Resource Library

[This is an excerpt.] Residency training presents a unique combination of factors affecting well-being. Studies suggest that mental/emotional distress is pervasive among residents, caused by contextual factors affecting emotional resilience (eg, sleep deprivation) and abrupt, stressful triggers (eg, patient deaths). Interventions including positive psychology coaching, peer support, mindfulness curricula, and web-based cognitive behavioral therapy have demonstrated modest but inconsistent improvements in well-being; however, they may be considered burdensome. By contrast, mobile phone-based interventions are less onerous and have been well-accepted. No interventions, however, address abrupt or acute distressing events. [To read more, click View Resource.]

OBJECTIVE: To determine the prevalence of imposter phenomenon (IP) experiences among physicians and evaluate their relationship to personal and professional characteristics, professional fulfillment, burnout, and suicidal ideation. PARTICIPANTS AND METHODS: Between November 20, 2020, and February 16, 2021, we surveyed US physicians and a probability-based sample of the US working population. Imposter phenomenon was measured using a 4-item version of the Clance Imposter Phenomenon Scale. Burnout and professional fulfillment were measured using standardized instruments. RESULTS: Among the 3237 physician responders invited to complete the subsurvey including the IP scale, 3116 completed the IP questions. Between 4% (133) and 10% (308) of the 3116 physicians endorsed each of the 4 IP items as a “very true” characterization of their experience. Relative to those with a low IP score, the odds ratio for burnout among those with moderate, frequent, and intense IP was 1.28 (95% CI, 1.04 to 1.58), 1.79 (95% CI, 1.38 to 2.32), and 2.13 (95% CI, 1.43 to 3.19), respectively. A similar association between IP and suicidal ideation was observed. On multivariable analysis, physicians endorsed greater intensity of IP than workers in other fields in response to the item, “I am disappointed at times in my present accomplishments and think I should have accomplished more.” CONCLUSION: Imposter phenomenon experiences are common among US physicians, and physicians have more frequent experiences of disappointment in accomplishments than workers in other fields. Imposter phenomenon experiences are associated with increased burnout and suicidal ideation and lower professional fulfillment. Systematic efforts to address the professional norms and perfectionistic attitudes that contribute to this phenomenon are necessary.

The long term effects of the covid-19 pandemic on healthcare staff have been considerable, with at least one third of critical care staff experiencing burnout and two fifths showing symptoms of post-traumatic stress disorder.1 But has resilience, a term that has gained much traction in recent years, made any difference? Resilience is the capacity to recover quickly from difficulties or toughness.2 Healthcare professionals (HCPs) had already shown this trait before the pandemic—their training requires hours of study and work experience and regular interaction with ill health, disability, and death. Medical …

New graduate nurses (NGN) often have an idealistic view of nursing compared to the reality of providing complex patient care. NGNs may lack communication and collaborations skills needed to effectively interact with challenging patients, families, and interdisciplinary teams, leading to stress and burnout. This evidence-based quality improvement project provided NGNs an opportunity to practice communication and collaboration techniques within a nurse residency program (NRP). Two scenarios with role-playing and debriefing were developed to practice communication techniques to enhance NGNs’ confidence. Results indicate the NRP improved these skills in NGNs. NRPs may assist NGNs transition to practice and successful integration into the registered nurse (RN) role.

The eight health system teams that participated in IHI's Pursuing Equity initiative share strategies, examples of specific improvements tested, lessons learned, challenges and mitigation strategies, and tools and resources for improving health equity.

BACKGROUND: New graduate nurse job satisfaction persistently decreases at 6 months postgraduation. To prepare future nurses for career resilience, schools of nursing are implementing resilience into their curriculum. METHOD: A large Midwestern school of nursing developed and instituted small group discussions, individual assignments, and online simulations to foster career resilience in a required specialty course. The course, offered in the last year of nursing school, included 93 nursing students and a comparison group of 93 nursing students. RESULTS: The intervention showed an increase in Connor-Davidson Resilience Scale (CD-RISC) scores. Online simulations were useful for classroom learning, helped students discover new ways of thinking, and increased understanding of course content. Differences in simulation techniques were found, and students reported benefitting more from faculty-guided simulations than self-guided simulations. CONCLUSION: Nurse educators implementing resilience simulation programs can increase new graduate nurse resilience using online simulation, which is an effective technique for teaching nursing students. [J Nurs Educ. 2022;61(6):348-351.].

[This is an excerpt.] Crises in public health and social unrest have heightened the need to support trainee well-being. External factors coupled with oncology-specific factors, such as regularly facing mortality, balancing palliation with toxicity, the rapid pace of treatment advances, and engaging in emotionally charged conversations with patients, can lead to burnout. Burnout is characterized by emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment; it affects physicians and physicians-in-training at greater rates than the general population. Emotional exhaustion, depersonalization, and burnout affected 28%, 17%, and 33% of radiation oncology residents, respectively, in the United States in 2016. Consequences may include inadequate patient care, professional ineffectiveness, and physician harm, including substance abuse, clinical depression, and suicidality. [To read more, click View Resource.]

This qualitative study aimed to explore a multigenerational workforce’s impact on employee engagement as perceived by Federally Qualified Health Centers’ (FQHCs) C-suite executives. It sought to answer one research question: What is the perceived impact of generational diversity on employee engagement of Federally Qualified Health Centers (FQHCs) in the United States? This cross-sectional study was national. Primary data were collected using a self-developed, two-part survey instrument: (1) eight demographic questions and (2) two open-ended, short-answer questions. Cognitive interviews, reviews by five subject matter experts, and a pilot study were completed to ensure the instrument’s validity and reliability. Demographic data were analyzed using Minitab V19, and qualitative data were analyzed using MAXQDA V2020. The final sample (n=81) represented 6% of the 1,400 U.S. FQHCs and consisted of respondents from all five U.S. geographic regions: Northeast, Southeast, Midwest, Southwest, and West. Of the 81 FQHCs, one-third had a four-generation workforce, and over one-half had a five-generation workforce. A multigenerational workforce was important and necessary because of enhanced work creativity, improved problem solving, and a better representation of FQHCs’ diverse patients. Conversely, a multigenerational workforce also presented challenges, including the need to address generation-specific expectations, family dynamics, rewards and recognition, technology proficiency, and learning and training opportunities. Engaging a multigenerational workforce presented benefits and challenges. The benefits included fostering a sense of learning culture, transferring knowledge and skills, and promoting more representative patient communities which FQHC employees served. The challenges included varied expectations, different communication styles, and inter-generation perceptions in healthcare workplaces. © The Author(s), 2022.

[This is an excerpt.] Though the United States is an increasingly racially and ethnically diverse and multicultural society, the health care workforce lacks corresponding diversity. Studies demonstrate that a diverse health care workforce can improve patients’ access to and satisfaction with care and health outcomes, and that shared identities between providers and patients may improve health equity (HHS Advisory Committee on Minority Health 2021).

Despite long-standing efforts to increase diversity, health care professions have not achieved equitable representation of Black/African American and Hispanic/Latinx people (HHS Bureau of Health Professions and Office of Minority Health 2009; Morris et al. 2021). To identify promising policies and practices for sustainably increasing diversity in the physician and nursing workforces, the Urban Institute examined pathway programs (also known as pipeline programs) in medicine and nursing. These programs provide academic, financial, and social supports to encourage more students from systemically and structurally excluded groups to enter and remain in health care professions. This study adopts the term systemically and structurally excluded to call attention to the ways that Black/African American and Hispanic/Latinx students and professionals in particular have been locked out of equitable educational and professional opportunities (see box 2). [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Promoting Diversity, Equity, & Inclusion.

INTRODUCTION: The learning environment is shaped by both formal and hidden curricula. Faculty play a critical role in the learning environment but may not be prepared to address the hidden curriculum. This workshop teaches faculty how to manage the hidden curriculum's challenges. METHODS: Medical students’ end-of-clerkship evaluations revealed low ratings in the domains of feedback, respectful interactions, professional language use, and empathy. We created a virtual 60-minute case-based faculty development workshop to highlight the role of faculty in improving the learning environment. A preworkshop survey was emailed to participants. At the workshop, following a brief introduction, participants were divided into groups to discuss the cases and develop strategies to improve the learning environment. A postworkshop survey was used to assess the workshop. RESULTS: Sixty faculty members attended the seminar. Fifty-seven percent completed a preworkshop survey, and 33% completed the postworkshop survey. After the workshop, more faculty felt well prepared to engage students and residents. The majority of participants (85%) reported being more aware of issues around the learning environment. Most (85%) felt that their interactions with medical students would change in a positive way after the workshop. Ninety percent agreed the workshop was relevant to their needs, 70% agreed they learned a new skill in the workshop, and 80% committed to creating an inclusive learning environment after the workshop. DISCUSSION: This workshop was well received by participants and was associated with an improvement in learning environment ratings. Faculty development seminars are an efficient tool to improve the learning environment.

OBJECTIVES: Poor electronic health record (EHR) usability is associated with patient safety concerns, user dissatisfaction, and provider burnout. EHR certification requires vendors to perform user testing. However, there are no such requirements for site-specific implementations. Health care organizations customize EHR implementations, potentially introducing usability problems. Site-specific usability evaluations may help to identify these concerns, and "discount" usability methods afford health systems a means of doing so even without dedicated usability specialists. This report characterizes a site-specific discount user testing program launched at an academic medical center. We describe lessons learned and highlight three of the EHR features in detail to demonstrate the impact of testing on implementation decisions and on users. METHODS: Thirteen new EHR features which had already undergone heuristic evaluation and iterative design were evaluated over the course of three user test events. Each event included five to six users. Participants used think aloud technique. Measures of user efficiency, effectiveness, and satisfaction were collected. Usability concerns were characterized by the type of usability heuristic violated and by correctability. RESULTS: Usability concerns occurred at a rate of 2.5 per feature tested. Seventy percent of the usability concerns were deemed correctable prior to implementation. The first highlighted feature was moved to production despite low single ease question (SEQ) scores which may have predicted its subsequent withdrawal from production based on post implementation feedback. Another feature was rebuilt based on usability findings, and a new version was retested and moved to production. A third feature highlights an easily correctable usability concern identified in user testing. Quantitative usability metrics generally reinforced qualitative findings. CONCLUSION: Simplified user testing with a limited number of participants identifies correctable usability concerns, even after heuristic evaluation. Our discount usability approach to site-specific usability has a role in implementations and may improve the usability of the EHR for the end user.

BACKGROUND: During the COVID-19 pandemic, a substantial number of emergency health care workers (HCWs) have screened positive for anxiety, depression, risk of posttraumatic stress disorder, and burnout. The purpose of this qualitative study was to describe the impact of COVID-19 on emergency care providers' health and well-being using personal perspectives. We conducted in-depth interviews with emergency physicians, emergency medicine nurses, and emergency medical services providers at 10 collaborating sites across the United States between September 21, 2020, and October 26, 2020. METHODS: We developed a conceptual framework that described the relationship between the work environment and employee health. We used qualitative content analysis to evaluate our interview transcripts classified the domains, themes, and subthemes that emerged from the transcribed interviews. RESULTS: We interviewed 32 emergency HCWs. They described difficult working conditions, such as constrained physical space, inadequate personnel protective equipment, and care protocols that kept changing. Organizational leadership was largely viewed as unprepared, distant, and unsupportive of employees. Providers expressed high moral distress caused by ethically challenging situations, such as the perception of not being able to provide the normal standard of care and emotional support to patients and their families at all times, being responsible for too many sick patients, relying on inexperienced staff to treat infected patients, and caring for patients that put their own health and the health of their families at risk. Moral distress was commonly experienced by emergency HCWs, exacerbated by an unsupportive organizational environment. CONCLUSIONS: Future preparedness efforts should include mechanisms to support frontline HCWs when faced with ethical challenges in addition to an adverse working environment caused by a pandemic such as COVID-19.

BACKGROUND: Advancing inclusivity in graduate nursing education is paramount for preparing diverse nursing leaders to mobilize change within health care and educational systems. This scoping review examined inclusivity in graduate nursing education. METHOD: CINAHL, Medline, and ERIC databases were searched for studies published in English since 2011. Key journals and reference lists of included studies were hand searched. Included studies focused on inclusivity in the context of graduate nursing education. RESULTS: Data from 31 included studies are presented. Most of the studies (n = 22) aimed to cultivate inclusivity among students, primarily through cultural competence training. A few studies enacted inclusivity through program-level strategies (n = 4) or explored the lived experiences of diverse students (n = 5). CONCLUSION: Future research and education initiatives should advance a more holistic, intersectional approach to cultivating inclusivity, as well as emphasize enacting inclusivity through strategies to transform the learning environment. [J Nurs Educ. 2022;61(12):679–692.]

The COVID-19 pandemic led to heightened anxiety, distress, and burnout among healthcare workers and faculty in academic medicine. Penn Medicine launched Coping First Aid (CFA) in March 2020 in response to the pandemic. Informed by Psychological First Aid principles and therapeutic micro skills, CFA was designed as a tele-mental healthcare service for health system employees and their families delivered by trained lay volunteer coaches under the supervision of licensed mental health clinicians. We present an overview of the model, feasibility and utilization data, and preliminary implementation and effectiveness outcomes based on cross sectional coach (n = 22) and client (n = 57) self-report surveys with a subset of program users in the first year. A total of 44 individuals completed training and were certified to coach. Over the first 24 months of the program, 513 sessions occurred with 273 clients (119 sessions were no-shows or canceled). Follow-up appointments were recommended in 52.6% (n = 270) of sessions and 21.2% (n = 109) of clients were referred for professional mental health care. Client survey respondents reported CFA was helpful; 60% were very or extremely satisfied, and 74% indicated they would recommend the program. Our preliminary findings suggest that CFA was feasible to implement and most clients found the service beneficial. CFA provides a model for rapidly developing and scaling mental health supports during and beyond the pandemic.

The hospital workforce is experiencing overwork and burnout in response to COVID-19. It is imperative to identify those experiencing mental duress and determine protective factors to promote mental wellness and workforce retention. Our research aim was to identify the mental wellness and professional quality of life among hospital staff working during a global health pandemic, and to determine if age or years of experience served as protective factors. We electronically surveyed hospital staff in North Dakota during Summer 2021. Participants reported demographic data and completed clinically validated behavioral health screening tools assessing anxiety, depression, perceived stress, and work-related quality of life. The survey was administered to all 47 hospitals in North Dakota and received 771 complete responses. All hospital staff ages 18 and older were invited to participate. Age and years of experience were collected categorically in line with research on the topic. Years of experience had a significant influence (p < 0.05) on compassion satisfaction, burnout, and perceived stress. Compassion satisfaction was lowest for those who had worked 5-10 years, and then began to increase incrementally every 10 years thereafter. Hospital staff with 21-30 years of experience reported the highest mean score for both perceived stress and depression. Age had a significant influence (p < 0.05) on scores for anxiety, depression, compassion satisfaction, burnout, secondary traumatic stress, and perceived stress. Those closest to retirement (the oldest and those with the greatest years of experience) reported higher compassion satisfaction, while the youngest cohorts reported experiencing greater stress and burnout and may subsequently leave the profession. This may impact access to, and quality of, care. This study demonstrates the need to implement interventions with a focus on defending healthcare workers from the psychological effects of their caring profession.

INTRODUCTION: Clinicians that care for hospitalised patients face unprecedented work conditions with exposure to highly infectious disease, exceedingly high patient numbers, and unpredictable work demands, all of which have resulted in increases in stress and burnout. Preliminary studies suggest that increasing workloads negatively affect inpatient clinician well-being and may negatively affect job performance; yet high workloads may be prioritised secondary to financial drivers or from workforce shortages. Despite this, the correlation between workload and these negative outcomes has not been fully quantified. Additionally, there are no clear measures for inpatient clinician workload and no standards to define ideal workloads. Using the protocol described here, we will perform a scoping review of the literature to generate a comprehensive understanding of how clinician workload of medical patients is currently defined, measured in clinical settings and its impact on the workforce, patients and institutional outcomes. METHODS AND ANALYSIS: We will follow the methodology outlined by Joanna Briggs Institute and Arksey and O'Malley to conduct a comprehensive search of major electronic databases including Ovid Medline (PubMed), Embase (Embase.com), PsycINFO, ProQuest Dissertations and Google Scholar. All relevant published peer-reviewed and dissertaion grey literature will be included. Data will be extracted using a standardised form to capture key article information. Results will be presented in a descriptive narrative format. ETHICS AND DISSEMINATION: This review does not require ethics approval though all included studies will be screened to ensure appropriate approval. The synthesis of this literature will provide a better understanding of the current state of work for inpatient clinicians, associated outcomes, and will identify gaps in the literature. These findings will be used in conjunction with an expert Delphi panel to identify measures of inpatient clinician workload to then guide the development of a novel workforce mobile application to actively track clinician work. We aim to lay the groundwork for future workforce studies to understand the optimal workloads that drive key outcomes for clinicians, patients and institutions.

Undergraduate medical education (UGME) is the time when doctors' attitudes toward patients and their profession are formed. It is also a period of tremendous stress for future physicians, including high levels of negative stress. Such stress can be maladaptive and may sow the seeds of burnout and long-term dissatisfaction. We believe that the introduction of yoga practice in the 1st year of medical school could ameliorate the negative stressors to which undergraduate medical students are exposed. Although there are some studies in the U.S. and internationally that support the use of Yoga in UGME, they do not provide sufficient data to make a compelling case for widespread implementation of yoga programs in undergraduate curricula. We, therefore, wish to advocate for conducting a trial of the integration of yoga in the undergraduate medical curriculum to combine yoga's ancient health wisdom into the context of modern scientific medicine. Large, prospective, multicenter, and multi-method pilot projects are needed to identify how a program of yoga practice and theory could counter the UGME environment that ultimately produces depression, anxiety, and non-effective coping strategies among medical students. A curriculum for yoga for undergraduate medical students deserves serious consideration and a prominent place among efforts to improve UGME.

INTRODUCTION: In January 2020, a small, private school of nursing in a university in the pacific northwest, established the Initiative for Vital Practice (I4VP). The I4VP’s primary goal was to create a sustainable pathway for increasing vital practice through increasing resiliency and self-care practices. OBJECTIVES: The ensuing pathway’s objectives were to, (1) take previously identified factors related to perceived stress related to workloads, impacts on professional quality of life and psychosocial exposures during the COVID-19 pandemic; and (2) develop and pilot test a wellness intervention (i.e., wellness pods) for faculty and staff to build community and find new ways to enhance well-being through peer support. METHODS: Five focused Wellness Pods were developed on Microsoft Teams platform using the individual channels: (1) stress and mind–body exploration pod; (2) mindfulness in healthcare pod; (3) healing relationship pod; (4) environmental pod; and (5) physical activity pod. Faculty and staff self-selected into a Wellness Pod that interested them. The Wellness Pods met weekly in person over a period of two months. Quantitative and qualitative data was collected via cross-sectional surveys including: four sociodemographic items, one item on current stress level, one write-in item on current stress management at work, two write-in items focused on the cognitive reasoning for participation, the 7-item subjective vitality scale focused individual difference, the 7-item subjective vitality scale focused on the state level, the 10-item perceived stress scale, and one item ranking which wellness pod the individual wanted to participate in. There was one trained facilitator for the overall Wellness Pods operations and communication. RESULTS: The average score on the perceived stress scale was 22.3 (SD = 3.5), indicating moderate levels of perceived stress. The average score on the individual difference vitality score was 26.5 (SD = 7.6), whereas the state level vitality score was 21.4 (SD = 9.98), indicating moderate levels of subjective vitality. Two categories: stress management and wellness pods, were identified through content analysis. CONCLUSIOSN: Through pilot testing, this project demonstrated feasibility for future wellness pods interventions for faculty and staff at schools of nursing. Future research is needed to evaluate the effectiveness of the wellness pods intervention.

BACKGROUND: We proposed that the behaviors that demonstrate compassionate care in the intensive care unit (ICU) can be self-assessed and improved among ICU clinicians. Literature showing views of intensivists about their own compassionate care attitudes is missing. METHODS: This was an observational, prospective, cross-sectional study. We surveyed clinicians who are members of professional societies of intensive care using the modified Schwartz Center Compassionate Care Scale® (SCCCS) about their self-reported compassionate care. A modified SCCCS instrument was disseminated via an email sent to the members of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine between March and June 2021. RESULTS: Three hundred twenty-three clinicians completed the survey from a cohort of 1000 members who responded (32.3% response rate). The majority (54%) of respondents were male physicians of 49 (+ − 10 SD) years of age and 19 (12 + − SD) years in practice. The mean SCCCS was 88.5 (out of 100) with an average score of 8 for each question (out of 10), showing a high self-assessed physician rating of their compassionate care in the ICU. There was a positive association with age and years in practice with a higher score, especially for women ages 30–50 years ( P = 0.03). Years in practice was also independently associated with greater compassion scores ( p < 0.001). Lower scores were given to behaviors that reflect understanding perspectives of families and patients and showing caring and sensitivity. In contrast, the top scores were given to behaviors that included conducting family discussions and showing respect. CONCLUSION: Physicians in the ICU self-score high in compassionate care, especially if they are more experienced, female, and older. Self-identified areas that need improvement are the humanistic qualities requiring sensitivity, such as cognitive empathy, which involves perspective-taking, reflective listening, asking open-ended questions, and understanding the patient’s context and worldview. These can be addressed in further clinical and ICU quality improvement initiatives.

LEARNING OBJECTIVE: The goal of this study was to gain a deeper understanding of the personal and professional impact inter-physician conflict has on physicians’ well-being. BACKGROUND: Despite the recognized importance of collaboration and communication, interpersonal conflict amongst healthcare providers in different specialties remains a pervasive issue. Recent work elucidated some of the social conditions and processes that contribute to conflict between EM and IM physicians at the time of admission. However, little is known about the consequences that inter-physician conflict has on providers’ well-being. OBJECTIVE: The goal of this study was to gain a deeper understanding of the personal and professional impact inter-physician conflict has on physicians’ well-being. METHODS: In this study, the authors used constructivist grounded theory to explore themes related to the impact of conflict on individual providers. A purposive sampling approach was used to recruit participants (n=18), which included EM residents and attending physicians as well as IM attending physicians. Two authors conducted hour-long, semi-structured interviews and then coded the transcripts following Charmaz’s three stages of coding. The authors used constant comparative analysis until thematic sufficiency was reached. RESULTS: Participants described personal impacts of inter-physician conflict including emotional and moral distress which occurs in the context of feeling demoralized by colleagues. Conflict further impacted participants professionally by promoting cynicism, job dissatisfaction, and a negative view of their professional identity and professional accomplishments. Finally, participants described the ‘emotional residue’ that remained after conflict, which tended to perpetuate future conflict. CONCLUSIONS: Physicians attributed emotional exhaustion, cynicism, and reduced sense of personal accomplishment to conflicts arising during conversations around admission. In this way, inter-physician conflict is an under-recognized contributor to physician burnout that should be explored to support the well-being of trainees and attending physicians.