Resource Library

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.]

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.

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.

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.

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).

PURPOSE: Working in a hospital setting during a global health pandemic can lead to increased levels of anxiety, stress, burnout, and depression. Anecdotal evidence exists, but there is little research utilizing clinically validated tools to measure hospital staff psychological distress. METHODS: In Summer 2021, 771 hospital staff in North Dakota responded to an electronic survey collecting demographic data and employing validated behavioral health screening tools to assess anxiety, depression, emotional distress, and work-related quality of life. FINDINGS: Compassion satisfaction was significantly higher for those who worked in rural areas than urban [t(769) = –1.99, P = .0467]. The burnout rating was significantly higher for those who worked in urban areas than rural [t(769) = 2.23, P = .0261)]. There was no significant geographic variation in stress, anxiety, or depression. Anxiety, depression, burnout, and stress were all significantly higher for those who worked directly with COVID-19 patients than those who did not, regardless of hospital location. CONCLUSIONS: Hospital staff caring for COVID-19 patients experienced equitable (and high) levels of depression and anxiety. However, data indicate that rural providers experienced greater protective factors, resulting in lower rates of burnout and higher compassion satisfaction. Rural communities, hospitals, and health systems may have characteristics that could be duplicated in urban areas to support hospital staff well-being. Support and promotion of mental wellness must also come from the hospital system, and health care and policy leaders. If we do not care for our hospital staff, there will not be hospital staff left to care for the community.

[This is an excerpt.] Despite extensive literature measuring the prevalence and the consequences of burnout among resident physicians, effective interventional controlled trials are lacking.1,2 Mindfulness, therapy, and schedule changes have shown small benefits, but require learning a new skill, significant institutional resources, or organizational change.2 Additionally, ability to safely participate in many group or self-care activities has been limited by the recent COVID-19 pandemic. Gratitude3 and 3 good things3 (G/3GT) journaling are low-cost, individual-level interventions that have been shown to significantly improve measures of burnout, happiness, depression, gratitude, and stress; studies so far have not focused on resident burnout.3,  4,  5,  6 We piloted an app-based G/3GT journaling intervention for four weeks with pediatric residents measuring adherence and burnout as primary outcomes, with gratitude and life satisfaction as secondary outcomes. [To read more, click View Resource.]

While some surveyed nurses said they plan to leave direct patient care, the effects of COVID-19 on the nursing workforce may be leveling off.

BACKGROUND: The prevalence estimates of burnout among residents vary widely. Resident physicians working overnight have additional stressors and therefore, may be at higher risk of developing burnout. OBJECTIVE: To determine the rates of burnout among residents working night rotations versus day rotations. METHODS: This is a prospective, cross sectional, survey-based assessment of the prevalence of burnout among Obstetrics and Gynecology (OBGYN) residents on nights versus days rotations conducted at a large academic residency program that spans two separate hospitals in New York. All residents in the residency program were asked to complete the Maslach Burnout Inventory - Human Services Survey for Medical Personnel (MBI-HSS (MP)) after the first rotation of the academic year in 2018, 2019, and 2020. The results for each of the three aspects of the MBI-HSS (MP): emotional exhaustion, depersonalization, and personal accomplishment, were then compared for those on nights versus day rotations using students t-test. RESULTS: A total of 76 responses were received, 13 from residents on night rotations and 63 from residents on day rotations with a response rate of 61.8%. Comparing resident responses for a night versus day rotation, the residents averaged a low level of emotional exhaustion (a score of 17?±?9) on day shift, compared to a moderate level of emotional exhaustion (a score of 18?±?14) on nights (p?=?0.37). Similarly, 55.6% of respondents reports low personal accomplishment on days, compared to 76.9% while on nights. CONCLUSIONS: Emotional exhaustion scores were lower for residents on daytime rotations (mean score 17, SD 9), compared to those on nights rotations (mean 18, SD 14). Although there was no difference in depersonalization when comparing the day and night shift, 45% of the responses indicated high levels of depersonalization regardless of the type of shift. These results highlight the need to continue efforts to minimize burnout in medical training.

INTRODUCTION: Several factors may affect student wellbeing, including tolerance for ambiguity, burnout, empathy, quality of life, and stress. A better understanding of how pharmacy students score on these scales relative to other health professional students could help educators and schools address and improve student wellbeing. The study objective was to determine a baseline measure of pharmacy student tolerance for ambiguity, burnout, empathy, quality of life, and stress. METHODS: A voluntary survey including several assessment scales (Tolerance for Ambiguity, Oldenburg Burnout Inventory, Interpersonal Reactivity Index [empathy], Quality of Life Scale, and Perceived Stress Scale) was sent by email to all pharmacy students within a standalone college of pharmacy. RESULTS: Two hundred thirty-one pharmacy students completed all aspects of the survey. Comparing each scale with sex, female students trended higher in Interpersonal Reactivity Index and scored significantly higher on the Oldenburg Burnout Inventory (disengagement), while male students scored significantly higher for Quality of Life. Fourth-year students scored significantly higher on the Tolerance for Ambiguity scale as compared to first- and second-year students and on the Quality of Life scale as compared with third-year students. Third-year students experienced the greatest levels of burnout. Differences were also noted based on students' anticipated area of practice (empathy) and desire to work with an underserved population (empathy and stress). CONCLUSIONS: Pharmacy students' responses to the included scales varied greatly when considering various demographic parameters. The significant differences identified are illuminating and represent potential areas for curricular improvement, student support, and further study within pharmacy school curricula.

OBJECTIVES: Assess the association of residents’ exam performance and transient emotions with their reports of burnout, suicidality, and mistreatment. BACKGROUND: An annual survey evaluating surgical resident well-being is administered following the American Board of Surgery In-Training Examination (ABSITE). One concern about administering a survey after the ABSITE is that stress from the exam may influence their responses. METHODS: A survey was administered to all general surgery residents following the 2018 ABSITE assessing positive and negative emotions (scales range from 0 to 12), as well as burnout, suicidality over the past 12 months, and mistreatment (discrimination, sexual harassment verbal/emotional or physical abuse) in the past academic year. Multivariable hierarchical regressions assessed the associations of exam performance and emotions with burnout, suicidality, and mistreatment. RESULTS: Residents from 262 programs provided complete responses (N = 6987, 93.6% response rate). Residents reported high mean positive emotion (M = 7.54, SD = 2.35) and low mean negative emotion (M = 5.33, SD = 2.43). While residents in the bottom ABSITE score quartile reported lower positive and higher negative emotion than residents in the top 2 and 3 quartiles, respectively (P < 0.005), exam performance was not associated with the reported likelihood of burnout, suicidality, or mistreatment. CONCLUSIONS: Residents’ emotions after the ABSITE are largely positive. Although poor exam performance may be associated with lower positive and higher negative emotion, it does not seem to be associated with the likelihood of reporting burnout, suicidality, or mistreatment. After adjusting for exam performance and emotions, mistreatment remained independently associated with burnout and suicidality. These findings support existing evidence demonstrating that burnout and suicidality are stable constructs that are robust to transient stress and/or emotions.

Professional healthcare worker burnout is a crisis in the United States healthcare system. This crisis can be viewed at any level, from the national to local communities, but ultimately, must be understood at the level of the individual who is caring for patients. Thus, interventions to reduce burnout symptoms must prioritize the mental health of these individuals by alleviating some of the symptoms of depression, grief, and anxiety that accompany burnout. The practice of Shinrin-Yoku (Forest Bathing) is a specific evidence-based practice which research has shown can improve an individual's mental health and, when performed in a group, can support a sense of social connection. We investigated the impact of a three-hour, guided Shinrin-Yoku (Forest Bathing) nature-based intervention on burnout symptoms among physicians and other healthcare workers by using a randomized, controlled trial. The Oldenburg Burnout Inventory (OLBI) and Mini-Z assessments were used to collect baseline burnout scores and participants were randomized into the intervention group, which completed the assessment again after the Shinrin-Yoku walk, or into a control group, which completed the assessments again after a day off from any clinical duties. A total of 34 participants were enrolled in the intervention group and a total of 22 participants were enrolled in the control group. Ultimately, no statistically significant differences were detected between the pre-test and post-test scores for the intervention group or between the post-test scores of the intervention group compared to the control group. However, the subjective responses collected from participants after participating in the Shinrin-Yoku walk overwhelmingly reported decreased feelings of stress and increased mental wellbeing. This raises important questions about the difference between symptoms of burnout and other aspects of mental health, as well as the limitations of a one-time nature-based intervention on levels of chronic burnout symptoms. Thus, further research on the effects of engaging healthcare providers in an ongoing practice of Shinrin-Yoku is warranted.

BACKGROUND: The COVID-19 global pandemic has put health care professionals under immense pressure and hindered their ability to provide quality services. PURPOSE: This study aimed to examine the professional quality of life (ProQOL) among Georgia nurse practitioners during the COVID-19 global pandemic. METHODOLOGY: The ProQOL survey was distributed to nurse practitioners in Georgia by the professional organization's listserv. Multiple analysis of variance (ANOVA) analyses were performed to assess differences between employment settings, geographic location, and other relevant demographic qualifiers and levels of compassion satisfaction, burnout, and secondary traumatic stress. RESULTS: Hundred nurse practitioners (NPs) (n = 100) responded to the survey. Ninety-one percent were female and ages 25–35 years. Male NPs showed higher rates of compassion fatigue and secondary traumatic stress. CONCLUSIONS: A ProQOL survey demonstrated increased burnout and secondary traumatic stress among frontline practitioners in Georgia due to increased workloads, feelings of inadequacy, fear of being infected by the virus, and prolonged exposure to deaths. IMPLICATIONS: Ensuring effective communication, team collaboration, emotional, adequate staffing, and psychological support can help reduce compassion fatigue among NPs.

OBJECTIVE: This study aimed to examine the COVID-19 pandemic's impact on fire service safety culture, behavior and morale, levers of well-being, and well-being outcomes. METHODS: Two samples (Stress and Violence against fire-based EMS Responders [SAVER], consisting of 3 metropolitan departments, and Fire service Organizational Culture of Safety [FOCUS], a geographically stratified random sample of 17 departments) were assessed monthly from May to October 2020. Fire department–specific and pooled scores were calculated. Linear regression was used to model trends. RESULTS: We observed concerningly low and decreasing scores on management commitment to safety, leadership communication, supervisor sensegiving, and decision-making. We observed increasing and concerning scores for burnout, intent to leave the profession, and percentage at high risk for anxiety and depression. CONCLUSIONS: Our findings suggest that organizational attributes remained generally stable but low during the pandemic and impacted well-being outcomes, job satisfaction, and engagement. Improving safety culture can address the mental health burden of this work.

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This resource is found in our Actionable Strategies for Public Safety Organizations: Drivers (Relational Breakdown) AND Drivers (Operational Breakdown)

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INTRODUCTION: Hospital departments of pharmacy are experiencing significant challenges in the recruitment and retention of trained hematology-oncology pharmacists. The reasons for these challenges are varied, but one consistent challenge is the growing attrition of clinically-trained pharmacists from the patient care environment. METHODS: An electronic 21-item survey was distributed to oncology pharmacists across the United States. The survey assessed work environment, board certification, clinical commitment, and other factors. How those factors might be associated with reported job satisfaction and risk for attrition was examined. RESULTS: A total of 607 individuals responded to at least one of the survey questions, with the majority representing those actively in clinical practice. The results demonstrate that the oncology pharmacy workforce is a highly trained and capable one, with a high level of satisfaction with their work. That said, over 60% of those who responded indicated that they were either actively seeking or open to alternate employment outside of the patient care environment. The largest contributing factors to attrition risk include untenable work burdens, burnout, lack of work-life integration, and ineffective leadership, while commitments to clinical work were associated with improved job satisfaction and decreased attrition risk. CONCLUSION: These results bring to light the current state of satisfaction and attrition risk for the oncology pharmacy workforce nationwide. A significant opportunity exists to improve the experience of these pharmacists, particularly in the patient care environment. Based on these findings, departmental, organizational, and national leadership must pursue more tenable work burdens, better value and recognition measures, and more accurate and meaningful metrics for clinical pharmacists in order to retain this important workforce.