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BACKGROUND: Research has shown sleep problems, elevated fatigue, and high cases of burnout, as well as signs of post-traumatic stress and psychological distress among nurses during the COVID-19 pandemic. Many US hospitals attempted to minimise its impact on staff by providing basic resources, mental health services, and wellness programs. Therefore, it is critical to re-evaluate these well-being indices and guide future administrative efforts. PURPOSE: To determine the long-term impact of the COVID-19 pandemic after 18 months on hospital nurses' insomnia, fatigue, burnout, post-traumatic stress, and psychological distress. DESIGN: Cross-sectional. METHODS: Data were collected online mainly through state board and nursing association listservs between July–September 2021 (N = 2488). The survey had psychometrically tested instruments (Insomnia Severity Index, Occupational Fatigue Exhaustion Recovery Scale, Maslach Burnout Inventory, Short Post-Traumatic Stress Disorder, and Patient Health Questionnaire-4) and sections on demographics, health, and work. The STrengthening the Reporting of Observational studies in Epidemiology checklist was followed for reporting. RESULTS: Nurses had subthreshold insomnia, moderate-to-high chronic fatigue, high acute fatigue, and low-to-moderate intershift recovery. Regarding burnout, they experienced increased emotional exhaustion and personal accomplishment, and some depersonalisation. Nurses had mild psychological distress but scored high on post-traumatic stress. Nurses who frequently cared for patients with COVID-19 in the past months scored significantly worse in all measures than their co-workers. Factors such as nursing experience, shift length, and frequency of rest breaks were significantly related to all well-being indices. CONCLUSION: Nurses' experiences were similar to findings from the early pandemic but with minor improvements in psychological distress. Nurses who frequently provided COVID-19 patient care, worked ≥12 h per shift, and skipped rest breaks scored worse on almost all well-being indices. Relevance to clinical practice Administration can help nurses' recovery by providing psychological support, mental health services, and treatment options for insomnia, as well as re-structure current work schedules and ensure that rest breaks are taken.

Background: Addressing threats to the nursing and public health workforce, while also strengthening the skills of current and future workers, requires programmatic solutions. Training programs should be guided by frameworks, which leverage nursing expertise and leadership, partnerships, and integrate ongoing evaluation.

Purpose statement: This article provides a replicable framework to grow, bolster, and diversify the nursing and public health workforces, known as the Nurse-led Equitable Learning (NEL) Framework for Training Programs. The framework has been applied by several multipronged, federally funded training programs led by investigators embedded in an academic nursing institution.

Methods: The NEL framework focuses on: (1) increasing equitable access to the knowledge, skills, and competencies needed to prepare a diverse workforce to deliver effective interventions; (2) fostering academic-practice linkages and community partnerships to facilitate the deployment of newly gained knowledge and skills to address ongoing and emerging challenges in care delivery; and (3) continuously evaluating and disseminating findings to inform expansion and replication of programs.

Results: Ten programs using this framework have successfully leveraged $18.3 million in extramural funding to support over 1000 public health professionals and trainees. Longitudinal evaluation efforts indicate that public health workers, including nurses, are benefiting from the programs' workplace trainings, future clinicians are being rigorously trained to identify and address determinants of health to improve patient and community well-being, and educators are engaging in novel pedagogical opportunities to enhance their ability to deliver high quality public health education.

Conclusions: Training programs may apply the NEL framework to ensure that the nursing and public health workforces achieve equitable, sustainable growth and deliver high quality evidence-based care.

This resource is found in our Actionable Strategies for Health Organizations: Promoting Diversity, Equity, & Inclusion.

The relationship between burn out and organizational culture have not been thoroughly investigated in non-patient-facing health systems’ employees, such as analysts and administrative managers. Therefore, the relationship between organizational culture and burn out among health systems’ employees is investigated. A 57-question Likert scale survey was sent to health systems’ employees. A total of 67 responses were collected. Two factor analysis models about and canonical correlation between burnout and organizational culture are presented. The results show that organizational culture factors and burnout factors are related. There is an 83% correlation between burn out and organizational culture among health systems’ employees. This research contributes to the literature by being among the first to study non-patient-facing health systems’ employees’ perceptions of organizational culture and experiences of burn out. Additionally, this research has several practical implications for health systems’ leaders. For example, leaders should focus on improving organizational culture to alleviate burn out in health systems’ employees.

[This is an excerpt.] Unsafe staffing levels in New York’s hospitals undermine the quality of care patients receive. All New Yorkers — from patients, community members, healthcare workers and their unions to legislators and regulators — have a stake in ensuring that the laws and regulations meant to protect patient safety are working well. New York took a major step forward to address patient safety and the nurse staffing crisis when legislators passed a safe staffing law in 2021. The Clinical Staffing Committees and Disclosure of Nursing Quality Indicators law directed all hospitals to set minimum safe staffing standards and established a universal 1:2 nurse-to-patient staffing ratio for critical care patients. Nearly three years after the law was enacted and two years after it became enforceable, New York is at a critical point. The law established an independent advisory commission, which was tasked with releasing a report on the law’s impact in October 2024 and making recommendations to
the legislature in 2025. The Commission has yet to release a report due to the lack of data available to evaluate staffing law progress. To fill the gap in evaluating the safe staffing law, New York State Nurses Association (NYSNA) members and staff took the work of gathering staffing data into their own hands, conducting staffing surveys at more than 60 facilities across the state. NYSNA members working in intensive care units (ICUs) and caring for critical patients conducted staffing reports for 532 shifts from 32 critical care units from 20 hospitals across the state. The data from these staffing surveys was compiled to create this report on the current state of the staffing crisis and how well the staffing law is working to address that crisis. [To read more, click View Resource.]

In this fourth installment of Vivian Health’s annual Healthcare Workforce report, we once again examine the attitudes of healthcare professionals about their careers, well-being and lifestyle to better understand rapidly changing employment dynamics. This survey was conducted December 12, 2023 –January 11, 2024, and includes responses from 863 clinicians.

Over the past several years, the ongoing coronavirus disease 2019 pandemic has contributed to challenging working and life conditions. As a result, the midwifery and health care workforce has faced significant shortages due to burnout. Increased societal awareness of historical trauma and systemic racism embedded within US culture has also led to increased anxiety and signs of trauma among midwifery and health profession students. Now more than ever, innovative teaching strategies are needed to support students, reduce the risks of burnout, and increase diversity in the workforce. One strategy is to adopt a trauma-informed pedagogy within midwifery education. Trauma-informed pedagogy is founded on core assumptions of trauma-informed care and thus supports student success by recognizing that the student cannot be separated from their own life experiences. Faculty and preceptors can develop empathetic, flexible supports that communicate care and concern regarding students’ personal and social situations, and emotions. Empathetic behavior from teachers also increases student learning motivation, making it easier for students to actively engage in learning thereby reducing their distress. The purpose of this State of the Science review, therefore, was to describe the literature surrounding trauma-informed pedagogy and to offer concrete educational strategies that faculty members and educational programs can employ to increase the success of a diverse student body. This can be accomplished through flexibility in curriculum design and outcome measurement to ensure attainment of end of program learning outcomes. Institutional and administrative support are essential to develop a faculty who realize the benefit and value of trauma-informed pedagogy underpinning student success.

Public service employees are often those in front-line positions, and face stress due to their boundary spanning job requirements. During the Covid 19 pandemic, additional strain was felt by these front-line workers as they were required to continue close contact with others. For police officers, stress may lead to psychological effects such as burnout, lower levels of job satisfaction, and higher levels of turnover intentions. Additionally, some occupational groups such as policing are at a higher risk of developing mental health problems. This is becoming increasingly important for many cities and their police department budgets, as increasing labor costs for staffing and turnover has become a major concern. This study seeks to better understand how these specific factors influence turnover intentions for police officers in a mid-size suburban US police department, how organizations can help address mental health, and make practical suggestions on how to impact these staffing decisions.

GOAL: This article explores how broad, contextual factors may be influential in the retention of direct care workers (DCWs; i.e., entry-level caregivers) who provide vital support to patients in healthcare settings. We reflect on lessons learned from an evaluation of a multisite intervention to improve retention among DCWs employed primarily in hospital settings at three health systems. METHODS: We evaluated a multitiered program for entry-level caregivers that included a risk assessment, a 4-day curriculum, and follow-up sessions, as well as workforce coaching at the three health systems. As part of our evaluation, we collected data on roughly 3,000 DCWs from the three health systems; the information included hiring date, any transfer date, and any termination date for each new DCW, as well as demographic information, position characteristics, and termination status and reasons for any termination. In addition, we collected information about organizational characteristics, including staffing and number of employees. We also conducted interviews with 56 DCWs and 21 staff members who implemented a retention program across each of the three health systems and remotely conducted virtual observations of the curriculum sessions at each system. PRINCIPAL FINDINGS: Although the program we evaluated focused on individual-level factors that may affect retention, our findings revealed other broader, contextual challenges faced by DCWs that they said would have an impact on their willingness to stay in their positions. These challenges included (1) job-related factors including limited compensation, aspects of the job itself, and the inability to advance in one's position; (2) health system challenges including the mission, policies, staffing, and organizational culture; and (3) external factors including federal policies and the ongoing COVID-19 pandemic. PRACTICAL APPLICATIONS: As the direct care workforce continues to grow, interventions to improve retention should consider the interconnectedness of these multilevel factors rather than solely individual-level factors. In addition, further research is needed to rigorously evaluate any potential intervention and consider how such an approach can target DCWs in hospital-based settings who are most affected by the multilevel challenges identified. Finally, any intervention to improve retention must be also aligned to ensure equity, especially in this population of low-wage DCWs, many of whom are marginalized women and individuals of color.

[This is an excerpt.] Patient medical advice requests (PMARs) have been increasing over the past decade, with a rapid intensification of this trend during the COVID-19 pandemic that persists. Many primary care practices have workflows in which primary care physicians (PCPs) directly receive these messages, despite data showing that this additional work is linked to clinician burnout and requires team-based care. Most published models discuss registered nurse (RN)-level workflow changes for management of PMARs, but nursing staffing shortages frequently limit implementation of this model. To solve this, we taught certified medical assistants (CMAs) how to manage incoming PMARs utilizing existing telephone call routing guidelines. [To read more, click View Resource.]

Vacation has been shown to be an important restorative activity in the general population; less is known about physicians’ vacation behaviors and their association with burnout and professional fulfillment.To examine the number of vacation days taken per year and the magnitude of physician work while on vacation and their association with physician burnout and professional fulfillment, by individual and organizational characteristics.This cross-sectional survey of US physicians was conducted between November 20, 2020, and March 23, 2021. Data analysis was performed from March to July 2023.Burnout was measured using the Maslach Burnout Index, and professional fulfillment was measured using the Stanford Professional Fulfillment Index. Number of vacation days taken in the last year, time spent working on patient care and other professional tasks per typical vacation day (ie, work on vacation), electronic health record (EHR) inbox coverage while on vacation, barriers to taking vacation, and standard demographics were collected.Among 3024 respondents, 1790 of 3004 (59.6%), took 15 or fewer days of vacation in the last year, with 597 of 3004 (19.9%) taking 5 or fewer days. The majority, 2104 respondents (70.4%), performed patient care–related tasks on vacation, with 988 of 2988 (33.1%) working 30 minutes or more on a typical vacation day. Less than one-half of physicians (1468 of 2991 physicians [49.1%]) reported having full EHR inbox coverage while on vacation. On multivariable analysis adjusting for personal and professional factors, concern about finding someone to cover clinical responsibilities (odds ratio [OR], 0.48 [95% CI, 0.35-0.65] for quite a bit; OR, 0.30 [95% CI, 0.21-0.43] for very much) and financial concerns (OR, 0.49 [95% CI, 0.36-0.66] for quite a bit; OR, 0.38 [95% CI, 0.27-0.54] for very much) were associated with decreased likelihood of taking more than 3 weeks of vacation per year. Taking more than 3 weeks of vacation per year (OR, 0.66 [95% CI, 0.45-0.98] for 16-20 days; OR, 0.59 [95% CI, 0.40-0.86] for >20 days vs none) and having full EHR inbox coverage while on vacation (OR, 0.74; 95% CI, 0.63-0.88) were associated with lower rates of burnout on multivariable analysis, whereas spending 30 minutes or longer per vacation day on patient-related work (OR, 1.58; 95% CI, 1.22-2.04 for 30-60 minutes; OR, 1.97; 95% CI, 1.41-2.77 for 60-90 minutes; OR, 1.92; 95% CI, 1.36-2.73 for >90 minutes) was associated with higher rates of burnout.In this cross-sectional study of 3024 physicians, the number of vacation days taken and performing patient-related work while on vacation were associated with physician burnout. System-level efforts to ensure physicians take adequate vacation and have coverage for clinical responsibilities, including EHR inbox, may reduce physician burnout.

BACKGROUND: The organizational studies' literature suggests that employees' expressions of voice and silence may be distinct concepts with different predictors. Organizational researchers also argue that both employees' voice and silence are related to burnout; however, these relationships have not been adequately examined in the healthcare context. OBJECTIVE: This study aimed to investigate the relationships among nurses' perceived impact, psychological safety, voice behaviors, and burnout using a theoretical model. Voice behaviors were conceptualized as voice and silence. DESIGN: A cross-sectional, correlational study design was employed. SETTINGS: Study data were collected in 34 general hospitals in South Korea. PARTICIPANTS: A total of 1255 registered nurses providing direct care to patients were included in this study. METHODS: Using a convenience sampling method, a web-based survey was conducted to obtain data. All variables were measured using standardized instruments. A structural equation modeling analysis was employed to test a hypothesized model positing that perceived impact and psychological safety have both direct and indirect effects on nurse burnout through voice and silence. The response rate was 72.8 %. RESULTS: The findings supported the hypothesized model. Both perceived impact and psychological safety were positively related to expressions of voice, but both were negatively associated with silence. We also found that perceived impact was more strongly associated with voice than with silence, while psychological safety had a stronger impact on silence than on voice. Furthermore, voice reduced burnout, while silence increased it. Finally, perceived impact reduced burnout through voice (β = −0.10, 95 % confidence interval [−0.143, −0.059]) and silence (β = −0.04, 95 % confidence interval [−0.058, −0.014]), and psychological safety also decreased burnout through voice (β = −0.04, 95 % confidence interval [−0.057, −0.016]) and silence (β = −0.07, 95 % confidence interval [−0.101, −0.033]). Additional analyses revealed that prohibitive voice and silence significantly mediated the associations between psychological safety and burnout and perceived impact and burnout, but the mediating role of promotive voice was not statistically significant. CONCLUSIONS: It is important to recognize that voice and silence are distinct concepts. Moreover, to reduce nurse burnout, nurse managers and hospital administrators should develop separate strategies for promoting nurses' perceived impact and psychological safety, as their influences on voice and silence differ. Registration Not applicable. Tweetable abstract Voice and silence both influence nurse burnout. Separate strategies should be applied to voice and silence, as they are different concepts.

[This is an excerpt.] Moral distress and moral injury have received little attention in radiology, despite increasing focus on burnout. Instead, the conversation continues to emphasize personal wellness to mitigate burnout. Wellness is important to ensure every individual is healthy and able to fully perform their jobs. Wellness committees, group outings, snack carts, and yoga can help to produce a sense of community and provide short term gratification. However, wellness interventions do not address the issues causing moral distress in radiology. Fixing the causes of moral distress will reduce burnout. [To read more, click View Resource.]

Policing worldwide is facing a staffing and retention crisis. If the staffing exodus continues, communities will be left with too few police and large cohorts of inexperienced new recruits on the job. Drawing on 2,669 survey responses collected as part of a national study of law enforcement officers across the USA, we test an integrated theoretical model of the predictors of turnover intentions. We computed a path model using structural equation modelling, finding that job demand stressors (including trauma, organizational, and operational stressors), burnout, psychological distress, and commitment (including organizational commitment and occupational commitment) all play important roles in explaining the intentions of officers to exit the policing profession. Based on the study findings, the importance of trauma, organizational and operational job demand stress, and the differential impact of organizational and occupational commitment on police turnover intentions is established. Addressing burnout and psychological distress through a wellness agenda is likely to assist in stemming the outflow of officers from policing. The current study makes a significant empirical and practical contribution to the small body of existing police turnover research. The current research guides police leaders on the critical factors that must be considered when developing strategies and initiatives that aim to positively impact on the retention of officers within policing.

Poor well-being and burnout among the nursing workforce were heightened by the COVID-19 pandemic. The purpose of this study was to deliver, spread, and sustain an evidence-based wellness program, Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE), for nurse leaders, staff registered nurses (RNs), and patient care technicians (PCTs) to ameliorate or prevent burnout, promote resilience, and improve the work environment. The program included Community Resiliency Model (CRM) training provided by a certified 6-member wellness team. A baseline and 6-month follow-up survey included measures of well-being, moral distress, burnout, resilience, perceived organizational support (POS), job satisfaction, intent to leave (ITL), and work environment. A total of 4900 inpatient RNs, PCTs, and leaders of a 1207-bed academic medical center in the southeastern United States were analyzed. From baseline (n = 1533) to 6-month follow-up (n = 1457), well-being, moral distress, burnout, job satisfaction, and work environment improved; however, resilience, POS, and ITL did not. Although we have seen some improvements in well-being and mental health indicators, it is still early in the intervention period to have reached a critical mass with the training and other interventions. The mental health and work environment issues among nurses are so complex, no one-size-fits-all intervention can resolve.

BACKGROUND: Nurses experience elevated rates of operational stress injuries (OSIs). This can necessitate taking leave from work and subsequently engaging in a workplace reintegration process. An unsuccessful process can have long term impacts on a nurse's career, affecting the individual, their family, and broader community, while contributing to nursing shortages. A knowledge gap regarding the workplace reintegration of nurses experiencing mental health challenges, impedes the development and implementation of initiatives that might increase the success of nurses reintegrating into the workplace. This scoping review explored the existing literature concerning workplace reintegration for nurses experiencing OSIs. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines were utilized. Three key search terms across six databases were employed followed by a qualitative content analysis of the resulting literature. RESULTS: Eight documents were included. The literature exhibited high heterogeneity in objectives, content, and article types. The content analysis revealed five themes: (1) recognizing stigma, (2) elements of successful workplace reintegration, (3) considerations for military nurses, (4) considerations for nurses with substance use disorders, and (5) gaps in the existing literature. CONCLUSION: A paucity of programs, policies, procedures, and research exists regarding workplace reintegration for nurses facing mental health challenges. It is imperative to recognize that nurses may experience OSIs, necessitating mental health support, time off work, and operationally/culturally-specific assistance in returning to work. Innovative and evidence-based approaches to workplace reintegration are needed to enhance the retention of a skilled, experienced, compassionate, and healthy nursing workforce.

An Oxford researcher measured the effect of popular workplace mental health interventions, and discovered little to none.

[This is an excerpt.] A recent survey of 3,000 health care workers revealed that younger clinicians ages 18–29 — nurses, doctors, dentists, medical assistants, and others — were significantly more likely than older clinicians to report witnessing racial discrimination against patients. The survey reported on health care workers’ observations of discrimination against patients, how this discrimination impacts patient care, and how it affects the health care workers who witness it. [To read more, click View Resource.]

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

Policing by its very nature has been widely recognised as being inherently stressful with little that can be done to prevent police officers' exposure to both primary and secondary trauma. Officers involved in the investigation of child abuse and sexual offences have been further recognised as working in some of the most stressful and demanding roles in policing. However, there has been little research within this high-risk group of officers which seeks to understand how they cope with both the organisational and occupational stressors they are exposed to, as well as which strategies help them to 'get up in the morning'. Data were collected through twenty-three (23) semi-structured interviews, with Straussian Grounded Theory used as a framework to develop a model of coping. This study highlighted that although some officers were affected by the traumatic nature of their work, there were other risk factors present which appear to have impacted on them more significantly including 'burnout', 'compassion fatigue' and 'moral injury.' Protective factors were identified as 'being in control', 'organisational, social and peer support' as well as 'having a purpose' all of which impacted on an officer's ability to cope with the work they do. The present findings extend our knowledge of key concepts relating to police officer coping which may help officers working in these high-risk roles to cope with challenges they face daily. Recommendations for further research on how to support this group of officers, as well as implications for practice are discussed.

Medical students are educated through two dichotomous curriculums, the formal, planned curriculum and the hidden curriculum unintentionally taught through socialization within the culture of medicine. As a consequence of shared trauma amongst the physician workforce during the COVID-19 pandemic, moral injury (MoI) and compassion fatigue (CoF) have become prevalent within the health care system, including palliative care medicine, with echoing ramifications on the observing trainee population. Thus, it is imperative to determine risk factors, protective factors and targeted interventions to offset MoI and CoF within the health care workforce and trainee population. Methods of strengthening personal and institutional resilience are vital to developing long-term structural change replacing the hidden curriculum of MoI and CoF with one of resilience and support. As palliative care providers are especially vulnerable to MoI and CoF, this article will examine the impact of the COVID-19 pandemic on MoI, CoF, and resilience within the hidden curriculum through the lens of palliative care.

Social work practice is not a highly paid or high-status occupation. The historical roots of social work lie in charity work directed toward social needs and poverty, with much of this work previously women’s unpaid work. This set the stage for a norm of unpaid labor in the predominantly female occupation. Women who are mature-aged, lone parents, carers and on low income have continuously been the numerical majority within social work. As such, the unpaid field placement disproportionately affects women. This article provides a gendered analysis of qualitative data obtained from women participants in a national survey of social work students from five Australian universities (n=409) following 1000 h of field education placement. Open-ended questions aimed to explore the experiences of financial stress from lengthy unpaid placements on the mental health and well-being of social work students. The findings contribute to a growing body of feminist literature critiquing the current field education model and argue for significant reflection,flexibility, and change. To meet the collective social work goals of social justice and dismantling systemic oppression, a new placement model is needed that is both inclusive and sustainable.