[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.]
This resource is found in our Actionable Strategies for Government: Aligning Values & Improving Diversity, Equity & Inclusion (Improving Diversity, Equity & Inclusion).
Executive Order on Advancing Effective, Accountable Policing and Criminal Justice Practices to Enhance Public Trust and Public Safety
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.
Expanding Moral Injury: Why Resilience Training Won’t Fix It
[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.]
This resource is found in our Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Support Career Development).
Expanding Registered Apprenticeship Opportunities to Underrepresented Populations: Findings from the American Apprenticeship Initiative Evaluation
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.
Experiences of Intensive Care Unit Nurses Working with COVID-19 Patients: A Systematic Review and Meta-Synthesis of Qualitative Studies
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.
Experiences of U.S. Nurses Compared With Nonnurses in the First Year of COVID-19: Findings From a National Registry
Career selection in medicine is a complex and underexplored process. Most medical career studies performed in the U.S. focused on the effect of demographic variables and medical education debt on career choice. Considering ongoing U.S. physician workforce shortages and the trilateral adaptive model of career decision making, a robust assessment of professional attitudes and work-life preferences is necessary. The objective of this study was to explore and define the dominant viewpoints related to career choice selection in a cohort of U.S. IM residents. We administered an electronic Q-sort in which 218 IM residents sorted 50 statements reflecting the spectrum of opinions that influence postgraduate career choice decisions. Participants provided comments that explained the reasoning behind their individual responses. In the final year of residency training, we ascertained participating residents’ chosen career. Factor analysis grouped similar sorts and revealed four distinct viewpoints. We characterized the viewpoints as “Fellowship-Bound-Academic,” “Altruistic-Longitudinal-Generalist,” “Inpatient-Burnout-Aware,” and “Lifestyle-Focused-Consultant.” There is concordance between residents who loaded significantly onto a viewpoint and their ultimate career choice. Four dominant career choice viewpoints were found among contemporary U.S. IM residents. These viewpoints reflect the intersection of competing priorities, personal interests, professional identity, socio-economic factors, and work/life satisfaction. Better appreciation of determinants of IM residents’ career choices may help address workforce shortages and enhance professional satisfaction.
Exploring US Internal Medicine Resident Career Preferences: A Q-methodology Study
Burnout is increasingly documented in occupational therapy (OT); however, practitioner and student well-being have not been examined to date. The research aim was to explore the relationship between well-being, resilience, stress, and self-care in OT. For this purpose, a cross-sectional survey of practitioners and students was done, including a background survey, World Health Organization-5 Well-Being Index (WHO-5), Brief Resilience Scale (BRS), Perceived Stress Scale (PSS), and Mindful Self-Care Scale (MSCS). Open-ended questions and Visual Analog Scales were used to gather satisfaction and service access. Practitioners (n = 235) and students (n = 200) reported well-being "less than half of the time" on the WHO-5, "moderate" stress on the PSS, and "normal" resilience on the BRS. The BRS, PSS, and MSCS explained a significant proportion of variance on the WHO-5 for practitioners and students. Most participants used at least one self-care strategy and desired additional organizational services. The findings of elevated stress and decreased well-being underscore the importance of reimagining wellness initiatives in OT.
Exploring Well-Being: Resilience, Stress, and Self-Care in Occupational Therapy Practitioners and Students
The nursing faculty shortage continues to grow with time with impending detrimental effects. Several factors influence the nursing faculty shortage, including inadequate compensation to clinical areas, low pool of potential nurse educators in graduate programs, and a faculty wave of retirements. Based on this information, it is vital for nursing institutions to improve job satisfaction and the intent to remain among millennial nursing faculty. The purpose of this study is to evaluate the relationship between job satisfaction and intent to remain within an organization among millennial nursing faculty. A cross-sectional, correlational research design was used to test the hypotheses of the study. Data were collected electronically from 188 participants using the Nurse Faculty Job Satisfaction and Intent to Remain in the Academic Organization instrument. The findings revealed a statistically significant relationship between job satisfaction, compensation, opportunities for advancement, recognition, and interpersonal relationships and intent to remain in an organization among millennial nursing faculty. The content analysis identified several themes including overall job satisfaction, inadequate compensation, lack of leadership support, and positive relationships with coworkers. The information gained from this study has significant implications for nursing education, practice, and policy. The study aims to enhance the knowledge surrounding essential elements for millennial nursing faculty to feel satisfied with the job and remain with an organization.
Exploring the Relationship Between Job Satisfaction and Intent to Remain Within an Organization Among Millennial Nursing Faculty
BACKGROUND: Humanism in Medicine Initiative (HIMI), an extracurricular program at Ohio State University College of Medicine (OSUCOM) with 27 subgroups, fosters the humanities. Stress and burnout among first- and second-year medical students are prevalent across the United States. Solutions for stress among first- and second-year medical students have been proposed, but no gold standard exists. The relationship of humanism with stress and burnout has yet to be described in the literature. OBJECTIVE: This study investigates the relationship between participation in the HIMI and stress, burnout, and academic success among first- and second-year medical students. METHODS: First- and second-year medical students enrolled at OSUCOM between August 2018 and August 2019 were recruited. Attendance in the HIMI and membership records were used to measure their participation. Curricular examination scores and those on Step 1 of United States Medical Licensing Examination (USMLE) were used to measure academic success. Stress and burnout were measured using the Maslach Burnout Inventory and the Perceived Stress Scale. RESULTS: In total, 412 students were enrolled with 362 (87%) students participating in HIMI. Those with high participation were more often Black, Asian, female, or with a humanities undergraduate major compared to the overall study population. There were significant relationships between Gold Humanism Honors Society (GHHS) induction and participation of first- and second-year medical students in service- (?21=5.8, P<.05) or leadership-focused (?21=19.3, P<.001) HIMI groups. Medium levels of participation in the HIMI were associated with significantly higher stress. Performance on the Step 1 USMLE was not significantly associated with participation levels in the HIMI (low=233.7 vs high=238.0; P=.10). CONCLUSIONS: The HIMI is an extracurricular program vastly utilized by first- and second-year medical students at OSUCOM and did not impact Step 1 USMLE scores. Medium participation in the HIMI was associated with higher stress, and service- and leadership-focused HIMI participation was associated with a higher level of induction to the GHHS. This study identifies areas for future studies to understand the relationship of the HIMI with stress and academic success.
Extracurricular Humanism in Medicine Initiative and Medical Student Wellness: Retrospective Study
[This is an excerpt.] In his first State of the Union, the President will outline a unity agenda consisting of policy where there has historically been support from both Republicans and Democrats, and call on Congress to send bills to his desk to deliver progress for the American people. As part of this unity agenda, he will announce a strategy to address our national mental health crisis.Our country faces an unprecedented mental health crisis among people of all ages. Two out of five adults report symptoms of anxiety or depression. And, Black and Brown communities are disproportionately undertreated – even as their burden of mental illness has continued to rise. Even before the pandemic, rates of depression and anxiety were inching higher. But the grief, trauma, and physical isolation of the last two years have driven Americans to a breaking point. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Government: Ensuring Workers' Physical and Mental Health (Support Workers' and Learners' Mental Health & Well-Being).
FACT SHEET: President Biden to Announce Strategy to Address Our National Mental Health Crisis, As Part of Unity Agenda in his First State of the Union
OBJECTIVE: This study aimed to identify factors associated with burnout in nurses and nurses' opinions regarding interventions to promote well-being during crisis conditions such as those experienced during the COVID-19 pandemic. BACKGROUND: Burnout among nurses is prevalent under usual conditions and may increase during crises such as COVID-19. METHODS: Researchers conducted a survey of 1103 frontline nurses in a single New York City hospital during the first (spring 2020) and second (fall 2020/winter 2021) local waves of COVID-19. RESULTS: Burnout prevalence increased from 45% to 52% between the first and second wave. Younger age, female gender, posttraumatic stress, anxiety or depressive symptoms, history of burnout, feeling less valued by hospital leadership, less informed of responsibilities, less certain about duration of enhanced workload, and prepared by prepandemic experience were predictive of burnout in multivariable analyses. CONCLUSIONS: Although some identified risk factors for burnout were nonmodifiable, others may be modifiable by hospital leadership.
Factors Associated With Burnout Among Nurses Providing Direct Patient Care During the COVID-19 Pandemic
OBJECTIVES: The aims of the study were to determine the prevalence of burnout in physical medicine and rehabilitation residents in the United States and to identify the personal- and program-specific characteristics most strongly associated with residents reporting burnout. DESIGN: This was a cross-sectional survey of US physical medicine and rehabilitation residents. Emotional exhaustion, depersonalization, and burnout were assessed using two validated items from the Maslach Burnout Inventory. Associations of burnout with demographics and personal factors, residency program characteristics, perceived program support, and work/life balance were evaluated. RESULTS: The survey was completed by 296 residents (22.8%), with 35.8% of residents meeting the criteria for burnout. Residents' perception of not having adequate time for personal/family life was the factor most strongly associated with burnout (?2 = 93.769, P < 0.001). Residents who reported inappropriate clerical burden and working more than 50 hrs/wk on inpatient rotations were most likely to report that they did not have adequate time for personal/family life. Faculty support (?2 = 41.599, P < 0.001) and performing activities that led residents to choose physical medicine and rehabilitation as a specialty (?2 = 93.082, P < 0.001) were protective against burnout. CONCLUSIONS: Residents reporting having inadequate time for their personal/family life was most strongly associated with physical medicine and rehabilitation resident burnout, although many personal and program characteristics were associated with burnout.
Factors Associated With Burnout in Physical Medicine and Rehabilitation Residents in the United States
INTRODUCTION: Burnout is a syndrome resulting from chronic workplace stress that has not been successfully managed. Prevention and management of burnout in the doctor of physical therapy (DPT) student population may help reduce the development of burnout later in their work life. REVIEW OF LITERATURE: Few published studies assessing burnout have been conducted with physical therapist students. In studies with medical and nursing students, individual factors that influence the development of burnout include reduced level of physical activity, reduced level of social support, not experiencing positive life events, increased fatigue, increased stress, and decreased resilience. Environmental factors that influence the development of burnout include grading scheme and perceptions of the learning environment. SUBJECTS: Participants included 20 DPT students from across the United States. METHOD: A total of 522 students from a previous study who volunteered for the present grounded theory qualitative study were stratified by burnout group (burnout and nonburnout) and geographic region. Once stratified, students were randomized and then contacted through email to set up an interview time to participate in a Zoom audio interview. A total of 20 semistructured interviews were completed ranging from 20 to 40 minutes. RESULTS: Three major themes emerged from the data, each with 3 subthemes. The major themes included burnout experience, factors that negatively affected well-being, and factors that positively affected well-being. DISCUSSION AND CONCLUSION: The results of this study indicate that DPT students experienced burnout as a combination of exhaustion, disengagement, and chronic overload. Factors that negatively affected well-being while in DPT school included unmanageable stress, an excessive workload, and time pressures. Factors that positively affected well-being while in DPT school included prioritizing time, support from faculty, friends, and family, and self-awareness.
Factors Contributing to Burnout and Well-Being in Physical Therapist Students
OBJECTIVES: This study aimed to identify rates of and contributors to burnout and professional fulfillment among emergency medicine (EM) resident physicians. METHODS: This was a cross-sectional, national survey of resident members of the Society for Academic Emergency Medicine (SAEM). Primary outcomes were burnout and professional fulfillment measured using a previously validated instrument with additional domains pertaining to the academic environment. The survey included question domains examining organizational factors (e.g., academic work environment, satisfaction with training, electronic health records, values alignment, and control over schedule) and individual factors (e.g., self-compassion, meaningfulness of clinical work, impact of work on health and personal relationships, perceived appreciation, thoughts of attrition, and expectations of the field of EM). Logistic regression was performed to determine the relationships between the primary outcomes and each domain. RESULTS: The survey was sent electronically to 2641 SAEM resident members. A total of 275 residents completed the survey with a response rate of 10.4%. A total of 151 (55%) respondents were male, and 210 (76%) were White. A total of 132 (48%) residents reported burnout, and 75 (28%) reported professional fulfillment. All organizational and individual factors were significantly associated with both primary outcomes. EM residents reported that meaningfulness of clinical work had the most significant positive association with professional fulfillment (adjusted odds ratio [OR] 2.2 [95% confidence interval CI 1.8–2.7]) and negative association with burnout (adjusted OR 0.46 [95% CI 0.37–0.56]). Thoughts of attrition from academics and accurate expectations of EM were also associated with both primary outcomes, with adjusted ORs (95% CIs) of 0.40 (0.21–0.72) and 5.6 (1.9–23.8) for professional fulfillment and 4.1 (2.5–7.1) and 0.19 (0.08–0.40) for burnout, respectively. CONCLUSIONS: This study found a high prevalence of burnout and a low prevalence of professional fulfillment among EM residents. Multiple factors were significantly associated with each occupational phenomenon, with meaningfulness of clinical work demonstrating the strongest relationships with burnout and professional fulfillment.
Factors Driving Burnout and Professional Fulfillment among Emergency Medicine Residents: A National Wellness Survey by the Society for Academic Emergency Medicine
Professional nurses are leaving their current positions in acute care hospitals and, in some cases, the profession in greater numbers than ever. Nurse leaders must understand factors surrounding nurses' intent to leave to develop strategies to mitigate this phenomenon and retain nurses. This review of the literature seeks to synthesize studies on nurses' intent to leave. Themes include job satisfaction, resources and staffing impacting workloads, leadership, and burnout.
Factors Influencing Nurse Intent to Leave Acute Care Hospitals: A Systematic Literature Review
INTRODUCTION: The novel coronavirus infectious disease (COVID-19) has spread rapidly with vast global implications. This study assessed how family physicians in Kansas responded to COVID-19 and the effects of the pandemic on the physicians’ well-being. METHODS: The authors conducted a cross-sectional survey of 113 family physicians in Kansas between May 22, 2020 and June 25, 2020. The study participants completed an anonymous, 18-item survey assessing family physicians’ concerns about being exposed to COVID-19, levels of personal depression, anxiety, stress, and burnout in addition to demographic information. RESULTS: There was a 45.6% response rate, with 50.4% (n=57) of the respondents reporting manifestations of burnout. The physicians who personally treated any presumptive or confirmed COVID-19 patient, compared to those who did not, were more likely to report at least one manifestation of burnout (odds ratio[OR]=3.96; 95% confidence interval [CI], 1.38-11.36; P = .011), experience emotional exhaustion (OR=3.21; 95% CI, 1.01-10.10; P<.05), and feel a higher level of personal stress (OR=1.13; 95% CI, 1.01-1.27; P=.011). CONCLUSION: Our findings demonstrate that the COVID-19 pandemic may be taking an emotional toll on family physicians in Kansas. This study provides a baseline from which to continue further monitoring of outcomes such as burnout, depression, anxiety, and stress, to determine the need for interventions, and influence the implementation of programs to support physician wellness. These data can help drive wellness and mental health support initiatives at local, state, and national levels to help diminish the negative impact of the COVID-19 pandemic on physicians.
Family Physicians in Kansas Response to the COVID-19 Pandemic
BACKGROUND: Firefighters are often exposed to occupational stressors that can result in psychological distress (ie, anxiety and depression) and burnout. These occupational stressors have only intensified with the onset of the COVID-19 pandemic and will likely persist in the postpandemic world. OBJECTIVE: To address occupational stressors confronting firefighters, we pilot tested a novel, cost-effective, smartphone app–based meditation intervention created by Healthy Minds Innovations that focused on mindfulness (awareness) training along with practices designed to cultivate positive relationships (connection), insight into the nature of the self (insight), and a sense of purpose in the context of challenge (purpose) with a sample of professional firefighters from a large metropolitan area in southwestern United States. METHODS: A total of 35 participants were recruited from a closed online group listserv and completed the self-guided 10-unit meditation app over the course of 10 days, at 1 unit per day. We assessed anxiety symptoms, depression symptoms, burnout, and negative affect as well as saliva diurnal cortisol rhythm, an objective indicator of stress-related biology, before and after use of the meditation app. RESULTS: This study demonstrated the meditation app was both feasible and acceptable for use by the majority of firefighters. We also found significant reductions in firefighters’ anxiety (P=.01), burnout (P=.05), and negative affect (P=.04), as well as changes in cortisol diurnal rhythm, such as waking cortisol (P=.02), from before to after use of the meditation app. CONCLUSIONS: Our study findings call for future research to demonstrate the efficacy of this meditation app to reduce psychological distress and burnout in firefighters.
Feasibility, Acceptability, and Preliminary Efficacy of an App-Based Meditation Intervention to Decrease Firefighter Psychological Distress and Burnout: A One-Group Pilot Study
Physician health and wellness can be negatively affected by burnout, which in turn can lead to multiple potential professional and personal issues. Burnout issues can start in medical school and progress during residency and fellowship, and throughout a physician’s career. A previous survey of allergists and immunologists reported a burnout rate of 35%. However, there are currently few data regarding health and wellness specifically for fellows-in-training (FIT) in allergy and immunology. This workgroup report was developed to assess health and wellness among FIT in our specialty. The American Academy of Allergy, Asthma & Immunology electronically distributed an anonymous questionnaire using the validated mini-Z survey to a total of 388 allergy and immunology FIT. In addition to the mini-Z items, the survey queried personal and professional demographic characteristics and included open-ended wellness questions. A total of 82 FIT completed the survey, yielding a 24% response rate. The burnout rate was 39%, which is lower than the national average among US physicians. Overall job satisfaction was 82%, and 72% reported satisfactory or better control over workload. Our results identify FIT-specific concerns in our specialty that can be used to develop tailored interventions to improve wellness and minimize burnout among this group. However, future surveys are needed to continue to address allergy and immunology FIT-specific wellness challenges.
Fellows in Training Wellness in Allergy and Immunology: AAAAI Workgroup Report
[This is an excerpt.] At the beginning of April 2020, the COVID-19 pandemic burned me out. I was ready to quit nursing. I wanted to run as far away as I could, away from dying patients, away from the heartaches. I remember waking up in bed, physically drained from a fitful sleep, emotionally shattered by the friends and the patients we lost. I debated calling out sick that morning just because I dreaded hearing the frequent overhead pages for the code team. The apex of this pandemic that we were preparing for came much too early. Physicians, nurses, and technicians were running around responding to calls for intubations, desperately trying to race against time. We were all covered from head to toe with impervious gowns, face shields, double gloves, boots, and surgical caps; the N95 masks would later leave marks on our faces. The scars in our hearts were unseen, and post-traumatic stress disorder, a real threat. We were protected, we assured ourselves, but how could you be confident about how safe you are when the COVID-19 fatalities keep on rising? The whole hospital (and all of New York City) was in a pandemic chokehold. [To read more, click View Resource.]
Finding My Joy: Fighting Nurse Burn-out
While structural change is needed to address the burnout epidemic among healthcare workers, it is important for physicians to avail themselves of the many productivity strategies that can help them succeed in navigating the multiple responsibilities of academic medicine. We present here 5 key strategies within our control that can help increase productivity in the pursuit of work in academic medicine that is meaningful and sustainable: (1) Clarify Priorities, (2) Track Tasks Systematically, (3) Focus and Monotask, (4) Invest in Timesavers, and (5) Celebrate Successes. The specific tools listed under each strategy may help academic physicians feel grounded and maintain our focus on doing meaningful work. While system-wide culture change around expectations, and institutional support for physician wellbeing, is more critical than ever, individual physicians can still benefit from learning strategies to prioritize, track, focus on, delegate and celebrate the work that matters to us in our lives.
