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BACKGROUND: Although more people than ever are seeking primary care, the ratio of primary care providers to the population continues to rapidly decline. As such, registered nurses (RNs) are taking on increasingly central roles in primary care delivery. Yet little is known about their characteristics, their work environments, and the extent to which they experience poor job outcomes such as nurse burnout. PURPOSE: The purpose of this study was to examine the characteristics of the primary care RN workforce and analyze the association of the nurse work environment with job outcomes in primary care. METHODS: Cross-sectional analysis of survey data representing N = 463 RNs who worked in 398 primary care practices, including primary care offices, community clinics, retail/urgent care clinics, and nurse-managed clinics. Survey questions included measures of the nurse work environment and levels of burnout, job dissatisfaction, and intent to leave. DISCUSSION: Approximately one-third of primary care RNs were burnt out and dissatisfied with their jobs, with the highest risk of these outcomes among RNs in community clinics. Community clinic RNs were also significantly more likely to be Black or Hispanic/Latino, hold a Bachelor of Science in Nursing, and speak English as a second language (all p < .01). Across all settings, better nurse work environments were significantly associated with lower levels of burnout and job dissatisfaction (both p < .01). CONCLUSION: Primary care practices must be equipped to support their RN workforce. Adequate nursing resources are especially needed in community clinics, as patients receiving primary care in these settings frequently face structural inequities.

A multisite research team proposed a survey to assess burnout among healthcare epidemiologists. Anonymous surveys were disseminated to eligible staff at SRN facilities. Half of the respondents were experiencing burnout. Staffing shortages were a key stressor. Allowing healthcare epidemiologists to provide guidance without directly enforcing policies may improve burnout.

IMPORTANCE: Moral injury and distress (MID), which occurs when individuals have significant dissonance with their belief system and overwhelming feelings of being powerless to do what is believed to be right, has not been explored in the unique population of military surgeons deployed far forward in active combat settings. Deployed military surgeons provide care to both injured soldiers and civilians under command-driven medical rules of engagement (MROE) in variably resourced settings. This practice setting has no civilian corollary for comparison or current specific tool for measurement. OBJECTIVE: To characterize MID among military surgeons deployed during periods of high casualty volumes through a mixed-methods approach. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study using convergent mixed methods was performed from May 2020 to October 2020. Participants included US military surgeons who had combat deployments to a far-forward role 2 treatment facility during predefined peak casualty periods in Iraq (2003-2008) and Afghanistan (2009-2012), as identified by purposeful snowball sampling. Data analysis was performed from October 2020 to May 2021. MAIN OUTCOMES AND MEASURES: Measure of Moral Distress for Healthcare Professionals (MMD-HP) survey and individual, semistructured interviews were conducted to thematic saturation. RESULTS: The total cohort included 20 surgeons (mean [SD] age, 38.1 [5.2] years); 16 (80%) were male, and 16 (80%) had 0 or 1 prior deployment. Deployment locations were Afghanistan (11 surgeons [55%]), Iraq (9 surgeons [45%]), or both locations (3 surgeons [15%]). The mean (SD) MMD-HP score for the surgeons was 104.1 (39.3). The primary thematic domains for MID were distressing outcomes (DO) and MROE. The major subdomains of DO were guilt related to witnessing horrific injuries; treating pregnant women, children, and US soldiers; and second-guessing decisions. The major subdomains for MROE were forced transfer of civilian patients, limited capabilities and resources, inexperience in specialty surgical procedures, and communication with command. Postdeployment manifestations of MID were common and affected sleep, medical practice, and interpersonal relationships. CONCLUSIONS AND RELEVANCE: In this qualitative study, MID was ubiquitous in deployed military surgeons. Thematic observations about MID, specifically concerning the domains of DO and MROE, may represent targets for further study to develop an evaluation tool of MID in this population and inform possible programs for identification and mitigation of MID.

Social workers are struggling within their professional and personal lives. Many clinical social workers who work in the mental health and medical field are struggling with poor health behaviors, secondary traumatic stress (STS), depression, anxiety, and burnout due to staff shortages, rapid turnover, compassion fatigue, and poor staff recruitment (Toh et al., 2018). Untreated trauma related to bereavement issues can result in PTSD and complicated grief symptoms in clinical populations when left untreated by a trained mental health clinician (Glad et al., 2022). Social work clinicians can expect therapeutic encounters to include discussions of deaths, loss, and reduced security contributing to negative mental health occurrences as a result of the COVID-19 pandemic. Social workers who work with families and individuals who are experiencing trauma are often adversely affected by these interactions, resulting in negative outcomes for the social worker (Caringi et al., 2017). A recent study of the COVID-19 pandemic and related mental health issues found an increase in anxiety and mental health issues related to stress, grief, fear, and depression (Estes & Thompson, 2020). Many social work clinicians may require mental health treatment of their own COVID-19 experiences, while simultaneously developing vicarious trauma (VT) and countertransference issues as a result of working with a clinical population in the treatment setting.

[This is an excerpt.] Burnout rates among physicians continue to rise. In the 2023 Medscape Physician Burnout and Depression Report, 57% of family medicine physicians reported feeling burnt out — up 10 percentage points in five years. Among all specialties, 53% of physicians reported burnout. The top contributor was “too many bureaucratic tasks,” such as paperwork and charting requirements. Too many working hours and the increasing computerization of practice were also cited as key causes. A prior study helped quantify this burden. It showed that family physicians spent an average of 5.9 hours of an 11.4-hour workday in the electronic health record (EHR), with an average of nearly 90 minutes of “pajama time” (work outside of normal working hours) per day. [To read more, click View Resource.]

OBJECTIVE: To evaluate feasibility and effectiveness of Clinically Designed Improvisatory Music (CDIM) to reduce work-related stress for Neurology, Psychiatry, and other health professionals. BACKGROUND: Chronic stress characterizes healthcare providers’ lives. Music interventions show reductions in stress in the work setting. Our previous research showed that CDIM reduced cardiovascular burden and feelings of stress and anxiety in neurology patients. In this study, we investigated whether CDIM could also be used for Neurology and Psychiatry health care providers to decrease levels of stress. DESIGN/METHODS: CDIM is a form of clinical music designed along neuropsychiatric principles of felt safety. I was played by a certified music practitioner for 30 minutes. We used CDIM in three settings: 1. Neurology Department, 2. Psychiatric social workers, 3. Physician Recuperation Room located at Northwestern Memorial Hospital. All participants rated their experience on a scale of 1–10 reporting changes in emotions and states pertinent to burnout (likelihood to recommend [LTR], positive emotion, degree of tension, ability to experience pleasure, and energy levels). RESULTS: Four hundred twenty nine (429) healthcare providers took part in CDIM interventions. Participants recommended CDIM at a rate of 93% (+ 9%). They reported positive effects on emotion at 80% (+ 19%), decreased tension at 82% (+ 15%). Eighty percent (80%) found the intervention pleasurable and reported increased levels of energy following CDIM. Changes in energy levels went up from 60% (+ 16%) to to 80% (+ 16%). This latter change was significant at p= 0.0001. CONCLUSIONS: The CDIM interventions resulted in improvements in tension, energy, and of pleasure, which suggest an increase in capacity. These preliminary results indicate feasibility and effectiveness of CDIM as a viable intervention for supporting wellness and fighting burnout. We plan to provide and disseminate CDIM more widely to include more healthcare providers and staff, and to include physiologic measures by using wearable devices. DISCLOSURE: Ms. Takarabe has nothing to disclose. Rajan Shah has nothing to disclose. Mrs. Walesa has nothing to disclose. Miss Ngo has nothing to disclose. Dr. Wall has nothing to disclose. Mr. Pause has nothing to disclose. Gaurava Agarwal has nothing to disclose. Dr. Bonakdarpour has nothing to disclose.

BACKGROUND: Clinician burnout is a longstanding national problem threatening clinician health, patient outcomes, and the health care system. The aim of this study is to determine the proportion of hospitals and Federally Qualified Health Centers (FQHCs) that are measuring and taking system actions to promote clinician well-being. METHODS: This cross-sectional study used an electronic questionnaire from April 21 to June 27, 2022, to assess the current state of organizational efforts to assess and address clinician well-being among a national sample of 1,982 Joint Commission-accredited hospitals and 256 accredited FQHCs. Outcomes of interest included the proportion of hospitals and FQHCs that assessed the prevalence of clinician burnout, established a chief wellness officer position, established a wellness committee, made clinician well-being an organizational performance metric, and implemented other activities/interventions that target clinician burnout. RESULTS: A total of 481 (21.5%) organizations responded to the survey (hospital n = 396 [20.0%], FQHC n = 85 [33.2%]). Response rates did not differ by organization size, type, teaching status or urban vs. rural location. Approximately one third (34.0%) of the organizations in the sample conducted an organizational well-being assessment among clinicians at least once in the past three years. Although nearly half of responding organizations reported implementing some kind of intervention to address clinician burnout, only 28.7% of organizations had adopted a comprehensive approach to address clinician well-being/burnout. Only 10.1% of hospitals and 5.4% of FQHCs reported having an established senior leadership position responsible for assessing and promoting clinician well-being at the organization level, and less than half (29.3% FQHCs, 37.6% hospitals) of organizations reported having an established wellness committee. Among 500+ bed hospitals, 61.2% had surveyed, 75.6% had established a well-being committee, 78.0% had implemented interventions to promote clinician well-being, and 26.8% had established a chief wellness officer. CONCLUSION: Although half of Joint Commission-accredited hospitals and FQHCs reported taking steps to improve clinician well-being, a minority are measuring clinician well-being, and few are taking a comprehensive approach or established a chief wellness officer position to advance clinician well-being as an organizational priority. Organizational clinician well-being improvement efforts are unlikely to be successful without measurement and leadership in place to drive change.

Key points

• Self-perceived wellness is known to worsen during medical education and training.
• Mitigation strategies should have a bifocal approach addressing individual as well as system-level factors.
• Organizations can better support well-being for their workforce by having leadership structure in place to drive well-being strategy and program development.
• Wellness programs need to have a multipronged strategy and should be focused on four key areas: healthy work environments, efficient processes, healthy people, and safe teams.

[This is an excerpt.] This report presents the results of a survey of 2,212 students from 91 countries and two roundtable sessions with key opinion leaders and faculty in the USA and UK. The aim is to gain a deep understanding of students’ experiences today and their expectations of the future in healthcare, as well as the perspectives of those instructing them. [To read more, click View Resource.]

[This is an excerpt.] In 2017, my husband suffered a critical illness. He is also a physician, and during the course of his short stay at our local hospital, the doctors caring for him—his colleagues—were distant and impassive in the face of his extremis. They delayed his transfer, despite my urgent requests, until his next option for treatment was extracorporeal membrane oxygenation, a therapy not offered at the small facility. They were caring people and not reckless physicians, so their stonewalling and what felt like brinkmanship with my husband’s life seemed out of character. But their inaction stuck with me because of how unsettling and inexplicable it was, given what I knew of them, and of medicine. If asked what was wrong, they might have said they were burned out, because there was no other language for their experience at the time. But to me, their struggle seemed different. It seemed like their hands were tied, as though without accurate language, they were resigned to a situation they couldn’t articulate and therefore could not solve. [To read more, click View Resource.]

BACKGROUND: The aim of this study was to describe clinicians' insights into the quality and safety of patient care delivered to emergency department (ED) boarding patients, as well as clinician safety and satisfaction related to ED boarding. METHODS: This was a single-site, mixed methods sequential explanatory study. Quantitative data were obtained from a cross-sectional survey sent to ED attending physicians, resident physicians, advanced practice providers, and nurses. Semistructured focus group interviews with a subsample of participants sought to add depth to the interpretation of survey data and identify areas of improvement in boarding care. Chi-square and Wilcoxon rank sum tests were used to evaluate for response differences between groups. Qualitative data were thematically coded and analyzed. RESULTS: A total of 94 questionnaires were obtained for a response rate of 34.1%. Clinicians reported that boarding highly contributed to the perception of burnout. All groups reported high rates of perceived verbal and/or physical abuse from boarding patients (86.8% of nurses, 41.1% of providers, p = 0.0002). A total of 39 clinicians participated in focus groups regarding boarding care, and six themes were identified, including patient safety concerns, lack of knowledge/resources/training, and poor communication. Key themes identified as possible solutions to improve care included standardization of care, proactive planning, and culture change. CONCLUSION: Clinicians identified many concerns regarding patient safety and the quality of care delivered to boarding patients and identified several areas for improvement. Clinicians also felt that boarding negatively affected their satisfaction and safety.

[This is an excerpt.] The incidence and impact of burnout among physicians are of ever-increasing concern. Burnout is characterized by emotional exhaustion, depersonalization, and an impaired sense of personal accomplishment caused by work-related stress. The data consistently reveal that among physicians, surgeons are at a substantially increased risk of burnout. Thus, for the benefit of ourselves, our colleagues, our trainees, and our patients, it is paramount that we tackle the subject of burnout, specifically its prevention and management, with thoughtfulness and rigor. [To read more, click View Resource.]

OBJECTIVE: Explore the relevant evidence about stress-related cognitive appraisal and coping strategies among registered nurses in the emergency department (EDRNs) coping with the COVID-19 pandemic. METHODS: This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus electronic databases for related studies from inception through February 2, 2022. This review further conducted study selection based on the PRISMA flow diagram and applied Lazarus and Folkman's Psychological Stress and Coping Theory to systematically organize, summarize, and report the findings. FINDINGS: Sixteen studies were included for synthesis. Most of the studies showed that the majority of EDRNs were overwhelmed by the COVID-19 pandemic. Depression, triaging distress, physical exhaustion, and intention to leave ED nursing were cited as major threats to their wellness. Additionally, comprehensive training, a modified triage system, a safe workplace, psychological support, promotion of resilience, and accepting responsibility may help EDRNs cope with pandemic-related challenges effectively. CONCLUSION: The long-lasting pandemic has affected the physical and mental health of EDRNs because they have increased their effort to respond to the outbreak with dynamically adjusted strategies. Future research should address a modified triage system, prolonged psychological issues, emergency healthcare quality, and solutions facing EDRNs during the COVID-19 or related future pandemics. CLINICAL RELEVANCE: EDRNs have experienced physical and psychological challenges during the pandemic. The ED administrators need to take action to ensure EDRNs' safety in the workplace, an up-to-date triage system, and mental health of frontline nurses to provide high-quality emergency care for combating COVID-19.

Nurses are a critical part of the health care system. Yet the nursing profession continually faces shortages in all specialties. Several causes and issues of concern related to the nursing shortage in nephrology are discussed, including the prevalence of kidney disease and its increasing number of associated comorbidities, which has also heightened the urgent need for nephrology nurses. Data have shown that the lack of nephrology nurses caring for patients with kidney disease impacts patient outcomes and nephrology nurse burnout. Strategies must be implemented to manage these growing needs that affect both patient outcomes and nurse staffing. This article aims to identify methods to combat the nursing shortage, promote recruitment and retention strategies for nephrology nurses, and discuss leadership issues related to the topic.

[This is an excerpt.] Burnout is used to describe the cognitive and emotional responses of practitioners to chronic emotional and interpersonal stress. Operating room nurses are a group engaged in nursing professions in special environments. Due to the long-term high-intensity and fast-paced work, professional mental and physical labour are also required, which can easily lead to job burnout of nurses (Li et al., 2021). We read with great interest a recent article in Journal of Advanced Nursing on burnout in operating room nurses and the relevance of potential traumatic events (Wang et al., 2022). The authors explored and compared the association between potential job-related traumatic events and burnout among operating room nurses under three different statistical approaches. [To read more, click View Resource.]

OBJECTIVE: To determine the effectiveness of communication training and its impact on burnout among healthcare providers (physicians, physician assistants, nurse practitioners), in the setting of the COVID-19 pandemic. METHODS: To evaluate the effectiveness of communication training on burnout during the COVID-19 pandemic, healthcare providers participating in a Communication in Healthcare (CIH) module between October 31, 2019, through February 20, 2020, were identified using a scanned sign-in sheet. A 3-question online survey regarding the utilization of communication skills during the COVID-19 pandemic was sent via email. An ordinal scale was used to rate the effectiveness of the training on subsequent burnout and work satisfaction during the pandemic. RESULTS: Of the 98 surveys distributed via email, a total of 33 participants completed the survey. Seventy-three percent of respondents agreed that communication training helped prevent burnout, and 39% strongly agreed that the modules improved work satisfaction. CONCLUSION: Our study found communication training was effective in reducing burnout in healthcare providers, in the setting of the COVID-19 pandemic. The participants felt the communication tools learned from the training modules were useful in improving work satisfaction and communication with patients during the pandemic.

This case-control study investigates the association between a communication and optimal resolution program to address unexpected adverse patient outcomes and measures of health care worker satisfaction.

BACKGROUND: Nurses have been identified as the most vulnerable health care profession to experience compassion fatigue. Currently, not much is known about the availability and credibility of online compassion fatigue resources for nurses. This systematic review of consumer websites explores the prevalence and quality of compassion fatigue educational resources available online to nurses. METHOD: A descriptive, cross-sectional, nonexperimental design was used. Findings were collected from the websites of the top 20 hospitals in the United States, all professional nursing organizations in the United States, and the top three most used social media platforms. Web-sites were evaluated for quality using the Journal of the American Medical Association (JAMA) benchmarks and Health on the Net Foundation certification. RESULTS: A total of 143 websites were evaluated. Of these, three websites were identified as having the most credible, comprehensive educational resources on compassion fatigue. CONCLUSION: There is a need for more hospitals, professional nursing organizations, and social media websites to provide high-quality compassion fatigue educational resources for nurses.

[This is an excerpt.] I will always remember the first time I interviewed a patient with suicidal ideation. I (P.A.) was a third-year medical student on my pediatrics rotation. The patient was a teenager recently admitted to our service for an intentional overdose. I was a few months into my clinical clerkships, already feeling the exhaustion of perpetually changing services, preceptors, and expectations. [To read more, click View Resource.]

A descriptive study of the impact of the COVID-19 pandemic on non-direct care nurses