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OBJECTIVE: To characterize measures of EHR use and ambulatory care quality performance among PCPs. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study of PCPs with longitudinal patient panels using a single EHR vendor was conducted at Brigham and Women’s Hospital and Massachusetts General Hospital during calendar year 2021. EXPOSURES Independent variables included PCPs demographic and practice characteristics and EHR time measures (PCP-level mean of daily total EHR time, after-hours time, time from 5:30 PM to 7:00 AM and time on weekends, and daily EHR time on notes, sending and receiving patient, staff, results, prescription, or system messages [in-basket], and clinical review). MAIN OUTCOMES AND MEASURES: Outcome variables were ambulatory quality measures (yearend, PCP panel–level achievement of targets for hemoglobin A1c level control, lipid management, hypertension control, diabetes screening, and breast cancer screening). RESULTS: The sample included 291 physicians (174 [59.8%] women). Median panel size was 829 (IQR, 476-1157) patients and mean (SD) clinical full-time equivalent was 0.54 (0.27). The PCPs spent a mean (SD) of 145.9 (64.6) daily minutes on the EHR. There were significant associations between EHR time and panel-level achievement of hemoglobin A1c control, hypertension control, and breast cancer screening targets. In adjusted analyses, each additional 15 minutes of total daily EHR time was associated with 0.58 (95% CI, 0.32-0.84) percentage point greater panel-level hemoglobin A1c control, 0.52 (95% CI, 0.33-0.71) percentage point greater hypertension control, and 0.28 (95% CI, 0.05-0.52) higher breast cancer screening rates. Each daily additional 15 minutes of in-basket time was associated with 2.26 (95% CI, 1.05-3.48) greater panel-wide hemoglobin A1c control, 1.65 (95% CI, 0.83-2.47) percentage point greater hypertension control, and 1.26 (95% CI, 0.51-2.02) percentage point higher breast cancer screening rates. Associations were largely concentrated among PCPs with 0.5 clinical full-time equivalent or less. There were no associations between EHR use metrics and diabetes screening or lipid management in patients with cardiovascular disease. CONCLUSIONS AND RELEVANCE: This cross-sectional study found an association between EHR time and some measures of ambulatory care quality. Although increased EHR time is associated with burnout, it may represent a level of thoroughness or communication that enhances certain

IMPORTANCE: Physician burnout is an ongoing epidemic; electronic health record (EHR) use has been associated with burnout, and the burden of EHR inbasket messages has grown in the context of the COVID-19 pandemic. Understanding how EHR inbasket messages are associated with physician burnout may uncover new insights for intervention strategies. OBJECTIVE: To evaluate associations between EHR inbasket message characteristics and physician burnout. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study in a single academic medical center involving physicians from multiple specialties. Data collection took place April to September 2020, and data were analyzed September to December 2020. EXPOSURES: Physicians responded to a survey including the validated Mini-Z 5-point burnout scale. MAIN OUTCOMES AND MEASURES: Physician burnout according to the self-reported burnout scale. A sentiment analysis model was used to calculate sentiment scores for EHR inbasket messages extracted for participating physicians. Multivariable modeling was used to model risk of physician burnout using factors such as message characteristics, physician demographics, and clinical practice characteristics. RESULTS: Of 609 physicians who responded to the survey, 297 (48.8%) were women, 343 (56.3%) were White, 391 (64.2%) practiced in outpatient settings, and 428 (70.28%) had been in medical practice for 15 years or less. Half (307 [50.4%]) reported burnout (score of 3 or higher). A total of 1?453?245 inbasket messages were extracted, of which 630?828 (43.4%) were patient messages. Among negative messages, common words included medical conditions, expletives and/or profanity, and words related to violence. There were no significant associations between message characteristics (including sentiment scores) and burnout. Odds of burnout were significantly higher among Hispanic/Latino physicians (odds ratio [OR], 3.44; 95% CI, 1.18-10.61; P?=?.03) and women (OR, 1.60; 95% CI, 1.13-2.27; P?=?.01), and significantly lower among physicians in clinical practice for more than 15 years (OR, 0.46; 95% CI, 0.30-0.68; P?

IMPORTANCE: Private equity acquisitions of physician practices in the US have been increasing rapidly; however, the implications for health care delivery and spending are unclear. OBJECTIVE: To examine changes in prices and utilization associated with private equity acquisitions of physician practices across multiple specialties. DESIGN, SETTINGS, AND PARTICIPANTS: This was a difference-in-differences event study of US physician practices specialized in dermatology, gastroenterology, and ophthalmology that were acquired by private equity firms from 2016 to 2020. Within each specialty, each private equity−acquired (PE-acquired) practice was matched with as many as 5 control practices based on the preacquisition number of unique patients, encounters, risk score, share of services billed out-of-network, and spending. The PE-acquired practices were compared with matched controls through year 2 after acquisition, using a difference-in-differences event study. Data analyses were performed from March 2021 to February 2022. EXPOSURES: Private equity acquisition of physician practices. MAIN OUTCOMES AND MEASURES: Measures of spending and utilization, including the charge and price (amount paid) per claim, new and unique patients, and total encounters. RESULTS: Compared with the 2874 control practices, the 578 PE-acquired physician practices exhibited an average increase of $71 (+20.2%) charged per claim (95% CI, 13.1%-27.3%; P < .001) and $23 (+11.0%) in the allowed amount per claim (95% CI, 5.6%-16.5%; P < .001). The PE-acquired practices increased their numbers of unique patients seen by 25.8% (95% CI, 15.8%-35.6%; P < .001) compared with control practices, driven by a 37.9% increase in visits by new patients (95% CI, 25.6%-50.2%; P < .001). In aggregate, their volume of encounters increased by 16.3% (95% CI, 1.0%-32.0%; P = .04) compared with the control group, with a 9.4% increase in the share of office visits for established patients that were billed as longer than 30 minutes (95% CI, 1.7%-17.0%; P = .02). No statistically significant changes in patient risk scores were found between PE-acquired practices and controls. Within specialties, we found modest differences along selected outcomes. CONCLUSIONS AND RELEVANCE: In this difference-in-differences study, private equity acquisition of physician practices in dermatology, gastroenterology, and ophthalmology were associated with differential increases in allowed amount and charges per claim, volume of encounters, and new patients seen, as well as some changes in billing and coding.

BACKGROUND AND OBJECTIVES: Health behaviors of physical activity and sleep are critical to the prevention of numerous chronic diseases. The health behaviors of healthcare professionals are even more critical, as healthcare providers who practice positive health behaviors are more likely to promote these healthy behaviors in their patients. AIMS: To assess the health status and health behaviors of medical students, faculty, and staff in an academic health center in the US, and examine the associations between behaviors, physical and mental health outcomes and burnout. METHODS: Students, faculty, residents and staff from a large university medical system completed an online survey between late-September and mid-November 2019. Associations were examined between health behaviors and health status including mental health outcomes with burnout. RESULTS: Participating in any leisure time physical activity and having a Pittsburgh Sleep Quality Index score < 5 were associated with fewer physical health conditions and lower odds of reporting pain at any site (n = 2060; students n = 242, residents n = 32, staff n = 1425, faculty n = 361). Leisure physical activity and fewer sleep symptoms were associated with fewer reported depressive, anxiety and stress-related symptoms. Participating in leisure physical activity and good-quality sleep were associated with lower odds of burnout. CONCLUSIONS: The current study found high rates of physical inactivity and poor sleep among medical students, faculty and staff at an academic health center. These health behaviors were associated with poor mental health and high burnout. Programs and policies are needed improve these health behaviors to reduce burnout.

PURPOSE: Burnout among nurses negatively impacts patient care experiences and safety. Inpatient pediatric nurses are high-risk for burnout due to high patient volumes, inadequate staffing, and needing to balance the demands of patients, families and team members. We examined the associations of inpatient pediatric nurse burnout with their perspectives on the importance of quality at the hospital, patient experience measurement, quality improvement (QI), unit culture, and staffing. METHODS: We conducted a cross-sectional study at an urban children's hospital. We surveyed pediatric nurses about their perspectives including the single-item Maslach Burnout Inventory. We fit separate regression models, controlling for role, location and unit, predicting outcome measures from the dichotomized burnout scale. RESULTS: Twenty-seven percent of pediatric nurses reported burnout. Nurses who had more con?dence in patient experience measurement, received frequent patient experience performance reports, felt included in QI, and experienced QI efforts as integrated into patient care reported not being burned out (compared to those reporting burnout; all p-values<0.05). More open communication among nurses (e.g., about possible problems with care) and unit-level teamwork were also associated with not being burned out, whereas a larger QI workload was associated with burnout (p-values<0.05). CONCLUSIONS: Open communication among nurses and nurses being more involved and valued in QI efforts were related to not being burned out. Research is needed to further examine aspects of QI involvement that reduce burnout.

OBJECTIVE: To examine the association of physician burnout with the career engagement and the quality of patient care globally. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, PsycINFO, Embase, and CINAHL were searched from database inception until May 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational studies assessing the association of physician burnout (including a feeling of overwhelming emotional exhaustion, feelings of cynicism and detachment from job defined as depersonalisation, and a sense of ineffectiveness and little personal accomplishment) with career engagement (job satisfaction, career choice regret, turnover intention, career development, and productivity loss) and the quality of patient care (patient safety incidents, low professionalism, and patient satisfaction). Data were double extracted by independent reviewers and checked through contacting all authors, 84 (49%) of 170 of whom confirmed their data. Random-effect models were used to calculate the pooled odds ratio, prediction intervals expressed the amount of heterogeneity, and meta-regressions assessed for potential moderators with significance set using a conservative level of P<0.10. RESULTS: 4732 articles were identified, of which 170 observational studies of 239 246 physicians were included in the meta-analysis. Overall burnout in physicians was associated with an almost four times decrease in job satisfaction compared with increased job satisfaction (odds ratio 3.79, 95% confidence interval 3.24 to 4.43, I2=97%, k=73 studies, n=146 980 physicians). Career choice regret increased by more than threefold compared with being satisfied with their career choice (3.49, 2.43 to 5.00, I2=97%, k=16, n=33 871). Turnover intention also increased by more than threefold compared with retention (3.10, 2.30 to 4.17, I2=97%, k=25, n=32 271). Productivity had a small but significant effect (1.82, 1.08 to 3.07, I2=83%, k=7, n=9581) and burnout also affected career development from a pooled association of two studies (3.77, 2.77 to 5.14, I2=0%, n=3411). Overall physician burnout doubled patient safety incidents compared with no patient safety incidents (2.04, 1.69 to 2.45, I2=87%, k=35, n=41 059). Low professionalism was twice as likely compared with maintained professionalism (2.33, 1.96 to 2.70, I2=96%, k=40, n=32 321), as was patient dissatisfaction compared with patient satisfaction (2.22, 1.38 to 3.57, I2=75%, k=8, n=1002). Burnout and poorer job satisfaction was greatest in hospital settings (1.88, 0.91 to 3.86, P=0.09), physicians aged 31-50 years (2.41, 1.02 to 5.64, P=0.04), and working in emergency medicine and intensive care (2.16, 0.98 to 4.76, P=0.06); burnout was lowest in general practitioners (0.16, 0.03 to 0.88, P=0.04). However, these associations did not remain significant in the multivariable regressions. Burnout and patient safety incidents were greatest in physicians aged 20-30 years (1.88, 1.07 to 3.29, P=0.03), and people working in emergency medicine (2.10, 1.09 to 3.56, P=0.02). The association of burnout with low professionalism was smallest in physicians older than 50 years (0.36, 0.19 to 0.69, P=0.003) and greatest in physicians still in training or residency (2.27, 1.45 to 3.60, P=0.001), in those who worked in a hospital (2.16, 1.46 to 3.19, P<0.001), specifically in emergency medicine specialty (1.48, 1.01 to 2.34, P=0.042), or situated in a low to middle income country (1.68, 0.94 to 2.97, P=0.08). CONCLUSIONS: This meta-analysis provides compelling evidence that physician burnout is associated with poor function and sustainability of healthcare organisations primarily by contributing to the career disengagement and turnover of physicians and secondarily by reducing the quality of patient care. Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency. Systematic review registration PROSPERO number CRD42021249492.

[This is an excerpt.] My last editorial on mental health and wellness in oral and maxillofacial surgery (OMS) generated many comments from colleagues, friends, and trainees. It has made me consider what next steps we should take to improve mental health and emotional wellbeing for our profession. Does it simply mean carving out time for recreational activities, seeking out family support, or employing techniques to reduce stress? Or, does it mean finding a balance between our personal and professional lives? [To read more, click View Resource.]

Healthy and supportive engagement between faculty and students is imperative for positive learning experiences. Multiple factors can impede engagement, including faculty burnout. After 30 years of teaching nursing, the author faced burnout. Based on student comments and Scripture, suggestions are made about character and teaching attributes that can positively adjust educator attitudes to enhance student learning.

BACKGROUND: The coronavirus pandemic (COVID-19) has focused attention on healthcare workers’ concerns about working during a pandemic, yet research on the effect of the pandemic specifically on paramedics is lacking. This literature review aims to critically examine the current knowledge of paramedics’ experience of barriers to, and enablers of, responding to suspected or confirmed COVID-19 cases. METHODS: An integrative review was undertaken using articles found by a systematic search of four research databases. Inclusion criteria included paramedics or emergency medical technicians who had experience of barriers or enablers responding to patients during the coronavirus pandemic. RESULTS: Nine articles met the inclusion and exclusion criteria. Barriers included communication and poor leadership, fear of infection to self and family, frequent changes in guidelines and inconsistencies across agencies, stress/burnout, and concerns with personal protective equipment. Enablers included job security, perceived social support, solidarity with other paramedics, and use of modern technologies for communication. CONCLUSIONS: There are unique experiences of working during the COVID-19 pandemic in the prehospital environment. Particular challenges occurred with leadership, communication within the organisation and between agencies, and working in an unpredictable environment.

Establishment of a diverse neurosurgical workforce includes increasing the recruitment of women in neurosurgery. The impact of pregnancy on the training and career trajectory of female neurosurgeons poses a barrier to recruitment and retention of women in neurosurgery. A recent Women in Neurosurgery survey evaluated female neurosurgeons' perception and experience regarding childbearing of female neurosurgeons and identified several recommendations regarding family leave policies. Additionally, pregnancy may carry higher risk in surgical fields, yet little guidance exists to aid both the pregnant resident and her training program in optimizing the safety of the training environment with specific considerations to risks inherent in neurosurgical training. This review of current literature aims to address best practices that can be adopted by pregnant neurosurgery residents and their training programs to improve the well-being of these residents while considering the impact on their education and the educational environment for their colleagues.

There is little debate that health care in the United States is in need of reform. But where should those improvements begin? With insurers? Drug makers? The doctors themselves? In Big Med, David Dranove and Lawton Robert Burns argue that we’re overlooking the most ubiquitous cause of our costly and underperforming system: megaproviders, the expansive health care organizations that have become the face of American medicine. Your local hospital is likely part of one. Your doctors, too. And the megaproviders are bad news for your health and your wallet. Drawing on decades of combined expertise in health care consolidation, Dranove and Burns trace Big Med’s emergence in the 1990s, followed by its swift rise amid false promises of scale economies and organizational collaboration. In the decades since, megaproviders have gobbled up market share and turned independent physicians into salaried employees of big bureaucracies, while delivering on none of their early promises. For patients this means higher costs and lesser care. Meanwhile, physicians report increasingly low morale, making it all but impossible for most systems to implement meaningful reforms. In Big Med, Dranove and Burns combine their respective skills in economics and management to provide a nuanced explanation of how the provision of health care has been corrupted and submerged under consolidation. They offer practical recommendations for improving competition policies that would reform megaproviders to actually achieve the efficiencies and quality improvements they have long promised. This is an essential read for understanding the current state of the health care system in America—and the steps urgently needed to create an environment of better care for all of us.

BACKGROUND: Transplant surgery fellowship is physically and emotionally demanding. The objective of this study was to characterize biophysiological stress and sleep patterns among transplant surgery fellows. METHODS: Participating fellows wore a biophysical monitor over a 28-day period and completed biweekly surveys. Sleep patterns were dichotomized as normal or sleep deprived, and heart rate variability (HRV) was used to assess stress. RESULTS: Seventeen fellows participated. Fellows were frequently sleep deprived (43.9% of nights) and stress was near universal (87.2% of days). Burnout was reported by 2 fellows (11.8%). Only 4 fellows (23.5%) reported compliance with the Transplant Accreditation and Certification Council managed time policy; these fellows experienced fewer days of stress than non-compliant fellows (79.8% vs 89.2% p = 0.02). CONCLUSIONS: This is the first study to quantify sleep deprivation and stress among transplant fellows. Future work is needed to evaluate the effects of sleep deprivation, and stress on burnout and patient outcomes.

This thesis examines the impact of work experiences on empathy among people employed in the law enforcement profession. It is hard to imagine that what law enforcement officers (LEOs) go through would not affect how they relate to the public or handle themselves for career longevity. It is possible that the mere exposure both physically and mentally experienced by LEOs erodes the very empathy needed to navigate such a profession and is not only detrimental to the community they serve but to themselves. Data were collected using a voluntary, anonymous survey which was distributed to LEOs across the United States over an eight-month period. The analysis probes whether empathy is diminished by what a LEO encounters while on-the-job. The results suggest that the regular day to day activities of a LEO do not noticeably reduce empathy as I first thought they would. Upon further review however, certain experiences like the physical stressors associated with police work do predict increased anger, and symptoms of depression and PTSD. Conversely, I found that the more the LEO feels supported by their family, friends, community, and department, the less they experience anger, depression, and PTSD. It should be noted that empathy actually increases if the LEO experiences an injury or illness that affects their job. This was unexpected and may be a starting point to be explored by further studies. Studies involving LEOs are far from new and often follow a more common theme where a LEO feels “burnout.” Unfortunately, there have been few studies that attempt to capture the feeling of empathy in general and even less with its relation to the law enforcement profession. Although the original survey designed for this thesis was very comprehensive, participation was lower than expected. Thus, the results only paint a partial picture of how experiences LEOs encounter on the job affect how they feel. Further research should examine how LEOs’ feelings and experiences might improve positive relations with the community and increase wellness for the LEOs that serve it.

BACKGROUND AND OBJECTIVE: There are high rates of professional burnout among family physicians and trainees. We undertook this study to investigate whether a brief mindfulness intervention could help manage burnout and improve well-being among family physicians in a residency program. METHODS: A total of 21 family physicians participated in a brief, 8-week mindfulness program. We used a single-sample, pre/post design at a Midwestern family medicine residency program. At two points in time (baseline and postintervention), participants completed an online survey measuring burnout, depression, anxiety, stress, perceived resilience, and compassion. We used linear mixed models to estimate the effect of the intervention on the outcome measures. RESULTS: Participants had improvements after the 8-week intervention. At postintervention, they had significantly better scores on anxiety (P<.004), stress (P<.001), perceived resilience (P<.001), and compassion (P<.001). There were no significant changes on the personal accomplishment, emotional exhaustion, and depersonalization subscales of either the abbreviated Maslach Burnout Inventory or the depression subscale of the Depression Anxiety Stress Scales-21. CONCLUSION: This brief mindfulness program was associated with significant reduction in the scores of anxiety and stress as well as significant improvement in perceived resilience and compassion scores. Brief mindfulness interventions may be a convenient and effective approach to support and improve health and well-being among family physicians.

INTRODUCTION: Bullying behavior in residency is common, with prevalence rates ranging from 10% to 48%. Negative acts adversely impact junior physicians. The aims of this study were to examine (a) gender differences in experiences of bullying and/or negative acts while working as a medical resident, (b) residents’ perceptions of injunctive (ie, approval of) and descriptive (ie, behavior) norms related to reporting bullying behaviors, and (c) whether greater self-other differences predict greater engagement in reporting bullying behavior by others in the workplace.

METHODS: Self-report surveys were administered to family medicine, internal medicine, surgical, and emergency medicine residents (N=61).

RESULTS: Female residents reported experiencing significantly more bullying than males. Overall, resident physicians held inaccurate beliefs, and thought other residents reported bullying more often than they did. Finally, the degree of inaccuracy was associated with reporting bullying behavior.

CONCLUSION: These findings are an initial indication that normative interventions may be applicable with this population. In a field that struggles with high rates of burnout, finding ways to improve the culture of an organization may assist with addressing at least part of these systemic issues.

AIMS: This study aimed to examine the degree and severity of workplace bullying in nurses and to assess the relationship between bullying and work environment factors. BACKGROUND: Workplace bullying occurs in nursing at an alarming rate and may escalate with more adverse working conditions. METHODS: Online survey data from a nationally representative sample of 1,170 U.S. registered nurses, collected between 2020 and 2021, were analysed. Five items measuring workplace bullying were used to identify bullying subgroups (unbullied, bullied but unrecognized, moderate bullying and severe bullying) using latent profile analysis. Ordinal logistic regression examined relationships between workplace factors and bullying. RESULTS: Over 40% of nurses reported being bullied in the past year. Four bullying subgroups were distinguished. Inadequate staffing, lack of time to get the job done and lack of breaks away from the work area were all significantly associated with severe bullying. CONCLUSION: Ensuring adequate staffing based on patient needs and nurse competency can mitigate workplace bullying in nurses. Further studies are needed to examine the effectiveness of stress reduction programmes on bullying using longitudinal designs. IMPLICATIONS FOR NURSING MANAGEMENT: This result indicates a critical need to improve nursing work environments, which could provide many benefits for nursing workforces, including potential to lessen bullying severity that adversely affects nurse well-being.

BACKGROUND: Burnout is a growing problem among health care professionals, with consequences for patient safety and personal satisfaction. The prevalence of burnout among hospital pharmacists in Canada is unknown; however, it has been documented at over 60% in other countries.  OBJECTIVES: To assess the prevalence of burnout and variables associated with burnout among hospital pharmacists in Canada. METHODS: This cross-sectional cohort study was based on a survey made available to more than 2600 Canadian hospital pharmacists from February 10 to April 2, 2020, through the Canadian Society of Hospital Pharmacists QID platform. The questionnaire collected data for the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSSMP), demographic data, employment characteristics, and workplace factors; it also included an open-ended question about burnout. RESULTS: A total of 171 respondents provided data suitable for analysis. Of these, only 13 (7.6%) met the criteria for burnout on all 3 subscales of the burnout inventory; however, 105 respondents (61.4%) surpassed the threshold for burnout on the emotional exhaustion subscale. In univariate analyses, not working to one’s full scope of practice was associated with meeting the criteria for burnout on all 3 scales. Linear regression highlighted associations between scores on the emotional exhaustion subscale and gender identity, perceived excessive on-call duties, area of practice, and positivity of workplace culture. Content analysis of the open-ended question supported the quantitative findings and pointed to 3 major themes: workload quantity, workload quality, and workplace culture.  CONCLUSIONS: Results on the emotional exhaustion subscale of the MBI-HSSMP and responses to the open-ended question suggested a relatively high prevalence of burnout among Canadian hospital pharmacists, and indicated potential links between burnout and certain workplace characteristics.

This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Optimizing Teams).

Rates of burnout among clinicians have been exacerbated by the COVID-19 (COVID)pandemic. A survey of Missouri primary care professionals at federally qualified health centers was conducted during a COVID surge in August 2021 to assess burnout, stress, and job satisfaction as well as if respondents had sought assistance for burnout or attended resiliency training. Despite respondents reporting rates of burnout (56%) that exceed those reported nationally (48%), only 17% sought help for burnout. Most (81%) had not attended resiliency training; of those who did, 16% said sessions “make me feel less alone,” while an equivalent number found sessions not useful, identifying an absence of resources within their organization. Comments focused on the need for dedicated time to receive support, including time to seek assistance during working hours, time to take breaks, and time for self-care. The data suggest one path forward to remediate burnout: provide the workforce with time to access support.

OUTCOMES:
1. Understand the components of the Maslach Burnout Inventory and use it to describe the severity of burnout among oncology infusion room nurses
2. Evaluate the effects of a nurse-led primary palliative care intervention on burnout among oncology nurses and identify potential influencing factors

IMPORTANCE: Palliative care clinicians display less burnout than oncology clinicians, but little is known about the impact of providing oncology care and primary palliative care in the same setting.

OBJECTIVE(S): We hypothesized that nurses providing primary palliative care in addition to oncology care would experience less burnout over time compared to nurses providing oncology care only.

METHOD(S): Secondary analysis of a cluster randomized trial of an oncology nurse-led primary palliative care intervention (CONNECT). Three groups of nurses were evaluated: nurses at intervention clinics who provided palliative care in addition to oncology care, nurses at intervention clinics who did not provide palliative care, and nurses at standard care sites. Upon study enrollment and 1 year following, nurses completed the Maslach Burnout Inventory (subscales: emotional exhaustion [EE; range 0-54, higher scores indicating more burnout], depersonalization [DP; range 0-40, higher scores indicating more burnout], and personal accomplishment [PA; range 0-48, lower scores indicating more burnout]). Multivariable regression analyses were performed to test differences in follow-up burnout scores between nurse groups.

RESULTS: Overall burnout rates were low at enrollment for all groups (EE 17.0 ± 12.0, DP 2.6 ± 3.5, PA 41.7 ± 5.2). Nurses who provided palliative care did not report lower burnout scores than nurses in the other two groups at 1 year. Nurses at intervention sites who did not provide palliative care reported greater emotional exhaustion than nurses at standard care sites (adjusted mean difference=6.85; 95% CI, 0.92 to 12.79; p=0.02).

CONCLUSION(S): Providing primary palliative care in addition to oncology care does not appear to impact burnout among oncology infusion room nurses. Impact: As oncology practice evolves to encompass primary palliative care, delivery models must be constructed in ways that safeguard clinician well-being.

Burnout is a state of emotional, physical, and mental exhaustion often caused by excessive and prolonged stress. Given the emotionally and often physically demanding nature of the work of correctional professionals, they are at substantial risk of suffering the adverse consequences of burnout. We systematically reviewed (Stage 1) the influence of burnout amongst forensic psychologists, psychiatrists, case workers, nurses, and correction officers. Interventions were then reviewed (Stage 2) at the individual and collective level to examine the effectiveness or efficacy of treatments for burnout among professionals working in corrections.