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The focus of this rapid response brief is on the birth doula workforce, which is the dominant type of doula discussed in the literature (other types of doulas not covered in this brief serve their clients through abortion or infant loss, death, and adoption among many others). Based on literature from January 2021, we found that: • The literature that has been published from January 2021-August 2022 on the birth doula workforce is limited, with many more studies focused on the association between doula services and perinatal outcomes. • The literature focused on the doula workforce identifies challenges that individual doulas face as part of their work, particularly doulas who identify as Black, Indigenous, and other People of Color (BIPOC)and/or Lesbian, Gay, Bisexual, Transgender, Queer, Intersex or Asexual (LGBTQIA). Until recently, a majority of those served by birth doulas, and doulas themselves, identified as White and cis-gendered. A growing number of doulas identifying as community-based doulas – who identify with and are often from the communities they serve – are working to expand access to services for underserved communities and are increasing racial and ethnic diversity within the doula field. • Challenges experienced by the doula workforce include witnessing and/or experiencing discrimination while working with their clients in a variety of healthcare settings, struggling with ineffective or inadequate payment models, meeting resistance when collaborating with other perinatal providers, feeling alienated from mainstream doula groups, and experiencing burnout.

The SARS-CoV-2 pandemic (COVID-19) dramatically increased the number of stressors on healthcare workers, including palliative care practitioners. Restrictions and increased demands on time made it difficult for the UMass Memorial Health palliative care team to utilize preexisting wellness strategies. In response to team members’ stress reactions, a buddy system intervention was conceived and implemented to restore a sense of connection and self-efficacy (Phase 1). Our objective with this quality improvement project was to assess the feasibility and effectiveness of the buddy system and evaluate staff attitudes toward this intervention. After four months, feedback from team members informed redesign to a more structured buddy system (Phase 2). A mixed-methods design of this project included a qualitative online survey along with quantitative data collection with the Professional Quality of Life Scale V (ProQOL V) and the Brief Resilience Scale (BRS) during Phase 1. Phase 2 was also evaluated quantitatively with ProQOL V and BRS. Semi-structured interviews were conducted at the end of this project to enhance qualitative data on staff attitudes and beliefs. Of the 12 study participants, 10 completed all phases of the study. Participants reported the buddy system was a useful, easy-to-implement intervention for mitigating personal distress and compassion fatigue (CF) by providing a strong sense of support and connection to team members.

The objectives of this study were to examine the prevalence of burnout, specify contributors to and protective factors against burnout, and gather suggestions to improve well-being in psychiatry Program Directors.

[This is an excerpt.] Early career (EC) cardiologists within the first 7 years of graduation represent a unique professional group. Faced with the task of building a practice on the professional front and raising a family on the personal front, many EC cardiologists encounter several simultaneous challenges. Entering independent practice, defining a clinical niche, meeting clinical productivity targets,1 launching a research career, obtaining research funding, and potential lack of mentorship2 are some of the professional challenges EC cardiologists face. EC cardiologists may have to navigate numerous personal challenges such as sustaining a successful marriage,3 supporting a family, raising children, paying student debt, and planning for a strong financial future. Although each of these challenges is unique in its own way, striking a balance between busy professional schedules and parental responsibilities remains pivotal to ensuring success on both fronts. These parenting challenges have been further amplified for physician parents during the COVID-19 pandemic, given the disruption to daycare routines, with subsequent parental anxiety.4,5 Although some previous studies evaluated the challenges of pregnancy during residency and fellowship training,6-8 these studies did not explore the parenting challenges beyond childbirth and are not uniformly applicable to physicians in practice. A paucity of literature addresses parenting challenges of EC physicians, and data are even more sparse in the field of cardiology. [To read more, click View Resource.]

Nurse burnout is a threat to safe, efficient health care delivery, yet estimated rates of nurse burnout are above 40 %. A critical step in reducing burnout is identifying phenomena that are amenable to intervention. Loneliness may be one such factor, yet the relationship between loneliness and burnout is not clearly described. This review aims to summarize existing literature documenting this connection. A systematic search was performed to identify studies reporting a relationship between burnout and loneliness with social support serving as a proxy construct. Twenty-four articles met inclusion criteria: 18 quantitative, two mixed-methods, and four qualitative studies. These studies identified a relationship between burnout and social support, with social support explaining approximately a third of the variability in burnout. Qualitative data suggest that social support is critical to coping with work stressors and is likely related to burnout. This review provides evidence that reducing nurse loneliness is a promising strategy for improving nurse wellbeing.

The culture of modern surgical training is difficult to quantify in absolute terms. We aim to provide context by examining the origin of surgical residency in the early twentieth century and how it evolved over time. In order to understand the culture underlying surgical training, three main stakeholders are identified including patients, surgeons, and residents. The relationships between these parties are explored, and common value systems are discussed. We examine modern barriers that residents face in the work environment and highlight the ways in which they contribute to burnout and attrition among surgical trainees. Positive and negative aspects of the hierarchical training structure and work dynamics inherent in surgical residency are analyzed. Mentorship is identified as a key component of the modern surgical education framework, though limitations exist in the scope of mentorship offered to trainees by attending surgeons. We discuss important realities of worldwide heterogeneity in surgical training culture and specifically utilize case examples highlighting differing surgical educational experiences in regions with limited resources. Limitations are highlighted acknowledging significant contributions from North American, European, and Australian groups to the body of literature cited in this chapter. Herein, we provide a snapshot of modern surgical culture. This chapter spans the inception of surgical residency programs, followed by key stakeholders and interprofessional relationships that are central to surgical training, and finally discusses surgical resident working conditions, power dynamics, and mentorship.

The lingering COVID pandemic has left the nursing profession in a particularly vulnerable state. Nursing burnout, turnover, increased workload, and the lack of professional development opportunities have become workplace dissatisfiers. The “Great Resignation Era” created large turnover and vacancy rates within inpatient hospital units. To mitigate staffing shortages, nurse leaders were challenged to balance large cohorts of new graduate orientees while also motivating and engaging seasoned nurses with leadership opportunities. Traditional orientation pathways proved to be unsuccessful during this unique climate and warranted more creative measures to balance the needs of both new graduates and seasoned nurses.

Challenges among trainees can impact their surgical education, their ability to provide quality patient care, and the training program as a whole. The extent to which trainees in difficulty are identified and addressed can serve as a barometer for the culture of a program. As such, it is incumbent upon residency and fellowship program directors to take interest in better understanding their trainees at an individual level, and the collective fabric of their training program at a systems level. This chapter explores the dimensions of difficulties in training, focusing both on trainees who present with difficulties through their interactions and behavior, and contrasting this with residents who may also find themselves in difficulty by virtue of external stressors. The overall goal of this chapter is to examine and identify an approach to ensuring the wellbeing of individual trainees, and that of a training program collectively. Educators must ensure that trainees meet their clinical and professional competencies, as well as the goals of the surgical training program. To train a generation of thoughtful and adept surgeons, it is essential to address difficult trainees and focus on cultivating professional behaviours within a positive training environment.

[This is an excerpt.] Burnout is pervasive in the medical community. Like most U.S. medical students, I went straight from university to medical school without a break. As a third-year medical student, I reached my breaking point. Academically, things were fine, but behind that façade, my life had become so scholastically slanted that I could no longer recognize myself. I stopped exercising, quit my favorite hobbies, and neglected my family and friends. I had become caught in the “academic current”—a collective group ambition that, when appropriately harnessed, spurs scientific breakthroughs and drives clinical mastery, but when left unchecked, can pull trainees under. At a proverbial fork in the river, I decided to get out of the water. [To read more, click View Resource.]

BACKGROUND: Physician burnout is a major problem in the United States. Small studies suggest scribes can improve clinician satisfaction, but scribe programs have not been evaluated using separate control groups or structured measures of electronic health record (EHR) use. METHODS: We conducted a pre-post, non-randomized controlled evaluation of a remote scribe pilot program introduced in September 2019 in an academic primary care practice. Scribes were paired with physicians via an audio-only cellphone connection to hear and document in real-time. Physician wellness was measured with the 10-item Mini-Z and 16-item Professional Fulfillment Index. EHR use was measured using vendor-derived platforms that provide routine EHR-related data. RESULTS: 37 of 38 scribe users (97.4%) and 68 of 160 potential control physicians (42.5%) completed both pre and post intervention questionnaires. Compared with controls, scribe users had improvements in Mini-Z wellness metrics including Joyful Workplace (mean improvement 2.83, 95%CI 0.60, 5.06) and a single-item dichotomized burnout measure (OR 0.15, 95%CI 0.03, 0.71). There were significant reductions among scribe users compared to controls in total EHR time per 8 scheduled hours (?1.14 h, 95%CI -1.55, ?0.72), and an increase in the percentage of orders with team contribution (10.4%, 95%CI 5.2, 15.6). These findings remained significant in adjusted analyses. CONCLUSIONS/IMPLICATIONS: A remote scribe program was associated with improvements in physician wellness and reduced EHR use. Healthcare organizations can consider scribe programs to help improve wellness among their physician workforce.

BACKGROUND: Mental health problems, including burnout among nurses, are common and important. With the rapid development of information and communication technologies and the rise in use of smartphones, the use of e-mental health strategies is increasing in public and clinical settings, and initial clinical trials using this intervention have been conducted. This systematic review evaluated whether e-healthcare interventions improve burnout and other mental health aspects in nurses. METHODS: Six electronic databases including MEDLINE (via PubMed), EMBASE (via Elsevier), the Cochrane Library Central Register of Controlled Trials, the Cumulative Index of Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, and PsycARTICLES were searched to collect relevant randomized controlled trials up to January 28, 2021, using e-healthcare interventions for mental health in nurses. The e-healthcare intervention was classified as web-based, smartphone-based, and real-time online interventions. The primary outcome was burnout in this population. Due to the heterogeneity of the interventions used in the included studies, quantitative synthesis was not performed, but included studies were analyzed qualitatively. Also, the details of e-healthcare for the mental health of nurses were analyzed. The methodological quality of included studies was assessed using Cochrane's Risk of Bias tool. RESULTS: Seven randomized controlled trials were included in this study. The 20-minute session of an online form of the emotional freedom technique was reported to significantly improve burnout severity compared to no intervention (P < .001). Other outcomes, such as career identity, quality of work life, workplace bullying, job stress, turnover intention, distress, anxiety, and resilience in nurses, were also reported to be improved by e-healthcare interventions. The methodological quality of the included studies was generally poor. CONCLUSIONS: In conclusion, there was some evidence that e-healthcare interventions may improve mental health outcomes, including burnout in nurses, compared with no intervention. However, due to the poor methodological quality and wide heterogeneity of the interventions and outcomes in the included studies, we were not able to reach sufficiently reliable conclusions. E-healthcare intervention for nurses in the new coronavirus disease era was discussed. High-quality clinical trials in this area should be conducted in the future.

BACKGROUND: First responders are faced with stressful and traumatic events in their work that may affect their psychological health. The current review examined the effectiveness of psychological interventions to treat posttraumatic stress disorder (PTSD), anxiety, depression, stress and burnout in first responders. METHODS: Four databases were searched to identify controlled studies that examined the efficacy of psychological interventions to reduce PTSD symptoms (primary outcome) in first responders (including firefighters, police/law enforcement officers, search and rescue personnel, emergency and paramedics teams). Secondary outcomes were anxiety, depression, burnout, and stress. RESULTS: 15 studies were identified, including 10 studies that measured PTSD, 7 studies for anxiety, 10 studies for depression, 7 studies for stress and 1 for burnout. Interventions were associated with a significant reduction in PTSD (SDM = -0.86; 95% CI = -1.34 –- 0.39), depression (SDM = -0.63; 95% CI = -0.94 –-0.32), and anxiety (SDM = -0.38; 95% CI = -0.71 –-0.05) but not stress (SDM = -0.13; 95% CI = -0.51–0.25). CBT-based and clinician-delivered interventions were associated with significantly greater reductions in PTSD than other types of interventions and non-clinician interventions, but no differences were found for depression. There was evidence of moderate to high risk of bias across all studies. CONCLUSIONS: Psychological interventions are effective in reducing PTSD, depression and anxiety symptoms but not stress in first responders. Further research is needed using high quality randomised designs over longer periods of follow-up.

The COVID-19 pandemic has put extreme stress on the health care system globally, leading to workforce shortages as well as increased health care worker burnout, exhaustion, moral injury, and many forms of traumas. These pandemic-related difficulties have taken place in the context of overwhelming pre-existing workforce challenges and inconsistencies, as well as in a workforce where burnout, stress, and mental health problems were already at high occurrences. Many health care workers experienced being furloughed or having their hours reduced, particularly early in the pandemic when nations were trying to implement mitigation protocols. Total employment in the healthcare industry declined during the early months of the pandemic but has gradually recovered since summer 2020. Federal, state, and local governments took significant action to address the need for prevention and treatment services that arose from COVID-19. This led to the disruptions in health care delivery and finances as a result of the pandemic through supplemental funding from federal relief legislation and easing many regulatory requirements. Even after the pandemic, many of the effects the pandemic has had on the health care workforce will likely persist. This paper takes a closer look at the power of mattering, the effects of moral injury as related to healthcare workers and the tools needed to begin the healing process.

INTRODUCTION: Burnout rates for emergency medicine residents are high. One intervention and initiative to enhance wellness and address burnout is the resident retreat. Retreats have multiple formats and are often designed with an emphasis on social events. This longitudinal retreat curriculum for a three-year residency training program was designed emphasizing rest, a step away from what is familiar, and reflection. METHODS: Individual resident retreats were designed for each year of postgraduate training. The agenda for each is organized and intentional. Activities focused on personal well-being, self-reflection, team building, professional development, and physical activities are coupled with topics unique to class year roles and responsibilities. Retreats are held away from the hospital establishing a separation from the workplace. RESULTS: The retreat program has been sustainable for almost decades with trainees evaluating it highly. Faculty and residents enthusiastically participate in the program and consider it a fundamental part of the residency; 93.75% of residents surveyed strongly agreed that the retreats benefit their training while 94.2% strongly agreed that retreats increased their enthusiasm for training. CONCLUSIONS: An emergency medicine resident retreat program focusing on unique elements for each post-graduate year is achievable and sustainable in an emergency medicine residency program. Over time, the retreat has become an integral part of the residency experience with positive experiences for both faculty and trainees.

Nursing during a pandemic like COVID-19 is challenging, because of pervasive uncertainty, fear, lack of knowledge about the virus and its manifestations, and caring for complicated patients without adequate personal protective equipment and other needed resources. Many suffer from moral distress as a result of their inability to do what they think is right for their patients. Herein is a description of moral distress during COVID, what causes it, and what can be done to promote the mental, physical, and moral well-being of invaluable nurses.

As nurse leaders across the country contend with critical challenges, including the ongoing impact of COVID-19, tightening budgets, staff resignations, nurse burnout, and declining nurse engagement, some wonder whether the Magnet® framework is still relevant today. It has been nearly 40 years since the original Magnet research was published. How does it stand up in the wake of modern-day realities? Do the findings continue to hold true? This Magnet Perspectives column takes a closer look at the research that led to the program's creation, development of the Magnet Model, and the program's relevance in meeting the challenges of today's demanding healthcare environment. In addition, this month's JONA includes “The Business Case for Magnet® Designation: Using Data to Support Strategy” demonstrating the framework Magnet continues to provide cost savings and cost avoidance.

There is limited research regarding student registered nurse anesthetist (SRNA) burnout. To our knowledge there is no recently published work that has explored the associations between characteristics of SRNAs and burnout. Addressing this gap could establish the SRNA experience of burnout, identify demographic characteristics and situational factors that may correlate with burnout, and lay the foundation for future research. The purpose of this exploratory descriptive study was to assess the SRNA experience of burnout and any relationship between burnout to demographic or situational factors via the Oldenburg Burnout Inventory-S and demographic questions. The research questions were: 1) Do SRNAs experience different levels of burnout during the didactic curricula and/or clinical training element of nurse anesthesia school? 2) Is there an association between SRNA burnout and demographic or situational factors? Power analysis set the minimum n at 421. Five hundred thirty SRNAs responded to the randomized survey through the American Association of Nurse Anesthesiology. Data analysis was conducted using one-way ANOVA, Spearman's rho, 2-tailed t-test, and Chi square analysis. More hours in class per week correlated with lower exhaustion scores. Higher disengagement scores were reported by SRNAs further in their training, while more hours per week in clinical correlated with both higher disengagement scores and increased total burnout scores.

The purpose of this phenomenological study was to describe the experience of frontline nurses working during the COVID-19 pandemic. The first author conducted two individual audiotaped interviews with 23 qualified staff nurses. All the authors analyzed the professionally transcribed data according to hermeneutic principles. The researchers identified five major themes: (a) we are family; (b) heroes work here; (c) fear of contagion; (d) mental health and well-being; and (e) new reality. Given the uncertainties of working during the COVID-19 pandemic, findings revealed the value of supportive collegial relationships and the need to support the mental health and well-being needs of frontline nurses during the pandemic. Nurses need supportive environments to help ease the challenges associated with serving on the frontline during times of crisis. Findings have implications for future public health preparedness and response efforts.

AIM: Explore the existing literature on the experience and needs of palliative nurses facing job burnout. BACKGROUND: On a global scale, with the increase of aging, the number of people in need of palliative care has increased significantly, which has a huge impact on the professional pressure of palliative nurses. Existing literature focuses on examining palliative care from the perspective of patients, but palliative nurses also face the threats to physical and mental health caused by job burnout. EVALUATION: A systematic literature search has been carried out in the following databases as of October 2021: PubMed, EMBASE, CINAHL, Web of Science, and Scopus. The Cochrane Library and Joanna Briggs Institute Library were also searched to confirm if there are any available systematic reviews on the subject. Manually searched the reference list of included papers. KEY ISSUES: Seventeen studies were included in this review. Five key issues in the palliative care nurse's experience: (1) psychological harm, (2) physical symptoms, (3) negative emotions, (4) Burnout caused by communication barriers, and (5) Lack of experience. Two key issues in the needs of palliative care nurses: (1) social support, and (2) training and education. CONCLUSION: The pressure of facing death for a long time and controlling the symptoms of patients has a very important impact on the mental and physical health of palliative nurses. Nursing staff have needed to be satisfied, and it is essential to provide support and help relieve the pressure on palliative nurses.

Due to the rapid spread of COVID-19, virtual education was proposed globally. This study aimed to examine the views and experiences of nursing students regarding quality, quantity, e-learning challenges, and solutions. This is a qualitative study using a purposive sampling method in which 42 nursing students were included. Data were collected through in-depth semi-structured face-to-face or telephone interviews and analyzed using content analysis. Concepts that were raised in the experience of nursing students were: "Incompatibility of educational processes", including ineffective teaching methods, limited interaction, limited feedback, low creativity, and educational injustice. "Loss of opportunities" including lack of clinical competence, concern for job opportunities, and lack of time management. "Imposed burnout", including forced labor and personal protection. "Personal helplessness", including lack of access to electronic facilities, struggles with the coronavirus, unemployment, and family conflicts. The enforcement of e-learning imposed restrictions on students with different conditions. Older students, those living in rural areas, students with work and family responsibilities, and people with limited electronic resources experienced challenges that require educational management based on challenges. Because e-learning goes beyond COVID-19 and given the continuing trend in e-learning in the coming years, it is necessary to address these challenges.