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Healthcare workers are experiencing high stress and burnout, at rates up to 70%, hindering patient care. Studies often focus on stressors in a particular setting or within the context of the pandemic which limits understanding of a more comprehensive view of stressors experienced by healthcare workers. The purpose of this study was to assess healthcare workers? self-reported major stressors. Between June 2018 and April 2019, U.S. healthcare workers (N?=?2,310) wrote answers to an open-ended question: "What are your biggest stressors as you look back over the last few weeks?" A summative content analysis was used to analyze the data. Healthcare workers described three types of stressors: work stressors (49% of total stressors), personal life stressors (32% of total stressors), and stressors that intersect work and personal life (19% of total stressors). Future research and clinical practice should consider the multi-faceted sources of stress.

Physician associates/assistants (PAs) and advanced practice RNs (APRNs) are a vital part of the healthcare team. As the PA and APRN workforce continues to grow, collaborations can move beyond the bedside. With organizational support, a shared APRN/PA Council allows these clinicians to raise a collective voice on issues that are unique to their practice and to implement meaningful solutions, thus improving the quality of their work environment and clinician satisfaction.

BACKGROUND: Nurses have been identified as an occupational group at increased risk of suicide. This systematic review examines the prevalence of, and factors influencing, suicide and related behaviours among nurses and midwives (PROSPERO pre-registration CRD42021270297). METHODS: MEDLINE, PsycINFO, and CINAHL were searched. Articles published from 1996 onwards exploring suicidal thoughts and behaviours among nurses and midwives were included. Quality of included studies was assessed. Articles were subjected to narrative synthesis informed by suicide data examined, study design, and quality. PRISMA guidelines were followed. RESULTS: A total of 100 studies were eligible for inclusion in the review. Articles examining suicide exclusively among midwives were absent from the literature. Several studies confirmed that nursing professionals, especially female, are at increased risk of suicide, particularly by self-poisoning. Factors contributing to risk include psychiatric disorders, alcohol and substance misuse, physical health problems, and occupational and interpersonal difficulties. In studies of non-fatal suicidal behaviours, including during the COVID-19 pandemic, psychiatric, psychological, physical and occupational factors were contributory. There has been little investigation of interventions for prevention of suicide in nurses. LIMITATIONS: Only articles published in English language were reviewed. CONCLUSIONS: The findings highlight the risk of suicide in nurses. They also show a combination of factors contribute to suicide and non-fatal suicidal behaviour in nurses, with psychiatric, psychological, physical health, occupational and substance misuse (especially alcohol) problems being particularly important. The limited evidence regarding prevention measures indicates a major need to develop primary and secondary interventions for this at-risk occupational group, for example, education regarding enhancing wellbeing and safe alcohol use, alongside accessible psychological support.

The ACR Intersociety Committee meeting of 2022 (ISC-2022) was convened around the theme of “Recovering From The Great Resignation, Moral Injury and Other Stressors: Rebuilding Radiology for a Robust Future.” Representatives from 29 radiology organizations, including all radiology subspecialties, radiation oncology, and medical physics, as well as academic and private practice radiologists, met for 3 days in early August in Park City, Utah, to search for solutions to the most pressing problems facing the specialty of radiology in 2022. Of these, the mismatch between the clinical workload and the available radiologist workforce was foremost—as many other identifiable problems flowed downstream from this, including high job turnover, lack of time for teaching and research, radiologist burnout, and moral injury.

Trauma histories are common among people with HIV and associated with poor HIV outcomes, underscoring the importance of integrating trauma-informed care (TIC) into HIV services. As part of the quantitative phase of an explanatory sequential mixed-methods study, we assessed individual and clinic-wide support (using the Attitudes Related to Trauma-informed Care-45 (ARTIC-45)) and factors influencing TIC support through surveys with 152 administrators, providers, and staff from 38 Ryan White Clinics (RWCs) in the Southeastern US. Mean responses to the ARTIC-45 Personal and System Support Subscales were 5.18 (SE = 0.09; range 1–7) and 4.45 (SE = 0.16; range 1–7), respectively. In bivariate analysis, higher personal and system support were associated with strong clinic leadership culture (personal support: β = 0.08, t-value = 2.66, p = 0.009; system support: β = 0.16, t-value = 4.71, p < 0.001) and lower staff burnout (personal support: β=-0.05, t-value=-3.10, p = 0.002; system support: β=-0.07, t-value=-3.63, p < 0.001). System support was also associated with rural clinic setting (β = 0.61, t-value = 2.34, p = 0.021), strong staff culture (β = 0.14, t-value = 4.70, p = < 0.001), and resource availability (β = 0.16, t-value = 5.76, p < 0.001), and negatively associated with academic clinic setting (β=-0.52, t-value=-2.25, p = 0.026). Thus, while there is encouraging individual support for TIC, RWCs need tools (training and/or resources) to foster leadership and staff culture and trauma support to enable their transition to trauma-informed HIV care.

Physicians are experiencing symptoms of burnout at unprecedented rates. It is essential to assess programmatic factors contributing to physician burnout as actionable items for work climate improvement. Creation of an evidence base of strategies and methods to cultivate a culture of wellness requires iterative assessment, program development and implementation, and evaluation. To serve their function optimally, assessment tools need to be reliable, valid, and sensitive to change. In this Invited Commentary, the authors discuss Vermette and colleagues' report on the Residency Program Community Well-Being (RCWB) instrument. The authors examine the utility of the RCWB, a novel, validated tool that quantifies the subjective community well-being of an individual residency program and has 3 subscales that measure key aspects of interpersonal interactions among residents, with emphasis on those within the program leadership sphere of influence. The commentary authors recommend further validation of the RCWB, but acknowledge the instrument is a useful contribution to currently available measures in the domains of community well-being, workplace climate, and culture of wellness. Workplace interventions focused on community well-being or culture of wellness are particularly salient ethical and educational priorities for medical training programs. Prioritizing community well-being will help nurture trainees as an investment in the future of medical care, rather than an exploitable resource valued primarily for short-term work demands.

INTRODUCTION: Access to patients’ electronic medical records (EMRs) on personal communication devices (PCDs) is beneficial but can negatively impact surgeons. In a recent op-ed, Cohen et al. explored this technology “empowerment/enslavement paradox” and its potential effect on surgeon burnout. We examined if there is a relationship between accessing EMRs on PCDs and surgeon burnout. METHODS: This was a cohort study with retrospective and prospective arms. Trainees and attendings with a background in general surgery completed the Maslach Burnout Index for Medical Personnel, a validated survey scored on three areas of burnout (emotional exhaustion, depersonalization, and low personal accomplishment). Data on login frequency to EMRs on PCDs over the previous 6 mo were obtained. Pearson correlation coefficients were calculated to determine if burnout and login frequency were associated. RESULTS: There were 52 participants included. Residents were 61.5% (n = 32) of participants. The mean login frequency over 6 mo was 431.0 ± 323.9. The mean scores (out of 6) for emotional exhaustion, depersonalization, and personal accomplishment were 2.3 ± 1.1, 1.9 ± 1.2, and 4.9 ± 0.8, respectively. There was no correlation between burnout and logins. Residents had higher median depersonalization scores (2.3 versus 1.2, P = 0.03) and total logins (417.5 versus 210.0, P < 0.001) than attendings. Participants who overestimated logins had higher median emotional exhaustion and depersonalization scores than those who underestimated (2.6 versus 1.4, P = 0.03, and 2.4 versus 0.8, P = 0.003, respectively). CONCLUSIONS: Using EMRs on PCDs is common, but frequency of logins did not correlate with burnout scores in this study. However, perception of increased workload may contribute to experiencing burnout.

Female surgical trainees experience bias that begins at the preclinical stages of medical school, extending into their surgery clerkships, and then into their residency training. There are important implications in terms of training opportunities and career advancement, mentorship, sponsorship, and ultimately burnout. Childbearing and lactation also impact the experiences and perceptions of female trainees who have children. There are limited interventions that have improved the experience of women in surgical training. Mentorship appears to play an important role in ameliorating some of the negative consequences of the training environment and improving outcomes for women surgeons.

PURPOSE OF REVIEW: The aim of this review is defining burnout in medical oncologists, analyzing the causes, and evaluating both individual and institutional approaches to overcome burnout. RECENT FINDINGS: Burnout is defined as a reaction to long-term work-related stress, which is a serious condition and has negative consequences at both personal and professional levels. In recent years, there has been a greater emphasis on burnout in medicine in general and specifically in oncology given the complexity of care provided to oncology patients. More research is being done in this field and more coping strategies are evolving to help oncologists reduce the amount of stress and burnout they are experiencing. SUMMARY: Oncologists need to recognize and acknowledge burnout and use different strategies to find joy in their work while maintaining their work-life balance. Strategies like individual-directed interventions and organizational-directed interventions, such as providing support and resources to oncologists to relieve their work-related stress may have a positive impact on oncologists’ well-being, their patients’ care, and satisfaction.

Project teams often fight to find a balance between the triple restrictions of money, scope, and schedule to deliver excellent products or services. The dual goal of realising benefits and satisfying the needs of stakeholders drives this conflict. It is possible that the climate and pace of the project will not be able to keep up with the increased demand for the deliverables, which will lead to burnout among project members and possibly attrition for the team. In this work, we analyse the factors that lead to project settings that are not sustainable and provide solutions to address the problem. The reading of 28 pieces of literature relating to project management in the information technology (IT), construction, energy, and health sectors is required to accomplish this goal. The results of the review are tabulated and mapped to the process groups and knowledge areas outlined in the 6th edition of the Project Management Body of Knowledge (PMBOK). This is done based on the Project Management Institute (PMI). According to the findings, increasing focus on the Project Resource Management knowledge area, which interacts with the Planning and Executing process groups, is necessary for the development of an environment that is environmentally sustainable. Plan resource management, develop teams, and manage teams are three processes that are included in these categories and fall under the category of being particularly significant. The next most important area of expertise is project communication management, which is followed by project schedule management.

Burnout is characterized by feelings of depersonalization, emotional exhaustion, and low personal achievement, which adversely affects orthopaedic surgeons and their patients. Burnout is increasingly being recognized as a systemic problem, resulting from excessive workloads, administrative burdens, inadequate job resources, and lack of work-life balance. There is a growing movement to develop system-level strategies to address it. Here, we summarize evidence-based organizational strategies and approaches to assist institutions in addressing burnout in orthopaedic surgery, and we summarize key recommendations outlined in landmark burnout guidelines. Among the recommendations made by the World Health Organization (WHO) and the National Academy of Medicine (NAM), we identified seven key themes in order to address burnout, which include: (1) recognizing the presence of burnout and investing in strategies to measure and address it; (2) harnessing leadership support and commitment; (3) establishing and sustaining a culture of wellness and support; (4) promoting diversity and inclusion in the workplace; (5) securing access to mental healthcare and promoting individual resilience; (6) reducing workplace inefficiencies; and (7) enhancing orthopaedic surgeons’ autonomy and control.

OBJECTIVE: To investigate different ways of improving neurology resident wellbeing through enhancing the daily work environment. BACKGROUND: Resident physician burnout has been shown to affect the quality of clinical care provided. Burnout may also lead to major depression and increases risk for suicide amongst physicians. Resident burnout rates were higher during the COVID-19 pandemic. At our academic institution, there is 5 adult neurology residents and 1 pediatric neurology resident per year. We implemented multiple changes to improve the residents’ work environment and therefore alleviate some of the burnout associated with long work hours and isolation during the COVID-19 pandemic. DESIGN/METHODS: Quality improvement project. Different changes were implemented then residents were surveyed to measure satisfaction. All questions were measured across a 3-point scale, “yes”, “no”, “maybe”. Analyses were reported as frequencies. RESULTS: 13 out of 18 residents answered the survey. 100% thought that having a residency wellness chief helped improve wellness overall. 62% reported they worked 70 hours per week. More than 50% felt that getting out on time is the most important thing to their quality of life. 30% of residents thought that feeling heard is most important to them. 92% of residents thought that having snacks and drinks available in the work room was valuable to them. 92% of residents agreed that having a futon in the team room allowed residents to rest during night call amidst the pandemic when there were concerns over sharing call rooms. 62% of residents agreed that we should plan quarterly social events. CONCLUSIONS: Implementing simple measures like appointing a resident wellness, making snacks available in the work room and adding a futon made our residents feel appreciated. These small changes were effective in alleviating some of the stress associated with working during the pandemic.

The electronic health record (EHR) has profoundly changed the practice of medicine and is perceived as both a blessing and a burden by clinicians who use it. While most EHRs now have customizable tools that, if used optimally, can save physicians time, there are also many more unnecessary clicks and automated messages clogging up inboxes.

This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Reducing Administrative Burdens).

BACKGROUND: A National Academy of Medicine report emphasizes the importance of creating positive work environments to address the negative effects of burnout on health care workers. The purpose of this investigation was to determine the scope of burnout among military hospital personnel and explore the relationship between teamwork, burnout, and patient safety culture. METHODS: A logistic regression analysis investigated the relationship between teamwork and burnout using the 2019 US Department of Defense Patient Safety Culture Survey data from 15,838 military hospital workers. Additional regressions investigated teamwork/burnout relationships among individual work areas and staff positions. RESULTS: About one third of respondents (34.4%) reported experiencing burnout. Work areas most likely to report burnout included many different/other work areas (43.4%), pharmacy (41.8%), and labor and delivery/obstetrics (41.8%). Staff positions most likely to report burnout included pharmacy/pharmacists (39.7%), assistants/technicians/therapists (38.1%), and nurses/nursing (37.6%). Analysis revealed an association between lower burnout and high teamwork, both within (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.48–0.60) and across (OR 0.64, 95% CI 0.57–0.72) units. Within-unit teamwork was associated with reduced odds of burnout across almost all work areas and staff positions, with the greatest odds reduction among personnel working in emergency (OR 0.25, 95% CI 0.14–0.43), radiology (OR 0.41, 95% CI 0.20–0.83), and labor and delivery/obstetrics (OR 0.42, 95% CI 0.27–0.65); and physicians/medical staff (OR=0.44, 95% CI: 0.28–0.69), other staff positions (OR 0.48, 95% CI 0.28–0.81), and assistants/technicians/therapists (OR 0.58, 95% CI 0.46–0.73). CONCLUSION: Effective teamwork may reduce burnout in hospital workers. This association between teamwork (particularly teamwork within units) and burnout was found in all work areas, even in those with the highest levels of self-reported workplace chaos. Greater adoption of workplace interventions focused on improving teamwork, such as TeamSTEPPS, is warranted.

You’ve most certainly heard of physician burnout, but there are some related terms that are important for doctors to understand.

BACKGROUND: Every two years, the National Council of State Boards of Nursing (NCSBN) and the National Forum of State Nursing Workforce Centers (Forum) conduct the only national-level survey focused on the entire U.S. nursing workforce. The survey generates data on the supply of registered nurses (RNs) and licensed practical nurses/licensed vocational nurses (LPNs/LVNs). These data are especially crucial in providing information on emerging nursing issues, which in 2022, was the impact of the (COVID-19) pandemic on the nursing workforce. PURPOSE: To provide data critical to planning for enough adequately prepared nurses and ensuring a safe, diverse, and effective healthcare system. METHODS: This study used a mixed-mode approach, involving mailing a national, randomized sample survey to licensed RNs and LPNs/LVNs in most jurisdictions, supplemented by a national, randomized sample survey emailed to licensed RNs and LPNs/LVNs in four jurisdictions and data from the e-Notify nurse licensure notification system for five jurisdictions. Data from RN and LPN/LVN respondents were collected between April 11, 2022, and September 30, 2022. Data included nurse demographics, educational attainment, employment, practice characteristics, and trends. RESULTS: The total number of active RN and LPN/LVN licenses in the United States were 5,239,499 and 973,788, respectively. The median age of RNs was 46 years and 47years for LPNs/LVNs, which reflects a decrease of 6 years for each cohort from the 2020 data. This decline was associated with estimated losses to the workforce of at least 200,000 experienced RNs and 60,000 experienced LPNs/LVNs. An average of 89% of all nurses who maintain licensure are employed in nursing with roughly 70% working full-time. Hospitals and nursing/extended care facilities continue to be the primary practice setting for RNs and LPNs, respectively. Increased proportions of male and Hispanic/Latino nurses have introduced greater racial diversity in the nursing workforce. The nursing workforce is becoming increasingly more educated with more than 70% of RNs holding a baccalaureate degree or higher. More than one-quarter of all nurses report that they plan to leave nursing or retire over the next 5 years. Increased demand from the COVID-19 pandemic and inflation led nursing incomes to rise significantly across the country. Nurses were also specifically asked how the COVID-19 pandemic impacted them, and more than 60% of all nurses reported an increase in their workload because of the pandemic. CONCLUSION: In the wake of the COVID-19 pandemic, the nursing workforce has undergone a dramatic shift with the loss of hundreds of thousands of experienced RNs and LPNs/LVNs. The nursing workforce has become younger and more diverse with increases reflected for Hispanic/Latino and male nurses. An increasing proportion of the RN workforce holds a baccalaureate degree or higher, moving closer to goals established by the National Academy of Medicine. Salaries have notably increased for nurses, likely due to inflation and increased demand for nursing services. With a quarter of the population contemplating leaving the profession, the impact of the pandemic may still be felt in the future.

BACKGROUND: Korean immigrants are among the fastest-growing ethnic minority groups and make up the fifth-largest Asian group in the United States. A better understanding of the work environment factors and its impact on Korean American nurse and primary care provider (PCP) burnout may guide the development of targeted strategies to help mitigate burnout and workplace stressors, which is critical for the retention of Korean American nurses and PCPs to promote better alignment of national demographic trends and meet patients’ preference for cultural congruence with their health care providers (HCPs). Although there is a growing number of studies on HCP burnout, a limited number of studies specifically focus on the experience of ethnic minority HCPs, particularly during the COVID-19 pandemic. Objective: In light of these gaps in literature, the aim of this study was to assess burnout among Korean American HCPs and to identify work conditions during a pandemic that may be associated with Korean American nurse and PCP burnout. METHODS: A total of 184 Korean American HCPs (registered nurses [RNs]: n=97; PCPs: n=87) practicing in Southern California responded to a web-based survey between February and April 2021. The Maslach Burnout Inventory, Areas of Worklife Survey, and Pandemic Experience & Perceptions Survey were used to measure burnout and work environment factors during the pandemic. A multivariate linear regression analysis was used to assess work environment factors associated with the 3 subcategories of burnout. RESULTS: No significant differences were found in the level of burnout experienced by Korean American nurses and PCPs. For RNs, greater workload (P<.001), lower resource availability (P=.04), and higher risk perception (P=.02) were associated with higher emotional exhaustion. Greater workload was also associated with higher depersonalization (P=.003), whereas a greater (professional) community (P=.03) and higher risk perception (P=.006) were associated with higher personal accomplishment. For PCPs, greater workload and poor work-life balance were associated with higher emotional exhaustion (workload: P<.001; worklife: P=.005) and depersonalization (workload: P=.01; worklife: P<.001), whereas only reward was associated with personal accomplishment (P=.006). CONCLUSIONS: Findings from this study underscore the importance of strategies to promote a healthy work environment across multiple levels that recognize demographic variation among Korean American RNs and PCPs, potentially influencing their burnout mitigation needs. A growing recognition of identity-informed burnout experiences across frontline Korean American RNs and PCPs argues for future explorations that capture nuance both across and within this and other ethnic minority nurse and PCP groups. By recognizing and capturing these variations, we may better support the creation of targeted, burnout-mitigating strategies for all.

BACKGROUND: Burnout has risen across healthcare workers during the pandemic, contributing to workforce turnover. While prior literature has largely focused on physicians and nurses, there is a need to better characterize and identify actionable predictors of burnout and work intentions across healthcare role types. OBJECTIVE: To characterize the association of work overload with rates of burnout and intent to leave (ITL) the job in a large national sample of healthcare workers. Design: Cross-sectional survey study conducted between April and December 2020.SettingA total of 206 large healthcare organizations. PARTICIPANTS: Physicians, nurses, other clinical staff, and non-clinical staff. MEASURES: Work overload, burnout, and ITL. Results: The sample of 43,026 respondents (mean response rate 44%) was comprised of 35.2% physicians, 25.7% nurses, 13.3% other clinical staff, and 25.8% non-clinical staff. The overall burnout rate was 49.9% (56.0% in nursing, 54.1% in other clinical staff, 47.3% in physicians, and 45.6% in non-clinical staff; p < 0.001 for difference). ITL was reported by 28.7% of healthcare workers, with nurses most likely to report ITL (41.0%), followed by non-clinical staff (32.6%), other clinical staff (32.1%), and physicians (24.3%) (p < 0.001 for difference). The prevalence of perceived work overload ranged from 37.1% among physicians to 47.4% in other clinical staff. In propensity-weighted models, work overload was significantly associated with burnout (adjusted risk ratio (ARR) 2.21 to 2.90) and intent to leave (ARR 1.73 to 2.10) across role types. LIMITATIONS: Organizations’ participation in the survey was voluntary. CONCLUSIONS: There are high rates of burnout and intent to leave the job across healthcare roles. Proactively addressing work overload across multiple role types may help with concerning trends across the healthcare workforce. This will require a more granular understanding of sources of work overload across different role types, and a commitment to matching work demands to capacity for all healthcare workers.

The COVID-19 pandemic disrupted the world of leadership. Every healthcare professional—front-line staff and leaders alike—adapted their work to confront this virus. The contributions of clinical leaders during the COVID-19 pandemic are unique and important. Experiences of clinical leadership reinforce the critical nature of leadership strategy, quality improvement principles, and commitment to integrated, whole-system quality. Clinical leaders, possessing the dual responsibility of front-line care and system-level leadership, hold critical insights regarding change in healthcare organizations as a whole. In their pandemic response, clinical leaders demonstrated key leadership characteristics that required individual growth and facilitated team cohesion: communicating with consistency and humanity; being the first to try; attending to burnout and moral injury; and building bridges to strengthen the overall response. John Kotter’s landmark book, Leading Change, provides an anchoring framework for examining the experiences and strategies of clinical leaders during the COVID-19 pandemic.

In 2019, the National Academy of Sciences, Engineering, and Medicine identified clinician burnout as a major problem that required immediate action because of its threat to both health care worker safety and patient safety. Unfortunately, the rise of COVID-19 in 2020 with no signs of a clear ending (as of the summer of 2022) has compounded this problem. Consequently, much focus has been placed by many to address clinician burnout and help alleviate this major threat to safety. Unfortunately, compared with clinician burnout, articles and resources to address frontline leader (FL) burnout are fewer. FLs are key to supporting teams and are integral to their success. They also execute and operationalize organizational strategic plans to ensure patient safety at the point of care. The burnout issue with bedside clinicians is a big issue, a fractured fault line in our health care system. However, without addressing the well-being of FLs, this fault line becomes a chasm. The column shares background from the American Organization for Nursling Leadership longitudinal studies and other pertinent research. It also provides examples of practices across the nation of how nurse executives are supporting their teams and promoting leader support and well-being.

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