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Burnout is a common term in the medical profession, specifically regarding the prevalence among physicians; however, physician assistants have been found to have comparable burnout rates to physicians, but the topic has received less attention. Many techniques have been evaluated in the treatment and prevention of burnout. Mindfulness techniques have reduced burnout among physicians and can be extrapolated to treating burnout with physician assistants. Strategies can be implemented within a busy schedule and have been proven to reduce stress and burnout. However, more research is needed on the direct impact of Mindfulness on physician assistants. This article will highlight the prevalence of burnout in physician assistants, how to identify burnout, and the role of Mindfulness in combating burnout. Recognition of burnout is essential to treat it, and budget constraints often impact programming options. Mindfulness has been proven to reduce burnout and can be implemented time-efficient and cost-effectively.

Moral Injury is an emerging construct that has been primarily examined in military groups but is increasingly expanding to a broader range of non-military occupational settings. A key barrier to this research on moral injury in broader occupational groups has been the lack of valid and reliable measures specifically developed for non-military settings. The current paper addresses this gap by developing the Occupational Moral Injury Scale (OMIS), a measure designed to capture both morally injurious events (MIEs) and primary markers of moral injury (guilt, shame, anger, loss of trust, existential conflict) in any occupational setting, without the need for modification. A combination of Confirmatory Factor Analyses (CFA) and Item Response Theory (IRT) analyses were used in scale development and refinement. Drawing upon a sample of 1454 frontline health and first responder workers across two studies, factor analytic results revealed an expected bifactor structure of five primary factors capturing exposure to morally injurious events (MIEs; Commission with Agency, Commission under Duress, Act of Omission, Witnessing, Betrayal) and a general factor of moral injury. Subscales demonstrated excellent internal consistency, and when compared to theoretically relevant constructs OMIS scores demonstrated strong convergent and divergent validity. Differential validity was also observed among the OMIS subscales. The OMIS provides a psychometrically validated tool for assessing moral injury risk in any occupational setting. The OMIS will help facilitate further research and understanding of how moral injury presents in high-risk occupational settings beyond the military and allow for direct comparison between these groups for the first time.

The COVID-19 response introduced legal restrictions on social distancing globally, affecting healthcare staff personally and professionally. These restrictions suspended routine hospital visiting, which may have left staff feeling they had to compromise on the care they provided. Such conflict may be experienced as moral injury. This scoping review aimed to synthesise international evidence, to answer this question: “Have COVID-19 restrictions affected healthcare staff’s experiences of moral injury? If so, how?” Nine studies met the search criteria. Although healthcare staff seemed to be aware of the risks and effects of moral injury, they were still reluctant to “name” it. Healthcare staff’s own emotional and spiritual needs were mostly ignored. Although psychological support is often the recommended approach by organisations, a greater focus on spiritual and emotional support is recommended.

Physicians, physician assistants (PA’s), and nurse practitioners (NP’s) are medical care providers who perform history and physical exams to create treatment plans for patients seeking medical care and are known collectively as clinicians. Clinicians have a high rate of burnout initially attributed to the amount of stress from their careers in the ever-changing field of medicine. Burnout was prevalent prior to the start of the Coronavirus disease of 2019 (COVID-19) pandemic in 2020 and has continued to increase during the pandemic due to added stress of a new disease, daily changes in protocols, lack of personal protective equipment (PPE), staff shortages, increased workloads, and lack of needed resources. Burnout is a multifactorial process, leading to emotional exhaustion, depersonalization, and finally a loss of purpose. Organizations pay a large price for the burnout of clinicians due to increased medical errors, decreased productivity, lines of service loss, and clinician turnover. Studies were conducted to define burnout, determine root causes, and find solutions to help improve medicine. Initially, organizations placed the onus on clinicians to improve their own burnout, but more recent studies show clinician control is only one piece of the puzzle. Leadership can play a key role in reducing, preventing, or conversely contributing to burnout in clinicians. This clinical review article looks at the root causes of burnout, and ways in which leadership style can exacerbate or ameliorate the problem of clinician burnout.Method: A PubMed literature search was conducted using the term physician, clinician, burnout, and leadership styles in numerous combinations. Fifty-one articles were found and eighteen are used in this clinical review article.Results: Clinician burnout is driven by factors beyond their perceived control, specifically autonomy, loss of control of scheduling, work environment, and misaligned values with the organization. Organizational leaders play a key role in most of these components and can either compound or decrease burnout in the clinicians they manage. Creating a wellness - centered leadership model can lead to improvement of organizational culture, increased support of clinicians, identification and development of clinical talent, and alignment of clinician and organizational missions and values. This type of organizational culture decreases clinician burnout.Conclusion: Burnout is an epidemic among clinicians affecting over 50% of the workforce. It is important for organizations to address clinician burnout to improve the health of organizations and the communities they serve. Leadership at all levels can create an organizational culture that decreases and even prevents burnout rather than adding to it

This review investigated the prevalence of burnout syndrome among nursing students through a meta-analysis. The results showed an overall prevalence of burnout among nursing students at 46%, with mild burnout at 26.1%, moderate burnout at 47.7%, and severe burnout at 22.5%. There was a positive correlation between the academic semester and the average level of burnout, with an increase in academic semesters, burnout among students increases. The high prevalence of burnout among nursing students can impact their academic achievement, increase dropout rates, and affect the quality of care provided in the future. To mitigate burnout, interventions should be implemented early in nursing programs. Nurse educators can play a significant role in creating an engaging learning environment to build resilience and reduce burnout. Nursing students can also take care of themselves by having a suitable time management plan, engaging in regular recreational and sports activities, meditating, and getting enough sleep. This review emphasized the importance of addressing burnout in nursing education to ensure the well-being of future nurses and the quality of patient care.

Physician Associate, formerly known as Physician Assistant, (PA) is a growing occupation that originated in the 1960s. Previous research focused on the prevalence of musculoskeletal disorders and burnout in nursing, nursing students, PA, and ubiquitously assumed among many healthcare professionals; however, burnout and musculoskeletal disorders are under-researched in PA students. PURPOSE: To investigate the prevalence of burnout and musculoskeletal disorders in Physician Associate students. METHODS: This study was conducted at a private university in Florida. Twelve PA students participated in the study, nine females and three males (mean age 26.3 ± 1.8 years; mean height 166.6 ± 7.6 cm; mean weight 67.9 ± 14.0 kg). Eleven PA students were in their fifth clinical rotation and one in their sixth. Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI) and the Canadian Medical History Checklist: Symptoms Survey for Work-Related Musculoskeletal Disorders (WMSDs) were used. In the MBI questionnaire, burnout was quantified by three subcomponents: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). The WMSDs questionnaire measured the degree of acute pain in the neck, shoulder, elbow, wrist, hand, upper back, lower back, and foot. Participants filled out the two questionnaires in one session and the data were collected and analyzed. RESULTS: In the MBI survey, 84% of participants reported high to moderate EE (67% high, 17% moderate, and 17% low); 58.3% of participants reported high to moderate DP (33.3% high, 25% moderate, and 41.7% low); 66.6% of participants reported high to moderate PA (33.3% high, 33.3% moderate, and 33.3% low). In the WMSDs questionnaire, 75% of participants reported having pain or discomfort, in the last year, caused by their job that lasted two days or more in the neck, shoulder, and upper back, whereas 58% reported lower back pain or discomfort. Out of all participants reporting pain or discomfort, several participants reported that pain worsened while working, 67.7% reported for the neck; 44.4% for the shoulder; 67.7% for the upper back; and 57.1% for lower back pain. CONCLUSION: The results of the questionnaires indicated a high prevalence of burnout and musculoskeletal disorders in PA students. Physician Associate programs should include educational content emphasizing techniques to minimize burnout and reduce the prevalence of musculoskeletal disorders. Further research is needed to identify the influence of physical activity and relaxation techniques on burnout levels and the prevalence of musculoskeletal disorders in PA students.

Professional burnout refers to mental weariness caused by occupational stress. However, there is a lack of systematic studies on the prevalence of professional burnout among dentists. The purpose of this study was to investigate the prevalence of professional burnout among dentists. Databases including PubMed, PsycINFO, Embase, Cochrane, and Web of Science were systematically searched from inception to 28 October 2021. The random-effects model and forest plots were used to assess the pooled prevalence of professional burnout among dentists. A total of 15 studies with a total of 6038 study subjects were included in the meta-analysis, and the overall professional burnout among dentists was 13% (95%CI: 6–23). Subgroup analysis suggested a high prevalence of burnout in Europe, and the least in the Americas. The pooled burnout prevalence in cross-sectional surveys was significantly lower than that in longitudinal studies. In addition, the overall burnout prevalence in the last decade was significantly lower than that of a decade ago. This meta-analysis demonstrated that the prevalence of burnout was relatively low among dentists, and there was a downward trend. Therefore, it is important to continue to pay close attention to the mental health of dentists and effectively prevent and treat professional burnout to better maintain the provision of health care services.

RATIONALE: Anxiety is an increasingly common problem in society, including at work, yet the effects of an emotional culture of anxiety remain unexplored. We offer a new lens on anxiety in the workplace, examining its collective enactment in the form of an emotional culture of anxiety. OBJECTIVE: This study examines the implications of an emotional culture of anxiety for psychological and financial outcomes within a poorly performing healthcare organization. We also examine whether an emotional culture of companionate love, which helps people “calm and connect”, can counteract the negative effects of an emotional culture of anxiety. METHODS: Drawing on survey data of 822 employees from 85 departments in a large US medical center and a time-lagged archival measure of financial performance across those departments, we used ordinary least squares regression and random coefficient regression modeling to examine the main effects of these two emotional cultures and the buffering effect of an emotional culture of companionate love on an emotional culture of anxiety for department costs, department psychological safety, and individual employee burnout and satisfaction. RESULTS: We find significant direct relationships between an emotional culture of anxiety and an emotional culture of companionate love on employee burnout and satisfaction in the predicted directions. We also find a significant interaction between the two emotional cultures, with a culture of companionate love attenuating the relationship of a culture of anxiety on job satisfaction, burnout, and financial performance in the form of time-lagged department costs. CONCLUSIONS: Our results indicate that a culture of companionate love can be a protective force against the negative outcomes of an emotional culture of anxiety. Examining these two emotional cultures concurrently offers a better understanding of how to address the pernicious effects of anxiety in organizations.

The shortage of healthcare workers is a growing problem across the globe. Nurses and physicians, in particular, are vulnerable as a result of the COVID-19 pandemic. Understanding why they might leave is imperative for improving retention. This systematic review explores both the prevalence of nurses and physicians who are intent on leaving their position at hospitals in European countries and the main determinants influencing job retention among nurses and physicians of their respective position in a hospital setting in both European and non-European countries. A comprehensive search was fulfilled within 3 electronic databases on June 3rd 2021. In total 345 articles met the inclusion criteria. The determinants were categorized into 6 themes: personal characteristics, job demands, employment services, working conditions, work relationships, and organizational culture. The main determinants for job retention were job satisfaction, career development and work-life balance. European and non-European countries showed similarities and differences in determinants influencing retention. Identifying these factors supports the development of multifactorial interventions, which can aid the formulation of medical strategies and help to maximize retention.

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This resource is found in our Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Support Career Development).

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BACKGROUND: There have been numerous studies examining student-faculty and faculty-student incivility in nursing programs (Atmiller, 2012; Clark et al., 2021; Clark & Springer, 2010; Eka & Chambers, 2019; Tourangeau et al., 2014). Research on faculty-to-faculty incivility in nursing programs has been lacking. PURPOSE: The purpose of this study was to determine if there was a relationship among faculty-to-faculty incivility, job satisfaction and intent to leave. Furthermore, this study examined the barriers to addressing incivility, the contributing factors to workplace incivility and strategies to improve workplace incivility. METHODS: The initial sampling method used was a randomized stratified cluster sampling method. Due to a poor response rate the sampling process was changed to convenience sampling. The researcher collected data using The Workplace Incivility/Civility Survey. Additional questions were added to collect demographic data, incidences of incivility in the workplace, the physical and emotional response to these incidences, job satisfaction and intent to leave. RESULTS: Data analysis showed that 50 % of the participants believe faculty-to-faculty incivility is a moderate to severe problem in their workplace. Furthermore, there is a negative correlation between faculty-to-faculty incivility and job satisfaction or faculty retention. Additional findings showed that 38.6 % of the participants had minimal to no confidence in addressing workplace incivility. Fear of professional or personal retaliation was the greatest barrier to addressing workplace incivility. CONCLUSION: The current nursing faculty shortage has created a barrier to addressing the nursing workforce shortage. Universities and nursing programs need to address the factors that lead to decreased job satisfaction and faculty attrition with incivility being one of the factors.

BACKGROUND: Resilience aids healthcare professionals in navigating through and bouncing back from stressful situations in the workplace. Resilience can increase job satisfaction, work motivation, and professional commitment while decreasing burnout, and ultimately job turnover. More resilient employees experience lower instances of burnout and greater life satisfaction. OBJECTIVE: The primary study objective is to determine the relationship that pharmacist resilience has on burnout and job performance. METHODS: Licensed pharmacists in Florida were sent a Qualtrics survey (Qualtrics, Provo, UT) via email, which included demographics data, and valid and reliable assessment tools for resilience, burnout, and job performance. Linear regressions were used to test if resilience significantly predicted each of the output variables: burnout and job performance. RESULTS: Survey responses were received from 942 pharmacists. The regressions showed that resilience significantly predicted both burnout (β1 = −.701, P < .001) and job performance (β1 = .35, P < .001). As resilience increased, the levels of burnout decreased, and job performance increased. Resilience explained 29% of the variance in burnout, and 11% of the variance in job performance. CONCLUSION: The results of this study suggest that resilience significantly predicts both pharmacist work-related burnout and job performance. The more resilient the pharmacist, the lower the chances of work-related burnout and the higher the likelihood of better job performance. Organizations should pursue opportunities to educate healthcare workers on methods to increase resilience and to bring attention to the importance of this topic.

OBJECTIVE: Burnout during residency education is a phenomenon which requires careful study. A single item for measuring burnout shows promise for its brevity and concordance with the most commonly used measure of burnout, the Maslach Burnout Inventory, but has not been compared to the Copenhagen Burnout Inventory. We compared the single-item measure of burnout question to the Copenhagen Burnout Inventory to assess the convergence between these two measures of burnout. METHOD: Family Medicine residents (n = 32) from three residency programs completed the single-item measure of burnout question and the Copenhagen Burnout Inventory. We compared the single-item measure of burnout measure to the three scales of the Copenhagen Burnout Inventory. RESULTS: Our analyses indicated that the single item measure is highly correlated with personal burnout (r = .76), moderately correlated with patient burnout (r = .58), and not correlated with work burnout (r = .18). CONCLUSIONS: Because the single-item measure of burnout is particularly useful for identifying personal burnout, it should be useful for identifying early signs of burnout amount physicians in training.

Over many decades, CHWs, CHRs, Promotoras and other members of our community-based, frontline workforce have advocated and organized to articulate the CHW identity. Yet CHWs’ identities, origins and capacities are still not well understood in the U.S. – resulting in strategies, policies and programs that often do not respect, protect or authentically partner with us.  

NACHW, in partnership with CHWs, CHW Networks and allies across the country have developed the Six Pillars of Community Health Workers – to communicate clearly and succinctly who we are, where we are, what we do, and our capacity and needs for sustainability.

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This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Operational Strategies (Rewarding & Recognizing Workers and Learners).

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OBJECTIVES: The aims of the study were to describe the well-being and lifestyle behaviors of health-system pharmacists during the COVID-19 pandemic and to determine the relationships among well-being, perceptions of workplace wellness support, and self-reported concern of having made a medication error. METHODS: Pharmacist (N = 10,445) were randomly sampled for a health and well-being survey. Multiple logistic regression assessed associations with wellness support and concerns of medication error. RESULTS: The response rate was 6.4% (N = 665). Pharmacists whose workplaces very much supported wellness were 3× more likely to have no depression, anxiety, and stress; 10× more likely to have no burnout; and 15× more likely to have a higher professional quality of life. Those with burnout had double the concern of having made a medication error in the last 3 months. CONCLUSIONS: Healthcare leadership must fix system issues that cause burnout and actualize wellness cultures to improve pharmacist well-being.

BACKGROUND: The events surrounding the COVID-19 pandemic have created heightened challenges to coping with loss and grief for family and friends of deceased individuals, as well as clinicians who experience loss of their patients. There is an urgent need for remotely delivered interventions to support those experiencing grief, particularly due to growing numbers of bereaved individuals during the COVID-19 pandemic. OBJECTIVE: To determine the feasibility and acceptability of the brief, remotely delivered StoryListening storytelling intervention for individuals experiencing grief during the COVID pandemic. Setting/Subjects: A single-arm pilot study was conducted in the United States. Participants included adult English-speaking family members, friends, or clinicians of individuals who died during the COVID-19 pandemic. All participants engaged in a televideo StoryListening session with a trained StoryListening doula. MEASUREMENTS: Participants completed a brief follow-up telephone interview two weeks after the StoryListening session. We describe enrollment and retention data to assess feasibility and conducted a deductive thematic analysis of the follow-up interview data to assess acceptability. RESULTS: Sixteen clinicians and 48 friends/family members enrolled in the study (n = 64; 75% enrollment), 62 completed a StoryListening session; 60 completed the follow-up interview. Participants reported that the intervention was useful and offered a valuable opportunity to process their grief experience. CONCLUSIONS: The StoryListening intervention is feasible and acceptable for friends/family members and clinicians who have experienced grief during COVID. Our intervention may offer an accessible first-line option to address the increasing wave of bereavement-related distress and clinician burnout in the United States.

PURPOSE OF REVIEW: To describe the unique stressors of surgical training and fellowship and how grit and resilience influence trainee wellness

RECENT FINDINGS: Surgical training is an intense, high-stress experience. For fellows-in-training, unique stressors are associated with this chapter of training, from financial pressors to the stress of job acquisition. Wellness is essential for surgical fellows, not just for the critical need for quality mental health of providers, but also for the patients who are also affected by provider burnout. There are various wellness programs that can be instituted nationally and institutionally to optimize fellow wellness, but one of the most high-yield foci for fellow wellness is focused mentorship, the key to assuring wellness and harnessing grit.

SUMMARY: Surgical residency and fellowship are prodigiously demanding experiences, which mandate grit and resilience. It is imperative that widespread cultural and institutional changes take place to best support surgical trainees.

BACKGROUND: The global coronavirus disease 2019 (COVID-19) pandemic has necessitated considerable changes in the delivery of pharmacy services, with pharmacists experiencing increasing demands and a high rate of burnout. The ability to categorize pharmacists based on their burnout risk and associated factors could be used to tailor burnout interventions. OBJECTIVE: This study aimed to identify subgroups (profiles) of pharmacists and use these profiles to describe interventions tailored to improve pharmacist’s well-being. METHODS: A survey was disseminated to pharmacists working in Australia during April and June 2020. The survey measured demographics, burnout, and psychosocial factors associated with working during COVID-19. A two-step cluster analysis was used to categorize pharmacists based on burnout and other variables. RESULTS: A total of 647 survey responses contained data that were used for analysis. Participants were mostly female (75.7%) and working full time (65.2%). The final cluster analysis yielded an acceptable two-cluster model describing 2 very different pharmacist experiences, using 10 variables. Cluster 2 (representing 53.1% of participants) describes the “affected” pharmacist, who has a high degree of burnout, works in community pharmacy, experiences incivility, is less likely to report sufficient precautionary measures in their workplace, and has had an increase in workload and overtime. In contrast, cluster 1 (representing 46.9% of participants) describes the profile of a “business as usual” hospital pharmacist with the opposite experiences. Interventions focused on the “affected” pharmacist such as financial support to employ specialized staff and equitable access to personal protective equipment should be available to community pharmacists, to reduce the risk to these frontline workers. CONCLUSION: The use of cluster analysis has identified 2 distinct profiles of pharmacists working during COVID-19. The “affected” pharmacist warrants targeted interventions to address the high burnout experienced in this group.

Nurse leaders are thinking outside the box to solve some of nursing's current challenges and bring joy back to practice. Find out how chief nursing executive Kathy Howell is working to solve three of nursing's common challenges at UCHealth, transforming patient care delivery, and creating a better working environment for nurses.

This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Workplace Violence Prevention) and Improving Workload & Workflows (Optimizing Teams).

BACKGROUND: It has been shown that the burnout rate for emergency medicine providers is among the highest seen in healthcare. While resilience and grit have been studied as protective against burnout, the ability to thrive may be a more useful target. Thriving has previously been defined as a combination of vitality—having energy available and feeling “alive”—and learning—acquiring and applying valuable knowledge. Thriving has been found to be dependent on several categories, one of which is unit contextual features (UCFs). UCFs are factors such as challenge or hindrance stressors, autonomy, and trust. OBJECTIVES: This study is being done to determine if Emergency Medicine residents are thriving, and what UCFs are contributing to their ability or inability to thrive during residency. Methods: We administered a mixed-methods survey developed from previously validated surveys regarding the UCFs and overall thriving to emergency medicine residents at one four-year emergency medicine residency training program in March of 2022. RESULTS: We received 38 responses (out of 58 residents) with 8-11 respondents per PGY level. Overall thriving score for all residents was 3.2/5. First-year residents had a score of 3.5/5 while 2nd-4th years each had a score of 3.1/5. Social support was the UCF that most contributed to thriving while hindrance stressors, challenge stressors, and autonomy negatively affected the residents’ thriving. CONCLUSIONS: We found ideal targets for interventions from the survey, with qualitative responses that can help guide those interventions to increase thriving. Other residencies could similarly use this survey to identify targets for intervention. Responses highlighted hindrance stressors present in the ED that would be ideal targets for intervention, while targeting social support may not have as much of an impact. The study was limited due to administration once during the year as time during the academic year may affect the level of thriving.

[This is an excerpt.] Nurses have long been a vital component of the healthcare ecosystem, providing critical care to patients, communicating with families, and helping other members of their healthcare team stay in step, working together to provide care. As a former ICU nurse, I know how busy and stressful the nursing profession can be, often balancing work, kids and family, hobbies, and more. After particularly emotionally draining days, I would remind myself of my “Why.” Why am I in healthcare? Why do I do what I do? For me, it was the faces of patients looking for answers or hope, my relationships with fellow exhausted coworkers putting in long hours, and friends and family members as they waited for updates on their loved ones. [To read more, click View Resource.]