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[This is an excerpt.] A new Surgeon General’s Advisory highlights the urgent need to address the health worker burnout crisis across the country. Workers providing health services face many on-the-job challenges that can lead to work-related stress. For many of the 20 million health workers in the U.S., the COVID-19 pandemic has led to new and worsening mental health concerns, including burnout, compassion fatigue, depression, anxiety, substance use disorders, and suicidal ideation. These concerns affect each worker’s overall health, job performance, and ultimately, patient care and safety. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Government: Empowering Workers & Strengthening Leadership and Governance (Invest in Programs and Evidence).

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This important new book provides the first comprehensive compilation of strategies for promoting physical and mental wellbeing, specifically for nurses and midwives. Written by experts on workforce health and wellbeing in conjunction with the Florence Nightingale Foundation, the book emphasises the importance supporting the wellbeing of self and others, even during times of extreme stress such during winter or when dealing with COVID-19. It covers multiple aspects of self-care, including how to tackle shift work, prevent dehydration and cope with moral injury and guilt – all illustrated with real-life case studies from nurses and midwives working at the coalface. Health and Wellbeing at Work for Nurses and Midwives is suitable for students right through to Chief Nursing Officers and is applicable to readers from all countries. It is sure to stand the test of time as a trusted guide to this crucial aspect of the professional lives of nurses and midwives. Authentic case studies bring concepts to life Written in a conversational and accessible style – suitable for readers of all levels Contributions from across the nursing and midwifery workforce speak directly to the nursing/midwifery experience Key recommendations for translating theory to practice Reflective exercises used throughout to allow readers to engage deeply with the strategies and ideas Edited by experts in their fields and based on evidence

Our nation’s healthcare facilities were dangerously understaffed prior to the pandemic. And for nearly three years, health professionals have worked through unprecedented challenges. This has compounded the strain on an already exhausted workforce, leaving most emotionally drained and far too many in mental health distress. Today’s staffing crisis is really a shortage of staff willing to endure the current working conditions, and it’s a crisis of the healthcare industries’ own making.  As a result, frontline healthcare workers have been leaving and are continuing to leave the health professions in record numbers.

In response, delegates to the American Federation of Teachers’ biennial national convention in July 2022 passed a pointed resolution, “Addressing Staffing Shortages in the Healthcare Workforce.” This resolution called for the convening of a national task force composed of local leaders and frontline members, and that task force produced the Healthcare Staffing Shortage Task Force Report.

While the consequences of the chronic understaffing of our nation’s healthcare facilities can be deadly, the problem is solvable. Our nation’s healthcare employers must invest in the workforce, improve the working conditions, make healthcare facilities a safe place to work, and engage frontline workers in collaborative decision-making. Prioritizing patients over maximizing revenue means recruiting and retaining the workforce needed to deliver high-quality care.

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This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Operational Strategies (Workloads and Workflows).

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The Covid-19 pandemic brought new challenges for employees and employers all over the world. Drawn upon the JD-R model, a multilevel approach is conceptualised where the reduced resources (e.g., social support) and increased demands imposed by the pandemic (e.g., work/home spillover, social distancing, adoption of remote work and new technologies), improved the frequency of burnout. The framework of conservation of resources theory (COR) is adopted to explain that the lack of resources brought by demands to acquire and protect employee's resources during the pandemic (e.g., job security, well-being) exacerbated burnout behaviour and under certain circumstances allowed employees to hide their burnout symptoms. Moreover, the lack of social support, cultures and climates of presenteeism, and perceptions of stigmatisation that health problems are not culturally valued in the workplace, moderate at different levels the role of burnout in explaining the burnout shame phenomenon. In the current study the model presented is conceptualised as a dynamic spiral where higher levels of burnout shame lead people to hide and seek fewer resources (e.g., social support), which in turn tends to boost burnout levels and consequently, reduce the levels of well-being and job performance.

[This is an excerpt.] The first step is to raise awareness of the potential barriers that new female PDs may face. The data provided by Hughes et al. indicate that many of the current female PDs are recent graduates from surgical training and are relatively new to their residency leadership position. Having an important role and being younger than male colleagues may lead to difficult power differentials, especially when unpopular decisions must be made to improve resident education. [To read more, click View Resource.]

Healthcare professionals have battled physically, mentally, and emotionally overwhelming workforce pressures for years. The COVID-19 pandemic exacerbated this burnout substantially since its onset in 2020. Recently implemented federal initiatives aim to assist in the development of moral resiliency against a morally distressing workplace environment. But is this enough? Meeting the immediate need for substantial mental health resources in the healthcare field is essential and will be a long-lasting endeavor.

OBJECTIVES: Most emergency medicine (EM) residency programs have orientation curricula to guide interns through the transition from medical school to residency, although no standard components are required. This transition is recognized as a challenging time for young physician learners; however, there is no current understanding of the perspective of incoming interns as they enter residency. We sought to identify themes, examine the current literature, and reflect on the experiences of our residency leadership to inform the creation of orientation activities that foster positive experiences, as well as directly address intern fears and anxieties. METHODS: This qualitative study collected free text responses on the first day of EM orientation regarding areas of high excitement and high fear as interns entered residency. Data were collected from 2011 to 2019 in a 4-year EM residency program and a 6-year combined EM-Anesthesia residency program in the Mid-Atlantic. An inductive approach was used to code intern responses and develop themes within each category, and a frequency analysis was performed. RESULTS: A total of 112 interns participated. Thematic analysis of coded responses yielded 11 themes around “most excited” and 13 themes around “most scared.” The most frequent themes for “most excited” were: (1) Forming new relationships, (2) Building and applying knowledge, and (3) Being responsible for the care and education of others. For “most scared,” the most frequent themes were: (1) work–life balance and burnout, (2) making harmful mistakes, and (3) knowledge wealth and retention. CONCLUSIONS: We identified themes of high excitement and high fear for interns entering residency orientation. Based on the themes developed and current literature, recommendations for residency programs regarding intern orientation are provided, specifically that programs intentionally address opportunities for professional identity formation, building relationships with new people/places, emphasizing wellness, and mitigating burnout.

AIMS: To explore factors associated with nurses' moral distress during the first COVID-19 surge and their longer-term mental health. DESIGN: Cross-sectional, correlational survey study. METHODS: Registered nurses were surveyed in September 2020 about their experiences during the first peak month of COVID-19 using the new, validated, COVID-19 Moral Distress Scale for Nurses. Nurses' mental health was measured by recently experienced symptoms. Analyses included descriptive statistics and regression analysis. Outcome variables were moral distress and mental health. Explanatory variables were frequency of COVID-19 patients, leadership communication and personal protective equipment/cleaning supplies access. The sample comprised 307 nurses (43% response rate) from two academic medical centres. RESULTS: Many respondents had difficulty accessing personal protective equipment. Most nurses reported that hospital leadership communication was transparent, effective and timely. The most distressing situations were the transmission risk to nurses' family members, caring for patients without family members present, and caring for patients dying without family or clergy present. These occurred occasionally with moderate distress. Nurses reported 2.5 days each in the past week of feeling anxiety, withdrawn and having difficulty sleeping. Moral distress decreased with effective communication and access to personal protective equipment. Moral distress was associated with longer-term mental health. CONCLUSION: Pandemic patient care situations are the greatest sources of nurses' moral distress. Effective leadership communication, fewer COVID-19 patients, and access to protective equipment decrease moral distress, which influences longer-term mental health. IMPACT: Little was known about the impact of COVID-19 on nurses' moral distress. We found that nurses' moral distress was associated with the volume of care for infected patients, access to personal protective equipment, and communication from leaders. We found that moral distress was associated with longer-term mental health. Leaders should communicate transparently to decrease nurses' moral distress and the negative effects of global crises on nurses' longer-term mental health.

OBJECTIVES: To evaluate the effects of state community health worker (CHW) certification programs and Medicaid reimbursement for CHW services on wages and turnover. METHODS: A staggered difference-in-differences design was used to compare CHWs in states with and without CHW certification or CHW Medicaid reimbursement policies. Data were derived from the 2010 to 2021 Current Population Survey in the United States. RESULTS: CHW wages increased by $2.42 more per hour in states with certification programs than in states without programs (P = .04). Also, hourly wages increased more among White workers, men, and part-time workers (P = .04). Wages increased by $14.46 in the state with the earliest CHW certification program adoption (P < .01). Neither of the policies assessed had an effect on occupational turnover. CONCLUSIONS: CHW wages are higher in states with certification programs. However, wage gaps exist between Whites and non-Whites and between men and women. PUBLIC HEALTH IMPLICATIONS: Federal, state, and employer-based strategies are needed to establish and sustain effective CHW programs to meet the needs of communities experiencing health and access disparities.

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

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Prior research suggests that individuals react negatively when they perceive they are underpaid. Moreover, individuals frequently select pay referents who share their race and gender, suggesting that demographic similarity affects one’s knowledge of pay differences. Leveraging these insights, the authors examine whether the gender and racial composition of a work unit shapes individuals’ reactions to pay deprivation. Using field data from a large health care organization, they find that pay deprivation resulting from workers receiving less pay than their same-sex and same-race coworkers prompts a significantly stronger response than does pay deprivation arising from workers receiving less pay than their demographically dissimilar colleagues. A supplemental experiment reveals that this relationship likely results from individuals’ propensity to select same-category others as pay referents, shaping workers’ information about their colleagues’ pay. The study’s findings underscore the need to theoretically and empirically account for how demographically driven social comparison processes affect reactions to pay inequality.

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This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards& Recognition (Adequate Compensation)

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[This is an excerpt.] Unpredictable and challenging circumstances make the nursing profession extremely demanding and stressful. A survey conducted just before the COVID-19 pandemic showed that job pressure, leading to stress and poor mental health, is the main reason nurses leave the profession. The pandemic exacerbates the nurse retention problem in the global healthcare system, as higher psychological pressure is placed on nurses. The concept of stress in nursing may refer to the physiological state resulting from the lack of proper experience and knowledge in uncertain situations. Such stress is harmful to nurses and patients. Nurses' emotional and psychological state is a critical factor affecting their performance, risk of errors, healthcare delivery quality, patient care, recovery, and death. Hospitals worldwide allocate funds to address stress-related issues among nurses to identify and adopt stress-alleviating measures. [To read more, click View Resource.]

OBJECTIVE: The taxing nature of surgery residency is well-documented in the literature, with residents demonstrating high rates of burnout, depression, suicidal thoughts, sexual harassment, and racial discrimination. Mentoring has been shown to improve camaraderie, address challenges of underrepresentation in medicine, and be associated with lower burnout. However, existing formal mentoring programs tend to be career-focused and hierarchal without opportunity to discuss important sociocultural issues. An innovative approach is needed to address these cultural and anthropological issues in surgery residencies while creating camaraderie and learning alternative perspectives across different levels of training. We sought to describe the framework we used to fill these needs by creating and implementing a novel mentoring program. DESIGN: A vertical, near-peer mentoring system of 7 groups was created consisting of the following members: 1 to 2 medical students, a PGY-1 general surgery resident, a PGY-4 research resident, and a faculty member. Meetings occur every 3 to 4 months in a casual setting with the first half of the meeting dedicated to intentional reflection and the second half focused on an evidence-based discussion regarding a specific topic in the context of surgery (i.e., burnout, discrimination, allyship, and finding purpose). SETTING: Program implementation took place at the University of Michigan in Ann Arbor, MI. PARTICIPANTS: Medical students, general surgery residents, and general surgery faculty were recruited. CONCUSIONS: We have successfully launched the pilot year of a cross-spectrum formal mentoring program in general surgery. This program emphasizes camaraderie throughout training while providing opportunities for evidence-based discussion regarding sociocultural topics. We have included increased opportunities for community inclusivity and mentoring while allowing trainees and faculty members to discuss sensitive topics in a supportive environment. We plan to continue developing the program with robust evaluation and to expand the program to other surgical specialties and to other institutions.

This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Support & Ensure Safe Staffing).

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[This is an excerpt.] The first part of the solution and thus the first enabler of psychological safety in virtual teams is consciously accepting the team’s challenges. When we say “accepting” these challenges, we do not mean surrendering to their inevitability but rather proactively identifying the specific challenges the team is facing and building a willingness to address them as a team. [To read more, click View Resource.]

OBJECTIVE: This study sought to determine the feasibility of collecting physiologic data in thoracic surgery residents and whether it would correlate with burnout and burnout with performance. METHODS: This was a prospective study of thoracic surgery residents over a 5-month period. Participants were evaluated with a wearable biometric device (heart rate variability and sleep) and the Maslach Burnout Inventory. Resident performance was quantified using Accreditation Council for Graduate Medical Education Milestones (scale, 1-5) normalized to program-designated targets (3 for postgraduate year 6 or lower residents and 4 for postgraduate year 7 residents). RESULTS: The cohort consisted of 71% female participants (5/7) with 86% of residents having 1 or more children. High levels of emotional exhaustion (median, 30 [interquartile range, 20-36], where>26 is high) and high levels of depersonalization (median, 16 [interquartile range, 14-22], where>12 is high) were common, but personal accomplishment was also uniformly high (median, 43 [interquartile range, 41-46], where >38 is high). There was a significant correlation between heart rate variability and emotional exhaustion (r(12) ¼ 0.65, P ¼ .01) but not depersonalization (P ¼ .28) or personal accomplishment (P ¼ .24). Depersonalization and personal accomplishment did not correlate with resident performance (P ¼ .12 and P ¼ .75, respectively); however, increased emotional exhaustion showed a significant correlation with higher resident performance during periods when burnout was reported (r(6) ¼ 0.76, P ¼ .047). CONCLUSIONS: Dynamic measurement of resting heart rate variability may offer an objective measure of burnout in thoracic surgery residents. Thoracic surgery residents who report high levels of burnout in this cohort maintained the ability to meet program-designated milestones at or above the level expected of their postgraduate year.

AIM: This study aimed to investigate the effect of COVID-19 pandemic on nurses' burnout and related factors. BACKGROUND: Nurses at the frontlines in every field of the health system and composed most of the health service industry closely experience all negative events during the pandemic. METHODS: This study is a rapid systematic review. RESULTS: A total of 751 studies were selected, of which 13 studies were compatible with the inclusion criteria. The sample size ranged from 107 to 12.596. The studies determined that nurses' burnout levels were generally moderate level and above during the COVID-19 pandemic. Sociodemographic, occupational, psychological, and COVID-19-related factors affected this burnout. CONCLUSION: The results of this review may use to make implications that would ease the effect of the pandemic on nurses and develop strategies to protect nurses from burnout in similar possible situations. The protocol information is included here for blind peer review. Prospero registration number (ID) CRD42021244849. Registration and protocol Prior to undertaking the review, we registered the protocol in the International Prospective Register of Systematic Reviews (PROSPERO). The registration number is CRD42021244849. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244849. The changes made during the review process were registered in PROSPERO with an update.

OBJECTIVE: To examine how perceived leadership behaviours affect burnout, professional fulfilment and intent to leave the organisation among physicians. Design Anonymous cross-sectional survey study from November 2016 to October 2018. Setting 12 036 attending and resident physicians at 11 healthcare organisations participating in the Physician Wellness Academic Consortium (PWAC) were surveyed to assess burnout and professional fulfilment and their drivers. Participants A sample of 5416 attending physicians with complete data on gender, specialty, leadership, burnout and professional fulfilment. MAIN OUTCOMES AND MEASURES: The leadership behaviour of each physician’s supervisor was assessed using the Mayo Clinic Participatory Management Leadership Index and categorised in tertiles. Multivariable logistic regression analyses examined the effect of leadership behaviour rating of each physician’s supervisor on burnout, professional fulfilment and intent to leave controlling for gender and specialty. RESULTS: The response rate was 45% across 11 institutions. Half of the respondents were female. Professional fulfilment increased with increasing tertiles of leadership behaviour rating (19%, 34%, 47%, p<0.001). The odds of professional fulfilment were 5.8 times higher (OR=5.8, 95% CI: 5.1 to 6.59) for physicians in the top tertile compared with those in the lowest tertile. Physicians in the top tertile were also 48% less likely to be burned out (OR=0.52, 95% CI: 0.45 to 0.61) and reported 66% lower intent to leave (OR=0.34, 95% CI: 0.26 to 0.44). Individuals who rated their supervisor’s leadership in upper tertiles relative to lower tertiles exhibited lower levels of burnout (18% vs 35% vs 47%, p<0.001), and intent to leave (16% vs 24% vs 50% p<0.001). CONCLUSION: Perceived leadership behaviours have a strong relationship with burnout, professional fulfilment and intent to leave among physicians. Organisations should consider leadership development as a potential vehicle to improve physician wellness and prevent costly physician departures.

BACKGROUND: Peer-support programs in medical school can buffer feelings of inadequacy, anxiety, social isolation, and burnout, drawing upon the benefits of near-peer-support resources. This study examined the effects of providing support to students in a medical school peer-support program. METHODS: Using a pre-post, quasi-experimental study design, the investigators surveyed medical students who were peer supporters in their second through fourth years of medical school with four measures assessing (1) empathy, (2) self-efficacy, (3) mental health stigma, and (4) likelihood to assist peers with mental health problems to examine if serving as a volunteer peer supporter had any effect. Participants included 38 medical students that were actively enrolled peer supporters during the 2020-2021 year at a United States allopathic medical school. RESULTS: Medical students who participated as peer supporters were found to have higher ratings of empathy scores (Z = -1.964, p = 0.050, r = 0.34) and self-efficacy scores (Z = -2.060, p = 0.039, r = 0.35) after participation in the program. No significant changes were noted for mental health stigma or likelihood to assist peers with mental health problems. DISCUSSION: Peer-support programs present a low-cost, sustainable modality to promote wellbeing in medical students. There is a growing body of literature documenting the benefits of peer-support services. This brief, novel study examined the effects of providing peer support on the peer supporters and found higher self-reported ratings of empathy and self-efficacy after participation. These findings underscore peer-support programs as a valuable wellness resource not only for medical students who use the services but for those who provide them as well.

BACKGROUND: Limited data exists to guide strategies that reduce risks of burnout amongst pharmacy residents. OBJECTIVE: The primary objective of this analysis was to characterize wellbeing, burnout, and resiliency among pharmacy residents. The secondary objective was to assess the impact of a resident-run wellbeing committee on wellbeing, burnout, and resiliency. PRACTICE DESCRIPTION: In 2018, a wellbeing committee was developed at an academic medical center with the aim of promoting wellbeing and resilience amongst pharmacy residents. PRACTICE INNOVATION: The wellbeing committee functions through 3 workgroups focused on resources, engagement, and advocacy. Collectively, these workgroups aim to facilitate wellbeing discussions, plan mindfulness events, and advocate for policies to enhance the wellbeing of residents. EVALUATION METHODS: Pharmacy residents were invited to participate in an electronic survey aimed at characterizing resident wellbeing and assessing the impact of a resident-led wellbeing committee on wellbeing, burnout, and resiliency. The Resident & Fellow Wellbeing Index (RFWI) and Brief Resilience Scale (BRS) were utilized to assess burnout and resiliency, respectively. Continuous and categorical endpoints were assessed utilizing student t tests and chi-square tests, respectively. RESULTS: A total of 16 of 38 residents participated in this analysis. Scores for RFWI and BRS remained stable throughout the 16-week period. RFWI scores demonstrated that up to 50% of residents scored as "at risk" at any point during the study period, while over 80% of respondents maintained high levels of resilience. More than 50% of respondents reported a positive impact of the wellbeing committee on their wellbeing, burnout, and resilience. CONCLUSION: A resident-led wellbeing committee demonstrated favorable impact on wellbeing, burnout, and resilience for majority of pharmacy residents. While this data suggests that such a committee may serve to protect residents from the negative impacts of burnout, future studies are necessary to further elucidate strategies to promote resident wellbeing.

OBJECTIVE: Evaluate the effect of a virtual coaching program offered to women surgery residents in a surgical society. SUMMARY BACKGROUND DATA: Randomized controlled experiments evaluating the effect of coaching on trainee well-being and burnout is lacking. METHODS: Women surgery residents in the Association of Women Surgeons were recruited to participate in a randomized controlled trial of the effects of a virtual coaching program on trainee well-being. Attending surgeons served as coaches after completing in-person training. Residents (n=237) were randomized to intervention (three 1:1 coaching sessions over 9 mo) or control (emailed wellness resources). Participants were surveyed at baseline and post-intervention using validated measures of well-being, burnout, and resilience. Changes in outcome measures between pre- and post-survey were compared between study arms. RESULTS: Survey response rates were 56.9% (n=66) in the control group and 69.4% (n=84) in the intervention group (P=0.05). The intervention group showed significant improvement in professional fulfillment (P=0.021), burnout (0.026), work exhaustion (0.017), self-valuation (0.003), and well-being (P=0.002); whereas the control group showed significant improvement in self-valuation (P=0.015) and significant decline in resilience (P=0.025). The intervention group had a significant improvement in well-being (P=0.015) and intolerance of uncertainty (P=0.015) compared to controls. CONCLUSIONS: Women surgery residents who participated in a remote coaching program offered by a surgical society demonstrated improvement in aspects of well-being relative to peers who did not receive coaching. Therefore, remote coaching offered by a professional society may be a useful component of initiatives directed at trainee well-being.