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OBJECTIVE: This matched case-control study compared the long-term employment status of direct care nurses based on participation in a psychoeducational group intervention and calculated the estimated cost savings. BACKGROUND: Chronic stress, in addition to lack of support and low autonomy, can lead to burnout among nurses. Burnout is a common reason for job dissatisfaction and turnover. Interventions combining education with therapeutic processing and peer support may lead to healing and growth in nurses already experiencing the effects of chronic stress and burnout. The COVID-19 pandemic also contributed to stress among nurses. METHODS: Fifty-four direct care nurses who participated in the intervention were paired with 54 direct care nurses who did not participate, matched on the following variables: age, gender, race, work setting, and campus. RESULTS: This study found a higher percentage of direct care nurses who participated in the intervention remained employed compared with the matched control subjects who did not participate. CONCLUSION: At a relatively low cost compared with the cost of turnover by each nurse, the psychoeducational group intervention may provide an opportunity to improve retention among nurses.

PROBLEM: Learner mistreatment has remained an ongoing challenge in academic medicine despite accreditation requirements mandating that every program has systems in place to prevent and respond to mistreatment. While efforts vary across institutions, much remains unanswered in the literature about best practices. Additionally, for the foreseeable future, challenges in the learning environment will likely continue and potentially worsen, given the confluence of multiple external stressors including the COVID-19 pandemic, faculty burnout and general political divisiveness in the nation. It is essential, therefore, to focus on indicators of improvement via process metrics such as knowledge and awareness of mistreatment policies and procedures, willingness to report, reasons for not reporting, and satisfaction with having made a report, while simultaneously focusing on the more complex challenge of eliminating mistreatment occurrences. INTERVENTION: We describe the aspects of our mistreatment prevention and response system first implemented in 2017 along with process and outcome measures. The interventions included expanding our policy outlining appropriate conduct in the teacher-learner relationship; a graduated response protocol to allegations of mistreatment with a clear escalation approach; an online reporting system; a graduate medical education exit survey which mirrors the AAMC Graduation Questionnaire on mistreatment; a robust communication and professional development campaign; a comprehensive data dashboard; and a comprehensive summary report dissemination plan. CONTEXT: The interventions were implemented at the largest allopathic medical school in the U.S., with nine campuses across the state. The system is available to all learners, including medical students, graduate students, residents, and fellows. IMPACT: Both institutional and national data sources have informed the continuous improvement strategies. Data from internal reporting systems, institutional surveys, and national data are presented from 2017 to 2021. Findings include an increasing number of incidents reported each year, including confidential reports from students who include their contact information rather than report anonymously, which we view as an indicator of learner trust in the system. Our data also show consistent improvements in learners’ awareness of the policy and procedures and satisfaction with having made a report. We also include other data such as the nature of complaints submitted and timeliness of our institutional response. LESSONS LEARNED: We present several lessons learned that may guide other institutions looking to similarly improve their mistreatment systems, such as a close partnership between faculty affairs, diversity affairs, and educational affairs leadership; communication, professional development, and training through multiple venues and with all stakeholders; easily accessible reporting with anonymous and confidential options and the ability to report on behalf of others; policy development guidance; data transparency and dissemination; and trust-building activities and ongoing feedback from learners.

[This is an excerpt.] Burnout is a major problem in health care and is associated with adverse sequelae for patients, healthcare workers, and organizations. Burnout among respiratory therapists (RTs) is as high as 79% and is associated with poor or ineffective leadership, inadequate staffing, high workload, non-leadership position, and work environment. An understanding of burnout is necessary for both staff and leadership to ensure RT wellbeing. This narrative review article will discuss the psychology of burnout, prevalence, drivers, mitigation strategies, and future directions for research. Burnout is a major problem in health care and is associated with adverse sequelae for patients, healthcare workers, and organizations. Burnout among respiratory therapists (RTs) is as high as 79% and is associated with poor or ineffective leadership, inadequate staffing, high workload, non-leadership position, and work environment. An understanding of burnout is necessary for both staff and leadership to ensure RT wellbeing. This narrative review article will discuss the psychology of burnout, prevalence, drivers, mitigation strategies, and future directions for research. [To read more, click View Resource.]

The Choosing Wisely campaign, established by the American Board of Internal Medicine Foundation in 2012, identifies health care services that patients and clinicians should consider ending due to limited clinical benefit. More than 80 clinician specialty societies across multiple health disciplines have generated more than 600 recommendations to help clinicians and patients choose care that is high value and avoid services that may be unnecessary or harmful. Choosing Wisely has changed the national conversation about the need to reduce low-value care. Now, this decade-long quest to improve the value of health care delivery has collided with a demoralized health care workforce, creating a unique opportunity to improve health care work environments by applying a Choosing Wisely mindset to clinical management practices.

PURPOSE OF REVIEW: The purpose of this review is to evaluate the recent literature on environmental factors impacting wellness for the acute care surgeon. This includes factors influencing physical, mental, and emotional well-being. RECENT FINDINGS: Recent studies have identified challenges to surgeon wellness including increased incidence of sleep deprivation, musculoskeletal pain and injuries, pregnancy complications, moral injury, posttraumatic stress disorder (PTSD), and burnout. Qualitative studies have characterized the surgeon's emotional response to occupational stress, adverse events, and surgical complications. Further descriptive studies offer interventions to prevent moral injury after adverse events and to improve surgeon work environment. SUMMARY: Acute care surgeons are at increased risk of sleep deprivation, musculoskeletal pain and injury, pregnancy complications, moral injury, PTSD, and burnout. Surgeons experience feelings of isolation and personal devaluation after adverse events or complications, and this may lead to practice limitation and progression to PTSD and/or burnout. Interventions to provide mentorship, peer support, and education may help surgeons recover after adverse events. Further study is necessary to evaluate institution-driven interventional opportunities to improve surgeon well-being and to foster an inclusive and supportive environment.

[This is an excerpt.] This report details findings from a recent study by PHI on hazard pay and paid sick leave policies enacted across all 50 states and DC from March 2020 to August 2021 (the first 18 months of the COVID-19 pandemic). The purpose of the study was to document how states responded to the challenges faced by direct care workers and other essential workers during one of the most devastating health crises in recent history—and to generate lessons for the future. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Strengthen Worker Compensation and Benefits).

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BACKGROUND: Physician burnout is often assessed by healthcare organizations. Yet, scores from different burnout measures cannot currently be directly compared, limiting the interpretation of results across organizations or studies. OBJECTIVE: To link common measures of burnout to a single metric in psychometric analyses such that group-level scores from different assessments can be compared. DESIGN: Cross-sectional survey. Setting US practices. Participants A total of 1355 physicians sampled from the American Medical Association Physician Masterfile. MAIN MEASURES: We linked the Stanford Professional Fulfillment Index (PFI) and Mini-Z Single-Item Burnout (MZSIB) scale to the Maslach Burnout Inventory (MBI) in item response theory (IRT) fixed-calibration and equipercentile analyses and created crosswalks mapping PFI and MZSIB scores to corresponding MBI scores. We evaluated the accuracy of the results by comparing physicians’ actual MBI scores to those predicted by linking and described the closest cut-point equivalencies across scales linked to the same MBI subscale using the resulting crosswalks. KEY RESULTS: IRT linking produced the most accurate results and was used to create crosswalks mapping (1) PFI Work Exhaustion (PFI-WE) and MZSIB scores to MBI Emotional Exhaustion (MBI-EE) scores and (2) PFI Interpersonal Disengagement (PFI-ID) scores to MBI Depersonalization (MBI-DP) scores. The commonly used MBI-EE raw score cut-point of ≥27 corresponded most closely with respective PFI-WE and MZSIB raw score cut-points of ≥7 and ≥3. The commonly used MBI-DP raw score cut-point of ≥10 corresponded most closely with a PFI-ID raw score cut-point of ≥9. CONCLUSIONS: Our findings allow healthcare organizations using the PFI or MZSIB to compare group-level scores to historical, regional, or national MBI scores (and vice-versa).

Addressing ethics issues in healthcare is essential to living out an organization's mission, vision, and values. In addition to exacerbating existing ethical dilemmas, the COVID-19 pandemic raised many new and complex questions for leaders and their organizations. Ethical issues related to the workforce require a deliberate and comprehensive consideration of values. The case study scenarios presented here demonstrate examples of common ethical staffing challenges that healthcare leaders have faced, notably the allocation of care providers among COVID-19 patients and the balancing of care quality with staff and patient safety. With access to expert resources and a decision-making framework, leaders can build the moral muscle to meet these challenges and reach ethically justifiable resolutions. These staffing issues highlight the need for increased access to ethics resources for organizational leaders, including moral development support and assistance from experts to resolve complex ethical matters.

Since 2011, the Teaching Health Center Graduate Medical Education (THC GME) program has sought to expand access to care by training residents in safety net settings.To examine impact on physician scope, location, and patient population served using a unique data set.Using 2017-2020 data from the American Board of Family Medicine National Graduate Survey, we compared demographics, practice location, populations served, and scope of practice between graduates of THC GME programs and graduates of other family medicine programs.Our sample comprised 8608 (out of 13?465) eligible family medicine graduates 3 years after completion of residency training, for a response rate of 63.9%. THC graduates were significantly more likely than other graduates to practice in a rural location (17.9% to 11.8%), within 5 miles of their residency program (18.9% to 12.9%), and to care for medically underserved populations (35.2% to 18.6%). Their scope of practice was wider than other graduates and more likely to comprise services like buprenorphine prescribing, behavioral health care, and outpatient gynecological procedures. Regression results suggest that THC training is independently correlated with a broader scope of practice. Graduates of THC programs were significantly more likely than graduates of other programs to practice close to their training sites and in rural areas, and to care for underserved patients while maintaining a broader scope of practice than other graduates.

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

The aim of our study was to evaluate the impact of COVID-19 on the mental health of in-training anesthesiology residents in the United States. A link containing validated survey tools including the Depression-Anxiety-Stress-Scale (DASS-21), the Abbreviated Maslach Burnout Inventory (aMBI), and the Brief Resilient Coping Scale (BRCS) along with questions related to work environment, and additional personal factors were emailed to 159 Anesthesiology residency programs across the US. 143 responses were received of which 111 were complete. The prevalence of depression, anxiety, stress and burnout was 42%, 24%, 31% and 71% respectively. Emotional exhaustion, depersonalization, and reduced feelings of personal accomplishment were experienced by 80%, 53%, and 65% of respondents, respectively. The BRCS scale showed 33% of respondents with low, 44% with moderate and 22% with high coping scales. Logistic regression analyses indicated those with a prior mental health diagnosis were 3 times more likely to have a non-normal DASS depression score, 4 times more likely to have a non-normal DASS anxiety score, and 11.74 times more prone to emotional exhaustion. Increased work hours and higher training levels were associated with increased levels of stress. In our survey, prior mental health illness, gender and increased work hours were the main drivers of increased risk.

PURPOSE: The purpose of this study is to examine whether differences in occupational burnout between Black and White officers can be explained by differences in areas of worklife and differences in indicators of reform. DESIGN/METHODOLOGY/APPROACH: Using a modified version of the Maslach Burnout Inventory, information on emotional exhaustion and depersonalization was collected from 910 Black and 8,240 White officers through the National Police Research Platform. Structural equation models with bootstrapped confidence intervals were used to test mediation hypotheses and estimate indirect effects.

[This is an excerpt.] The Physicians Foundation's Part One of Three: 2022 Survey of America's Physicians examines the current impact of drivers of health (DOH) on physician practice, physician wellbeing and their patients as well as possible solutions needed to address DOH. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Aligning Values (Invest/Advocate for Patients, Communities, & Workers).

BACKGROUND: Internationally, the impact of continued exposure to workplace environmental and psychological stressors on health care professionals’ mental health is associated with increased depression, substance misuse, sleep disorders, and posttraumatic stress. This can lead to staff burnout, poor quality health care, and reduced patient safety outcomes. Strategies to improve the psychological health and well-being of health care staff have been highlighted as a critical priority worldwide. The concept of resilience for health care professionals as a tool for negotiating workplace adversity has gained increasing prominence. Objective: This systematic review aims to examine the effectiveness of web-based interventions to enhance resilience in health care professionals. METHODS: We searched the PubMed, CINAHL, PsycINFO, and Ovid SP databases for relevant records published after 1990 until July 2021. We included studies that focused on internet-delivered interventions aiming at enhancing resilience. Study quality was assessed with the Risk of Bias 2 tool for randomized controlled trial designs and Joanna Briggs Institute critical appraisal tool for other study designs. The protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42021253190). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. RESULTS: A total of 8 studies, conducted between 2014 and 2020 and involving 1573 health care workers, were included in the review. In total, 4 randomized controlled trial designs and 4 pre- and postdesign studies were conducted across a range of international settings and health care disciplines. All of these studies aimed to evaluate the impact of web-based interventions on resilience or related symptoms in health care professionals involved in patient-facing care. Interventions included various web-based formats and therapeutic approaches over variable time frames. One randomized controlled trial directly measured resilience, whereas the remaining 3 used proxy measures to measure psychological concepts linked to resilience. Three pretest and posttest studies directly measured resilience, whereas the fourth study used a proxy resilience measure. Owing to the heterogeneity of outcome measures and intervention designs, meta-analysis was not possible, and qualitative data synthesis was undertaken. All studies found that resilience or proxy resilience levels were enhanced in health care workers following the implementation of web-based interventions. The overall risk of bias of all 8 studies was low. CONCLUSIONS: The findings indicate that web-based interventions designed to enhance resilience may be effective in clinical practice settings and have the potential to provide support to frontline staff experiencing prolonged workplace stress across a range of health care professional groups. However, the heterogeneity of included studies means that findings should be interpreted with caution; more web-based interventions need rigorous testing to further develop the evidence base.

Mentorship programs are an emerging strategy in the nursing profession to support and develop new staff in the field; this 12-month structured program found those in the mentoring role benefit, too. The sample included 11 oncology RNs working in the inpatient acute hospital setting, serving as mentors in the oncology nurse residency program. The results were statistically significant for compassion satisfaction, and burnout scores decreased. Qualitative analysis of the open-ended questions revealed mentors felt confident they make a difference, enhanced professional growth, and reduced burnout.

PURPOSE: Social workers are at risk of experiencing burnout, which is associated with numerous negative outcomes for professionals, agen­ cies, and their clients. The purpose of this study is to examine the relationship between professional burnout and workplace conditions, with a particular focus on incidents of client violence. METHOD: Data were from the 2015–2016 Social Work Safety Survey (SWSS) (N = 141). A multiple linear regression model was created to examine the effect of various workplace conditions on feelings of burnout, including experiencing incidents of client violence, workplace setting, average hours worked, length of time at current job, working primarily with clients who had experienced trauma, satisfaction with supervision, and having participated in a safety training. RESULTS: Feelings of burnout significantly increased as number of incidents of client violence and/or threats of client violence increased (B = 0.14). Additionally, the greater the average hours worked per week (B = .02) and working in private clinical practice (B = 0.63) significantly increased burnout scores. Length of time at current job was inversely predictive of feelings of burnout (B = −0.03). DISCUSSION: The findings from this study have significant implications for social work education and practice which may omit or overlook the effects of client violence and threats of violence in burnout prevention.

[This is an excerpt.] By the authority vested in me as President by the Constitution and the laws of the United States of America, I hereby order as follows: Section 1.  Policy.  Our criminal justice system must respect the dignity and rights of all persons and adhere to our fundamental obligation to ensure fair and impartial justice for all.  This is imperative — not only to live up to our principles as a Nation, but also to build secure, safe, and healthy communities.  Protecting public safety requires close partnerships between law enforcement and the communities it serves.  Public safety therefore depends on public trust, and public trust in turn requires that our criminal justice system as a whole embodies fair and equal treatment, transparency, and accountability. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Government: Aligning Values & Improving Diversity, Equity & Inclusion (Improving Diversity, Equity & Inclusion).

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The summer of 2020 posed some unique and specific challenges when I began residency training in family medicine, from the masks that placed a new barrier between myself and patients, to the surges of COVID-19 infections that overwhelmed my hospital, to the travel limitations that impeded my ability to visit loved ones. I expected to feel overwhelmed by the combination of a rigorous training program and global pandemic. Instead, each day I felt a growing sense of dread about the work that I was being asked to do: Treat COPD (chronic obstructive pulmonary disease) with inhalers and other medications my patients needed but could not afford. Discharge patients to untenable home situations knowing they would be doomed to return in a matter of days. Recommend mental health services while recognizing it would take months for patients to be seen.

[This is an excerpt.] Apprenticeships are structured work-based training programs that combine classroom instruction(“related technical instruction,” or RTI) with on-the-job learning (OJL) provided by a mentor at the employer’s worksite. Apprenticeships provide training in a specific occupation and deliver occupational skills that are recognized and transferable across employers. Apprentices are employed during their training, contribute to production, and earn progressively higher wages. Commonly used as a workforce development strategy in other countries, registered apprenticeships in the U.S. have typically been used as a training model for occupations in the building trades (e.g., electrician, carpenter) Reflecting this composition of apprenticeship programs, White men have accounted for most apprentices in the United States. The U.S. Department of Labor (DOL)’s American Apprenticeship Initiative (AAI) focused on expanding apprenticeship, particularly those that it (or a state)“registers” as meeting specific standards, into sectors with few apprenticeships (such as healthcare, manufacturing, and information technology) and to populations traditionally underrepresented in apprenticeship. Funded by the H-1B visa program, AAI awarded $175 million in five-year grants to 46 grantees in 2015. To build evidence about the effectiveness of registered apprenticeship for apprentices and employers, DOL commissioned an evaluation of the AAI grants in 2016, which included four sub-studies. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Support Career Development).

OBJECTIVES: Intensive Care Unit (ICU) nurses are at the forefront of fighting and treating the Coronavirus 2019 (COVID-19) pandemic and are often directly exposed to this virus and at risk of disease, due to their direct care for infected patients. This study aims to synthesize the experiences of ICU nurses working with COVID-19 patients. METHODS: A systematic review and meta-synthesis of qualitative studies were undertaken. A systematic literature search in four databases, including Web of Sciences, Scopus, Embase, and PubMed (including Medline), was performed. Original qualitative studies and the qualitative section of mixed method studies, written in English, which focused on the experiences of only ICU nurses working with COVID-19 patients, were included. RESULTS: Seventeen qualitative studies and two mixed-method studies were included in the review. As a result of the inductive content analysis, six main categories were identified, as follows: "distance from holistic nursing," "psychosocial experiences," "efforts for self-protection and wellbeing," "organizational inefficiency," "job burnout," and "emerging new experiences in the workplace." CONCLUSIONS: The findings from this study suggest that healthcare authorities and policymakers can facilitate the provision of high-quality patient care during the COVID-19 pandemic through appropriate planning to provide adequate support and training, prevent shortages of nursing staff and equipment, and provide adequate attention to the psychological needs and job satisfaction of ICU nurses.

BACKGROUND: Nursing professional organizations and media sources indicated early in the pandemic that the physical and psychological effects of COVID-19 might be distinct and possibly greater in nurses than in other types of healthcare workers (HCWs). OBJECTIVES: Based on survey data collected in Healthcare Worker Exposure Response and Outcomes (HERO), a national registry of U.S. HCWs, this study compared the self-reported experiences of nurses with other HCWs during the first 13 months of the pandemic. METHODS: Nurse responses were compared to responses of nonnurse HCWs in terms of viral exposure, testing and infection, access to personal protective equipment (PPE), burnout, and well-being. Logistic regression models were used to examine associations between nurse and nonnurse roles for the binary end points of viral testing and test positivity for COVID-19. We also examined differences by race/ethnicity and high-risk versus low-risk practice settings. RESULTS: Of 24,343 HCWs in the registry, one third self-identified as nurses. Nurses were more likely than other HCWs to report exposure to SARS-CoV-2, problems accessing PPE, and decreased personal well-being, including burnout, feeling tired, stress, trouble sleeping, and worry. In adjusted models, nurses were more likely than nonnurse HCWs to report viral testing and test positivity for COVID-19 infection. Nurses in high-risk settings were more likely to report viral exposure and symptoms related to well-being; nurses in low-risk settings were more likely to report viral testing and test positivity. Black or Hispanic nurses were most likely to report test positivity. DISCUSSION: Differences were identified between nurses and nonnurse HCWs in access to PPE, physical and mental well-being measures, and likelihood of reporting exposure and infection. Among nurses, testing and infection differed based on race and ethnicity, and type of work setting. Our findings suggest further research and policy are needed to elucidate and address social and occupational disparities.