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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.

For more than 2 years, the world has been upended by the COVID-19 pandemic. Arguably, no other group has experienced challenges as intense and unrelenting during this time as hospital-based health care workers (HCWs). These individuals have played, and continue to play, a key role in the battle against COVID-19, risking psychological and physical safety in the face of this historic pandemic. Mounting evidence shows that HCWs have experienced acute psychological distress, with alarmingly high rates of anxiety, depression, burnout, and sleep disturbances that are likely to persist beyond these recurring waves of the COVID-19 outbreak.

Nurses are central to health care as the largest professional workforce and the providers of constant, ongoing care. Difficulties retaining enough qualified and motivated nurses presents an ongoing problem that threatens the quality of healthcare delivery. Demands of nursing practice, often resulting in stress and burnout, is a major barrier to retaining nurses. Self-care approaches and techniques have proven effective in reducing stress and burnout, increasing job satisfaction and the likelihood of nurses remaining in the profession. Despite knowing the benefits, nurses frequently do not engage in self-care resulting in negative consequences both personally and professionally. To advance our knowledge in this important area, a review of the literature was conducted to explore nurses’ experience of self-care and how they made sense of their experiences. The literature was analysed critically and synthesised through a phenomenological lens. The identified themes were structured according to phenomenological concerns: selfhood, mood and embodiment, sociality and relatedness, temporality, spatiality, and nursing culture. Understanding self-care from a phenomenological perspective is important to forming a deeper comprehension of nurses’ relationship with self-care, including acceptance and resistance. This new knowledge can be used to develop strategies to encourage self-care. The implications for recruitment and retention within nursing, and ultimately to the quality of healthcare, are significant.

BACKGROUND: We aim to explore the factors related to job satisfaction among pain physicians and identify the reasons why individuals minimize or stop practicing outpatient pain medicine. OBJECTIVES/STUDY DESIGN: This is a survey-based study with the primary goal to identify factors determining job satisfaction and dissatisfaction among pain medicine fellowship graduates who continue to practice and those who are no longer practicing interventional pain. A secondary goal is to elucidate reasons for anesthesiologists trained in pain medicine to leave pain medicine, despite an additional year of training, and to work as general anesthesiologists. METHODS: In this study, all 114 pain program directors listed on the Accreditation Council for Graduate Medical Education (ACGME) website, or their administrative assistants were directly contacted via email. All email addresses were obtained from the ACGME website. The survey opened in September 2021, with reminder emails sent before the closing of the survey in December 2021. A final reminder email was sent 4 weeks prior to the closing of the survey. RESULTS: Of all the respondents, 79 (89.77%) were currently practicing pain medicine, and 9 (10.23%) were no longer practicing pain medicine. LIMITATIONS: Our study has a major limitation as we are unable to determine the response rate and are limited in the data points gathered. CONCLUSION: We hope this study will allow for pain medicine fellowship program directors to improve recruitment and retention of pain fellows in the field while addressing the pros and cons of future career aspirations with anesthesiology residents prior to fellowship selection. A larger, more thorough study with an exact response rate can compare the various outcomes based upon different types of settings, such as private practice, partnership, and academia, as well as geographical locations.

[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.]

OBJECTIVE: Frontline healthcare workers (FHCWs) responding to the COVID-19 pandemic develop posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptoms. Such symptoms are associated with burnout, occupational and relational difficulties. In the current study, we examined the prospective association between acute transdiagnostic COVID-19-related PTSD, MDD, and GAD symptoms at pandemic outset, and burnout and functional difficulties several months later in FHCWs in New York City. METHODS: Wave 1 symptoms of COVID-19-related PTSD, MDD, and GAD, were assessed in 787 FHCWs from April 14 to May 11th, 2020. Burnout and occupational difficulties were assessed at wave 1 and wave 2, approximately 7 months later. RESULTS: After adjusting for wave 1 burnout, wave 1 MDD symptoms, particularly sleep difficulties, loss of interest, and feeling tired/having little energy, collectively explained 42% incremental variance in this outcome. After adjusting for wave 1 work difficulties, MDD and PTSD symptoms, particularly feeling tired/having little energy, loss of interest, and negative expectations of self/world, collectively explained 42% incremental variance in this outcome. After adjusting for wave 1 relationship difficulties, MDD, GAD, and PTSD symptoms, particularly depressed mood, irritability, and appetite disturbance, explained 26% incremental variance in this outcome. CONCLUSIONS: Results highlight psychiatric symptoms assessed during the acute phase of the COVID-19 pandemic that may help predict burnout and work and relationship difficulties in FHCWs. Early interventions aimed at ameliorating transdiagnostic symptoms of MDD, PTSD, and GAD may help mitigate risk for burnout and functional difficulties in this population.

Despite growing evidence for the need for work-life balance (WLB) for faculty at academic health centers, mentors frequently do not know how to advise their mentees on this topic. WLB impacts job satisfaction and intent to stay, and physicians are particularly at risk. In this study, we explored exit survey comments of faculty of the University of New Mexico School of Medicine citing work-life balance as a reason to leave (WLB-ARTL). Between July 2017 and December 2020, 59 faculty provided open-ended survey responses related to reasons for leaving, what they liked and disliked about being faculty, mentorship, and more. Using a qualitative descriptive design, we analyzed open-ended responses using a systematic, iterative, thematic approach via NVIVO software. We classified themes using Shanafelt’s drivers of engagement and burnout: workload/job demands; efficiency/ resources; meaning in work; culture/values; control/flexibility; social support/community at work; and work-life integration. While there were numerous quotes across all themes, we chose to summarize emergent codes with the most faculty representation and those that can most easily be addressed through mentorship: career development, culture and people, and hours and schedule (related to themes of meaning in work, culture and values, community at work, work-life integration, and control and flexibility). To improve faculty retention, institutional leaders should focus on developing mentors’ career coaching and mentoring skills. Additional focus should be placed on training mentors to discuss and address WLB among their faculty mentees.

This qualitative study explored MSW students’ perceived facilitators and barriers to self-care. Research suggests MSW students experience high stress from heavy course workloads, internship, and exposure to human suffering. MSW students report difficulty engaging in self-care, even when provided by their programs. Hence, it is important to gain insights into what promotes and prohibits MSW student self-care. MSW students participated in four semi-structured focus groups (N = 27, x– age = 27.8 years, 85.2% female, 55.6% white, 44.4% students of color). Analysis followed a combination of constant comparison and template analysis. Five themes underscore barriers and facilitators to self-care. Findings suggest importance of fostering a culture of self-care in MSW programs and assisting students to alter cognitive roadblocks to self-care.

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.

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 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.

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: 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.

BACKGROUND: The Association of American Medical Colleges has identified the humanities as fundamental to medical education across all specialties. Evidence from undergraduate medical education (UME) demonstrates the humanities' positive impacts on outcomes that could be relevant to patient care and trainee well-being in emergency medicine (EM) residency training. However, less is known about the humanities' role in graduate medical education (GME). OBJECTIVES: The objectives were to describe EM residents' self-reported exposure to the humanities and its relationship with their empathy, tolerance of ambiguity, and patient-centeredness, and to assess their attitudes toward the humanities in GME. METHODS: This cross-sectional survey-based study was conducted at six U.S. EM residency programs in 2018–2019. Quantitative analyses included linear regressions testing for trends between humanities exposures and outcomes, adjusted for sex, year in training, and clustering within programs; adjunct analysis of free-text responses was performed using an exploratory constructivist approach to identify themes about views on the humanities' role in medicine. RESULTS: Response rate was 54.8% (153/279). A total of 65% of respondents were male and 28.1% of respondents had a preceding humanities degree. Preceding humanities degree and current self-reported humanities exposure were positively associated with performance on empathy subscales (p = 0.02). Seventy-five percent (n = 114) of respondents agreed humanities are important in GME; free-text responses revealed perceived positive impacts of humanities on generating well-rounded clinicians and enhancing patient care. CONCLUSIONS: Engagement with the humanities may be associated with empathy among EM residents. Although the magnitude of associations was smaller than that seen in UME, this study demonstrates resident interest in humanities and suggests that extracurricular engagement with the humanities may be insufficient to prolong positive impacts seen in UME. Further research is needed to explore how to sustain these benefits through integration or addition of the humanities in existing GME curricula.

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.