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[This is an excerpt.] Mental health and substance use disorders in the United States were on the rise even before the pandemic and COVID-19 exacerbated many behavioral health conditions. In 2020, 21 percent of adults (52.9 million) reported having a mental illness in the past year and 15 percent (37.9 million) reported having a substance use disorder in the past year, with almost 7 percent of adults having both conditions. Recently released Centers for Disease Control and Prevention (CDC) provisional data suggests that the rate of suicides in the U.S. increased 4 percent from 2020 to 2021, after two consecutive years of decline in 2019 and 2020. Behavioral health conditions begin early in childhood, with 1 in 6 children aged 2-8 being diagnosed with a mental, behavioral, or developmental disorder. Children experienced significant increases in diagnoses of anxiety and depression between 2016 and 2020. Youth have experienced substantial disruption to their development during COVID-19, as have those who are underserved – such as people from certain racial and ethnic groups, the LGBTQI+ community, people with disabilities, children and families involved with the child welfare system, and low-income individuals. [To read more, click View Resource.]

[This is an excerpt.] Much of the clinician well-being movement has focused on physicians and nurses.1 But as the May 2022 Surgeon General’s Advisory Addressing Health Worker Burnout and ongoing deliberations of the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience highlight, the coronavirus pandemic has underscored the need to attend to the well-being of the entire health care workforce, including nursing assistants, transport personnel, clerical staff, and others. [To read more, click View Resource.]

BACKGROUND: Workplace violence (WPV) in health care is an important public health issue and a growing concern in the ED. According to the 2018 Bureau of Labor Statistics, health care and social service industries workers experience the highest rates of injuries caused by WPV; 5 times as likely to suffer a WPV injury as compared to the all-worker incidence rate of 2.1, creating harm and work-related stress and burnout. According to American Nurses Association, “A health care culture that considers workplace violence as part of the job” is the number one barrier to reporting WPV. OBJECTIVE: Define WPV, create a multidisciplinary team, increase awareness, formalize reporting process, improve database, and track actionable trends. METHODS: Study data was abstracted retrospectively from 1/2019-12/2021 at an 80K visits ED, 750 bed quaternary hospital; the following variables: unit/department, persons involved (employees, patients, visitors), nature of violence, and time of day. Descriptive statistics and Wilcoxon rank sum test were used. Our Health system and committee adopted the OSHA definition of WPV: any act or threat of physical violence, harassment, intimidation, verbal abuse, or other threatening disruptive behavior that occurs at work. The multidisciplinary team includes Physicians, Nursing, Security, Quality Management, Human Resources, Safety, Patient and Family Centered Care, Patient Care Services, Case Management and Social Work, as well as close collaboration with the System Workforce Safety team. Increased WPV incident reporting was encouraged by embracing a culture of transparency. WPV events were reported to Security, Quality Management, and HR, and collected in an internal database. Data collection processes were improved and drilled down on indicators that could impact the ED specifically. RESULTS: From 1/2019-12/2021, there were a total of 445 WPV incidents, 85 in the ED (19%) (graph ED incidents/quarter and year). The median number of ED WPV incidents from 2019, 2020, and 2021 was significantly different across the 3 years (the Wilcoxon rank sum test p-value¼ 0.0317). The rate of ED WPV incidents per 1000 ED visits was: 2019, 0.13; 2020, 0.27; 2021, 0.76; ED volume 84,889, 66,652, and 74,121, respectively. In 2021, 243 WPV incidents reported at the hospital level, and 56 ED incidents (23%), greater than any other location in the hospital. Of the ED WPV incidents in 2021: 78.6% occurred between patients and employees, 19.6% between visitors and employees, and 1.8% between an unknown person and an employee. The nature of violence of ED WPV incidents as follows: 21.4% physical abuse, 25% physical abuse with injury, 30.4% harassment, 17.9% verbal abuse/ threats/harassment, and 5.4% sexual harassment. Most WPV incidents occurred between 2am – 4am and 3pm – 11pm. CONCLUSIONS: There was a significant increase of ED WPV incidents reported from 2019 to 2021. We concluded this increase was a result of a combination of factors related to data collection, emphasis on reporting, and factors related to crowding, restrictive visitation policies due to Covid-19, and patient factors. The ED was identified as having a disproportionate number of WPV incidents leading to the decision to place security posts 24/7. The ED WPV committee has also developed a formal debrief process for instances of WPV as well as “Proactive Rounding” with a combination of security and clinical teams.

BACKGROUND: In July 2003, an 80-h work week restriction for residencies was mandated. This was met with skepticism regarding its potential impact on operative training. We hypothesized no difference in outcomes for pediatric surgeons who trained under duty hour restrictions compared to historical complication rates. METHODS: Dual-institutional review of pediatric patients who underwent five of the most common operations (2013–2018) by first-year pediatric surgeons who trained under duty hour restrictions was performed. Tests of proportions were used to compare complication rates to published rates on data collected prior to 2003. RESULTS: Patient mean age was 10.1 years. No significant differences (p values > 0.05) were found in laparoscopic appendectomy rates of infection, bleeding or intra-abdominal abscess compared to previously published rates. Pyloromyotomy rates of infection or duodenal perforation were not different. No differences were detected in rates of infection, recurrence or testicular atrophy for inguinal hernia repair. Umbilical hernia rates of infection, bleeding, and recurrence were also not different. There was no difference in CVC rates of hemopneumothoraces; significantly more bleeding events were detected (1.2% vs. 0.1%; p value = 0.04). CONCLUSION: In this study, first-year complication rates of pediatric surgeons who trained under duty hour restrictions were not significantly different when compared to published rates.

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

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Globally, the health workforce has long suffered from labour shortages. This has been exacerbated by the workload increase caused by the COVID-19 pandemic. Major collapses in healthcare systems across the world during the peak of the pandemic led to calls for strategies to alleviate the increasing job attrition problem within the healthcare sector. This turnover may worsen given the overwhelming pressures experienced by the health workforce during the pandemic, and proactive measures should be taken to retain healthcare workers. This review aims to examine the factors affecting turnover intention among healthcare workers during the COVID-19 pandemic.

Firefighters work in an environment in which they are constantly exposed to stressful situations. Exposure to acute and chronic stress have shown to have dire effects on firefighters, including an increased risk of cardiovascular disease (Cardiovascular related health problems are the largest cause of death in firefighters), as well as burnout. Burnout is becoming a prominent issue in the fire service, as increasing emergency responses and decreasing participation make the job much more demanding. There is evidence in the literature to support mental toughness as an effective factor in combatting the physical and psychological consequences of stress, as well as increased organizational performance. However, no current research evaluates the effectiveness of mental toughness on these factors in a population of firefighters. The present study examined the effectiveness of a three-week, six session mental toughness intervention on stress perception and burnout in 15 firefighters located in the Eastern United States. The Mental Toughness Index (Gucciardi et al., 2015) was used to assess mental toughness, the Firefighter Assessment of Stress Test (Schuhman et al., 2021) was used to assess firefighter stress 3 perception, and the Oldenburg Burnout Inventory (Demerouti et al., 2003) was used to assess burnout. Participants were asked to perform a self-report questionnaire assessing their organizational performance, defined by reported absenteeism. Creating an effective mental toughness training program for firefighters can help address two major issues in the fire service, burnout and stress while also potentially increasing organizational performance, helping firefighters become prepared to successfully handle the physical and mental stressors faced while performing their job. Preliminary analysis showed no significant differences in mental toughness, burnout, perceived stress, or work performance between groups at baseline. Repeated Measures ANOVA analyses supported the effectiveness of the mental toughness intervention on mental toughness (p < .001), burnout symptoms (p = .002), perceived stress (p < .001), and work performance (p = .008). Correlational analyses yielded significant relationships between mental toughness and burnout ( r = -.573). No significant relationship was found at baseline between mental toughness and stress perception. However, a significant relationship was found postintervention between mental toughness and stress perception (r = -.507). Similarly, no significant relationship was found between mental toughness and work performance at baseline. However, a marginally significant relationship was found between mental toughness and work performance post-intervention ( r = -.354). Implications for this study support the efficacy for utilizing mental toughness interventions to address burnout, stress perception, and work performance in a firefighter population.

OBJECTIVE: Little is known about the scope and role of discriminatory experiences in dentistry. The purpose of this study is to document the experiences that American Indian/Alaska Native (AI/AN), Black, and Hispanic dentists have had with discrimination. METHODS: This study reports data from a 2012 nationally representative study of dentists documenting experiences with discrimination during their dental careers or during dental school by the setting of the discrimination, the providers’ education, and geographic location. This study does not differentiate between levels of discrimination and focuses holisticly on the experience of any discrimination. RESULTS: Seventy-two percent of surveyed dentists reported any experience with discrimination in a dental setting. The experiences varied by race/ethnicity, with 49% of AI/AN, 86% Black, and 59% of Hispanic dentists reporting any discriminatory experiences. Racial/ethnic discrimination was reported two times greater than any other type. CONCLUSIONS: Experiences with racial/ethnic discrimination are prevalent among AI/AN, Black, and Hispanic dentists, suggesting that as a profession work is needed to end discrimination and foster belonging.

AIM: This mixed-methods pilot study aimed to measure the feasibility and acceptability of a psychoeducational group programme and determine its impact on mental well-being. BACKGROUND: The programme was developed to promote self-care, growth and adaptive coping for nurse managers. The programme themes were resilience, insight, self-compassion and empowerment. METHODS: The sample included 19 hospital-based nurse managers. Outcomes included post-traumatic growth, resilience, insight, self-compassion, empowerment, perceived stress, burnout and job satisfaction. Paired samples t tests were conducted to compare outcomes at baseline to follow-up. Qualitative interviews were conducted. Thematic analysis was used to code the qualitative responses by keyword, which were then aggregated into themes. RESULTS: Participants reported higher post-traumatic growth and psychological empowerment after the intervention. The following six themes emerged most consistently from the qualitative interviews: feasibility of the programme, benefits of peer support, sources of stress, barriers to self-care, sources of strength and sustainability of effects. CONCLUSIONS: The results support the acceptability and feasibility of the psychoeducational group programme. Implications for nursing management Health care organizations can support and promote the implementation of programmes to alleviate burnout and improve mental well-being amid the complex demands of nursing management (ClinicalTrials.gov: NCT04987697).

Communication among interprofessional healthcare worker teams is critical to ensure a thriving and resilient workforce. We will evaluate the implementation and effectiveness of the Alda Healthcare Experience (AHE), a novel medical improvisation (improv) workshop designed to improve interprofessional communication skills among healthcare professionals. The AHE workshop includes a two-hour experiential training workshop led by an improv specialist and a clinical co-facilitator. In July 2022 we began implementing the AHE workshop by training 18 clinical co-facilitators who will co-facilitate the workshops for 550 healthcare workers from five hospital departments at Stony Brook University Hospital over the course of a year and a half. Using mixed-methods, we will conduct an Effectiveness-Implementation Hybrid Design project that includes an outcome evaluation (effectiveness) and a process evaluation (implementation).

The burnout literature is replete with burnout score results from quantitative surveys. There is a paucity of qualitative research that seeks to understand the impact of physician stressors on work-life balance and burnout. This study aimed to identify factors that support and disrupt work-life balance, drivers of burnout, and potential solutions among academic dermatologists. The objective was to better understand factors that promote wellness and ameliorate burnout. Concurrent explanatory mixed methods consisted of scores on the Abbreviated Maslach Burnout Inventory and open-ended semi-structured telephone interviews. The results were that positive factors, such as supportive home life and satisfaction derived from academic endeavors, compete with ongoing feelings of exhaustion, frustration, and apathy. Negative stressors include the electronic medical record, insufficient staffing, administrative and clinical task burden, and perceived lack of interest from mid-level and senior health system leadership in addressing clinicians' needs. This was a single-center academic study. As with all qualitative studies, these results may not be generalizable to all dermatologists. In addition, some participants were concerned about their anonymity. Modifiable root causes of burnout require institutional commitment to sustain the pace required by academic dermatologists.

OBJECTIVE: To assess changes to the experiences and wellbeing of urology trainees in the United States (US) and European Union (EU) during the COVID-19 pandemic.

METHODS: A 72-item anonymous online survey was distributed September 2020 to urology residents of Italy, France, Portugal, and the US. The survey assessed burnout, professional fulfillment, loneliness, depression and anxiety as well as 38 COVID specific questions.

RESULTS: Two hundred twenty-three urology residents responded to the survey. Surgical exposure was the main educational concern for 81% of US and 48% of EU residents. E-learning was utilized by 100% of US and 57% of EU residents with two-thirds finding it equally or more useful than traditional didactics. No significant differences were seen comparing burnout, professional fulfillment, depression, anxiety, or loneliness among US or EU residents, 73% of US and 71% of EU residents reported good to excellent quality of life during the pandemic. In the US and EU, significantly less time was spent in the hospital, clinic, and operating room (P <.001) and residents spent more time using telehealth and working from home during the pandemic and on research projects, didactic lectures, non-medical hobbies and reading. The majority of residents reported benefit from more schedule flexibility, improved work life balance, and increased time for family, hobbies, education, and research.

CONCLUSION: The COVID-19 pandemic has resulted in significant restructuring of residents’ educational experience around the globe. Preservation of beneficial changes such as reduction of work hours and online learning should be pursued within this pandemic and beyond it.

Background: The workloads of emergency medical service personnel (EMS) are varied. In the absence of recovery, health consequences can result. The aim of this review was to analyze the literature on the associations between psychosocial or physical work factors on one hand and the well-being outcomes and job satisfaction on the other hand. Methods: A systematic literature review examining the workloads, behavior, and well-being of EMS including emergency physicians, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for the reporting systematic reviews, was performed. The PubMed, Ovid Medline, Cochrane Library, Scopus, Web of Science, PsycINFO, Psyndex, and Embase electronic databases were used. Results: Thirty-three studies were included. These were divided into studies that predominantly focused on the behavior (6), stress and strain (22), and well-being (5) of EMS. Only four studies also examined emergency physicians. The studies indicated a high prevalence of psychological and physical stress factors. Burnout and posttraumatic stress disorders have been the most studied consequences of mismatched stress. The health status variable performs better in conjunction with higher qualifications. Age is not a protective variable in some studies. Conclusions: EMS workloads are varied and must be assessed on an individual basis. Studies on emergency physicians are needed. Organizational and personal measures must become the focus of health promotion and prevention in the workplace.

INTRODUCTION: Resident burnout is highly prevalent in general surgery. Burnout is increasingly recognized as a symptom of an unsupportive workplace. The objectives of this study were to describe resident perceptions of program responsiveness and to identify associated factors. METHODS: We used a convergent mixed-methods design. A cross-sectional survey was administered to all U.S. general surgery residents following the 2020 ABSITE, querying resident perceptions of their learning environment (including program responsiveness), burnout, thoughts of attrition and suicide, and career satisfaction. Multivariable logistic regression models adjusting for program/resident characteristics assessed associations of program responsiveness with aspects of the learning environment and resident wellness. 366 interviews and 27 focus groups with residents and faculty were conducted during in-person visits to 15 residency programs. Transcripts were analyzed thematically using inductive and deductive logics until thematic saturation was achieved. RESULTS: Of the 7233 clinically active residents from 323 programs who completed the survey (85.5% response rate), 5256 had data available for all outcomes of interest. 72.1% (n=3791) reported satisfaction with program responsiveness. These residents were significantly less likely to report 80-hour workweek violations (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.18-0.26), burnout (OR 0.47, 95% CI 0.41-0.53), thoughts of attrition (OR 0.32, 95% CI 0.27-0.38), and suicidality (OR 0.52, 95% CI 0.41-0.65). They were significantly more likely to report satisfaction with career choice, personal life, and work-life balance (all p < 0.001). Factors associated with improved perception of program responsiveness included larger program size (50+ vs. <23 residents; OR 1.48, 95% CI 1.01-2.19), having faculty mentorship (OR 2.64, 95% CI 2.22-3.14), having meaningful input into call and vacation schedules (OR 3.31, 95% CI 2.74-4.00), and feeling comfortable speaking up (OR 4.20, 95% CI 3.47-5.09). We conducted a qualitative analysis to identify the following components of program responsiveness: (1) core values reflecting a shared understanding of the importance of resident voice in shaping the training experience and the program, including mutual trust and respect between residents and faculty, transparency and communication, resident unity, and resident participation in and ownership of program improvement; (2) structural constructs that reflect and support responsiveness; (3) mechanisms for supporting resident agency, including resources and leadership support, faculty advocacy, and resident leadership opportunities. CONCLUSION: Program responsiveness in surgical residency is associated with improved resident wellness. Programs should develop formal channels to elicit and concretely address resident concerns, provide opportunities for resident representation, and entrust residents with the flexibility and autonomy to make decisions that support their own education and wellness.

BACKGROUND: There have been no studies to date of moral distress during the COVID-19 pandemic in national samples of U.S. health workers. The purpose of this study was to determine, in a national sample of internal medicine physicians (internists) in the U.S.: 1) the intensity of moral distress; 2) the predictors of moral distress; 3) the outcomes of moral distress. METHODS: We conducted a national survey with an online panel of internists, representative of the membership of the American College of Physicians, the largest specialty organization of physicians in the United States, between September 21 and October 8, 2020. Moral distress was measured with the Moral Distress Thermometer, a one-item scale with a range of 0 (“none”) to 10 (“worst possible”). Outcomes were measured with short screening scales. RESULTS: The response rate was 37.8% (N = 810). Moral distress intensity was low (mean score = 2.4, 95% CI, 2.2–2.6); however, 13.3% (95% CI, 12.1% - 14.5%) had a moral distress score greater than or equal to 6 (“distressing”). In multiple linear regression models, perceived risk of death if infected with COVID-19 was the strongest predictor of higher moral distress (β (standardized regression coefficient) = 0.26, p < .001), and higher perceived organizational support (respondent belief that their health organization valued them) was most strongly associated with lower moral distress (β = -0.22, p < .001). Controlling for other factors, high levels of moral distress, but not low levels, were strongly associated (adjusted odds ratios 3.0 to 11.5) with screening positive for anxiety, depression, posttraumatic stress disorder, burnout, and intention to leave patient care. CONCLUSIONS: The intensity of moral distress among U.S. internists was low overall. However, the 13% with high levels of moral distress had very high odds of adverse mental health outcomes. Organizational support may lower moral distress and thereby prevent adverse mental health outcomes.

BACKGROUND: Academic gastroenterology (GI) hospitalists are increasing, however the impacts on fellowship training and clinical care are unclear. Motivations for implementation of the GI hospitalist model are uninvestigated. AIMS: We aimed to determine the prevalence of GI hospitalists, explore motivations for and against adoption of a GIH model, and investigate the model's effects on fellowship training. METHODS: Leadership at current general GI fellowships were surveyed about current staffing models, as well as effects and perceptions of the hospitalist model. RESULTS: There was a total of 52 (26%) respondents and 12 (23%) reported having a GI hospitalist at their institution. A majority of respondents stated burnout and reduced time on service for other faculty was a primary reason for hiring a GI hospitalist. DISCUSSION: The largest perceived benefit of a hospitalist is reduced burnout and time on service for outpatient GI faculty. Many respondents also believed a GIH would improve fellowship education and quality of inpatient care.

This JAMA Forum discusses hospital policies that can harm patients, such as aggressively collecting payment on medical bills from those who cannot afford to pay, and provides ways to address current “never event” policies.

Making fair and equitable staffing decisions and patient assignments created complexities and undue nursing dissatisfaction on a 20-bed progressive care unit. Common themes shared by the nursing staff included inadequate staffing ratios, increased workload, and unease for patient safety. On the basis of these concerns, a unit-based needs assessment provided insight into what perceived and actual barriers exist preventing nurses from providing excellent care. Information gathered helped determine what could be done to overcome some barriers, and performing a comprehensive unit profile assessment allowed for better insight into how the unit was currently functioning. A comprehensive review of literature was undertaken to examine articles related to patient acuity utilizing the electronic databases CINAHL, PubMed, and MEDLINE. Key words and phrases included the following: acuity, patient acuity, acuity tools, progressive care acuity, nurse-patient assignment, workload, nursing assignments, and equitable staffing. Utilizing the results of the nurse survey, and information gained from articles gathered during the literature review, a patient acuity tool was created. The tool was believed to be an accurate representation of the patients' acuity, and the majority of charge nurses reported that they utilized the patient acuity tool score when making nurse-patient assignments. Overall staff satisfaction and perceptions of nurse-patient assignment equity were improved.

This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Safe & Appropriate Staffing).

The COVID-19 pandemic has exposed and amplified the longstanding occupational circumstances of nurses. In this article, the authors provide updates to their 2020 institutional recommendations and craft a national plan to tackle burnout and moral suffering.

This qualitative study investigated turnover intention and its influence on the public service motivation of U.S. police officers. The study was completed using a phenomenological design to elicit the lived experience of 21 retired and active police officers using face-to-face and telephonic interviews. The theoretical frameworks of turnover intention and public service motivation supported the research. Deductive thematic analysis was utilized to examine the results using NVivo 12. Furthermore, the findings supported the theoretical frameworks of turnover intention and public service motivation. The results revealed that each participant had different turnover intentions influencing distinct public service motivation characteristics. The turnover intentions that were most common amongst the participants were a lack of perceived organizational support (90%, 19 of 21) and increased stress (90%, 19 of 21). The characteristics of public service motivation that were most influenced were self-sacrifice (33%, 7 of 21), attraction to policy making (90%, 19 of 21), and compassion (33%, 7 of 21). Increased turnover intention did not always change the characteristics of public service motivation. Further research is needed to evaluate police participants, such as examining non-retired individuals who self-terminated and did not return to the profession, different genders to identify variations, longitudinal studies to explore police officers' public service motivation, and mixed research designs to provide a quantitative descriptive dimension with qualitative evidence that offers a holistic perspective.

A psychologically safe environment for healthcare teams is desirable for optimal team performance, team member well-being, and favorable patient safety outcomes. This piece explores facilitators of and barriers to psychological safety across healthcare settings. Future research directions examining psychological safety in healthcare are discussed.

This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Psychological Safety).