Resource Library

PURPOSE: Intensive care unit (ICU) caregivers are exposed to high levels of stress. Work-related stress can impact quality of life and may lead to burnout. Virtual reality (VR) simulates a person's presence in a pleasant and enjoyable artificial environment. Thus, VR may be used to improve breaktime efficacy during the work shift of ICU caregivers. OBJECTIVE: The study objectives were to evaluate the feasibility and efficacy of VR to decrease stress, anxiety, and fatigue, as well as to increase work disconnection during the breaktime. METHODS: We conducted a prospective, monocentric, open-label, crossover, randomised study comparing a half an hour breaktime including an 8-min-long VR session and a usual breaktime among ICU caregivers, on two consecutive work shifts. Participants were evaluated before and after the breaktime as well as at the end of the work shift for stress, anxiety, fatigue, and work disconnection using visual analog scales. RESULTS: For the 88 participants, VR was easy to use. VR induced a significantly higher reduction in the fatigue score after the breaktime. Individual changes in the fatigue score were +0.17 (1.87) vs. −0.33 (1.87). A significantly higher feeling of disconnection from the work environment at the end of the breaktime was also observed with VR: 5.98 (3.04) vs. 4.20 (2.64). No significant difference was observed for other parameters, in particular at the end of the shift. CONCLUSION: VR sessions could improve the efficacy of breaktimes among ICU caregivers and contribute to a better quality of work life; repeated or longer sessions may be required to induce sustained effects.

In January 2022, HRSA awarded 44 grants under the [1] Promoting Resilience and Mental Health among the Health Professional Workforce and [2] Health and Public Safety Workforce Resiliency Training Program. Alongside the 44 grantees, HRSA funded a technical assistance center - the WCC - to support grantees’ work and contribute to a national framework to address burnout, suicide, mental health, substance use, and resiliency, incorporating evidence-based strategies.  

In 2022, the WCC conducted a review of 43 of the 44 grantee proposals, voluntarily shared by grantees. As part of this review, we identified the measurements instruments for mental health, burnout, and moral injury proposed by the grantees. This information was shared back with grantees in August/September of 2022 as part of a brief summary of each grantee's projects and activities, and grantees updated the information as appropriate (34 grantees provided updates).  

The measurement instruments utilized by the HRSA grantees are provided in this inventory. They are organized as instruments used by: 1) multiple grantees (i.e., more than one); 2) by one grantee; and 3) additional instruments identified as part of the WCC's literature review and environmental scan.  

Measurement instruments are further categorized into 3 major areas: 1) Mental & Physical Health includes mental & physical health, resilience, and personal & social risk factors in this area; 2) Burnout includes measures of burnout, job satisfaction, and the work environment; 3) Moral Injury focuses on the experience of moral distress/injury and the organizational characteristics of shared governance aimed at institutionalizing worker engagement. We recognize these areas overlap.  

Links and survey questions are provided when instruments are publicly available (see spreadsheet tabs). For instruments that appear to be proprietary, we provide links to the instrument when they are available online and/or links to the proprietary websites.

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The Workplace Change Collaborative (WCC) was funded by the Health Resources and Services Administration to develop a “national framework that supports the rapid deployment of evidence informed or evidence-based strategies to reduce and address burnout, suicide, mental health conditions and substance use disorders and enhance resiliency.”

We developed the National Framework using an iterative process, including:

1. ‍Literature review, building from the seminal 1999 work of Leiter and Maslach, Six Areas of Worklife: A Model of the Organizational Context of Burnout;‍
2. Environmental scan, including a review of national and global reports addressing burnout and moral injury in health and public safety workers, as well as interviews with key national experts;‍
3. Review of 44 HRSA grantees’ target populations, planned activities, intended outcomes, and evaluations; and‍
4. External review of the draft National Framework by a broad group of 40+ national experts, health and public safety workers, and learners.

This reports summarizes the drivers, process, and outcomes of burnout and moral injury in the health and public safety workforce, as well as, actionable strategies to improve the well-being of the workforce for health and public safety organizations, government, and other key stakeholders.

[This is an excerpt.] By establishing wage boards, Oregon can improve wages and working conditions that foster a stable workforce, thriving communities, and a healthy economy. Presently, the majority of Oregon workers experience wages and benefits that are inadequate to support their families. Black and brown Oregonians are more likely to be shortchanged. Laws set up to protect workers’ right to join with others to bargain for a better deal are poorly enforced or outdated. This leaves workers exploited, honest employers disadvantaged, and the economy hampered by exorbitant levels of inequality. New approaches to addressing challenges faced by workers today are gaining traction, among them a concept called wage boards. To shore up the power of collective action and to build a healthier economy, Oregon should establish wage boards, as described in this policy brief. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Strengthen Worker Compensation and Benefits).

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[This is an excerpt.] Wellness-centered leadership refers to the idea that the behaviors of health care leaders influence the organizational culture, which is a powerful driver of well-being for health care professionals. In particular, leaders are responsible for generating trust in their organizations, both internally among clinicians and other employees, as well as externally among patients and the community. This trust fosters clinician well-being and is critical for good patient care. [To read more, click View Resource.]

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

BACKGROUND: To support healthcare workers (HCWs) during the increased burden caused by the SARS-CoV-2 pandemic, numerous recommendations for action and possible interventions have been developed. However, the actual protective factors, needs and desires of those affected, as well as potential barriers to implementing psychological interventions, have been insufficiently examined. This study addresses this research gap and captures HCWs' experiences and views. METHODS: Medical personnel including nursing staff and physicians were recruited for a qualitative study regarding protective factors as well as barriers to the implementation of support services. We conducted 21 individual, semistructured interviews with members of the medical staff at tertiary care center in Germany. The collected data were analyzed using a qualitative content analysis. RESULTS: The analyses showed that social interaction in the professional and private context was rated as helpful in coping with the challenges of everyday work amplified by the SARS-CoV-2 pandemic. The results also suggest that the available support services, despite being highly valued, were rarely accessed. Possible barriers included the fear of negative consequences when asking for support. It could be deduced that the fear and shame of admitting one's own mistakes as well as the work-related tradition of showing no weakness could be the underlying factors for this fear. The results of this study suggest that medical staff need a more extensive range of low-threshold support services, which should be adapted to the respective needs of the professional groups. The study also provides indica?tions that the norms and expectations represented in the hospital system require critical reflection.

This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Stress/Trauma & Resilience).

[This is an excerpt.] Leadership burnout is high and the risks of not addressing it could be devestating with the loss of an organization's investment in leaders and a decrease in team morale and momentum...[To read more, click View Resource.]

OBJECTIVE: We sought to quantify the effects of in-house call(IHC) on sleep patterns and burnout among acute care surgeons (ACS). BACKGROUND: Many ACS take INC, which leads to disrupted sleep and high levels of stress and burnout. METHODS: Physiological and survey data of 224 ACS with IHC were collected over 6 months. Participants continuously wore a physiological tracking device and responded to daily electronic surveys. Daily surveys captured work and life events as well as feelings of restfulness and burnout. The Maslach Burnout Inventory (MBI) was administered at the beginning and end of the study period. RESULTS: Physiological data were recorded for 34,135 days, which includes 4389 nights of IHC. Feelings of moderate, very, or extreme burnout occurred 25.7% of days and feelings of being moderately, slightly, or not at all rested occurred 75.91% of days. Decreased amount of time since the last IHC, reduced sleep duration, being on call, and having a bad outcome all contribute to greater feelings of daily burnout ( P <0.001). Decreased time since last call also exacerbates the negative effect of IHC on burnout ( P <0.01). CONCLUSIONS: ACS exhibit lower quality and reduced amount of sleep compared with an age-matched population. Furthermore, reduced sleep and decreased time since the last call led to increased feelings of daily burnout, accumulating in emotional exhaustion as measured on the MBI. A reevaluation of IHC requirements and patterns as well as identification of countermeasures to restore homeostatic wellness in ACS is essential to protect and optimize our workforce.

[This is an excerpt.] When healthcare staff have to make care decisions that go against their values, a conflict of conscience can arise. The concepts of moral injury and moral distress came to the fore in nursing during the COVID-19 pandemic when, says mental-health nurse researcher Emily Wood, healthcare professionals were being placed in difficult circumstances. They were, for example, having to make decisions about which of the sickest patients could be admitted to a limited number of intensive care beds. [To read more, click View Resource.]

Nurse practitioners (NPs) account for one-third of all hospital palliative care (PC) consults, and are prone to burnout and depersonalization (DP). DP threatens personalized communication fundamental to PC. This literature review examines instruments validated to measure burnout and DP. An electronic literature review of instruments previously used to measure burnout and DP was conducted in six databases. Three instruments were included in the review; the Maslach Burnout Inventory (MBI)-Human Service Survey (HSS), the Burnout Assessment Tool (BAT), and the Oldenburg Burnout Inventory (OLBI). All three instruments measure DP or similar constructs and are validated in English, but only the OLBI and the BAT measure burnout with a sum score of the constructs. The OLBI has been validated on a single U.S. population study and as a patient-reported outcome measure (PROM) in Europe. The BAT is the newest instrument and has not been validated on any U.S. population.

This Viewpoint highlights the increasing levels of burnout among physicians, discusses how burnout can erode professionalism, and suggests possible steps physicians and health care organizations might take to lessen burnout and maintain professionalism in the setting of burnout.

BACKGROUND: Critical care nurse shortages and burnout have spurred interest in the adequacy of nursing supply in the United States. Nurses can move between clinical areas without  additional education or licensure. PURPOSE: To identify transitions that critical care nurses make into non-critical care areas, and examine the prevalence and characteristics associated with those transitions. METHODS: Secondary analysis of state licensure data from 2001-2013. DISCUSSION: More than 75% of nurses (n = 8,408) left critical care in the state, with 44% making clinical area transitions within 5 years. Critical care nurses transitioned into emergency, peri-operative, and cardiology areas. Those observed in recession years were less likely to make transitions; female and nurses with masters/doctorate degrees were more likely. CONCLUSION: This study used state workforce data to examine transitions out of critical care nursing. Findings can inform policies to retain and recruit nurses back into critical care, especially during public health crises.

Registered nurse retention is declining, with a national turnover rate in 2021 of 27%. After implementing a toolkit, nursing leaders in 1 organization completed 75 stay interviews with nurses in a cardiothoracic telemetry and a cardiothoracic surgical intensive care unit. Nurses reported that unit culture, team/peers, and scheduling were important in decisions to stay in their positions, but respondents considered leaving for salary, growth/development, and traveling opportunities. The stay interview process affords nurse leaders an opportunity to examine why nurses stay or leave and supports the development of targeted retention strategies.

At present, less than 30% of researchers worldwide are women. Long-standing biases and gender stereotypes are discouraging girls and women away from science-related fields. Science and gender equality are, however, essential to ensure sustainable development as highlighted by UNESCO. In order to change traditional mindsets, gender equality must be promoted, stereotypes defeated, and girls and women should be equally represented in the proportion of researchers worldwide. Therefore, Frontiers in Pediatrics is proud to offer this platform to promote the work of women researchers, across the field of pediatric critical care.

The work presented here highlights the diversity of research performed across the entire breadth of pediatric critical care-related research and presents advances in theory, experiment, and methodology with applications to compelling problems.

BACKGROUND: The rapid transition to online teaching during the COVID-19 pandemic created additional stress and workload issues for nurse faculty. Burnout has been reported in nurse faculty who cite workplace factors that influence satisfaction and work-life balance as major contributing factors. PURPOSE: The purpose of this study was to examine life balance and professional quality of life among nurse faculty (N = 216) in 2021 during the first year of the COVID-19 pandemic and to describe the challenges of delivering virtual learning experiences. METHODS: A cross-sectional design was utilized to survey nurse faculty using the Life Balance Inventory and the Professional Quality of Life Scale. Descriptive statistics and correlations were calculated. RESULTS: Nurse faculty reported an unbalanced life balance (median = 1.76), average compassion satisfaction (median = 40.00), average burnout (median = 24.00), and low secondary traumatic stress (median = 21.00). Narrative themes included (1) COVID-19 pandemic has made balance nearly impossible, (2) Intentional disconnection from work activities, (3) Challenging/changing priorities, (4) Promoting a healthy work environment, and (5) Moral distress and exhaustion. DISCUSSION: Understanding the factors that influence nurse faculty delivery of virtual learning experiences during the COVID-19 pandemic may provide opportunities to improve nurse faculty work-life balance and professional quality of life.

As defined by the International Classification of Diseases 11th revision, burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: feelings of energy depletion or exhaustion, feelings of negativism or cynicism related to one's job, and reduced professional efficacy. Multiple studies using the most widely accepted standard for burnout assessment—the Maslach Burnout Inventory—reported an increased incidence of burnout amongst all healthcare workers, particularly physicians. The most reported factor leading to burnout is the lack of appropriate work-life integration (WLI). WLI is a complex issue that requires prioritization, value alignment, boundary setting, and lifelong work. This chapter highlights a few of the many barriers to WLI in medicine, the impact of burnout on the delivery of quality care, and strategies to achieve a goal-based WLI for healthcare workers offering direct patient care during and after training.

Despite growth in private equity (PE) acquisitions of physician practices in the US, little is known about how changes in ownership influence workforce composition. Using clinician-level data linked to practice acquisition information, we estimated changes in clinician workforce composition in PE-acquired practice sites relative to non-PE-acquired independent practice sites for dermatology, ophthalmology, and gastroenterology specialties. We calculated a clinician replacement ratio (cumulative number of entering clinicians during 2014–19 divided by the cumulative number of exiting clinicians) across 213 PE-acquired practices and 995 matched non-PE-acquired practices. Using a difference-in-differences approach, we also examined practice-level changes in yearly clinician counts at PE-acquired practices before and after acquisition compared with non-PE-acquired controls. In aggregate and across the study period, the clinician replacement ratio was higher for PE-acquired practices compared with non-PE-acquired controls (1.75 versus 1.37), as well as within each specialty and clinician type (physician versus advanced practice provider). Relative to non-PE-acquired control practices, we also found significant yearly increases in the number of advanced practice providers at PE-acquired practices after acquisition. Taken together, these findings suggest differential changes in workforce composition at PE-acquired practices, especially a shift toward advanced practice providers for care delivery.

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This resource is found in our Actionable Strategies for Government: Aligning Values & Improving Diversity, Equity & Inclusion (Aligning Values).

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BACKGROUND: The practice of compassion in healthcare leads to better patient and clinician outcomes. However, compassion in healthcare is increasingly lacking, and the rates of professional burnout are high. Most research to date has focused on individual-level predictors of compassion and burnout. Little is known regarding how organizational factors might impact clinicians' ability to express compassion and well-being. The main study objective was to describe the association between personal and organizational value discrepancies and compassion ability, burnout, job satisfaction, absenteeism and consideration of early retirement among healthcare professionals. METHODS: More than 1000 practising healthcare professionals (doctors, nurses and allied health professionals) were recruited in Aotearoa/New Zealand. The study was conducted via an online cross-sectional survey and was preregistered on AsPredicted (75407). The main outcome measures were compassionate ability and competence, burnout, job satisfaction and measures of absenteeism and consideration of early retirement. RESULTS: Perceived discrepancies between personal and organizational values predicted lower compassion ability (B = -0.006, 95% CI [-0.01, -0.00], p < 0.001 and f 2 = 0.05) but not competence (p = 0.24), lower job satisfaction (B = -0.20, 95% CI [-0.23, -0.17], p < 0.001 and f 2 = 0.14), higher burnout (B = 0.02, 95% CI [0.01, 0.03], p < 0.001 and f 2 = 0.06), absenteeism (B = 0.004, 95% CI [0.00, 0.01], p = 0.01 and f 2 = 0.01) and greater consideration of early retirement (B = 0.02, 95% CI [0.00, 0.03], p = 0.04 and f 2 = 0.004). CONCLUSIONS: Working in value-discrepant environments predicts a range of poorer outcomes among healthcare professionals, including hindering the ability to be compassionate. Scalable organizational and systems-level interventions that address operational processes and practices that lead to the experience of value discrepancies are recommended to improve clinician performance and well-being outcomes.

This resource is found in our Actionable Strategies for Health Organizations: Aligning Values (Establish a Culture of Shared Commitment).

[This is an excerpt.] Creating and maintaining healthy work environments is a salient issue for health care facilities throughout the United States. In a context of rapidly evolving clinical, population, and financial factors, many health care providers are at risk for burnout (Shanafelt & Noseworthy, 2016). Burnout may be higher among mental health clinicians when compared to other professions due in part to the severe symptoms of many patients and stigma associated with mental illness (O'Connor et al., 2018). Generally, internal organizational factors contributing to burnout include poor collaboration, organizational culture, lack of autonomy over one's own work, and hierarchical decision making (Dyrbye et al., 2017). Such factors may contribute to burnout because they impact how clinicians' view their career trajectory and work flexibility (Shanafelt & Noseworthy, 2016). In a recent article in the Wall Street Journal, the Surgeon General was reported to speak out about unhealthy work environments contributing to negative health outcomes (Chen & Smith, 2022). [To read more, click View Resource.]

STUDY OBJECTIVE: The influence of workplace mistreatment on the well-being and career satisfaction of emergency medicine residents is unknown. This study examined the relationships between burnout, career choice regret, and workplace mistreatment in a national sample of emergency medicine residents. METHODS: This was a secondary analysis of a survey study on the prevalence of workplace mistreatment among emergency residents. Residents who reported emotional exhaustion or depersonalization at least once per week were considered to have burnout. Residents who reported dissatisfaction with their decision to become an emergency physician were considered to have career choice regret. Respondents also reported the type (discrimination, abuse, sexual harassment) and frequency of mistreatment over the academic year. Multivariable logistic regression, adjusting for program characteristics, was used to examine resident characteristics associated with burnout and career choice regret, with the frequency of mistreatment as a covariate. RESULTS: Of the 8,162 eligible residents, 7,680 (94.1 %) participated. About a third of respondents reported burnout (2,188 of 6,902, 31.7%), whereas a minority (224 of 6,923, 3.2%) reported career choice regret. Of the 7,087 responses on mistreatment frequency, 2,117 (29.9%) reported “a few times per year,” and 1,296 (18.3%) reported “a few times per month or more.” Compared with residents who never experienced mistreatment, residents who reported increasing frequencies of mistreatment were associated with having burnout—from mistreatment a few times per year (OR [odds ratio],1.6; 99% CI [confidence interval], 1.3 to 1.9) to a few times per month or more (OR, 3.3; 99% CI, 2.7 to 4.1). Compared with residents without burnout, residents who reported burnout were associated with having career choice regret (OR, 11.3; 99% CI, 7.0 to 18.1). After adjusting for burnout, there were no significant relationships between the frequency of mistreatment and career choice regret. CONCLUSIONS: Workplace mistreatment is associated with burnout, but not career choice regret, among emergency medicine residents. Efforts to address workplace mistreatment may improve emergency medicine residents’ professional well-being.