Resource Library

OBJECTIVE: Our research objectives were to (1) assess the correlation between PD perceptions and their residents’ reported experiences and (2) identify PD and program characteristics associated with alignment between PD perceptions and their residents’ reports. DESIGN, SETTING, PARTICIPANTS: A survey was administered to US general surgery residents following the 2019 American Board of Surgery In-Training Examination (ABSITE) to study wellness (burnout, thoughts of attrition, and suicidality) and mistreatment (gender discrimination, sexual harassment, racial/ethnic/religious discrimination, bullying). General surgery program directors (PDs) were surveyed about the degree to which they perceived mistreatment and wellness within their programs. Concordance between PDs’ perceptions and their residents’ reports was assessed using Spearman correlations. Multivariable logistic regression models examined factors associated with alignment between PDs and residents. RESULTS: Of 6,126 residents training at SECOND Trial-enrolled programs, 5,240 (85.5%) responded to the ABSITE survey. All 212 PDs of programs enrolled in the SECOND Trial (100%) responded to the PD survey. Nationally, the proportion of PDs perceiving wellness issues was similar to the proportion of residents reporting them (e.g., 54.9% of PDs perceive that burnout is a problem vs. 40.1% of residents experience at least one burnout symptom weekly); however, the proportion of PDs perceiving mistreatment vastly underestimated the proportion of residents reporting it (e.g., 9.3% of all PDs perceive vs. 65.9% of all residents report bullying). Correlations between PDs’ perceptions of problems within their program and their residents’ reports were weak for racial/ethnic/religious discrimination (r = 0.176, p = 0.019), sexual harassment (r = 0.180, p = 0.019), burnout (r = 0.198, p = 0.007), and thoughts of attrition (r = 0.193, p = 0.007), and non-existent for gender discrimination, bullying, or suicidality. Multivariable regression models did not identify any program or PD characteristics that were consistently associated with improved resident-program director alignment. CONCLUSIONS: Resident and PD perceptions were generally disparate regarding mistreatment, burnout, thoughts of attrition, and suicidality. Reconciling this discrepancy is critical to enacting meaningful change to improve the learning environment and resident well-being.

[This is an excerpt.] Health systems do not exist in isolation. Political, market, professional, and cultural forces heavily influence health care delivery, workplace stress, and health worker professional well-being. For decades, health workers have been reporting a loss of meaning in work due to overwhelming job demands and limited supportive resources in the environments in which they operate (Maslach, 2018). In the United States, up to 54 percent of nurses and physicians, 60 percent of medical students and residents, and 61 to 75 percent of pharmacists have symptoms of burnout—high emotional exhaustion, depersonalization (e.g., cynicism), or a low sense of personal accomplishment from work (Jones et al., 2017; NASEM, 2019; Patel et al., 2021). Burnout is a longstanding issue and a fundamental barrier to professional well-being. It was further exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. Health workers who find joy, fulfillment, and meaning in their work can engage on a deeper level with their patients, who are at the heart of health care (Lai et al., 2022; NASEM, 2019). Thus, a thriving workforce is essential for delivering safe, high-quality, patient-centered care. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Aligning Values (Establish a Culture of Shared Commitment) AND Actionable Strategies for Government: Empowering Workers & Strengthening Leadership and Governance (Invest in Programs and Evidence) AND Aligning Values & Improving Diversity, Equity & Inclusion (Aligning Values and Improving Diversity, Equity & Inclusion) AND Advancing Measurement & Accountability (Measure Well-Being).

Burnout, compassion fatigue, and perceived stress among undergraduate nursing students are significant factors leading to a poorer quality of life, decreased job satisfaction, and adversely impact patient outcomes. Burnout among undergraduate nursing students is a critical individual and workforce issue with contributing factors including a relentless schedule, academically challenging and rigorous programs, pressure to perform, and the completion of clinical hours caring for patients. This paper describes our feasibility study of a nature-based intervention (NBI) to reduce perceived stress and quality of life as it relates to burnout, and compassion fatigue. Quantitative data was collected through demographics, surveys, and electronic sensor data. The project's aim was to determine the feasibility of NBI monitored by NatureDoseTM to decrease perceived stress burnout and compassion fatigue among undergraduate nursing students.

[This is an excerpt.] Prior authorization is harming individuals with cancer, according to new survey results from ASCO. The survey found that prior authorization delays necessary care, worsens cancer care outcomes, and diverts clinicians from caring for their patients. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Reducing Administrative Burdens).

‍

[This is an excerpt.] Many current neonatologist staffing models do not support the needs of the evolving neonatology workforce, administrative obligations, and patient population. Decades ago, NICU coverage involved daily rounds by a neonatologist followed by night coverage using a home-call model [1]. Due to increasing patient volume and acuity, adequate NICU coverage now often requires 24-hour in-house neonatologists [2] in both private practice and academic settings. Since the same neonatologist may round before and after an overnight shift, shifts may last up to 36 h [3]. Weekends have always been expected, but are now compounded by frequency, in-hospital requirements, weekend conferences, and not balanced by commensurate days off. Meanwhile, expectations of academic productivity, teaching, quality improvement work, and administrative obligations are unchanged or increased, and must be done during increasingly scarce “non-clinical” time. [To read more, click View Resource.]

[This is an excerpt.] In 2020, there were 78,740 cases of nonfatal workplace injuries and illnesses that resulted in at least one day away from work among registered nurses in private industry. This was a 290.8-percent increase, about four times as many cases, compared with 2019, when there were 20,150 such cases. The increase in days away from work cases for registered nurses in private industry was driven by a drastic increase in cases due to exposure to harmful substances or environments. There were 660 of these cases in 2019 and 55,750 in 2020. Cases of work-related COVID-19 were coded within this category. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Workplace Violence Prevention).

[This is an excerpt.] On January 11, 2022, the Partners for Nurse Staffing, a collaboration of five professional organizations, launched the Nurse Staffing Think Tank. Charged with identifying recommendations to address the nurse staffing crisis within a 12-18 month implementation timeframe, the group met every other week for
a total of six meetings. The first meetings focused on identifying high-priority areas. Subsequent work conducted in small groups identified recommendations within each high-priority area, as well as action items and measurable outcomes. The target audience for this work includes nurses, health care leaders and policymakers. The result of this work provides an action plan for the necessary cultural shift in health care delivery that can drive improved nurse retention, healthier work environments and better patient outcomes. The recommendations described here are actionable for health system and hospital leaders. Actions under the category, “Healthy Work Environment,” also pertain to regulatory bodies, policymakers and specialty nursing organizations. [To read more, click View Resource.]

‍

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

PURPOSE: Psychotropic medications are used to manage behavioral symptoms of dementia in nursing homes despite limited efficacy and the risk of adverse effects, and may be considered an easier solution for the treatment of behavioral symptoms. However, non-pharmacologic interventions are preferable but are most effective with consistent staffing. To address this, the Centers for Medicare and Medicaid Services implemented additional regulatory scrutiny through F-tag for deficiencies of care, targeting inappropriate psychotropic medication use (F-758 tag). The purpose of this study was to examine associations between nurse staffing levels and the occurrence of deficiency citations for inappropriate psychotropic medication use in residents with dementia symptoms. DESIGN: This was secondary data analysis of a cross-sectional study using CASPER (Certification and Survey Provider Enhanced Reporting) and PBJ (Payroll-Based Journal) data from 14,548 Medicare or Medicaid-certified facilities surveyed between December 1, 2017 and December 31, 2018. METHODS: Staffing measures included nursing hours per resident day and registered nurse skill-mix. Generalized linear mixed models with facilities nested within states, were used to estimate the magnitude of the associations between the occurrence of inappropriate psychotropics use deficiency citations and nurse staffing levels. Covariates included facility location, size, ownership, the presence of dementia special care units, and the proportion of residents with dementia, depression, psychiatric disorders, mental behavioral symptoms, and residents with Medicare/Medicaid. RESULTS: There were 1875 facilities with deficiency citations regarding inappropriate psychotropics use for residents with dementia. When controlling for covariates, facilities with greater hours per resident day for registered nurses (odds ratio [OR] = 0.54, 95% confidence interval [CI] = 0.44–0.67), certified nursing assistants (OR = 0.87, 95% CI = 0.77–0.99) and total nurse staff (OR = 0.87, 95% CI = 0.79–0.96) had significantly lower odds of inappropriate psychotropics use deficiency citations. Nursing homes with greater registered nurse skill-mix had significantly lower odds of receiving the deficiency tags (OR = 0.10, 95% CI = 0.04–0.26). CONCLUSION: Citations for inappropriate psychotropic medication use among residents with dementia were less likely to occur in facilities with higher staffing levels for registered nurses, certified nursing assistants, total nurse staff, and greater registered nurse skill-mix. Facilities need to be equipped with adequate nurse staffing levels to facilitate the use of non-pharmacological interventions and reduce inappropriate psychotropic medication use. CLINICAL RELEVANCE: Adequate nursing staffing is associated with fewer deficiencies related to the use of psychotropic medications to treat behavioral symptoms. Nursing home administrators and policymakers need to focus on assuring adequate nurse staffing levels to provide safe and high-quality dementia care.

BACKGROUND: The time that nurses spent on documentation can be substantial and burdensome. To date it was unknown if documentation activities are related to the workload that nurses perceive. A distinction between clinical documentation and organizational documentation seems relevant. This study aims to gain insight into community nurses’ views on a potential relationship between their clinical and organizational documentation activities and their perceived nursing workload.

METHODS: A convergent mixed-methods design was used. A quantitative survey was completed by 195 Dutch community nurses and a further 28 community nurses participated in qualitative focus groups. For the survey an online questionnaire was used. Descriptive statistics, Wilcoxon signed-ranked tests, Spearman’s rank correlations and Wilcoxon rank-sum tests were used to analyse the survey data. Next, four qualitative focus groups were conducted in an iterative process of data collection - data analysis - more data collection, until data saturation was reached. In the qualitative analysis, the six steps of thematic analysis were followed.

RESULTS: The majority of the community nurses perceived a high workload due to documentation activities. Although survey data showed that nurses estimated that they spent twice as much time on clinical documentation as on organizational documentation, the workload they perceived from these two types of documentation was comparable. Focus-group participants found organizational documentation particularly redundant. Furthermore, the survey indicated that a perceived high workload was not related to actual time spent on clinical documentation, while actual time spent on organizational documentation was related to the perceived workload. In addition, the survey showed no associations between community nurses’ perceived workload and the user-friendliness of electronic health records. Yet focus-group participants did point towards the impact of limited user-friendliness on their perceived workload. Lastly, there was no association between the perceived workload and whether the nursing process was central in the electronic health records.

CONCLUSIONS: Community nurses often perceive a high workload due to clinical and organizational documentation activities. Decreasing the time nurses have to spend specifically on organizational documentation and improving the user-friendliness and intercommunicability of electronic health records appear to be important ways of reducing the workload that community nurses perceive.

This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Reducing Administrative Burdens).

The critical concept of nursing shared governance is shared decision making between the bedside nurses and nurse leaders, which includes areas such as resources, nursing research/evidence-based practice projects, new equipment purchases, and staffing. This type of shared process allows for active engagement throughout the healthcare team to promote positive patient outcomes and also creates a culture of positivity and inclusion, which benefits job satisfaction.

[This is an excerpt.] The United States and the rest of the world continue to grapple with the COVID-19 pandemic. Considering that nurses make up the largest segment of the U.S. healthcare workforce, they are essential to the country’s collective pandemic response. Nurses are the primary source of direct care to persons infected by COVID-19, including historically marginalized populations, and the ongoing demands placed on nurses are leading to unprecedented stress, burnout, and uncertainty about their profession. Even before the pandemic, healthcare settings were chronically understaffed and nurses were burnt out. According to a prepandemic analysis, a shortfall of more than 150,000 registered nurses was anticipated by 2020 (Zhang et al., 2018). The pandemic has exacerbated the labor shortage well beyond prior forecasts, stressing an already fragile U.S. healthcare system and potentially contributing to worse patient outcomes and wider health inequities. [To read more, click View Resource.]

BACKGROUND: With the development of society, nurses have an increasingly more important role in the medical team. At the same time, due to various reasons, the number of active nurses is continuously decreasing, and the shortage of nursing personnel is becoming ever more serious. The COVID-19 pandemic made these clinical problems more serious. As the department with the greatest work pressure and the most intense pace, acute and critical care nurses are already facing serious problems related to job burnout and dismission. In the context of the COVID-19 pandemic, these problems should be solved urgently. Furthermore, with the rise of positive psychology, many scholars are turning their research direction to the positive professional experience of nurses so as to get inspiration to encourage nurses to face work with an optimistic attitude and guide nursing managers to better retain nursing talents. OBJECTIVE: The purpose of this paper is to summarize and evaluate the positive emotional experience and professional benefit of acute and critical care specialist nurses in the process of work. So as to better interpret their occupational benefit perception and guide nursing managers in adopting positive measures and promoting the development of high-quality nursing. METHODS: Cinahl plus, Embase, Medline and other twelve databases were searched for relevant literature. Meta-aggregation was used to synthesize the findings of the included studies. RESULTS: From a total of 12 articles included in this study, 55 main results were presented, 8 new categories were integrated, and three themes were formed: professional identity, social support, and personal growth. The professional identity included: being proud of professional ability and increasing professional value; social support included: friends and family support, organizational, environmental support, peer support, and support of patients and their families; personal growth included realizing self-worth and promoting self-development. CONCLUSION: Hospital managers should pay attention to the positive emotional experience of nurses in work and based on this, provide practical and beneficial protection for nurses from the aspects of salary, learning opportunities, working environment, social support and internal personality, stimulate work enthusiasm, guide nurses to correctly face negative emotions and occupational pressure, and improve the sense of professional benefit.

INTRODUCTION: Due to their occupational responsibilities and volatile work environment, paramedics are in constant contact with harmful, dangerous factors, making them vulnerable to a number of occupational health risks. These include harmful biological, chemical, physical, as well as psychophysical factors (musculoskeletal system strain, stress, patient aggression, occupational burnout). The present study aims to evaluate occupational hazard prevalence among emergency medical service (EMS) paramedics, the possibility of occupational illness incidence, and related prophylaxis. MATERIAL AND METHODS: The participant sample consisted of paramedics employed in five mobile EMS operational areas in the Masovian voivodship. The study involved 238 people, including 223 men and 15 women. The mean age was 39.03 ± 9.27 years for males, and 31.93 ± 7.76 years for females. The study took place between May and September 2019 using diagnostic survey methodology. RESULTS: Participants ordered the following factors based on a scale of threat: biological factors (47%), psychophysical factors (41%), chemical factors (7%), and physical factors (5%). Health issues included musculoskeletal system discomfort (39%) and mental overload (33%). Participants indicated harmful biological factors to cause illnesses such as influenza (85%), tuberculosis (79%), and hepatitis B or C (70%). The study showed that 73% of the participants are occupationally exposed to patient aggression, while 15% experienced occupational burnout. CONCLUSIONS: Paramedics are exposed to a number of occupational hazards daily. The ones most significant in terms of serious disease development are harmful biological factors, musculoskeletal risk factors, fatigue, mental overload related to occupational responsibilities.

Intensive care nurses are highly prone to occupational stress and burnout, affecting their physical and mental health. The occurrence of the pandemic and related events increased nurses’ workload and exacerbated stress and burnout. We conducted a prospective longitudinal mixedmethods study with a cohort of nurses working in a medical ICU (COVID unit; n = 14) and cardiovascular ICU (non-COVID unit; n = 5). Each participant was followed for six 12-hour shifts. Validated questionnaires measured occupational stress and burnout prevalence. Wrist-worn wearable technologies recorded physiological indices of stress. Participants elaborated on the contributors to stress via post-study questionnaire. Data were analyzed using statistical and qualitative methods. Participants who cared for COVID patients at the COVID unit were 3.71 times more likely to experience stress (p < .001) in comparison to non-COVID unit participants. No differences in stress levels were found when the same participants worked with COVID and non-COVID patients at different shifts at the COVID unit. The cohorts expressed similar contributors to stress including communication tasks, patient acuity, clinical procedures, admission processes, proning, labs, and assisting coworkers. Nurses in COVID units, irrespective of whether they care for a COVID patient, may experience high occupational stress and burnout.

This cross-sectional, retrospective, pre-post repeated measures study aimed to describe Ohio physicians’ burnout and mental health experiences as perceived prior to and during the COVID-19 pandemic. A one-time online survey was completed by 1,613 physicians registered with the State Medical Board of Ohio (SMBO). Wilcoxon signed-rank tests were used to assess differences between physicians’ self-reports of burnout and mental health prior to and during the pandemic. Mann-Whitney U tests examined response differences between physicians and residents. Data revealed statistically significant differences between physicians’ pre-pandemic and pandemic experiences for all measures of burnout and mental health (p < 0.001) with moderate effect sizes for feeling emotionally drained from work (Z = ?16.71, r = 0.43); feeling down, depressed, or hopeless (Z = ?18.09, r = 0.46); feeling less accomplished (Z = ?11.03, r = 0.29); and caring less about what happens to patients (Z = ?12.04, r = 0.31). Small effect sizes were found for thoughts of suicide and concerns about one’s substance use. Additionally, resident physicians were more likely than physicians to report many burnout and mental health concerns prior to and during the pandemic, although these effect sizes were small. These findings can inform stakeholders’ efforts toward the prevention and reduction of physician burnout and improvement of well-being.

Think about all that has changed in medicine in the past 50 years: the number of new diseases that have been recognized, the emergence of precision medicine, the expectations of patients and families to be involved in the decision-making related to their care, and the advent of electronic health records. Now add onto that the challenges of the past decade: a ravaging pandemic, social injustice and inequities, and political tension. It is no wonder physicians are feeling burned out and dissatisfied, with some questioning their values and intent to stay in the field.1 The risk of burnout in pediatricians is augmented by the unique emotional demands of caring for vulnerable youth and the evolving landscape of patients with increasing medical complexity. The field of health care is facing record turnover, with a projected shortage of more than 120?000 physicians by 2030.2 This has led to a palpable strain on our workforce and has not only affected the well-being of individuals but also led to tremendous negative repercussions on patient experience, safety, and quality of care.3 Without systemic exploration, we risk a dwindling health care workforce, the ongoing loss of physician lives, and escalating threats to the overall integrity of the health care system.

This manuscript details the methods, outcomes, and lessons learned from a successful multi-dimensional, interdisciplinary, institutional response to HCW well-being during the COVID-19 pandemic.

Physician burnout is a phenomenon used to describe the work-related syndrome, which encompasses emotional exhaustion, depersonalization, cynical disillusion, and a low sense of personal accomplishment. Rates of physician burnout are exponentially increasing globally but sadly underreported, resulting in reduced attention to it. This issue represents a public health crisis. For physicians to offer the best care to patients, they must be at their best state in terms of physical and mental energy levels for them to function effectively; if any of these are affected, it could result in poor patient outcomes. Highlighting these factors that could result in burnout and proffering solutions would go a long way in improving patient care.

OBJECTIVE: The aim of this study was to explore relationships between organizational factors and moral injury among healthcare workers and the impact of perceptions of their leaders and organizations during COVID-19. BACKGROUND: COVID-19 placed healthcare workers at risk for moral injury, which often involves feeling betrayed by people with authority and can impact workplace culture. METHODS: Secondary data from a Web-based survey of mid-Atlantic healthcare workers were analyzed using mixed methods. Data were synthesized using the Reina Trust & Betrayal Model. RESULTS: Fifty-five percent (n = 328/595) of respondents wrote comments. Forty-one percent (n = 134/328) of commenters had moral injury scores of 36 or higher. Three themes emerged: organizational infrastructure, support from leaders, and palliative care involvement. Respondents outlined organizational remedies, which were organized into 5 domains. CONCLUSIONS: Findings suggest healthcare workers feel trust was breached by their organizations’ leaders during COVID-19. Further study is needed to understand intersections between organizational factors and moral injury to enhance trust within healthcare organizations.

This report describes a theory of how to repair, build, and strengthen trust between health care organizations and clinicians, and between health care organizations and the communities they serve, presented as a three-step approach with specific change ideas and associated measures for improvement.

This resource is found in our Actionable Strategies for Health Organizations: Aligning Values (Establish a Culture of Shared Commitment).