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Occupational stress represents a serious threat to police officers’ wellness and safety. Based on responses to open-ended questions in a survey of police officers of a U.S. state police agency, this study analyzes and synthesizes the impact of work-family conflict on occupational stress described by both female and male state troopers. Four major themes emerged from data analysis, including organizational challenges, the emotional impacts of being a Trooper, the effects of stress on officers’ support network, and gender differences or similarities. The chapter begins with a brief introduction, followed by discussing the relevant literature on police stress and work-family conflict. It then describes data source and collection and presents major themes that arose from the analysis of respondents’ qualitative comments. This chapter concludes with policies and programs designed to assist officers and their families in mitigating stress and work-family conflict.

BACKGROUND: The shortage of nursing care in U.S. hospitals has become a national concern. PURPOSE: The purpose of this manuscript was to determine whether hospital nursing care shortages are primarily due to the pandemic and thus likely to subside or due to hospital nurse understaffing and poor working conditions that predated it. METHODS: This study used a repeated cross-sectional design before and during the pandemic of 151,335 registered nurses in New York and Illinois, and a subset of 40,674 staff nurses employed in 357 hospitals. FINDINGS: No evidence was found that large numbers of nurses left health care or hospital practice in the first 18 months of the pandemic. Nurses working in hospitals with better nurse staffing and more favorable work environments prior to the pandemic reported significantly better outcomes during the pandemic. DISCUSSION: Policies that prevent chronic hospital nurse understaffing have the greatest potential to stabilize the hospital nurse workforce at levels supporting good care and clinician wellbeing.

PURPOSE OF REVIEW: To evaluate the state of mentorship in the field of urology. RECENT FINDINGS: Mentorship has been shown to decrease burnout, increase recruitment of underrepresented minority groups, and have a positive influence on the career trajectory of mentees. Approximately half of surgical residency programs have mentorship programs. The current literature supports the idea that formal mentorship programs are successful based on level 1 satisfaction scores. However, studies are sparse and of low quality. Mentorship program success is rarely objectively measured. Structured mentorship programs appear to be beneficial, but require serious planning, evaluation, and ongoing support without which the programs can fail. Future research should be focused on objective and measurable metrics of success.

Health and human service providers who aid traumatized individuals frequently experience vicarious trauma (VT). Although VT plays a critical role in service providers' mental health and well-being, as well as in the quality of their service provision, little information is available concerning the development and implementation of VT interventions for service providers. To advance the development of evidence in this area, we undertook a scoping review in which we reviewed existing interventions intended to address VT among service providers working with traumatized clients. Searches of electronic databases were conducted to identify studies published in peer-reviewed journals, with no date restrictions. Over 1,315 citations were reviewed, and a total of 27 studies were included in the final review. The findings show that VT interventions in the literature can be divided broadly into four categories: psychoeducation, mindfulness intervention, art and recreational programs, and alternative medicine therapy. The VT interventions reviewed generally showed promise in their key outcomes, including reductions in secondary trauma stress, compassion fatigue, burnout, and other mental health outcomes. However, the current body of research is lacking both in rigor and in specificity regarding the definition of VT. Furthermore, existing VT interventions are generally self-care based and tend to focus on general stress management rather than addressing the specific effects of VT. Therefore, we call for an increase in efforts to tailor VT interventions to different service settings and participant characteristics, as well as greater attention to developing primary VT interventions at the organizational level.

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

BACKGROUND: The COVID-19 pandemic has affected the well-being of nursing professionals, especially long-term and acute care nurses, many of whom are nurses of color. PURPOSE: We examine the evidence and gaps in the literature addressing psychological well-being of racial/ethnic minority RN's in the U.S. during COVID-19. METHODS: We searched eight databases during March 2022 and used Joanna Briggs’ Scoping Review Methodology and PRISMA-ScR reporting standards. DISCUSSION: Seven studies met inclusion criteria. Two exclusively examined nurses; five reported findings from heterogeneous samples of health care workers. No significant racial/ethnic differences in well-being were reported among health care workers. Among nurses, if a difference existed, White nurses reported decreased psychological well-being relative to ethnic and racial minority nurses. Two studies report modest racial/ethnic differences in nurses’ psychological well-being. CONCLUSION: Significant gaps in the literature remain; future studies should analyze groups of health care workers separately, clearly identify racial and ethnic groups, and examine the role of respondents’ work setting.

BACKGROUND: Burnout has become a prominent topic, yet there are limited data on the manifestation of this phenomenon among surgical fellows. The goal of this study is to elucidate the prevalence of burnout and determine if there are protective or predisposing factors in surgical fellowship training. METHODS: A confidential electronic survey was distributed to Fellowship Council accredited fellows during the 2020–2021 academic year. Demographic information and training characteristics were queried. The fellows were then asked to complete the Maslach Burnout Inventory (MBI), Perceived Stress Scale (PSS), Short Grit Scale (SGS), Satisfaction with Life Scale (SLS), and General Self-Efficacy Scale (SE). Data were analyzed using p values of ≤ 0.05 as statistically significant. RESULTS: At the end of the survey period, 92 out of 196 (46.9%) fellowship trainees responded. 69.6% of respondents identified as men, 29.7% as international medical school graduates (IMGs), and 15.3% non-US IMGs. Based on criteria defined by the MBI, there was an 8.4% rate of burnout. Most respondents noted low stress levels (62.3%), good satisfaction with life (58.9%), a moderate amount of grit, and a high level of self-esteem. On comparative analysis, fellows with burnout had significantly higher stress levels, lower levels of satisfaction with life, and less self-esteem. CONCLUSIONS: Overall, there was a low rate of burnout among fellows. We suggest this may be reflective of a self-selecting effect, as trainees who choose to undergo additional training may be less likely to experience this syndrome. In addition, there may be a protective factor during fellowship that results from inherent mentoring, increased specialization, and autonomy. Further investigation of the predisposing factors to burnout in fellowship trainees is warranted based on the results of this study.

BACKGROUND: Burnout is a significant concern among health care professionals, particularly those working in the emergency department (ED). Given the negative personal and professional consequences that burnout can have on all health care professionals, multidisciplinary solutions are needed to address burnout. Our objective was to evaluate the feasibility and potential impact of resilience training delivered through a smartphone application on burnout among health care professionals working at a tertiary-care pediatric ED. METHODS: We conducted a single-center pilot randomized controlled study enrolling multidisciplinary health care professionals working in our ED. Participants assigned to the intervention group received self-driven access to a smartphone application that provided a structured resilience curriculum for a period of 3 months. The participants completed psychometric assessments both prior to and following the invention period. Changes in psychometric measures of the intervention group were then compared with a waitlist-control group. RESULTS: Following the intervention period, a total of 20 participants were included in the final analysis. The change in participant scores on psychometric measures prior to and following the intervention period was calculated. A statistically significant mean decrease in burnout measure (emotional exhaustion subscale of Maslach-Burnout Inventory mean score -5.88, p < .001) and increase in mindfulness measure (Mindful Attention Awareness Scale mean score 0.51, p < .001) was observed among the intervention group participants. CONCLUSIONS/APPLICATION TO PRACTICE: Our study suggests that a resilience training program delivered using a smartphone application can be an effective intervention in reducing burnout and increasing mindfulness skills. Our study also demonstrated the potential feasibility of a randomized controlled study of burnout within a multidisciplinary group of health care professionals.

BACKGROUND: Burnout is common among residents, which could be associated with their professional network characteristics. This study aimed to assess the social networks of psychiatry residents and develop an intervention to improve their network characteristics, burnout, and perception of the educational environment. METHODS: We recruited a cohort of 17 PGY-2 residents and assessed their social networks, burnout, and perception of the educational environment. After the baseline survey, we held a focus group with PGY-2 residents to discuss the results, their network characteristics, and interventions that can improve their relationships. The PGY-2 residents indicated that offering extracurricular opportunities to facilitate friendly interactions among the residents and faculty members would be the most feasible and acceptable intervention. Therefore, four “interest groups” for extracurricular activities were established. Residents and faculty members were invited to participate in interest groups to improve the network characteristics. Some PGY-2 residents and faculty members agreed to moderate interest group sessions (active members). RESULTS: After the intervention, active residents improved significantly in the perceived personal accomplishment subscale of the burnout inventory and their perception of the educational environment. Active faculty members also had a significant increase in their relationships with PGY-2 residents in one domain of social networks. CONCLUSIONS: Enhancing relationships between residents and faculty members through participatory intervention and extracurricular activities can improve faculty-resident connectivity and residents’ perception of personal accomplishment and educational environment quality. Supplementary information The online version contains supplementary material available at 10.1186/s12909-022-03440-5.

Health care organizations continue to search for solutions to mitigate physician burnout and its effect on provider mental health, turnover, and patient care. Emergency Care Specialists, a large independent emergency medicine practice based in Michigan, has found that the creation of a sabbatical program of recurrent month-long blocks of paid time off has resulted in sustained career satisfaction, extremely low rates of physician attrition, and decreased feelings of burnout. A program of this nature can be initiated by other health care entities in a cost-effective manner.

BACKGROUND: Burnout is an occupational phenomenon caused by ineffectively managed work-related stress. Burnout is common among healthcare professionals and has the capacity to compromise patient care, but is not well characterised in pharmacists. AIM: This systematic review aimed to establish the prevalence of burnout among pharmacists, and its associated risk factors. METHOD: A systematic search of Embase, PubMed, CINAHL and PsychInfo was carried out. Studies were included using the following eligibility criteria; original research investigating burnout prevalence in pharmacists in patient-facing roles in any jurisdiction, using any validated burnout measurement instrument. No language or date barriers were set. Data were extracted by the first author and accuracy checked by co-authors. A pooled prevalence was estimated, and narrative synthesis provided. RESULTS: Burnout prevalence data were extracted from 19 articles involving 11,306 pharmacist participants across eight countries. More than half (51%) of pharmacists were experiencing burnout. Associated risk factors included longer working hours, less professional experience, high patient and prescription volumes, excessive workload and poor work/life balance. The COVID-19 pandemic has negatively impacted pharmacist burnout and resilience. Involvement in education and training and access to burnout management resources were associated with lower rates of burnout, but burnout intervention effectiveness is unknown. CONCLUSION: Burnout remains high among pharmacists and may negatively affect the quality of patient care. There is significant heterogeneity pertaining to the definition and assessment of burnout and there remains a need to identify and evaluate effective individual and organisational burnout interventions.

INTRODUCTION: In light of increasing concerns regarding resident burnout, we developed a team-based approach (TBA) to radiology resident case conference to foster wellness by cultivating camaraderie and a positive learning environment. METHODS: Teaching faculty provided both a traditional hot-seat and a TBA format case conference. Resident perceptions of each conference format were assessed using a 16-item questionnaire, with 14 of the items utilizing a 7-point Likert scale to assess the learning environment, including measures related to wellness. A two-sided Wilcoxon rank-sum test was used to compare responses between the 2 formats of teaching conferences. RESULTS: Four paired teaching sessions were performed by 4 individual faculty. Sixty-six individual resident responses were received for the hot-seat and TBA conferences in aggregate. Residents responded “strongly agree” to positive statements more often for the TBA format compared with hot-seat for 13 out of the 14 items used to assess perceptions of the learning environment, including measures of wellness and camaraderie. The level of agreement on a 7-point Likert scale pertaining to the statement “The format of this case conference improves camaraderie among my co-residents” had a median value of 4.5 for the hot-seat format and 7 for the TBA format (P = 0.002). DISCUSSION: A TBA format for resident case conference may foster a sense of camaraderie among trainees. Residency programs may consider supplementing hot-seat conferences with the TBA method to address increasing burnout among trainees and promote resident wellbeing.

INTRODUCTION: The increasing burden of mental distress reported by healthcare professionals is a matter of serious concern and there is a growing recognition of the role of the workplace in creating this problem. Magnet hospitals, a model shown to attract and retain staff in US research, creates positive work environments that aim to support the well-being of healthcare professionals. METHODS AND ANALYSIS: Magnet4Europe is a cluster randomised controlled trial, with wait list controls, designed to evaluate the effects of organisational redesign, based on the Magnet model, on nurses’ and physicians’ well-being in general acute care hospitals, using a multicomponent implementation strategy. The study will be conducted in more than 60 general acute care hospitals in Belgium, England, Germany, Ireland, Norway and Sweden. The primary outcome is burnout among nurses and physicians, assessed in longitudinal surveys of nurses and physicians at participating hospitals. Additional data will be collected from them on perceived work environments, patient safety and patient quality of care and will be triangulated with data from medical records, including case mix-adjusted in-hospital mortality. The process of implementation will be evaluated using qualitative data from focus group and key informant interviews. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee Research UZ/KU Leuven, Belgium; additionally, ethics approval is obtained in all other participating countries either through a central or decentral authority. Findings will be disseminated at conferences, through peer-reviewed manuscripts and via social media. Trial registration number ISRCTN10196901.

This resource is found in our Actionable Strategies for Health Organizations: Establishing Commitment & Shared Governance (Shared Governance).

[This is an excerpt.] On July 1, 2022, new institutional requirements went into effect mandating Sponsoring Institutions to have leave policies that include a minimum of six paid weeks off for medical, parental, and caregiver leave. The establishment of this requirement is part of the ACGME’s commitment to resident and fellow well-being. Since discussions about codifying these types of leave in the Requirements began, and now that the final requirement is in effect, we receive questions and see some confusion about what is actually required. We recognize this particular area of the resident/fellow contract can be confusing. This post attempts to provide clarification. [To read more, click View Resource.]

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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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This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Relational Strategies (Measuring Well-Being & Accountability).

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Occupational stress is a crucial risk factor for the development of somatic and mental disorders and for the reduction of overall well-being. Acceptance and Commitment Therapy (ACT) is an established treatment in clinical practice and its use as a non-clinical workplace intervention proliferated in recent years. This study provides an up-to-date meta-analysis on how face-to-face ACT interventions affect occupational stress as well as psychological distress, psychological flexibility, and well-being. Random-effects meta-analyses were conducted exploring ACT's efficacy concerning the four constructs. Sub-group analyses and meta-regressions were performed to investigate individual, workplace-related, and treatment effects. A total of 17 studies including 860 participants allocated to ACT conditions and 736 participants allocated to control conditions were extracted. ACT outperformed control conditions (passive and active control) regarding psychological distress (Hedges' g = −0.38, 95% CI [-0.57; -0.19]) psychological flexibility (g = 0.33, 95% CI [0.13; 0.54]); and well-being (g = 0.24, 95% CI [0.02; 0.47]) at post-treatment, and regarding stress (g = −0.22, 95% CI [-0.41; −0.04]), psychological flexibility (g = 0.31, 95% CI [0.16; 0.47]), and well-being (g = 0.26, 95% CI [0.03; 0.49]) at follow-up. Additional analyses revealed ACT to be most effective for office employees while showing little to no effect for health care workers. Findings demonstrate ACT to be an effective treatment to reduce psychological distress and stress, and to increase psychological flexibility and general well-being in a non-clinical, workplace setting. An application for employees working in an office setting appears to be most promising.

Burnout is a complex issue resulting from chronic workplace stress. It encompasses:
• Exhaustion—feeling depleted, overextended, and fatigued
• Depersonalization—being detached from oneself and emotionally distant from one’s clients and work
• Feelings of inefficacy—having a reduced sense of professional accomplishment

Burnout has physical and emotional consequences for individuals and impacts their work with clients and within an organization. To fully address burnout, organizations need to adopt strategies that improve their organizational culture and climate to modify the six drivers of burnout: workload, control, reward, community, fairness, and values. This guide highlights organization-level interventions to prevent and reduce burnout among behavioral health workers.

[This is an excerpt.] Our health depends on the well-being of our health workforce. Even before the COVID-19 pandemic, the National Academy of Medicine found that burnout had reached “crisis levels” among the U.S. health workforce, with 35-54% of nurses and physicians and 45-60% of medical students and residents reporting symptoms of burnout.4 Burnout is an occupational syndrome characterized by a high degree of emotional exhaustion and depersonalization (i.e., cynicism), and a low sense of personal accomplishment at work. People in any profession can experience burnout, yet it is especially worrisome among health workers given the potential impacts on our health care system and therefore, our collective health and wellbeing. Burnout is associated with risk of mental health challenges, such as anxiety and depression—however, burnout is not an individual mental health diagnosis. While addressing burnout may include individual-level support, burnout is a distinct workplace phenomenon that primarily calls for a prioritization of systems-oriented, organizational-level solutions. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Workers & Learners AND What Workers & Learners Can Do AND What the Public Can Do AND Actionable Strategies for Government: Empowering Workers & Strengthen Leadership and Governance (Invest in Programs and Evidence) AND Aligning Values & Improving Diversity, Equity & Inclusion (Aligning Values and Improving Diversity, Equity & Inclusion) AND Advancing Measurement & Accountability (Establish Health & Public Safety Workforce Analysis and Planning Bodies) AND Strategies for Other Private Organizations

[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.

[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.]