (Relational Breakdown) AND Drivers (Operational Breakdown) AND Outcomes

‍

We examined the relationship between age, coping, and burnout during the peak of the COVID-19 pandemic with nurses in Texas (N = 376). Nurses were recruited through a professional association and snowball sampling methodology for the cross-sectional survey study. Framed in lifespan development theories, we expected that nurse age and experience would be positively correlated with positive coping strategies (e.g., getting emotional support from others) and negatively correlated with negative coping strategies (e.g., drinking and drug use). We also expected age to be negatively related to the emotional exhaustion and depersonalization facets of burnout and positively related to the personal accomplishment facet of burnout. Findings were largely supported in that age was positively associated with positive coping and personal accomplishment and age and experience were negatively correlated with negative coping and depersonalization. Age was not, however, associated with emotional exhaustion. Mediation models further suggest that coping explains some of the effect of age on burnout. A theoretical extension of lifespan development models into an extreme environment and practical implications for coping in these environments are discussed.

A Guide to Relieving Administrative Burden is a series of supplements developed by the American Academy of Family Physicians (AAFP) to provide information about innovations proven to relieve administrative burden and optimize your family medicine experience. It is based on AAFP Innovation Labs conducted with physicians like you, as well as a comprehensive literature review. Whether you have a solo practice or are an employee of a large health system, the guide will help you consider and adopt proven innovations.

This is the first supplement in the series. Subsequent supplements will focus on other critical administrative burdens family physicians face, including prior authorization, quality measurement and reporting, and chart review.

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