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BACKGROUND: Physician burnout is a common problem, with onset frequently occurring during undergraduate education. Early intervention strategies that train medical students in psychological flexibility skills could support well-being and mitigate burnout risks associated with unmodifiable career stressors. There is a need for randomized controlled trials to assess effectiveness. As psychological flexibility varies contextually and among individuals, tailoring interventions may improve outcomes. Smartphone apps can facilitate individualization and accessibility, and the evaluation of this approach is an identified research priority. OBJECTIVE: This study aimed to evaluate the effectiveness of a stand-alone app-delivered Acceptance and Commitment Training intervention for improving medical students' self-reported burnout, well-being, psychological flexibility, and psychological distress outcomes. We aimed to explore whether an individualized app would demonstrate benefits over a nonindividualized version. METHODS: This parallel randomized controlled trial was conducted with a sample of medical students from 2 Australian universities (N=143). Participants were randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waitlist) using a 1:1:1 allocation ratio. Individualized and nonindividualized participants were blinded to group allocation. The 5-week intervention included an introductory module (stage 1) and on-demand access to short skill training activities (stage 2), which students accessed at their own pace. Stage 2 was either nonindividualized or individualized to meet students' identified psychological flexibility training needs. RESULTS: The mean differences in change from baseline between the intervention groups and the waitlist group were not statistically significant for burnout outcomes: exhaustion (primary; individualized: -0.52, 95% CI -3.70 to 2.65, P=.75; nonindividualized: 1.60, 95% CI -1.84 to 5.03, P=.37), cynicism (individualized: -1.26, 95% CI -4.46 to 1.94, P=.44; nonindividualized: 1.00, 95% CI -2.45 to 4.46, P=.57), and academic efficacy (individualized: 0.94, 95% CI -0.90 to 2.79, P=.32; nonindividualized: 2.02, 95% CI 0.02-4.03, P=.05). Following the intervention, the individualized group demonstrated improved psychological flexibility (0.50, 95% CI 0.12-0.89; P=.01), reduced inflexibility (0.48, 95% CI -0.92 to -0.04; P=.04), and reduced stress (-6.89, 95% CI -12.01 to 5.99; P=.01), and the nonindividualized group demonstrated improved well-being (6.46, 95% CI 0.49-12.42; P=.04) and stress (-6.36, 95% CI -11.90 to -0.83; P=.03) compared with waitlist participants. Between-group differences for the individualized and nonindividualized arms were not statistically significant. High attrition (75/143, 52.4%) was observed. CONCLUSIONS: This trial provides early support for the potential benefits of Acceptance and Commitment Training for medical student well-being and psychological outcomes and demonstrates that psychological flexibility and inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were not statistically significant, improvements in secondary outcomes could indicate early risk mitigation. Replication studies with larger samples and longer-term follow-up are required, and future research should focus on improving implementation frameworks to increase engagement and optimize individualization methods.

OBJECTIVE: This study aims to evaluate the impact of several organisational initiatives implemented as part of a physician engagement, wellness and excellence strategy at a large mental health hospital. Interventions that were examined include: communities of practice, peer support programme, mentorship programme and leadership and management programme for physicians. METHODS: A cross-sectional study, guided by the Reach, Effectiveness/Efficacy, Adoption, Implementation and Maintenance evaluation framework, was conducted with physicians at a large academic mental health hospital in Toronto, Canada. Physicians were invited to complete an online survey in April 2021, which composed of questions on the awareness, use and perceived impact of the organisational wellness initiatives and the two-item Maslach Burnout Inventory tool. The survey was analysed using descriptive statistics and a thematic analysis. RESULTS: 103 survey responses (40.9% response rate) were gathered from physicians, with 39.8% of respondents reporting experiences of burn-out. Overall, there was variable reach and suboptimal use of the organisational interventions reported by physicians. Themes emerging from open-ended questions included the importance of addressing: workload and resource related factors; leadership and culture related factors; and factors related to the electronic medical record and virtual care. CONCLUSIONS: Organisational strategies to address physician burn-out and support physician wellness require repeated evaluation of the impact and relevance of initiatives with physicians, taking into account organisational culture, external variables, emerging barriers to access and participation, and physician needs and interest over time. These findings will be embedded as part of ongoing review of our organisational framework to guide changes to our physician engagement, wellness and excellence strategy.

Healthcare workers experience moral injury (MI), a violation of their moral code due to circumstances beyond their control. MI threatens the healthcare workforce in all settings and leads to medical errors, depression/anxiety, and personal and occupational dysfunction, significantly affecting job satisfaction and retention. This article aims to differentiate concepts and define causes surrounding MI in healthcare. A narrative literature review was performed using SCOPUS, CINAHL, and PubMed for peer-reviewed journal articles published in English between 2017 and 2023. Search terms included “moral injury” and “moral distress,” identifying 249 records. While individual risk factors predispose healthcare workers to MI, root causes stem from healthcare systems. Accumulation of moral stressors and potentially morally injurious events (PMIEs) (from administrative burden, institutional betrayal, lack of autonomy, corporatization of healthcare, and inadequate resources) result in MI. Individuals with MI develop moral resilience or residue, leading to burnout, job abandonment, and post-traumatic stress. Healthcare institutions should focus on administrative and climate interventions to prevent and address MI. Management should ensure autonomy, provide tangible support, reduce administrative burden, advocate for diversity of clinical healthcare roles in positions of interdisciplinary leadership, and communicate effectively. Strategies also exist for individuals to increase moral resilience, reducing the impact of moral stressors and PMIEs.

BACKGROUND: Given that emotional exhaustion and nurse engagement have significant implications for nurse well-being and organizational performance, determining how to increase nurse engagement while reducing nurse exhaustion is of value. PURPOSE: Resource loss and gain cycles, as theorized in conservation of resources theory, are examined using the experience of emotional exhaustion to evaluate loss cycles and work engagement to evaluate gain cycles. Furthermore, we integrate conservation of resources theory with regulatory focus theory to examine how the ways in which individuals approach work goals serves as a facilitator to the acceleration and deceleration of both of these cycles. METHODOLOGY/APPROACH: Using data from nurses working in a hospital in the Midwest United States at six time points spanning over 2 years, we demonstrate the accumulation effects of the cycles over time using latent change score modeling. RESULTS: We found that prevention focus was associated with the accelerated accumulation effects of emotional exhaustion and that promotion focus was associated with the accelerated accumulation effects of work engagement. Furthermore, prevention focus attenuated the acceleration of engagement, but promotion did not influence the acceleration of exhaustion. CONCLUSION: Our findings suggest that individual factors such as regulatory focus are key to helping nurses to better control their resource gain and loss cycles. PRACTICE IMPLICATIONS: We provide implications for nurse managers and health care administrators to help encourage promotion focus and suppress prevention focus in the workplace.

Undergraduate and graduate students are often enveloped in an array of stress and anxiety, and it is no surprise that undergraduate and graduate social work students are faced with high amounts of stress due to vicarious trauma as a result of exposure to via coursework and experiential learning. It also comes as no surprise that social work professionals are exposed to numerous stressors causing the burnout rate for social workers to be high. Mindfulness techniques are used in various cultures and religions around the world with the purpose of synching mind and body. Using mindfulness techniques, individuals can be fully aware and present, which allows for the identification of emotional and physical patterns and adjustment to provide the most benefits. Awareness and adaptation of one’s emotional and physical sensations, especially in a helping profession like social work, is crucial in combating stress and burnout. This thesis will examine various articles and peer-reviewed studies conducted on mindfulness techniques being implemented in undergraduate and graduate social work curricula. This thesis will hopefully link mindfulness training added to the pedagogy of undergraduate and graduate social work programs to a decrease in the stress and burnout rate for social work students.

Burnout is a phenomenon commonly found in the workplace. When burnout is job-related, it is considered job burnout. Historically, job burnout has been most common among those who work in human services fields and who deal with stressful situations on a regular basis. Job burnout consists of three components: emotional exhaustion, depersonalization, and feelings of work ineffectiveness. While job burnout may be common, not all workers in stressful fields experience it, which indicates that there must be organizational or individual factors that limit the likelihood of job burnout for some workers. This study examined the impact of four job-related factors (job stress, job involvement, job satisfaction, and organizational commitment) on the three components of job burnout for correctional workers in a large, maximum-security prison in the Southern United States. The findings indicated that the four job-related factors were related strongly and in the predicted direction to two or three of the measures of job burnout.

Achievement of the quadruple aim requires investment in the health and well-being of physicians. Its influence on essential elements of healthcare – access to care, patient satisfaction, quality of care and patient safety – cannot be ignored. The delivery of better health outcomes, lower healthcare costs and an improved patient experience rests on humanizing the clinician experience. The purpose of this study was to examine the impact of physician burnout on patient safety and outcomes and explore existing policies that may be amenable to policy intervention to address physician burnout. A literature review was used to identify factors contributing to physician burnout and the downstream effects on the quality of care delivered and patient outcomes. The search criteria were restricted to the years 2018 – 2023 and the following terms: “physician burnout,” “patient care” and “patient outcomes.” Among the eight articles used in the analysis, the following factors emerged as primary contributors to physician burnout: administrative burden/EHR, excessive workloads/long working hours, loss of autonomy and leadership culture/lack of alignment of professional values with those in leadership. The factors manifest at the bedside as a lack of empathy, poor decision-making skills and poor communication to patients and peers. On a larger scale, this translates to increased costs related to unnecessary tests, medical errors, malpractice claims/settlements and decreased access to care as physicians leave medicine. There are significant costs – both human and financial – associated with burnout. Developing a workplace environment optimal for delivery of care and aligning values of leadership/organization with the practices therein involves prioritizing these things, thus creating a culture of safety and demonstrating our commitment to it.

BACKGROUND: The COVID-19 pandemic has amplified long-standing issues of burnout and stress among the U.S. nursing workforce, renewing concerns of projected staffing shortages. Understanding how these issues affect nurses’ intent to leave the profession is critical to accurate workforce modeling. PURPOSE: To identify the personal and professional characteristics of nurses experiencing heightened workplace burnout and stress. METHODS: We used a subset of data from the 2022 National Nursing Workforce Survey for analysis. Binary logistic regression models and natural language processing were used to determine the significance of observed trends. RESULTS: Data from a total of 29,472 registered nurses (including advanced practice registered nurses) and 24,061 licensed practical nurses/licensed vocational nurses across 45 states were included in this analysis. More than half of the sample (62%) reported an increase in their workload during the COVID-19 pandemic. Similarly high proportions reported feeling emotionally drained (50.8%), used up (56.4%), fatigued (49.7%), burned out (45.1%), or at the end of their rope (29.4%) “a few times a week” or “every day.” These issues were most pronounced among nurses with 10 or fewer years of experience, driving an overall 3.3% decline in the U.S. nursing workforce during the past 2 years. CONCLUSION: High workloads and unprecedented levels of burnout during the COVID-19 pandemic have stressed the U.S. nursing workforce, particularly younger, less experienced RNs. These factors have already resulted in high levels of turnover with the potential for further declines. Coupled with disruptions to prelicensure nursing education and comparable declines among nursing support staff, this report calls for significant policy interventions to foster a more resilient and safe U.S. nursing workforce moving forward.

OBJECTIVE: There is emerging evidence that first responders, like military personnel, are at risk for exposure to potentially morally injurious events. However, studies examining expressions of moral injury in first responders are nascent, in large part due to the limited number of measures validated for use in this population. To address this gap, the present study sought to investigate the psychometric properties of the Expressions of Moral Injury Scale—Military Version (EMIS-M) in a sample of first responders. METHOD: The psychometric properties of the EMIS-M were investigated in a sample of 228 first responders to determine reliability, convergent validity, discriminative validity, and divergent validity. In addition, confirmatory factor analysis was conducted to test the bifactor model identified in a veteran sample (Currier et al., 2018). RESULTS: Results yielded an excellent fit for the bifactor model with correlated self-directed and other-directed subscales identified in the EMIS-M development study. In addition, the measure evidenced strong reliability, convergent validity, discriminative validity, and divergent validity. CONCLUSIONS: The findings of the present study suggest that the Expressions of Moral Injury Scale—First Responder Version is a psychometrically sound measure capable of assessing self- and other-directed expressions of moral injury in first responders. The significance of these findings to our understanding of moral injury in first responders and their implications for future research are discussed.

Burnout in family doctors (FDs) affects their well-being, patient care, and healthcare organizations, and is considered common worldwide. However, its measurement has been so inconsistent that whether the widely divergent prevalence figures can be meaningfully interpreted has been questioned. Our aim was to go further than previous systematic reviews to explore the meaning contribution and usefulness of FD-burnout prevalence estimates. Worldwide literature was systematically reviewed using Levac's scoping framework, with 249 papers undergoing full-text review. Of 176 studies measuring burnout, 78% used the Maslach Burnout Inventory (MBI), which measures burnout as now defined by the World Health Organization. We, therefore, concentrated on the MBI. Its burnout measurement was markedly inconsistent, with prevalence estimates ranging from 2.8% to 85.7%. Researchers made prevalence claims relating to burnout severity and implied diagnoses based on participants' MBI scores, even though the MBI has not been validated as a clinical or diagnostic tool. Except when comparisons were possible between certain studies, prevalence figures provided limited meaning and added little to the understanding of burnout in FDs. Our review revealed a lack of research-supported meaningful information about the prevalence of FD burnout and that care is required to avoid drawing unsubstantiated conclusions from prevalence results. This paper's overall purpose is to propose how obtaining meaningful prevalence estimates can begin, which are recognized as key to developing improved prevention policies and interventions. Researchers must adopt a consistent means to measure burnout, use the MBI as its authors intended, and explore making progress through quantitative and qualitative collaboration.

OBJECTIVE: The aims of this study were to explore the experiences of US clinical research nurses supporting the conduct of clinical trials before and during the COVID-19 pandemic and assess dimensions of burnout among these nurses using the Maslach Burnout Inventory-Human Services Survey. BACKGROUND: Clinical research nurses are a subspecialty of nursing that supports clinical trial conduct. Postpandemic clinical research nurse well-being, including indicators of burnout, has not been established. METHODS: A cross-sectional descriptive study via online survey was conducted. Results: A sample of US clinical research nurses scored overall high for the Maslach category of Emotional Exhaustion, moderate for Depersonalization, and moderate for Personal Achievement. Themes included together or apart, rewarding but challenging, and surviving or thriving. CONCLUSION: Supportive measures such as workplace appreciation and consistent change communication may benefit clinical research nurse well-being and reduce burnout during times of unpredicted crisis and beyond.

In 2019, the National Academy of Science identified clinician burnout as a growing public health concern. The COVID-19 pandemic has only compounded this crisis and transformed it into an escalating fracture within the US health care system. Concurrently evolving with this emergency is a rise in the number of nurses who intend to leave the profession. Frontline nurse leaders are the lynchpin in ensuring health care systems function. These leaders have accountability over patient care and clinician well-being. Focused efforts must address clinician burnout. However, without addressing the well-being of frontline nurse leaders, the fault line in our health care system becomes a vast chasm. Recently, published literature began to emerge describing and addressing frontline clinician burnout. Unfortunately, only a few, if any, address issues related to leaders. The aim of this qualitative case study research was to explore and discover general themes in system chief nurse executive leadership practices that support, mentor, develop, and retain nurse leaders as a basis for future research. Three major themes were identified for future study and exploration: enhancing leadership development programs; improving leader work environments; and focusing on leader well-being and support. Further research is needed to evaluate the effectiveness of these themes.

With the introduction of law enforcement-administered naloxone, officers are assuming the dual role of law enforcer and caregiver with opioid users. This study used cognitive role theory and Thorne’s interpretive approach to explore the dual roles experienced by officers. The purpose of this study was to understand (1) how officers who administer naloxone describe their experience of the dual role, and (2) how the officers describe the role expectations of law enforcer and caregiver. Seven officers completed semi-structured, one-on-one, telephone interviews. The eight themes that emerged were related to the officers’ views of (1) saving and changing opioid users’ lives; (2) humanizing the officers; (3) mental health, stress, and trauma of officers; (4) the cycle of opioid reuse and re-arrest of opioid users; (5) views of the opioid user; (6) views of their role; (7) flaws and recommended improvements to the system; and (8) views of the naloxone program. Findings showed the dual role has created role ambiguity and conflict and has created additional stress and trauma for the officers. Most officers in the study supported the use of naloxone and identified this new responsibility from the existing aspect of their role to save lives and improve the community. Recommendations included increased medical training to improve officers’ confidence in making medical decisions, policy improvements to reduce role ambiguity and conflict, department and community naloxone implementation campaigns to socialize the concept before implementation into a department, emotional and psychological monitoring and supports for officers administering naloxone, and more outreach for secondary support following naloxone administration leading to positive social change.

Moral distress (MD) occurs when an individual knows the ethically correct action to take in a situation but institutional constraints prevent the individual from acting. MD is a well-documented phenomenon among nurses and occurs at a high frequency in the critical care setting. When MD is not adequately addressed and actions are not taken to mitigate precipitating factors within an organization, moral injury, moral residue, and burnout may consequentially result in nurses leaving their role or the profession. Nurse leaders are positioned to exemplify ethical leadership and provide support for their staff when MD is experienced; however, nurse leaders experience MD to a more global degree and much less is understood regarding the experience of MD among nurse leaders, as few studies have examined MD within this population. The aim of this dissertation was to explore the experience of MD among nurse leaders through qualitative methods. An initial qualitative study among unit-based critical care nurses in a single hospital in Alabama examining how unit-based critical care nurse leaders navigate MD among their staff revealed nurse leaders are likely to experience MD as a result of similar sources to staff nurses with the additional source of role-specific challenges. A qualitative systematic review revealed the known experiences, consequences, and strategies to address MD existing within the literature. A second, qualitative descriptive study conducted state-wide in Alabama among unit-based critical care nurse leaders converged with the findings of the qualitative systematic review and further added context to existing literature by revealing the experience of MD among nurse leaders may not be impacted by geographic contexts. Findings of these studies may inform the development or adaptation of MD measurement tools and interventions, conceptual and theoretical frameworks, and/or further exploration of the experience of MD among the nurse leader population.

OBJECTIVE: Pharmacy students with substantial educational debt are at risk for excessive workloads, burnout, and clinical errors. During the COVID-19 pandemic, policies addressing economic hardships for all student debt borrowers included temporary suspension of monthly payments and 0% interest during the pause. This study aimed to understand student-level factors regarding student debt from the lived experiences of current pharmacy students and aimed to understand how current pharmacy students view temporary loan relief. METHODS: We used semi-structured interviews of pharmacy students across four years of progression in their pharmacy program to better understand student experiences with debt, different factors that may influence the impact of student debt on short-term and long-term outcomes for students, and student perspectives on debt relief policies and potential solutions. Our thematic analysis was grounded in existing evidence and a conceptual framework, while also allowing codes to emerge directly from the data. RESULTS: A total of 20 pharmacy students were interviewed with a median student debt of $77,000, with debt amounts ranging from $0 to $209,000. Students described what mediating factors influenced their experiences, the influence of student debt on clinician burnout, and other outcomes impacted by student debt. Six overarching themes emerged relevant to current students: student debt influences education and career decisions, debt is risky given the saturated pharmacy market, debt is an accepted burden, debt will inhibit starting a life, the COVID-19 loan relief is revealing, and early financial education is needed. CONCLUSION: Pharmacy students burdened with debt described a variety of different experiences and attitudes towards that debt and provided their perspectives on how student debt influences short-term education and career decisions. While students accept the tradeoff of debt for their education as an inevitable burden, reported coping mechanisms and strategies shared suggest some solutions may be available to ameliorate this burden.

OBJECTIVES: To understand the relationship between stressful work environments and patient care by assessing work conditions, burnout, and elements of the diagnostic process. METHODS: Notes and transcripts of audiotaped encounters were assessed for verbal and written documentation related to psychosocial data, differential diagnosis, acknowledgement of uncertainty, and other diagnosis-relevant contextual elements using 5-point Likert scales in seven primary care physicians (PCPs) and 28 patients in urgent care settings. Encounter time spent vs time needed (time pressure) was collected from time stamps and clinician surveys. Study physicians completed surveys on stress, burnout, and work conditions using the Mini-Z survey. RESULTS: Physicians with high stress or burnout were less likely to record psychosocial information in transcripts and notes (psychosocial information noted in 0% of encounters in 4 high stress/burned-out physicians), whereas low stress physicians (n=3) recorded psychosocial information consistently in 67% of encounters. Burned-out physicians discussed a differential diagnosis in only 31% of encounters (low counts concentrated in two physicians) vs. in 73% of non-burned-out doctors’ encounters. Burned-out and non-burned-out doctors spent comparable amounts of time with patients (about 25 min). CONCLUSION: Key diagnostic elements were seen less often in encounter transcripts and notes in burned-out urgent care physicians.

First responder social workers are exposed to a stressful work environment, which puts them at risk for burnout. Burnout increases turnover rates, which negatively impacts both social workers and the clients they serve. The use of self-care practices mitigates the harmful effects of burnout. Because first responder social workers in southern California have an average turnover rate of 6 to 12 months after hire, this study explored southern California first responder social workers’ experiences with self-care practices. A basic qualitative design using semistructured interviews was applied through the purposeful sampling of eight first responder social workers. The study was grounded in Orem’s theory of self-care. The findings highlighted that first responder social workers were aware and knowledgeable about self-care. First responder social workers experienced numerous benefits, including burnout prevention, improved ability to manage stress, and increased work performance with the utilization of self-care practices. Participants also faced challenges with regularly utilizing self-care practices that resulted in impaired functioning. This study will inform positive social change as it identified the challenges faced by first responder social workers in using self-care practices and offered possible solutions.

BACKGROUND: Violence directed at healthcare workers (HCWs) is common and may be more frequent in the emergency department (ED). In addition to physical injury, other consequences of workplace violence in the ED include an increased risk of burnout, post-traumatic stress disorder, reduced job satisfaction, and feelings of avoidance and futility. Understanding behaviors underlying workplace violence is the first step to employing mitigation strategies. The objective of this descriptive study was to assess the prevalence and types of violence against HCWs in a large, urban ED. METHODS: This study took place in the ED of an urban hospital with an annual ED census of approximately 100,000. A previously existing general patient safety incident “dropbox” for HCWs was utilized to capture workplace violence reports. At the completion of the study period, all data was collated into the electronic database and each report was categorized based on the nature and severity of the abuse. Further, all events were also coded as either involving or not involving specifically racist, sexist, or homophobic content. The primary outcomes were the number of reported events over the study period, and the percentage of total events that fell into each category. The secondary outcomes were the overall prevalence and ratio of events that included racist, sexist, or homophobic language or provocation. RESULTS: Over the 5-month survey period, 130 reports of workplace violence were recorded, on average 0.85 per day. Perpetrators were mostly male, and most victims were nurses. Hospital security was involved in 26% of cases. At least 37% of incidents involved patients that were intoxicated and/or had history of psychiatric illness. Type I events (swearing provocatively, shouting, and legal threats) were the most common at 44% of encounters while 22% involved physical violence. Racist, sexist, and homophobic comments were involved in 8 (6%), 18 (14%), and 3 (2%) incidents respectively. CONCLUSION: We found that workplace violence against HCWs was common in this study, and sometimes involved a component of racist, sexist, or homophobic bias. Consistent with previous ED literature, we found that abusive events occurred almost daily and that approximately 20% of events involved physical violence. Future efforts toward policy change to address workplace violence in health care is needed at local, state, and national levels.

PURPOSE: To evaluate the association between elements of the built environment and physician well-being using a scoping review. BACKGROUND: Physicians currently report low work satisfaction, high burnout and depression. The built environment has been shown to affect well-being in the general population, but its relationship to physician well-being is not well understood. Gaining a better understanding of this relationship will allow for better evidence-based design for physician well-being. METHODS: A scoping review of the literature was conducted of Scopus and PubMed databases using key words for (1) environmental variables such as "environmental design"; (2) physician terms, such as "doctor"; and (3) outcome measures of well-being, such as "burnout." Studies were included if they had at least one measure of the built environment and one measure of physician well-being. Of 1,723 abstracts screened, 146 full-text articles were reviewed, leaving 16 articles to be included for data extraction. RESULTS: Included studies were from all around the world, except for, notably, the United States. Robust interpretation of the data was challenging because of the lack of standardization in the assessment of environmental factors and physician well-being. Excessive noise was the variable most linked to well-being. Suitable surroundings, including lighting, furniture, and art, were also linked with satisfaction, but it was unclear whether there was an association with well-being. CONCLUSION: Understanding how environmental factors affect physician well-being is paramount but considerably understudied. Standardization of research approach should be developed in order to produce more robust research to create evidence-based designs for physician well-being.

OBJECTIVE: The current studies explored associations between exposure to potentially morally injurious events (PMIEs) and mental health outcomes among frontline workers affected by the coronavirus pandemic. METHOD: We administered online self-report surveys to emergency responders (N = 473) and hospital personnel (N = 854) in the Rocky Mountain region of the United States between April and June of 2020. Surveys assessed frequency and intensity of exposure to PMIEs alongside psychological and functional outcomes. RESULTS: Between 20% and 30% of frontline workers reported exposure to PMIEs of at least moderate frequency and intensity. Exposure to more intense PMIEs was associated with greater psychological symptoms (i.e., stress, depression, and anxiety) and functional impairment (i.e., professional burnout), especially among emergency responders who reported frequent exposure but also hospital workers who reported few exposures. CONCLUSION: Efforts to facilitate and maintain the well-being of the public health workforce should specifically address critical incidents encountered by frontline workers that have embedded moral and ethical challenges.