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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.

BACKGROUND: Research has not explicitly explored differences between male and female microvascular head and neck (MHN) surgeon burnout, which should be identified and addressed to ensure career satisfaction and longevity. OBJECTIVE: To measure and compare the prevalence of burnout among male versus female MHN surgeons. METHODS: A prospective questionnaire based on the Maslach Burnout Inventory (MBI) was distributed through a web-based survey to the American Association of Facial Plastic and Reconstructive Surgeons and American Head and Neck Society in 2021 and 2022. Additional variables collected included demographics, relationship and parental status, academic rank, annual salary, and COVID-19-related questions. RESULTS: One hundred thirteen surveys were collected. Twenty-nine (25.7%) were women and all completed MHN surgery fellowships. Women trended toward more emotional exhaustion than men (2.8 mean MBI vs. 2.3 mean MBI) but reported similar personal achievement (4.8 mean MBI vs. 4.9 mean MBI). Men experienced less workplace sexual harassment (p < 0.001). Women experienced more burnout (69% vs. 39%, p = 0.006) during the COVID-19 pandemic. CONCLUSION: Female MHN surgeons reported in this survey to experience more workplace sexual harassment and higher COVID-19-related burnout than their male counterparts.

OBJECTIVE: To assess associations of adverse childhood experiences (ACEs) and adverse occupational experiences (AOEs) with depression and burnout in US physicians. PARTICIPANTS AND METHODS: We performed a secondary analysis of data from a representative sample survey of US physicians conducted between November 20, 2020, and March 23, 2021, and from a probability-based sample of other US workers. The ACEs, AOEs, burnout, and depression were assessed using previously published measures. RESULTS: Analyses included data from 1125 of the 3671 physicians (30.6%) who received a mailed survey and 6235 of 90,000 physicians (6.9%) who received an electronic survey. The proportion of physicians age 29-65 who had lived with a family member with substance misuse during childhood (673 of 5039[13.4%]) was marginally lower (P <.001) than that of workers in other professions (448 of 2505 [17.9%]). The proportion of physicians age 29-65 who experienced childhood emotional abuse (823 of 5038 [16.3%]) was similar to that of workers in other professions (406 of 2508 [16.2%]). The average physician depression T-score was 49.60 (raw score ± SD, 6.48±3.15), similar to the normed US average. The AOEs were associated with mild to severe depression, including making a recent significant medical error (odds ratio [OR], 1.64; 95% CI, 1.33 to 2.02, P<.001), being named in a malpractice suit (OR, 1.30; 95% CI, 1.07 to 1.59, P=.008), and experiencing one or more coronavirus disease 2019-related AOEs (OR, 1.76; 95% CI, 1.56 to 1.99, P<.001). Having one or more ACEs was associated with mild to severe depression (OR, 1.58; 95% CI, 1.38 to 1.79, P<.001). The ACEs, coronavirus disease 2019-related AOEs, and medical errors were also associated with burnout. CONCLUSION: Assessing ACEs and AOEs and implementing selective primary prevention interventions may improve population health efforts to mitigate depression and burnout in physicians.

PURPOSE/OBJECTIVES: Case management in Veterans Affairs (VA) depends on leadership skills such as effective communication, excellent resource management, self-governance, patient advocacy, and a distinctly professional attitude. VA registered nurses (RNs) and social workers (SWs) also provide case management services, a role and service, which is pivotal to veteran satisfaction and effective health care coordination. The leader-follower framework (LF2) was used to assess and compare the responses of RNs, SWs, and case managers (CMs) on the annual VA All Employee Survey (AES) to provide insight regarding VA case management performance, which has influenced veteran satisfaction. PRIMARY PRACTICE SETTING: VA CMs work in a variety of clinical settings, which, in recent years, includes the use of telehealth modalities because of COVID-19. VA CMs remain flexible working in environments where and when veterans require their services while promoting safe, effective, and equitable health care services. FINDINGS/CONCLUSIONS: RNs and SWs indicated greater agreement and satisfaction scores in 2019 compared with 2018 on questions related to the leadership element of character and questions regarding mutual respect between VA senior leaders and the respondents. In contrast, RNs and SWs indicated less agreement and satisfaction scores on questions related to the leadership elements of competence, context, communication, personal, interpersonal, team, organizational, and greater burnout in 2019 than in 2018. RN response scores in 2018 and 2019 were greater and burnout scores were less than SWs. Additionally, the one-way analysis of variance indicated no difference for RNs and SWs who were performing the duties of a CM. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The responses of RNs indicated greater satisfaction and less burnout than SWs and were consistent whether RNs and SWs were in case management roles or not. These are important findings and concerning trends warranting further discussion and research. © 2023 Lippincott Williams and Wilkins. All rights reserved.

OBJECTIVES: Second victim syndrome refers to the negative mental and emotional after-effects physicians may experience after adverse patient outcomes. We evaluated the impact of second victim status on physician self-efficacy, burnout, perceived stress, and sleep patterns.

METHODS: Physicians at a university hospital voluntarily participated in an anonymous, survey which included second victim status, General Self-Efficacy Scale (GSE), Copenhagen Burnout Inventory (CBI), Perceived Stress Scale (PSS), and Insomnia Severity Index. The total possible survey points were: GSE, 40; CBI, 95; PSS, 40; and Insomnia Severity Index, 28. The Student t test for independent samples and Mantel-Haenszel were used to compare second victim with nonsecond victims.

RESULTS: Of the 115 respondents, 85 (74%) provided second victim status: 48% female, 93% non-Hispanic White, 35% surgeons, and 53% in practice for more than 20 years. There were 24 (28%) self-reported second victims. Demographics were similar between groups. GSE scores were comparable: second victim versus nonsecond victim: 31.4 vs 32.6 (P = .13), but fewer second victims reported that they could accomplish their goals (79.2 vs 88.7%; P = .03). Overall, 56% of physicians had CBI scores consistent with moderate burnout. Mean CBI scores were similar for both groups 56.6 vs 52.4; P = .17). Work-related burnout (22.9 vs 21.9; P = .44) and personal burnout (18.9 vs 17.3; P = .17) were comparable, but second victims more commonly reported patient-related burnout (15.3 vs 12.9; P = .039). Second victims responded often or always more frequently to questions regarding patients being hard to work with (8.3% vs 1.6%; P = .03), frustrating (12.5% vs 3.3%; P = .02), draining energy (16.7% vs 5%; P = .018), or wondering how long they could continue to work with patients (16.7% vs 11.5%; P = .039). There was no difference in mean PSS for lack of control (11.7 vs 10.5; P = .28) or ability to cope with existing stressors (10.0 vs 10.6; P = .34). Mean insomnia scores were comparable (9.4 vs 7.7; P = .22), but second victims experienced problems with waking too early more often (29.2% vs 14.5%; P = .01). Official debriefing and individualized counseling or coaching to cope with the event were top resources desired by second victims (54%). Mandatory time off or mandatory meetings with a psychiatrist or psychologist were least favored (8%).

CONCLUSIONS: More than 25% of physicians have experienced second victim sequalae, which do not distinguish by demographics. Despite high-level GSE, moderate burnout was present in more than 50% of physicians, irrespective of second victim status. Patient-related burnout was particularly evident among second victims. These numbers are alarming and should be addressed promptly by medical societies and hospitals. A valuable starting point may be offering individualized counseling for all physicians.

[This is an excerpt.] The prevalence of burnout among physicians increased in parallel with the COVID-19 pandemic. Despite disruptions in medical education, studies suggest that burnout among medical students has remained stable in recent years. We analyzed data from the 2019 to 2021 Association of American Medical Colleges (AAMC) Graduation Questionnaire, which is administered to graduating US medical school students, and data on COVID-19 cases and COVID-19–related deaths in the schools’ surrounding communities to explore the association between COVID-19 intensity in the clinical learning environment and student burnout and residency preparedness. [To read more, click View Resource.]

Work environments and practice structural features are associated with both burnout and the ability of practices to enhance quality of care.To characterize factors associated with primary care practices successfully improving quality scores without increasing clinician and staff burnout.This cross-sectional study assessed small- to medium-sized primary care practices that participated in the EvidenceNOW: Advancing Heart Health initiative using surveys that were administered at baseline (September 2015 to April 2017) and after the intervention (January 2017 to October 2018). Data were analyzed from February 2022 to January 2023.The primary outcome of being a quality and well-being positive deviant practice was defined as a practice with a stable or improved percentage of clinicians and staff reporting burnout over the study period and with practice-level improvement in all 3 cardiovascular quality measures: aspirin prescribing, blood pressure control, and smoking cessation counseling.Of 727 practices with complete burnout and aspirin prescribing, blood pressure control, and smoking cessation counseling data, 18.3% (n = 133) met the criteria to be considered quality and well-being positive deviant practices. In analyses adjusted for practice location, accountable care organization and demonstration project participation, and practice specialty composition, clinician-owned practices had greater odds of being a positive deviant practice (odds ratio, 2.02; 95% CI, 1.16-3.54) than practices owned by a hospital or health system.In this cross-sectional study, clinician-owned practices were more likely to achieve improvements in cardiovascular quality outcomes without increasing staff member burnout than were practices owned by a hospital or health system. Given increasing health care consolidation, our findings suggest the value of studying cultural features of clinician-owned practices that may be associated with positive quality and experience outcomes.

BACKGROUND: Stressors for health care workers (HCWs) during the COVID-19 pandemic have been manifold, with high levels of depression and anxiety alongside gaps in care. Identifying the factors most tied to HCWs’ psychological challenges is crucial to addressing HCWs’ mental health needs effectively, now and for future large-scale events. OBJECTIVE: In this study, we used natural language processing methods to examine deidentified psychotherapy transcripts from telemedicine treatment during the initial wave of COVID-19 in the United States. Psychotherapy was delivered by licensed therapists while HCWs were managing increased clinical demands and elevated hospitalization rates, in addition to population-level social distancing measures and infection risks. Our goal was to identify specific concerns emerging in treatment for HCWs and to compare differences with matched non-HCW patients from the general population. METHODS: We conducted a case-control study with a sample of 820 HCWs and 820 non-HCW matched controls who received digitally delivered psychotherapy in 49 US states in the spring of 2020 during the first US wave of the COVID-19 pandemic. Depression was measured during the initial assessment using the Patient Health Questionnaire-9, and anxiety was measured using the General Anxiety Disorder-7 questionnaire. Structural topic models (STMs) were used to determine treatment topics from deidentified transcripts from the first 3 weeks of treatment. STM effect estimators were also used to examine topic prevalence in patients with moderate to severe anxiety and depression. RESULTS: The median treatment enrollment date was April 15, 2020 (IQR March 31 to April 27, 2020) for HCWs and April 19, 2020 (IQR April 5 to April 27, 2020) for matched controls. STM analysis of deidentified transcripts identified 4 treatment topics centered on health care and 5 on mental health for HCWs. For controls, 3 STM topics on pandemic-related disruptions and 5 on mental health were identified. Several STM treatment topics were significantly associated with moderate to severe anxiety and depression, including working on the hospital unit (topic prevalence 0.035, 95% CI 0.022-0.048; P<.001), mood disturbances (prevalence 0.014, 95% CI 0.002-0.026; P=.03), and sleep disturbances (prevalence 0.016, 95% CI 0.002-0.030; P=.02). No significant associations emerged between pandemic-related topics and moderate to severe anxiety and depression for non-HCW controls. CONCLUSIONS: The study provides large-scale quantitative evidence that during the initial wave of the COVID-19 pandemic, HCWs faced unique work-related challenges and stressors associated with anxiety and depression, which required dedicated treatment efforts. The study further demonstrates how natural language processing methods have the potential to surface clinically relevant markers of distress while preserving patient privacy.

OBJECTIVE: To examine the relationship of work schedules with nurse turnover across various work settings. METHODS: A cross-sectional study design was used with data collected from 17,046 nurses who participated in the 2018 National Sample Survey of Registered Nurses in the U.S. Multivariate logistic regression was used to examine the effects of work hours and overtime on nurse turnover. RESULTS: Longer weekly work hours increased nurse turnover (OR = 1.104, 95% confidence interval [CI] = 1.006–1.023). A non-linear relationship was observed between overtime and turnover. Compared with nurses with no overtime, the turnover for nurses working 1–11 h overtime per week decreased (OR = 0.893, 95% CI = 0.798–0.999). When nurses worked ≥12 h, turnover increased (OR = 1.260, 95% CI = 1.028–1.545). Earning from the primary nursing position decreased turnover among nurses working in hospitals, other inpatient settings, and clinics. Job satisfaction decreased turnover. CONCLUSIONS: To prevent nurse turnover, it is important to monitor and regulate nurses’ working hours at institutional and government levels. Government support and policy implementations can help prevent turnover.

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This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Support & Ensure Safe Staffing)

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RATIONALE: Burnout is a personal and occupational phenomenon that has been associated with negative physical and psychological outcomes in medical staff. Additionally, there are implications for healthcare organizations, as those staff who are burned out are more likely to have lower productivity or leave the organization. As with the Covid-19 pandemic, future national emergencies and potentially large-scale conflicts will require similar and likely even larger scale responses from the U.S. Military Health System, thus it is important to understand burnout in this population so that the readiness of the staff and the military can remain at a high level. OBJECTIVE: This assessment was designed to examine levels of burnout among United States Military Health System (MHS) staff working at Army installations and the factors that influence the development of burnout. METHODS: Anonymous data was collected from 13,558 active-duty U.S. Soldiers and civilian MHS employees. burnout was measured using the Copenhagen burnout Inventory and the Mini-Z. RESULTS: Results showed nearly half of staff who responded (48%) reported being burned out, an increase since last measured in 2019 (31%). Factors related to increased burnout included concerns about work/life balance and workload, low job satisfaction and feeling disconnected from others. burnout was associated with increases in adverse physical and behavioral health (BH) outcomes. CONCLUSIONS: Results indicate that burnout is a common problem across MHS Army staff and is related to significant adverse health consequences for the individual and reduced retention of staff for the organization. These findings highlight the need to address burnout through policies that standardize health care delivery policies and practices, providing support to leadership to promote a healthy workplace, and individual support to those who experience burnout.

BACKGROUND AND OBJECTIVES: Clinician workload is a key contributor to burnout and well-being as well as overtime and staff shortages, particularly in the primary care setting. Appointment volume is primarily driven by the size of patient panels assigned to clinicians. Thus, finding the most appropriate panel size for each clinician is essential to optimization of patient care. METHODS: One year of appointment and panel data from the Department of Family Medicine were used to model the optimal panel size. The data consisted of 82 881 patients and 105 clinicians. This optimization-based modeling approach determines the panel size that maximizes clinician capacity while distributing heterogeneous appointment types among clinician groups with respect to their panel management time (PMT), which is the percent of clinic work. RESULTS: The differences between consecutive PMT physician groups in total annual appointment volumes per clinician for the current practice range from 176 to 348. The optimization-based approach for the same PMT physician group results in having a range from 211 to 232 appointments, a relative reduction in variability of 88%. Similar workload balance gains are also observed for advanced practice clinicians and resident groups. These results show that the proposed approach significantly improves both patient and appointment workloads distributed among clinician groups. CONCLUSION: Appropriate panel size has valuable implications for clinician well-being, patients' timely access to care, clinic and health system productivity, and the quality of care delivered. Results demonstrate substantial improvements with respect to balancing appointment workload across clinician types through strategic use of an optimization-based approach.

Limited research has examined what factors serve as potential barriers and motivators for law enforcement personnel in seeking mental health support. The current study presents findings from a survey of 158 sworn and civilian personnel from a large Southeastern Sheriff's office to shed light on these potential barriers/motivators. We drew on previous literature to create measures related to mental health stigma, confidentiality, burnout, various stressors, and organizational support, among others. The main effects OLS regression models suggest that increased perceptions of stigma and personal stressors significantly lowered employees' willingness to seek mental health support. However, increased burnout and job satisfaction were associated with employees seeking mental health support. Multiplicative models show that as job satisfaction increased within nonwhite respondents, those respondents were significantly more likely to seek mental health assistance. However, as personal stressors increased among nonwhite respondents, those respondents were significantly less likely to seek help. Finally, as overall health increased among white respondents, those respondents were significantly more likely to seek help. Findings indicate that mental health issues experienced by employees vary based on group membership. We discuss several future research directions and policy implications derived from these findings.

[This is an excerpt.] When the coronavirus pandemic hit North America in March of 2020 the medical profession was plunged into a crisis more devastating than any it had faced in the previous century. Trainees and physicians were called to the frontlines to care for extremely ill patients for long hours in the context of inadequate knowledge, skills, and equipment; patients were dying without loved ones to hold their hands and ease their passage. Ethical dilemmas around distribution of limited resources permeated each medical decision and led to moral injury for providers who could not deliver the quality of care that was standard just weeks prior. Healthcare professional burnout and suicide increased from the already significant pre-pandemic rates.1 Many medical schools limited students to virtual learning to protect them from exposure to the virus; yet a byproduct of this prudent decision was that many students found themselves isolated from peers and teachers, and in living situations suboptimal for class attendance and studying. Some questioned whether they were getting an education that would allow them to become good doctors. [To read more, click View Resource.]

Defining burnout and why it has increased among health care providers

When the World Health Organization announced a global pandemic in March of 2020, health care workers across the globe selflessly and tirelessly stood at the frontline. In addition to the clinical challenges an unknown virus brought forth, health care workers were not prepared for the emotional drain and mental health impact. The health care industry is increasingly facing a crisis as frontline workers experience moral distress, emotional trauma, and burnout in high stress health care environments. Debriefing, defined as facilitated interprofessional team reflection after a clinical event, has been shown to improve clinicians’ ability to manage their grief and is associated with lower burnout. A standardized program workshop and intervention, branded as Project Debriefing Event for Analysis and Recovery (D.E.A.R.), was piloted at a pediatric hospital with a multidisciplinary team. These volunteers served as champions to facilitate debriefings following stressful clinical events. The program included education sessions, integration of a standardized debriefing program, and additional resources. Impact of the workshop and educational intervention was evaluated using a pre–post survey design. Data demonstrated increased comfort for the interprofessional facilitators who provided the standardized debriefing. Participants found the sessions highlighted strengths and areas for opportunity. Champions and participants agreed the standardized process improved their emotional wellbeing. Future quality improvement projects are encouraged to standardize debriefing processes addressing the increased need for support to clinicians after a critical incident has occurred.