Resource Library

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.

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.

BACKGROUND: Providing long-term-care for a family member can be a source of severe stress for the untrained caregiver, and is known to cause depression, poor overall health, and lower quality of life for the caregiver. This burden may lead to poorer outcomes for the patient, as well as contribute to overall increasing costs of an already strained healthcare system. The purpose of this quality improvement project was to reduce the stress that accompanies caregiver burden through the intervention of diaphragmatic breathing. METHOD: Diaphragmatic breathing is a low-cost, psychophysiological intervention found to be helpful for reducing stress, which is a significant component of caregiver burden. Caregivers of pediatric patients enrolled in a homecare program were assessed for caregiver burden utilizing the Zarit Burden Interview-12 (ZBI-12). Those who had scored 15 or higher on the ZBI-12 were taught diaphragmatic breathing, and assessed again, two months after using the intervention. RESULTS: A paired dependent t-test revealed that palliative caregivers showed a reduction in ZBI-12 assessment score after implementation of a diaphragmatic breathing intervention (m = 17.4, s = 6.7), compared to before implementation of a diaphragmatic breathing intervention (m = 12.8, s = 8.6), t(11) = 2.513 , P < .05. CONCLUSION: The intervention resulted in less anxiety, stress, depression, and burnout among the pediatric palliative caregivers. Improvement of caregiver well-being was evidenced by decreased ZBI-12 scores in a postintervention assessment.

The COVID-19 pandemic has required close examination of workforce-related stressors that over decades have contributed to widespread burnout, negative health outcomes, including mental health outcomes, and the loss of the well-educated professionals who are the future of the nursing profession. In the United States and globally, evidence points to factors known to diminish well-being, including inequities, issues of minority status, persistent discrimination, and demanding work environments. The American Academy of Nursing (AAN), dedicated to organizational excellence, nursing leadership and evidence-based policy, develops statements reflecting its mission and those of its nursing affiliates and corporate member, The American Nurses Association. Within nursing, despite the efforts of its members toward advancement, professional fulfillment is often constrained by the systems in which nurses practice and workplace factors over which they have little control. Action by key organizations to initiate changes at systems levels in workplace safety, to increase professional mobility, and propel policies that increase access to health care resources could improve nurse well-being. This paper proposes recommendations from the AAN Expert Panels on Building Health Care System Excellence, Psychiatric Mental Health and Substance Use, and Global Health Expert Panels for the American Academy of Nursing to leverage related policy in the arenas of government and professional/healthcare organizations. Transforming health care work environments and advancing nurse well-being and equity can be accomplished through key, innovative policy changes. These will be achieved through collaboration among associations, organizations, nonprofit groups, and with the public and the media.

BACKGROUND: The American College of Radiology (ACR) passed a historic paid family/medical leave (PFML) resolution at its April 2022 meeting, resolving that “diagnostic radiology, interventional radiology, radiation oncology, medical physics, and nuclear medicine practices, departments and training programs strive to provide 12 weeks of paid family/medical leave in a 12-month period for its attending physicians, medical physicists, and members in training as needed.” The purpose of this article is to share this policy beyond radiology so that it may serve as a call to action for other medical specialties. PRINCIPAL FINDINGS: Such a PFML policy (1) supports physician well-being, which in turn supports patient care; (2) is widely needed across American medical specialties; and (3) should not take nearly a decade to achieve, as it did in radiology, especially given increasing physician burnout and the ongoing COVID-19 pandemic. CONTRIBUTION: Supported by information on the step-by-step approach used to achieve radiology-specific leave policies and considering current and normative policies at the national level, this article concludes by reviewing specific strategies that could be applied toward achieving a 12-week PFML policy for all medical specialties.

PURPOSE: The purpose of the study’s mixed-methods evaluation was to examine the ways in which a relational leadership development intervention enhanced participants’ abilities to apply relationship-oriented skills on their teams. DESIGN/METHODOLOGY/APPROACH: The authors evaluated five program cohorts from 2018–2021, involving 127 interprofessional participants. The study’s convergent mixed-method approach analyzed post-course surveys for descriptive statistics and interpreted six-month post-course interviews using qualitative conventional content analysis. FINDINGS: All intervention features were rated as at least moderately impactful by at least 83% of participants. The sense of community, as well as psychological safety and trust created, were rated as impactful features of the course by at least 94% of participants. At six months post-intervention, participants identified benefits of greater self-awareness, deeper understanding of others and increased confidence in supporting others, building relationships and making positive changes on their teams. ORIGINALITY/VALUE: Relational leadership interventions may support participant skills for building connections, supporting others and optimizing teamwork. The high rate of skill application at six months post-course suggests that relational leadership development can be effective and sustainable in healthcare. As the COVID-19 pandemic and systemic crises continue to impact the psychological well-being of healthcare colleagues, relational leadership holds promise to address employee burnout, turnover and isolation on interprofessional care teams.

This resource is found in our Actionable Strategies for Health Organizations: Strengthening Leadership.

Depolicing is a behavior that occurs when law enforcement officers disengage from proactive police work. Despite the term’s more recent popularity, these behaviors have been identified in policing literature for decades. Scholars have primarily tried to quantify the depolicing phenomenon through the lens of public scrutiny and the Ferguson Effect. However, there are currently no quantitative studies that have attempted to examine the multitude of reasons as to why depolicing behavior could potentially occur. The current inquiry uses survey data retrieved from eight municipal law enforcement agencies to further examine potential predictors of depolicing. The predictor variables consisted of public scrutiny, liability concerns, organizational unfairness, burnout, physical danger, COVID-19, and years of experience. Our results indicate that public scrutiny, liability concerns, COVID-19, and years of experience are all significant and positive predictors of depolicing. We also found that agency location and rank significantly impacted depolicing behavior. The findings and limitations are discussed.

BACKGROUND: Nurses experienced physical and mental exhaustion during the COVID-19 pandemic. Understanding the impact of the pandemic on nurses and effective strategies to support them is critical for increasing nurse resilience and reducing burnout. AIMS: The aims of this study were (1) to synthesize the literature examining how factors associated with the COVID-19 pandemic affected the well-being and safety of nurses (2) and to review interventions which may promote nurse mental health during crises. METHODS: Using an integrative review approach, a comprehensive search of the literature was conducted in March 2022 using the following databases: PubMed, CINAHL, Scopus, and Cochrane. We included quantitative, qualitative, and mixed-method primary research articles published in English in peer-reviewed journals from March 2020 through February 2021. Included articles focused on nurses caring for COVID-19 patients and addressed psychological factors, supportive hospital leadership strategies, or interventions to support well-being. Studies were excluded if they focused on professions outside of nursing. Included articles were summarized and appraised for quality. Findings were synthesized using content analysis. RESULTS: Of the 130 articles initially identified, 17 were included. Articles were quantitative (n = 11), qualitative (n = 5), and mixed methods (n = 1). Three themes were identified: (1) loss of life, hope, and professional identity; (2) lack of visible and supportive leadership; and (3) insufficient planning and response. These experiences contributed to increased symptoms of anxiety, stress, depression, and moral distress in nurses.

Frontline clinicians responding to the COVID-19 pandemic are at increased risk of burnout, but less is known about the trajectory of clinician burnout as caseloads increase and decrease. Personal and professional resources, including self-efficacy and hospital support, can attenuate the risk of burnout. Yet, empirical data documenting how burnout and resources changed as the pandemic waxed and waned are limited. This intensive longitudinal prospective study employed ecological momentary assessment methods to examine trajectories of burnout and resources over the pandemic’s first year in a New York City hospital. A 10-item survey was emailed every 5 days to frontline clinicians (physicians, nurses, and physician assistants). The primary outcome was a single-item validated measure of burnout; predictors included daily hospital COVID-19-related caseloads and personal and professional resources. Clinicians (n = 398) completed the initial survey and an average of 12 surveys over the year. Initially, 45.3% of staff reported burnout; over the year, 58.7% reported burnout. Following the initial COVID peak, caseloads declined, and burnout levels declined. During the second wave of COVID, as caseloads increased and remained elevated and personal and professional resource levels decreased, burnout increased. This novel application of intensive longitudinal assessment enabled ongoing surveillance of burnout and permitted us to evaluate how fluctuations in caseload intensity and personal and professional resources related to burnout over time. The surveillance data support the need for intensified resource allocation during prolonged pandemics.

PURPOSE: The purpose of this investigation was to develop, describe, and evaluate burnout curricula using meditation as a burnout reduction strategy. METHOD: The Maslach Burnout Inventory was the survey method used to assess PA student’s levels of burnout after completing developed burnout curricula. RESULTS: The results showed no relationship between burnout curricula completion and rates of student burnout. However, the findings showed burnout differences across the three cohorts of student classes. CONCLUSION: While limited by only the three cohorts of students, the study affirmed the need for faculty to stay attuned to aspects of student burnout.

Anger is an emotional state that occurs when unexpected things happen to or around oneself and is “an emotional state that varies in intensity from mild irritation to intense fury and rage.” It is defined as “a strong feeling of displeasure and usually of antagonism,” an emotion characterized by tension and hostility arising from frustration, real or imagined injury by another, or perceived injustice. It can manifest itself in behaviors designed to remove the object of the anger (e.g., determined action) or behaviors designed merely to express the emotion. For the Roman philosopher Seneca anger is not an uncontrollable, impulsive, or instinctive reaction. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It seems that the year 2022 was a year when many Americans were plainly angry. “Why is everyone so angry?” the New York Times asked in the article “The Year We Lost It.” We believe that Seneca is correct in that anger is unacceptable. Anger is a negative emotion that must be controlled, and Seneca provides us with the tools to avoid and destroy anger. Health care professionals will be more effective, content, and happier if they learn more about Seneca’s writings about anger and implement his wisdom on anger from over 2000 years ago.

Women represent almost half of all practicing surgeons in the USA; however, women continue to struggle with achieving equity in compensation, recruitment, promotion, and work-life balance. A review of recent literature about gender disparities in medicine, with focus on trauma surgery, was performed to better understand the issues and seek solutions.

Burnout in the medical workforce is a growing global concern. Visual arts–based interventions can be a novel way to mitigate burnout and bolster resilience in medicine. Improving tolerance of ambiguity and uncertainty has been associated with decreased rates of burnout in clinicians. No known systematic review exists summarizing the evidence behind the use of visual arts–based interventions to mitigate burnout in clinicians. The authors conducted a systematic literature review of PubMed, EMBASE, and CINAHL in November 2022 using the terms: art, medicine, burnout, and uncertainty. The authors review the evidence for the effects of visual arts–based interventions on clinician burnout. The search identified 58 articles, of which 26 met study inclusion criteria and were assessed by 2 reviewers. These studies reported mixed methods assessments of changes in burnout, empathy, and stress. Overall, visual arts–based interventions promoted empathy, connectedness, and tolerance of ambiguity and had positive effects on burnout; however, some results were mixed. Visual arts–based interventions to mitigate burnout show promise, and additional research should focus on feasibility and longer-term outcomes.

[This is an excerpt.] Sahni and Carrus (July 27 issue) assert that benefits of artificial intelligence (AI) in health care are unquestionable and that adoption has been too slow. They provide anecdotes and cite several single-institution, preliminary, or case studies but do not cite any of 39 randomized, controlled trials that were identified in a 2022 systematic review. Moreover, they do not discuss ethical concerns about the use of patient data to inform AI or such risks as displacing clinicians as the locus of health care decision making, despite expert acknowledgment of these problems. [ To read more, click View Resource.]

BACKGROUND: Burnout is costly to the healthcare system and is associated with medical error, absenteeism, and attrition. Emergency medical services (EMS) clinicians endure numerous stressors that predispose them to experience burnout. METHODS: An instrument was administered to licensed EMS clinicians recruited from 16 services across Massachusetts. The anonymous survey consisted of demographics, the Copenhagen Burnout Inventory (CBI) instrument, and 5-possibility Likert scales. Prevalence ratios were calculated to determine which demographic qualities and burnout-related factors were associated with increased CBI scores. RESULTS: In total, 386 EMTs were surveyed (62.2% male). The survey response rate was 21.4%. The mean CBI was 52.97 (SD 17.88). A positive burnout screen (CBI score = >50) was calculated for 55.4% of respondents. Respondents most often reported that inadequate compensation (87.5%) and high call volume (79.2%) contributed to perceived stress at work. Factors most associated with positive burnout screening amongst respondents were inadequate compensation (PR 5.8, CI 2.52–12.38, p < 0.001) and inadequate opportunity to process trauma (PR 2.88, CI 2.14–3.87, p < 0.001). CONCLUSION: Over half of the surveyed EMS population suffers from burnout, based on the CBI assessment tool. Factors contributing most to positive burnout screening include inadequate compensation and lack of opportunity to process trauma.

[This is an excerpt.] Resident-related research is pervasive throughout medical literature. Frequent areas of investigation include physical stress, burnout, and mental health. These critical studies aid in the improvement of curriculums, augmentation of resources, and over-all advancement of training programs. As a go-to convenience sample, residents are routinely approached to participate in a variety of studies during their training. These studies are frequently resident and faculty led, from within their current institution or those of potential future fellowship training or professional positions. Residents’ high-levels of education and in-depth knowledge of scientific practices belies the vulnerability of this captive group. The complexity of resident status within the hierarchy of graduate medical education structures and the factors motivating them to participate in scientific inquiry need to be investigated. Ethical considerations regarding residents’ diminished states of health during these intense years of training and the collection of health-related data should also be examined. In the current literature, issues related to coercion, collection of sensitive data, and participant risk are underdeveloped for resident participants in scientific study. [To read more, click View Resource.]

The COVID-19 pandemic altered work environments of nurses, yielding high rates of stress and burnout. Potential protective factors, including effective sleep, may influence psychological health and wellbeing. Evidence about sleep in nurses may help develop interventions that mitigate burnout and poor psychological outcomes. A cross sectional survey was distributed across three hospitals to nurses in New York City (NYC). During the first wave of the pandemic (March-April 2020), NYC had the highest incidence of laboratory-confirmed COVID-19 cases (915/100 000) and half of all COVID-related deaths nationwide. Multivariable logistic regression was used to determine associations between Pittsburgh Sleep Quality Index (PSQI) global sleep score, PSQI sleep dimensions, and psychological health (burnout, depression, anxiety, and compassion fatigue), unadjusted and then controlling for individual and professional characteristics. More than half of the participants reported burnout (64%), depression, (67%), and anxiety (77%). Eighty percent of participants had PSQI global scores >5 (poor sleep) (mean 9.27, SD 4.14). Respondents reporting good sleep (PSQI less than or equal to 5) had over five times the odds of no burnout (OR: 5.65, 95% CI: 2.60, 12.27); increased odds of screening negative for depression (OR: 6.91, 95% CI: 3.24, 14.72), anxiety (OR: 10.75, 95% CI: 4.22, 27.42), and compassion fatigue (OR: 7.88, 95% CI: 1.97, 31.51). Poor subjective sleep quality PSQI subcomponent was associated with burnout (OR: 2.21, 95% CI: 1.41, 3.48) but sleep duration subcomponent was not (OR: 0.84, 95% CI: 0.59, 1.19). Daytime dysfunction was significantly associated with all psychological outcomes. Sleep disturbances and medications yielded higher anxiety odds. Overall, sleep quality appears more strongly related to burnout than sleep duration in nurses working during the COVID-19 pandemic. Sleep interventions should target individual sleep dimensions in nurses.

INTRODUCTION: Student well-being is a growing area of interest, though existing literature assessing multiple areas of well-being is lacking. This study aimed to evaluate the well-being of pharmacy students corresponding to three well-being domains (physical health, mental health, personal well-being and burnout) and identify characteristics associated with these domains. METHODS: An online survey adapted from various instruments was disseminated to pharmacy students from 11 pharmacy programs. Survey responses were compared using basic descriptive statistics, and Pearson's chi-Square was used for association analyses. RESULTS: Eight hundred thirty-six students from responded to the survey (24.3% response rate). For physical health, 59.3% of students reported sleeping <7  hours per night and 60.4% reported exercising 1 to 5  hours per week. For mental health, 24.8% of students screened positive for depression and 42% screened positive for anxiety. Lastly, 65.9% of students were at risk for decreased well-being and 63.7% for burnout. Based on association analyses, gender and pharmacy year were associated with screening positive for anxiety and burnout, gender was associated with decreased well-being, and relationship status was associated with screening positive for depression. CONCLUSIONS: This study revealed pharmacy students are at risk for lack of sleep and exercise, depression or anxiety, decreased well-being, and burnout. Also, several characteristics were found to be associated with these negative well-being outcomes. Although response rate and participant demographics could impact the generalizability of these findings, findings further increase awareness about student well-being and inform pharmacy programs supporting well-being by better understanding student risks.