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[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.

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.

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.

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.

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.

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.