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[This is an excerpt.] States face extensive barriers overseeing and enforcing the Mental Health Parity and Addiction Equality Act (MHPAEA) amid a growing behavioral health care crisis in the United States. The Mental Health Parity and Addiction Equality Act (MHPAEA) requires insurers to cover mental health and substance use disorder services in a manner equal to physical health services; however, enforcing the law has proven challenging. Access to behavioral health services is critical, as the United States faces a growing mental health crisis exacerbated by the COVID-19 pandemic. However, it is clear states need more support. Researchers offer recommendations to policymakers to ensure the promise of MHPAEA is realized for patients across the country, including conducting targeted benefits reviews, providing additional federal resources, and clarifying federal guidance around protections. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Government: Ensuring Workers' Physical and Mental Health (Support Workers' and Learners' Mental Health & Well-Being).

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The US Medical Licensing Examination (USMLE) Step 1 exam has proven a difficult stressor for medical students during their training, even with the advent of pass-fail scoring. The preparation period before the exam places students at high risk for burnout and depression, leading to impaired exam performance and other serious consequences including suicide. Many medical schools already provide academic support for students during USMLE Step 1 preparation, yet to date, there are no published programs specifically geared towards mental health support during this time.

Frontline healthcare workers are exposed to significant suffering and loss. Recent studies have shown increased rates of depression and suicide among nurses and physicians when compared to the general population. Few clinician well-being interventions focus on increasing the awareness and expression of clinician’s emotions to improve psychosocial well-being. In particular, nurses are at the forefront of cancer care, and studies indicate that they cope with work-related emotions in isolation. Storytelling Through Music is a 6-week intervention that combines storytelling, reflective writing, songwriting, and stress management skills. The parent study was a quasi-experimental design, with 43 oncology nurses in either the intervention group or a non-randomized comparison group. This study evaluates the post-intervention qualitative data from participants in the intervention group (n=22). Content analysis was used for analysis, which revealed the following themes: belonging, finding meaning, and emotional transformation. Participants reported learning they were not alone in the emotional experience, that they were reminded of why they work in oncology, and that hearing their story in song transformed their feelings from sadness to something beautiful. Further, they described that hearing their story reflected back to them in song was deeply moving and provided them with emotional insight.

Strategies for enriching the resident, fellow, and faculty physician experience: a system-based approach to physician well-being

BACKGROUND: It is critical for intensive care unit (ICU) nurses to develop resilient coping strategies to cope with workplace adversities. The coping strategies will mitigate the development of maladaptive psychological disorders prone to working in a stressful environment. OBJECTIVES: The aim of this study is to analyse previous literature conducted on strategies that enhance resilience in ICU nurses to cope with workplace adversities beyond the coronavirus disease 2019 (COVID-19) pandemic. The study was conducted by examining all available global literature in the context of the aim of the study. METHOD: An integrative literature review was chosen for the study. Purposive sampling method was used to select the relevant databases to answer the review question, namely Google Scholar, EBSCOhost, Medline and Nursing/Academic Edition. The search terms used were ‘strategies’, ‘resilience’, ‘intensive care unit nurses’, ‘coping’, ‘workplace adversities’, ‘beyond COVID-19’ and post ‘COVID-19’. RESULTS: Three themes emerged from the study, namely promoting personal attributes, effective relational support and active psychological support. CONCLUSION: Enhancing resilience among ICU nurses requires both intentional individualised care from the ICU nurses and a systematic approach by nursing management that will meet the psychological needs of ICU nurses when working in a stressful ICU environment.

The AHA recognizes the urgency, severity and national scope of the health care workforce challenges facing the field — they are a national emergency that demand immediate attention from all levels of government, as well as workable solutions. We expect the Task Force’s work will uncover new areas in which financial support, regulatory flexibility and other policy solutions will advance workforce efforts, and we welcome ideas on those strategies. In the interim, the AHA has accelerated its existing calls for federal policymakers to support the health care workforce (see the Workforce Fact Sheet for an overview of many of our current priorities). We have urged policymakers and the Federal Trade Commission to address short-term challenges such as potential price gouging and other anti-competitive behavior on the part of nurse staffing agencies. We continue to advocate for short-term financial support to hospitals — such as adding additional money to the Provider Relief Fund, suspending the Medicare sequester, and providing repayment flexibility for accelerated and advance Medicare payments. These policies would help offset higher staffing and other costs attributable to the pandemic. We also have urged the Biden administration to extend the Public Health Emergency (PHE) and make permanent regulatory flexibilities granted during the pandemic that enable hospitals to more easily bring in practitioners from out-of-state, deliver services via telehealth and enable more innovative and flexible models of care (e.g., Hospitals at Home). Finally, we have been successful in urging the Administration to expedite visas to allow highly-trained foreign health care workers to come to the U.S. to help alleviate current shortages. With respect to the behavioral health of physicians, nurses and others, which is necessary so they can deliver safe and high-quality care, we were pleased to support passage of and funding for the Dr. Lorna Breen Health Care Provider Protection Act. We have asked Congress to increase funding for the Health Resources and Services Administration’s Title VII and VIII programs, including the health professions program, the National Health Service Corps, and nursing workforce development programs, which includes loan programs for nursing faculty. Finally, we have urged policymakers to invest in the longer-term pathway of health care professionals by lifting the cap on Medicare-funded physician residencies, boosting funding to nursing schools and faculty, and funding federal loan forgiveness and scholarship programs. We have stressed that making these investments now is vital since their full benefit will take time to realize.

[This is an excerpt.] The Strengthening the Workforce Pipeline: Recommendations for Public Health & Healthcare in Missouri report presents recommendations to address the future of the public health and healthcare workforce in Missouri. The stakeholder task force recognizes there is no short-term fix to this workforce issue. Thus, it is important to note that a key recommendation is the formation of a Public Health & Healthcare Workforce Commission under the authority and oversight of the Office of Workforce Development within the Missouri Department of Higher Education and Workforce Development. As this recommendation is implemented, the commission will continue developing and implementing solutions to address this workforce situation. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Government: Advancing Measurement & Accountability (Establish Health & Public Safety Workforce Analysis and Planning Bodies).

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INTRODUCTION: Contemporary healthcare faces new challenges and expectations from society. The profession of a nurse, as well as a paramedic, is essential for the efficient functioning of healthcare. It has its importance not only in promoting and preserving health but also in prevention. With the increasing importance of providing medical care at the highest level, it is expected of these two professional groups to have more knowledge and skills than a few years earlier. The daily contact with patients and their families, the low level of control of the environment, the hierarchical system of professional dependence, and the dissatisfaction with remuneration are becoming extremely burdensome aspects of the nursing and paramedic professions. Long-term exposure to stressors associated with these medical professions may, in the long term, lead to the emergence of occupational burnout syndrome. The aim of this study is an attempt to answer the question of whether and how stress factors affect the occurrence of occupational burnout in the work of nurses and paramedics working in various medical entities. MATERIAL AND METHODS: The study covered a group of 434 respondents, including 220 nurses and 214 paramedics, working professionally in hospital departments and care and treatment facilities as well as in hospital emergency departments and ambulance services. The study was carried out using a diagnostic survey based on the questionnaire technique using the authors’ questionnaire and the standardized MBI Ch. Maslach. Two statistical values were used to statistically analyze the research results and verify the adopted hypotheses: the chi-square test and the Student’s t-test. RESULTS AND CONCLUSIONS: The current study showed that the phenomenon of occupational burnout among the studied group affects only nurses, while this problem does not apply to the studied paramedics. The main stressor among the nurses and paramedics is, above all, a very high level of responsibility. Nurses are overburdened by excessive demands and shift work, while paramedics are mostly burdened by an excess of duties. Both nurses and paramedics claim that their work is often stressful, which leads to physical and mental exhaustion.

COVID-19 has exposed the grim underbelly of a fragmented, regionalized, costly, and inefficient approach to health service that is an engine for health workforce burnout. A matrix framework that defines the nature of system-level structural determinants of burnout and their relationship to service-level wellness can serve as a useful tool to understand workforce burnout causality, and guide meaningful intervention. This could inform a constructive system-level approach to health workforce burnout through the establishment of harmonized principle-based interventions across health sector jurisdictions and stakeholders.

The objective of this study was to describe how structural racism and sexism shape the employment trajectories of Black women in the US health care system. Using data from the American Community Survey, we found that Black women are more overrepresented than any other demographic group in health care and are heavily concentrated in some of its lowest-wage and most hazardous jobs. More than one in five Black women in the labor force (23 percent) are employed in the health care sector, and among this group, Black women have the highest probability of working in the long-term-care sector (37 percent) and in licensed practical nurse or aide occupations (42 percent). Our findings link Black women’s position in the labor force to the historical legacies of sexism and racism, dating back to the division of care work in slavery and domestic service. Our policy recommendations include raising wages across the low-wage end of the sector, providing accessible career ladders to allow workers in low-wage health care to advance, and addressing racism in the pipeline of health care professions.

INTRODUCTION: During the 2020-2021 academic year, the Family Medicine (FM) faculty at David Grant USAF Medical Center (DGMC) incorporated Clinic First principles into the resident educational experience. The faculty hypothesized that these changes could improve symptoms of resident burnout. MATERIALS AND METHODS: The study was conducted at a single United States Air Force (USAF) FM residency program in California and was approved by the DGMC Institutional Review Board. The validated Maslach Burnout Inventory Human Services Survey for Medical Personnel was used to assess (1) emotional exhaustion, (2) depersonalization, and (3) personal achievement both prior to and following implementation of the Clinic First-inspired curriculum. Descriptive and inferential statistics were used to summarize the data. RESULTS: There were 25 eligible FM residents who participated in the study. At baseline, the mean scores on the Maslach Burnout Inventory Human Services Survey for Medical Personnel indicated moderate burnout across all 3 domains. There was a statistically significant difference (P?=?.03) in the mean EE score over time, demonstrating worsening exhaustion. There was no statistically significant difference (P?=?.37 and P?=?.08, respectively) in the mean DP or PA score over time. CONCLUSIONS: Residents in the DGMC FM residency program were experiencing moderate burnout at the beginning of the 2020-2021 AY. Due to unforeseen challenges, the Clinic First initiative was not realized in its full potential, and the curriculum changes did not definitively protect against burnout. Further study is indicated.

High educational debt is prevalent among resident physicians and correlates with adverse well-being outcomes, including symptoms of stress and burnout. Residents also report low financial literacy levels, affecting financial well-being. Understanding resident viewpoints toward financial well-being initiatives is crucial to develop targeted resident financial well-being programs. This study aims to examine residents’ experiences financing their medical education and how these experiences influence well-being and attitudes toward financial education in residency. We recruited residents from a Southern California health system with residency programs in Family Medicine, Internal Medicine, General Surgery, Orthopaedic Surgery, and Psychiatry. We contacted residents by email and text message to participate in semi-structured interviews. We conducted interviews from October 2020 to March 2021 and analyzed 59 resident interviews using reflexive thematic analysis. Among residents, 76% (45/59) had ? $200,000 in student loans. Residents perceived mounting medical education debt as unfairly burdensome for trainees engaged in socially beneficial work, leaving residents feeling undervalued – a feeling heightened by the stressors of the COVID-19 pandemic – and hampering well-being. Compartmentalizing debt attenuated financial stressors but often made financial education seem less pressing. A subset of residents described how financial planning restored some agency and enhanced well-being, noting that protected didactic time for financial education was crucial. Resident interviews provide practical guidance regarding designing financial education sessions. Desired education included managing debt, retirement planning, and the business of medicine. How residents framed educational debt and their degree of financial literacy impacted their well-being and sense of agency. Residents proposed that residency programs can aid in stress mitigation by providing residents with skills to help manage debt and plan for retirement. To reduce clinician indebtedness, this approach needs to occur in tandem with systemic changes to financing medical education.

Medical education is a time wrought with personal and professional stressors, posing serious challenges to maintaining student wellness. Extensive research has thus been conducted to identify these stressors and develop practical solutions to alleviate their harmful effects. This narrative review of quantitative and qualitative literature summarizes trends in student wellness and examines interventions deployed by medical schools to ameliorate student distress. Current trends indicate that mental illness, substance use, and burnout are more prevalent in medical students compared to the general population due to excessive academic, personal, and societal stressors. Pass/fail grading systems and longitudinal, collaborative learning approaches with peer support appear to be protective for student wellness. Additionally, maintaining enjoyable hobbies, cultivating social support networks, and developing resiliency decrease distress in medical students on an individual level. Faculty and administrator development is also a necessary component to ensuring student wellness. The COVID-19 pandemic has posed unique challenges to the medical education system and has stimulated unprecedented innovation in educational technology and adaptability. Particularly, the discontinuation of the clinical skill evaluation components for both osteopathic and allopathic students should be a focus of medical student wellness research in the future.

A majority of primary care physicians in the US and 9 other high-income countries report that they are burned out as a result of increased workloads since the emergence of the COVID-19 pandemic, with many saying it has affected the quality of care they provide, according to a new report from the Commonwealth Fund.In addition, nearly half of older primary care physicians in most of the countries surveyed said they plan to leave the workforce soon. Such an outflow of physicians working in primary care is especially concerning, the report said, because for 2 decades or more, the US and other countries were already “bracing for a shortage of physicians, a problem that has reached crisis proportions in recent years.”

[This is an excerpt.] In healthcare, listening to what employees tell you they need goes a long way. When workers feel like their feedback isn't being heard, they can become disengaged – a problem that can lead to increased turnover, negative patient experience scores and more. For HR teams, a successful engagement strategy begins with listening, a skill that should go beyond routine employee surveys. Listening should be centered on a comprehensive plan that includes both structured and unstructured conversations that consider the needs of all employees and leaders. Cleveland Clinic recently launched a new listening effort as part of the organization's four-part engagement strategy. The program, which is being introduced to employees in phases, begins with a leadership approach focused on three key elements: listening, connecting and developing. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Worker & Learner Engagement).

This guide shares twelve evidence-informed interventions for preventing suicide and improving mental well-being for the health care workforce.

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

A second victim is a healthcare provider who has been involved in a critical event. A critical event is a clinical situation in which an unforeseen clinical outcome occurs, or the clinical deterioration of the patient takes place for many different reasons. The patient and his/her family are the first victims. The healthcare provider(s) involved in the event are second victims. After such an event, the healthcare provider may experience a constellation of negative emotions, such as guilt, sadness, depression, somatic symptoms, hypervigilance, and fear. Most second victims require support to cope with the adverse clinical situation. Many of the studies addressed in this integrative review, revealed that having a trusted colleague or staff member with whom to discuss the critical event is therapeutic. Some organizations have developed programs to support second victims in which specially trained staff members are deployed to discuss critical events with those involved, if the participant(s) desire the support. Other clinical facilities do not have established support programs; however, healthcare providers have expressed desire to discuss the critical event with supportive colleagues.

With the aging population and increasing number of cancer survivors contributing to a projected provider shortage, one solution is the specialization of nurse practitioners and physician assistants (part of the advanced practice provider [APP] workforce) in oncology. However, a lack of preparation in caring for the patient with cancer has led to burnout and stress in these groups. The authors studied an APP fellowship program to describe resilience, stress, and compassion in a transition-to-practice program and explore the experience of intentional, facilitated conversations. During 2019 and 2020, 18 APP fellows at a large, academic comprehensive cancer center participated in this descriptive study. The fellowship started in-person but changed to a virtual setting due to the COVID-19 pandemic. Resilience was measured through the Connor Davidson Resilience Scale 10, the Perceived Stress Scale, and the Professional Quality of Life Scale at four points in time: baseline, 6 months, 12 months, and 18 months. The experience of intentional, facilitated conversations was captured through simple theme collection as part of a standard program evaluation. Resilience, perceived stress, and compassion showed no statistical significance over the course of the fellowship. Evaluations of an intentional, facilitated conversation program found focal areas that included challenges, fatigue, empathy, relationships, role, self-awareness, and self-care. Despite the challenges of the pandemic on the health-care provider, the retention rate of APPs remained steady during the fellowship. The findings from this study suggested there was a benefit in an oncology fellowship for advanced practice and that intentional, facilitated conversations provide reflection and support during this experience.

[This is an excerpt.] The negative impact of burnout in health care is far-reaching. The direct physical and emotional manifestations in health-care workers are personally experienced and accordingly most widely recognized. However, the magnitude of downstream consequences for colleagues, critical care teams, hospitals, health care in general—and most importantly patients—is substantial and less well appreciated. [To read more, click View Resource.]

Sexual and/or gender minority health-care workers are subject to the heteronormativity and cisnormativity of society and often face open discrimination. Empowering these individuals to bring their full, authentic selves to work so that they can serve their patients and institutions with the totality of their strengths requires institutes and cisgender or straight allies to support LGBTQ+ communities by creating a culture of inclusivity and enacting progressive policies.