Resource Library

This study examined whether firefighters' trust beliefs in co-workers were associated with their psychosocial adjustment and burnout. In the study, 102 firefighters completed measures of trust beliefs in co-workers (honesty, reliability and emotional), psychosocial adjustment, (stress, psychological well-being), and years of service (as an index of burn-out). It was found that firefighters' honesty, reliability, and emotional trust beliefs in co-workers were associated with measures of psychosocial adjustment. Regression analyses confirmed that the firefighters' reliability trust beliefs in co-workers were negatively associated with stress. Also, firefighters' honesty trust beliefs in co-workers were negatively associated with years-of-service which was associated with stress. The findings supported the conclusion that firefighters' trust beliefs in co-workers played a role in psychosocial adjustment and yearsof-service burnout.

This chapter looks into detail at the various pathways to build workplace mental health by identifying organizational modifiable risk factors and identifying protective factors and strengths for prevention, growth, and resiliency. Discussion around common mental health conditions, prevention and continuum of care, and risk factors related to moral suffering, compassion fatigue, and burnout is highlighted along with protective factors, including, for instance, resiliency, self-compassion, compassion satisfaction, and psychological flexibility. Practical strategies for leaders are offered for better organizational culture, stigma reduction, and optimizing wellbeing. This chapter brings a unique twist to current debates around mental health and wellbeing, by having the testimonial from a veteran police officer who has been responded to a myriad of critical incidents and shares his narrative of experiences and insights as a veteran police officer. This chapter concludes with the importance of optimizing mental health education, prevention, and interventions to further healthy and more proactive organizational culture and workplace mental health.

Emergency medical technicians (EMT) and firefighters respond to critical incidents and provide emergent care. As the opioid crisis continues and drug overdose rates increase, first responders administer first aid to substance users, including Naloxone, more frequently. This study examined the influence of repeated exposure to drug-related critical incidents and provision of care to substance users on EMTs' and firefighters' secondary traumatic stress (STS) level, world assumptions, and substance use stigma. First responders' world assumptions, STS, burnout, and exposure to drug-related overdoses were analyzed for their power in predicting substance use stigma. Results suggest that occupational burnout, rather than STS, is more predictive of substance use stigma. Also, a firmer belief in the just world assumption was more predictive of substance use stigma than both Benevolence of World and Benevolence of People World Assumption subscales. Analyses point to a potentially useful and harmful function in an overreliance on the just world belief. EMTs with a firmer belief in the just world were found to have lower STS and burnout scores; conversely, they were also found to hold greater negative attitudes toward substance users. Findings have implications for future research, programmatic management, and educational training targeting substance use stigma and mental health concerns.

Medicine is defined by doing; however, bias, error, and burnout are potential consequences of speed and constant activity. On an individual level, slowing down might reduce bias; resting might reduce error; mindfulness might reduce burnout. Despite its benefits, stillness can be an unattainable privilege for some due to systems of power, including gender, race, and capitalism. In response, institutions must confront these systems and support individual clinicians through radical acts of solidarity because, just as we have fought to make doing-speaking, learning, and working-equal opportunity, so must we ensure that "non-doing" belongs to everyone.

OBJECTIVE: Mistreatment is widespread in graduate medical education, and much attention has been generated on this topic and its relationship to burnout in general surgery residency. In particular, peer-to-peer mistreatment poses a developmental dilemma – as junior residents find themselves mistreated and some turn around and perpetuate that mistreatment. There is a paucity of effective interventions. Forum Theatre (FT) is a novel educational tool to engage participants in solving difficult situations. We present the use of FT as a tool to explore solutions to address peer-to-peer mistreatment in a surgery residency. FT starts with the performance of a culture-specific conflict scenario and then invites the audience to participate in renditions of the situation ending in a collective solution. DESIGN: Stakeholder support was obtained from the general surgery program leadership. Time was protected during two 1-hour scheduled wellness didactic sessions. First, focus groups with each PG year identified the residents’ experience of mistreatment. Themes regarding peer-to peer mistreatment were identified and presented to a group of 3 volunteer actor residents who chose to focus on the unintended consequences of public, corrective feedback with the understanding this would be presented to the residency at large. Following this, they developed a scenario for enactment which was implemented during the second didactic session. The enacted scenario posed a problem with public feedback ending unsatisfactorily. The audience was then invited to engage the actors and participate in replays of the situation until a collective solution was identified. Retrospective pre-post survey and a 6-month post survey were administered. SETTING: General surgery residency at University of Texas Health San Antonio. PARTICIPANTS: General surgery residents. 32 of 66 (48.5%) residents participated. RESULTS: Participants noted an improved understanding of mistreatment, felt more confident in recognizing mistreatment, reported improved confidence in their ability to intervene when witnessing mistreatment and to recognize when they themselves were involved in mistreatment (p < 0.001 for all). In fact, of the residents who reported participating in mistreatment, 100% reported directing it towards peers. After the FT, 89% of residents said they “definitely” or “most likely” recommended participating in a FT to address mistreatment. 85.7% reported that the intervention was moderately to extremely effective for teaching topics in professionalism. These trends remained steady in the survey 6 months after the intervention as well. CONCLUSIONS: We found FT was feasible to implement in a busy general surgery residency and well received with sustained, self- reported behavior change. FT is a novel tool to engage residents to self-evaluate and participate in methods to address mistreatment. FT interventions can be tailored to the local culture to address conflicts specific to that setting.

Psychological safety (PsyS) is an important driver of teams’ performance and organizations are keen to foster it. However, there is little causal evidence on what drives it and how to increase it. This paper implements a randomized control trial with over1000 teams (over 7000 employees) in a global healthcare company to evaluate the impact of individualized attention of the manager to each team member team by encouraging managers to hold frequent 1-to-1 meetings and to focus them on mechanisms expected to increase PsyS. We exogenously vary the content of those meetings: focusing on employees’ needs and aspirations as individuals, or on allowing employees’ to better execute tasks and remove blockers that may hinder their best work. We find that, despite this very non-invasive intervention, the behavior of managers changed as they increased the number of meetings. PsyS also increased as did the relationship to and perceptions of the manager, particularly in the treatment arm that focused on the employees’ individual needs.

The incidence of burnout among radiologists has been increasing exponentially, largely attributed to increased work volumes, expectations for more rapid turn-around times and decreasing interpersonal interactions. While personal wellness activities have been described in the literature, there is little information on the role of cognitive behavioral therapy strategies to mitigate burnout. This manuscript will describe the value of naming automatic negative emotions which can lead to burnout and will provide an overview of strategies that can be used to combat them, using cognitive behavioral therapy techniques.

AIMS: We aim to evaluate the frequency and outcomes of workplace incivility in healthcare for nursing management. BACKGROUND: Incivility in the workplace is a significant problem that is important to nurse managers, as it goes directly against the fundamental values and ethics of providing high-quality care to patients. The Joint Commission (2021) and the American Nurses Credentialing Center have called on healthcare organizations to identify and intervene in the problem of workplace incivility. Evaluation Studies included in this scoping review were those that measured and analysed the frequency and outcomes of workplace incivility in healthcare. Four databases were searched, and 28 articles were reviewed. Evaluation was based on general quality, including study characteristics, instruments, and statistical analyses. Key issues Studies used a quasi-experimental design, and most focused on the Registered Nurse population. The Workplace Incivility Scale was the most commonly used instrument to measure workplace incivility frequency. The most frequently studied work-related outcomes were burnout, satisfaction, and turnover. CONCLUSIONS: Although the frequency of workplace incivility in healthcare is not clear, its consequences are substantial. Multiple studies have revealed significant relationships between workplace incivility and work-related outcomes that are important to nurse managers. Research is needed on non-nursing healthcare professionals, and validation studies are needed on instruments used to measure workplace incivility frequency. Implications for Nursing Management The findings of this review can help nurse managers better understand the phenomenon, frequency, and impact of workplace incivility in the healthcare setting and move toward addressing the problem of workplace incivility among nurses and other healthcare professionals.

BACKGROUND: Nurse educators are challenged to bridge the gap between academia and the health care environment to provide nursing students with the knowledge and skills to ensure their readiness to practice. With limited traditional clinical experiences, many new graduate nurses begin their careers in high-stress environments such as emergency departments. METHODS: A convenience sample of 66 emergency department nurses completed two qualitative survey questions related to their experiences working with new graduate nurses during the coronavirus disease 2019 (COVID-19) pandemic. RESULTS: Respondents reported lack of clinical skills was the biggest weakness observed in new graduate nurses. Four themes were identified: protection and unpreparedness, thirst for knowledge, burnout, and support and self-care; these themes built the foundation for the overarching theme of resilience. CONCLUSION: Nurse faculty must be able to support students' transition into a rapidly changing health care environment. Student preparation should focus on skill building, communication, self-care strategies, and resilience. [J Nurs Educ. 2022;61(12):711–715.]

INTRODUCTION: The COVID-19 pandemic created new and exacerbated existing stressors for frontline healthcare workers. Despite being disproportionately affected by COVID-19, little is known about the experiences of frontline healthcare workers serving marginalized populations in community settings. DESIGN: We used qualitative descriptive methods to understand the experiences of 12 frontline healthcare workers (HCWs) supporting primarily underserved populations in outpatient settings during COVID-19. Interviews were conducted from March to April 2021. METHODS: Interviews were held virtually via Zoom using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and uploaded into NVivo 12 qualitative data analysis software. The transcripts were dually coded by members of the research team and a thematic analysis was conducted. RESULTS: Four major themes from the interviews were identified: stressors and burnout, coping strategies, organizational support, and recommendations. HCWs described how the early adjustment period to the pandemic created new challenges as they attempted to navigate changes in the workplace and altered responsibilities at home. HCWs felt largely unsupported by their organizations as they attempted to cope with stressors. Organizational support programs and resources often did not meet frontline workers' needs, and sentiments of unappreciation from leadership contributed to feelings of burnout and frustration as pandemic-related challenges persisted and evolved. CONCLUSION: Despite encountering numerous stressors at work and home, resulting from pandemic-related disruptions, frontline HCWs continued to provide care for their clients while navigating emerging challenges. Health organizations should include HCWs in decision-making processes when implementing support systems for workers during times of crisis.

It probably won’t surprise you to learn that incivility on the front lines of business is on the rise. After all, as the pandemic wore on, we saw in real time how frontline workers went from being seen as “essential” to being seen as, essentially, punching bags. What might not be obvious is that incivility doesn’t affect only workers who experience it directly — it also affects those who witness it, with consequences for businesses and society. Christine Porath has studied incivility for more than 20 years, looking at the experiences at work of people around the world. Her research shows that business leaders have the power to improve things, both for workers and for society as a whole.

Important findings pertaining to burnout in physicians and nurses have been published over the past year. New findings occur in the context of significant cultural changes, ecological dangers, new financial trends, and evolution in the way organizations measure performance. These changes may provide an opportunity for organizations to focus on priorities that transcend profit. One way healthcare leaders can address burnout is by attending to what matters most to healthcare workers. The authors, all psychiatrists who work with business leaders, review what is currently recommended for burnout and then offer guidance. The importance of leaders thinking beyond financial materiality to psychological materiality as well as leaders and employees exploring meaning and connection at work are emphasized as antidotes to burnout.

BACKGROUND: The emotional nature of midwifery practice has been described by several researchers and midwives have reported extremely high burnout levels. Burnout is dynamic and effects individual midwives differently, depending on individual coping abilities and demographic and contextual factors. However, midwives themselves can reduce burnout at an individual level. AIM: This study aimed to explore the concept of burnout with midwives and to ascertain their perspectives on how burnout can be reduced. This paper presents findings in relation to individual midwives' responsibilities for the reduction of burnout. METHODS: This was a Participatory Action Research study. A total of 5 co-operative inquiry meetings were held with practising midwives (n = 21) over a six-month period (October 2018 - March 2019), in a large, urban teaching maternity hospital in Ireland. Data was analysed using Thematic Network Analysis. FINDINGS: Midwives explored in detail the emotional nature of midwifery practice and how this contributes upon midwives' burnout levels. Recommendations were made for individuals to reduce their own burnout levels. These include self-awareness and basic self-care skills. Some specific individual characteristics were suggested as increasing the risk of burnout such as younger, less experienced midwives. CONCLUSION AND RECOMMENDATIONS: Midwives require high levels of self-awareness to identify external demands, which make them more susceptible to burnout, and utilise their own positive coping mechanisms. Basic self-care is also necessary for midwife well-being. However, without commitment from healthcare systems to reduce chronic excessive workload, burnout levels will remain high, which impacts negatively on midwives and the women in their care.

BACKGROUND: Promoting residents' wellbeing and decreasing burnout is a focus of Graduate Medical Education (GME). A supportive clinical learning environment is required to optimize residents' wellness and learning. OBJECTIVE: To determine if longitudinal assessments of burnout and learning environment as perceived by residents combined with applying continuous quality Model for Improvement and serial Plan, Do, Study, Act (PDSA) cycles to test interventions would improve residents' burnout. METHODS: From November 2017 to January 2020, 271 GME residents in internal medicine, general surgery, psychiatry, emergency medicine, family medicine and obstetrics and gynecology, were assessed over five cycles by Maslach Burnout Inventory (MBI), and by clinical learning environment factors (which included personal/social relationships, self-defined burnout, program burnout support, program back-up support, clinical supervision by faculty, and sleep difficulties). The results of the MBI and clinical learning environment factors were observed and analyzed to determine and develop indicated Institutional and individual program interventions using a Plan, Do, Study, Act process with each of the five cycles. RESULTS: The response rate was 78.34%. MBI parameters for all GME residents improved over time but were not statistically significant. Residents' positive perception of the clinical supervision by faculty was significantly and independently associated with improved MBI scores, while residents' self-defined burnout; and impaired personal relations perceptions were independently significantly associated with adverse MBI scores on liner regression. For all GME, significant improvements improved over time in residents' perception of impaired personal relationships (p?

With nursing burnout on the rise, effective self-care interventions such as gratitude journals are needed to help nurses cope with symptoms of burnout. Gratitude journals can support nurses' emotional health by improving stress management and offering an opportunity for overall self-reflection.

Actions on H.R.9200 - 117th Congress (2021-2022): Stop Nurse Shortages Act

OBJECTIVE: The aim of this study was to obtain novel perspectives regarding the effects that surgical training has on the well-being of trainees. SUMMARY BACKGROUND DATA: Improving trainee well-being is a national concern given high rates of burnout, depression, and suicide among physicians. Supporters of surgical trainees may offer new perspectives regarding the effects of surgical training and point to strategies to optimize trainee wellness. METHODS: This qualitative study employs semi-structured interviews of 32 support persons of trainees at a single tertiary care center with multiple surgical training programs. Interviews focused on perspectives related to supporting a surgical trainee. Interview transcripts underwent qualitative analysis with semantic and conceptual coding. Themes related to effects of training on trainee wellness are reported. RESULTS: Four themes were identified: Who Can Endure the Most Hardship?—trainee attributes and programmatic factors contribute to trainees feeling the need to constantly endure the most hardship; Consequences of Hardship—constantly enduring hardships has significant negative effects on wellness; Trainees are Humans—trainees are people with basic human needs, especially the need for worth; Research Time as Refuge—dedicated research time is treated as an oasis away from clinical hardships. CONCLUSIONS: Perspectives from support persons can offer valuable insight into the wellness needs of surgical trainees. According to support persons, surgical training profoundly negatively impacts trainee wellness. Unlike during clinical training, dedicated research time is a period during which wellness can be prioritized. Programs should provide greater attention to mitigating the negative ramifications of surgical training and promoting wellness in a longitudinal fashion throughout training.

Moral injury (MI) describes the intense feelings of shame, guilt, anger, and betrayal that individuals may experience after violating their own moral codes or witnessing the moral transgressions of others. While MI is not a diagnosable mental health disorder, it has been associated with elevated symptoms of depression and anxiety, suicidal ideation, and am substance misuse. MI overlaps with some of the diagnostic properties of posttraumatic stress disorder (PTSD) but has been proposed as a distinct phenomenon. Originally identified in military contexts, moral injuries have also been observed in civilian populations. Healthcare workers (HCWs) are at risk of encountering potentially morally injurious events (PMIEs) in the workplace. During the COVID-19 crisis, HCWs forced to provide care with limited resources reported self-blame after losing patients and while fearful of infecting loved ones. As vaccine roll-out continues, it is essential that we encourage healing among the very population that serviced the ill in their time of need.

OBJECTIVE: To estimate the excess health care expenditures due to US primary care physician (PCP) turnover, both overall and specific to burnout. METHODS: We estimated the excess health care expenditures attributable to PCP turnover using published data for Medicare patients, calculated estimates for non-Medicare patients, and the American Medical Association Masterfile. We used published data from a cross-sectional survey of US physicians conducted between October 12, 2017, and March 15, 2018, of burnout and intention to leave one’s current practice within 2 years by primary care specialty to estimate excess expenditures attributable to PCP turnover due to burnout. A conservative estimate from the literature was used for actual turnover based on intention to leave. Additional publicly available data were used to estimate the average PCP panel size and the composition of Medicare and non-Medicare patients within a PCP’s panel. RESULTS: Turnover of PCPs results in approximately $979 million in excess health care expenditures for public and private payers annually, with $260 million attributable to PCP burnout-related turnover. CONCLUSION: Turnover of PCPs, including that due to burnout, is costly to public and private payers. Efforts to reduce physician burnout may be considered as one approach to decrease US health care expenditures.

Health care has been the second largest sector hit by the Great Resignation of last fall, following only food service and hospitality.