AIMS: This study assessed the feasibility of delivering three good things (3GTs) practice as part of professional nurse residency program, measured the degree to which it influenced work–life balance, resilience, and burnout, and explored what newly licensed nurses (NLRNs) identified as good things. BACKGROUND: Burnout occurs in response to chronic work-related emotional and interpersonal stress, negatively impacting nurses and patients. However, research shows that 3GT practice can increase positive emotions, enhance resilience, and reduce burnout. METHODS: In this study, 3GT was introduced to a convenience sample of 115 NLRNs during their professional residency program. For 14 days, participants received daily 3GT prompts. Individualized survey links were sent via SMS message at baseline, postsurvey (T1), and 6 months (T2). Survey data were collected about work–life balance, burnout, and resilience, and text data from participants' daily 3GT notations from March through November 2021. RESULTS: Seventy-one participants were recruited. T1 survey results indicated significant improvements in survey measures but only emotional recovery improvement was sustained at T2. Burnout was the only variable that correlated to participants' number of 3GT days practice. Simple joys, reflections about work, self-care activities, and relationships were major identified themes. CONCLUSIONS: The results demonstrate the generalizability, value, and feasibility of implementing a web-based 3GT intervention in a nurse residency program. Additional benefits may be those gained by the reflection that is prompted, thereby facilitating professional development among NLRNs.
Three Good Things: Promote Work–Life Balance, Reduce Burnout, Enhance Reflection among Newly Licensed RNs
The amount of time spent on the electronic health record is often cited as a contributing factor to burnout and work-related stress in nurses. Increased electronic health record use also reduces the time nurses have for direct contact with patients and families. There has been minimal investigation into the amount of time intensive care unit nurses spend on the electronic health record.To quantify the amount of time spent by intensive care unit nurses on the electronic health record.In this observational study, active electronic health record use time was analyzed for 317 intensive care unit nurses in a single institution from January 2019 through July 2020. Monthly data on electronic health record use by nurses in the medical, neurosurgical, and surgical-trauma intensive care units were evaluated.Full-time intensive care unit nurses spent 28.9 hours per month on the electronic health record, about 17.5% of their clinical shift, for a total of 346.3 hours per year. Part-time nurses and those working as needed spent 20.5 hours per month (17.6%) and 7.4 hours per month (14.2%) on the electronic health record, respectively. Neurosurgical and medical intensive care unit nurses spent 25.0 hours and 19.9 hours per month, respectively. Nurses averaged 23 clicks per minute during use. Most time was spent on the task of documentation at 12.3 hours per month, which was followed by medical record review at 2.6 hours per month.Intensive care unit nurses spend at least 17% of their shift on the electronic health record, primarily on documentation. Future interventions are necessary to reduce time spent on the electronic health record and to improve nurse and patient satisfaction.
Time Spent by Intensive Care Unit Nurses on the Electronic Health Record
As the 2021–2022 IHI Leadership Alliance year concludes, we are excited to share a member- led toolkit on preventing verbal and physical violence across the health care workforce that represents input from the member organizations and is supplemented with external industry scanning. This toolkit is intended to be a starting place for health care organizations on their journey to address workplace violence and is by no means all-encompassing. The recommendations and examples from Alliance organizations that are included in the toolkit offer system-level strategies and tactics that hospitals and health systems can implement, organized in the following categories:
• Prevention and Prediction
• Prioritization and Measurement
• System Designs
• Leadership and Policy
• Community Partnerships and Strategic Relationships
Toolkit: Preventing Verbal and Physical Violence Across the Health Care Workforce
INTRODUCTION: Computed Tomography (CT) involves larger radiation dose than the more common conventional x-ray imaging procedures. Existing DRLs have been established based on anatomical locations. However, some limitations of this approach have been identified. CT examinations, for the same anatomical location, could have several clinical indications with consequently different protocols corresponding to different radiation exposure levels. The objective of the study was to establish adult CT Clinical Indication Diagnostic Reference Level (DRLCI) and determine its Relationship with age, weight and Gender in Enugu State, Nigeria. METHODS: Dose values and technical parameters were obtained using International Commission on Radiological Protection (ICRP) Publication 135. Quality control checks were carried out on the machines. 2490 adult patients with weight 50±10 kg, the distribution was 1200 brain scans (48.2%), 420 chest scans (16.9%) and 870 abdominal scans (34.9%) were studied from the 5 participating centers. Head - CVA (300), Trauma (300), Metastasis/abscess (300), Infection (180), Seizure (120). Chest - Lung disease (240), Lung cancer/mass (180). Abdomen/Pelvis - Abdominal cancer/metastasis (120), Abdominal mass (300), Liver disease (240), Urography (210). RESULTS: DRLci for trauma, CVA, metastasis, infection and seizure are 43, 43, 43, 34 and 28 mGy respectively. Their corresponding DLP includes; 907, 879, 1689, 969, 995 mGy.cm. In the chest, the CTDI for lung disease and mass are 13 and 13 mGy. Their corresponding DLP includes; 763 and 1531 mGy.cm. In the abdomen, the CTDI for liver disease, malignancy, mass and urography are 16, 12, 16, and 15 mGy. CONCLUSION: DRLci for 10 common CT examination were established. Radiographers should focus on clinical DRLs rather than anatomical DRLs.
Tools to Manage Burnout and Compassion Fatigue
BACKGROUND: Hospitalists are physicians trained in internal medicine and play a critical role in delivering care in in-patient settings. They work across and interact with a variety of sub-systems of the hospital, collaborate with various specialties, and spend their time exclusively in hospitals. Research shows that hospitalists report burnout rates above the national average for physicians and thus, it is important to understand the key factors contributing to hospitalists' burnout and identify key priorities for improving hospitalists' workplace. METHODS: Hospitalists at an academic medical center and a community hospital were recruited to complete a survey that included demographics, rating the extent to which socio-technical (S-T) factors contributed to burnout, and 22-item Maslach Burnout Inventory - Human Services Survey (MBI-HSS). Twelve contextual inquiries (CIs) involving shadowing hospitalists for ?60 h were conducted varied by shift type, length of tenure, age, sex, and location. Using data from the survey and CIs, an affinity diagram was developed and presented during focus groups to 12 hospitalists to validate the model and prioritize improvement efforts. RESULTS: The overall survey participation rate was 68%. 76% of hospitalists reported elevated levels on at least one sub-component within the MBI. During CIs, key breakdowns were reported in relationships, communication, coordination of care, work processes in electronic healthcare records (EHR), and physical space. Using data from CIs, an affinity diagram was developed. Hospitalists voted the following as key priorities for targeted improvement: improve relationships with other care team members, improve communication systems and prevent interruptions and disruptions, facilitate coordination of care, improve workflows in EHR, and improve physical space. CONCLUSIONS: This mixed-method study utilizes participatory and data-driven approaches to provide evidence-based prioritization of key factors contributing to hospitalists' burnout. Healthcare systems may utilize this approach to identify workplace factors contributing to provider burnout and consider targeting the factors identified by providers to best optimize scarce resources.
Towards Better Understanding of Workplace Factors Contributing to Hospitalist Burden and Burnout Prior to COVID-19 Pandemic
Importance The health care sector lost millions of workers during the COVID-19 pandemic and job recovery has been slow, particularly in long-term care.
Objective To identify which health care workers were at highest risk of exiting the health care workforce during the COVID-19 pandemic.
Design, Setting, and Participants This was an observational cross-sectional study conducted among individuals employed full-time in health care jobs from 2019 to 2021 in the US. Using the data from the Current Population Survey (CPS), we compared turnover rates before the pandemic (preperiod, January 2019-March 2020; 71 843 observations from CPS) with the first 9 months (postperiod 1, April 2020-December 2020; 38 556 observations) and latter 8 months of the pandemic (postperiod 2, January 2021-October 2021; 44 389 observations).
Main Outcomes and Measures Health care workforce exits (also referred to as turnover) defined as a health care worker's response to the CPS as being unemployed or out of the labor force in a month subsequent to a month when they reported being actively employed in the health care workforce. The probability of exiting the health care workforce was estimated using a logistic regression model controlling for health care occupation, health care setting, being female, having a child younger than 5 years old in the household, race and ethnicity, age and age squared, citizenship status, being married, having less than a bachelor’s degree, living in a metropolitan area, identifier for those reporting employment status at the first peak of COVID-19, and select interaction terms with time periods (postperiods 1 and 2). Data analyses were conducted from March 1, 2021, to January 31, 2022.
Results The study population comprised 125 717 unique health care workers with a mean (SD) age of 42.3 (12.1) years; 96 802 (77.0%) were women; 84 733 (67.4%) were White individuals. Estimated health care turnover rates peaked in postperiod 1, but largely recovered by post period 2, except for among long-term care workers and physicians. We found a 4-fold difference in turnover rates between physicians and health aides or assistants. Rates were also higher for health workers with young children (<5 years), for both sexes and highest among women. By race and ethnicity, persistently higher turnover rates were found among American Indian/Alaska Native/Pacific Islander workers; White workers had persistently lower rates; and Black and Latino workers experienced the slowest job recovery rates.
Conclusions and Relevance The findings of this observational cross-sectional study suggest that although much of the health care workforce is on track to recover to prepandemic turnover rates, these rates have been persistently high and slow to recover among long-term care workers, health aides and assistants, workers of minoritized racial and ethnic groups, and women with young children. Given the high demand for long-term care workers, targeted attention is needed to recruit job-seeking health care workers and to retain those currently in these jobs to lessen turnover.
This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards& Recognition (Adequate Compensation)
Tracking Turnover Among Health Care Workers During the COVID-19 Pandemic: A Cross-sectional Study
BACKGROUND: Empathic communication skills have a growing presence in graduate medical education to empower trainees in serious illness communication. OBJECTIVE: Evaluate the impact, feasibility, and acceptability of a shared communication training intervention for residents of different specialties. DESIGN: A randomized controlled study of standard education v. our empathic communication skills-building intervention: VitalTalk-powered workshop and formative bedside feedback using a validated observable behavioral checklist. SETTING/SUBJECTS: During the 2018–2019 academic year, our intervention was implemented at a large single-academic medical center in the United States involving 149 internal medicine and general surgery residents. MEASUREMENTS: Impact outcomes included observable communication skills measured in standardized patient encounters (SPEs), and self-reported communication confidence and burnout collected by surveys. Analyses included descriptive and inferential statistics, including independent and paired t tests and multiple regression model to predict post-SPE performance. RESULTS: Of residents randomized to the intervention, 96% (n = 71/74) completed the VitalTalk-powered workshop and 42% (n = 30/71) of those residents completed the formative bedside feedback. The intervention demonstrated a 33% increase of observable behaviors (p < 0.001) with improvement in all eight skill categories, compared with the control who only showed improvement in five. Intervention residents demonstrated improved confidence in performing all elicited communication skills such as express empathy, elicit values, and manage uncertainty (p < 0.001). CONCLUSIONS: Our educational intervention increased residents' confidence and use of essential communication skills. Facilitating a VitalTalk-powered workshop for medical and surgical specialties was feasible and offered a shared learning experience for trainees to benefit from expert palliative care learning outside their field.
Training to Promote Empathic Communication in Graduate Medical Education: A Shared Learning Intervention in Internal Medicine and General Surgery
In 2020, the COVID-19 global pandemic changed the landscape of healthcare delivery and with it the need to better address team member well-being. Aside from patients and their families, healthcare professionals were among the most affected and at high risk for suffering psychological distress, including increased stress, depression, anxiety, substance use, and post-traumatic stress disorder. Prior to COVID-19, healthcare workers were already experiencing a high rate of job burnout, depression, and suicide. The pandemic brought in sharp focus the essential and urgent need for healthcare facilities to acknowledge the importance of team member well-being and the provision of spaces such as tranquility rooms for use while at work. This case study shares one health system’s evidence-based implementation plan for tranquility rooms, what was learned, and how team members responded. More research is needed to better understand team member well-being and the impact of tranquility rooms.
Tranquility Rooms for Team Member Well-Being: Implementation during COVID-19 Pandemic
IMPORTANCE: The COVID-19 pandemic has affected clinician health and retention. OBJECTIVE: To describe trends in burnout from 2019 through 2021 with associated mitigating and aggravating factors. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional surveys were sent to physicians and advanced practice clinicians throughout 120 large US health care organizations between February 2019 and December 2021. From 56 090 surveys, there were 20 627 respondents. EXPOSURES: Work conditions and COVID-19. MAIN OUTCOMES AND MEASURES: Surveys measured time pressure, chaos, work control, teamwork, electronic health record use, values alignment, satisfaction, burnout, intent to leave, and in 2021, feeling valued. Multivariate regressions controlling for gender, race and ethnicity, years in practice, and role determined burnout, satisfaction, and intent-to-leave correlates. RESULTS: Of the 20 627 respondents (median response rate, 58% [IQR, 34%-86%; difference, 52%]), 67% were physicians, 51% female, and 66% White. Burnout was 45% in 2019, 40% to 45% in early 2020, 50% in late 2020, and 60% in late 2021. Intent to leave increased from 30% in 2019 to more than 40% as job satisfaction decreased. Higher burnout was seen in chaotic workplaces (odds ratio [OR], 1.51; 95% CI, 1.38-1.66; P < .001) and with low work control (OR, 2.10; 95% CI, 1.91-2.30; P < .001). Higher burnout was associated with poor teamwork (OR, 2.08; 95% CI, 1.78-2.43; P < .001), while feeling valued was associated with lower burnout (OR, 0.22; 95% CI, 0.18-0.27; P < .001). In time trends, burnout was consistently higher with chaos and poor work control. For example, in the fourth quarter of 2021 burnout was 36% (95% CI, 31%-42%) in calm environments vs 78% (95% CI, 73%-84%) if chaotic (absolute difference, 42%; 95% CI, 34%-49%; P < .001), and 39% (95% CI, 33%-44%) with good work control vs 75% (95% CI, 69%-81%) if poor (absolute difference, 36%; 95% CI, 27%-44%; P < .001). Good teamwork was associated with lower burnout rates (49%; 95% CI, 44%-54%) vs poor teamwork (88%; 95% CI, 80%-97%; absolute difference, 39%; 95% CI, 29%-48%; P < .001), as was feeling valued (37%; 95% CI, 31%-44%) vs not feeling valued (69%; 95% CI, 63%-74%; absolute difference, 32%; 95% CI, 22%-39%; P < .001). CONCLUSIONS AND RELEVANCE: Results of this survey study show that in 2020 through 2021, burnout and intent to leave gradually increased, rose sharply in late 2021, and varied by chaos, work control, teamwork, and feeling valued. Monitoring these variables could provide mechanisms for worker protection.
Trends in Clinician Burnout With Associated Mitigating and Aggravating Factors During the COVID-19 Pandemic
BACKGROUND: Efforts to address the high depression rates among training physicians have been implemented at various levels of the U.S. medical education system. The cumulative effect of these efforts is unknown. OBJECTIVE: To assess how the increase in depressive symptoms with residency has shifted over time and to identify parallel trends in factors that have previously been associated with resident physician depression. DESIGN: Repeated annual cohort study. Setting: U.S. health care organizations. Participants: First-year resident physicians (interns) who started training between 2007 and 2019. Measurements: Depressive symptoms (9-item Patient Health Questionnaire [PHQ-9]) assessed at baseline and quarterly throughout internship. RESULTS: Among 16 965 interns, baseline depressive symptoms increased from 2007 to 2019 (PHQ-9 score, 2.3 to 2.9; difference, 0.6 [95% CI, 0.3 to 0.8]). The prevalence of baseline predictors of greater increase in depressive symptoms with internship also increased across cohorts. Despite the higher prevalence of baseline risk factors, the average change in depressive symptoms with internship decreased 24.4% from 2007 to 2019 (change in PHQ-9 score, 4.1 to 3.0; difference, −1.0 [CI, −1.5 to −0.6]). This change across cohorts was greater among women (4.7 to 3.3; difference, −1.4 [CI, −1.9 to −0.9]) than men (3.5 to 2.9; difference, −0.6 [CI, −1.2 to −0.05]) and greater among nonsurgical interns (4.1 to 3.0; difference, −1.1 [CI, −1.6 to −0.6]) than surgical interns (4.0 to 3.2; difference, −0.8 [CI, −1.2 to −0.4]). In parallel to the decrease in depressive symptom change, there were increases in sleep hours, quality of faculty feedback, and use of mental health services and a decrease in work hours across cohorts. The decrease in work hours was greater for nonsurgical than surgical interns. Further, the increase in mental health treatment across cohorts was greater for women than men. Limitation: Data are observational and subject to biases due to nonrandom sampling, missing data, and unmeasured confounders, limiting causal conclusions. CONCLUSION: Although depression during physician training remains high, the average increase in depressive symptoms associated with internship decreased between 2007 and 2019. PRIMARY FUNDING SOURCE: National Institute of Mental Health.
Trends in Depressive Symptoms and Associated Factors During Residency, 2007 to 2019
[This is an excerpt.] Trust is a central aspect of improving health care, and its importance in the health care arena is becoming increasingly recognized. The COVID-19 pandemic, along with renewed calls for racial justice, have highlighted the critical role that trust plays in our interactions in health care and beyond. To be effective, it is crucial that relationships between patients, clinicians, and health care organizations be grounded in trust, as trust impacts key health behaviors and outcomes, such as vaccine acceptance, treatment adherence, and patient satisfaction. However, we have seen and continue to see an erosion of trust as the national discourse around issues of health, policy, science, and information is becoming increasingly polarized. To address the critical and underlying importance of trust in health care, the ABIM Foundationand AcademyHealth are partnering to raise the visibility of trust issues within health care and further the evidence base on building trust. As part of this effort, AcademyHealth conducted a review of research on trust that was in progress or recently completed as of September 15, 2021, using the Health Services Research Projects in Progress (HSRProj) database. Funded by the National Library of Medicine, HSRProj has been a joint effort for many years between AcademyHealth and the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. HSRProj contains more than 38,000 archived, recently completed, and ongoing projects funded by more than 370 government agencies and philanthropic foundations. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Relational Strategies (Empowering Worker & Learner Voice).
Trust In Health Care: Insights From Ongoing Research
[This is an excerpt.] The Fitzhugh Mullan Institute for Health Workforce Equity defines health equity as a world in which there is a diverse health workforce that has the competencies, opportunities, and courage to ensure everyone has a fair opportunity to attain their full health potential.At least six critically important factors drive health workforce equity, as shown in the figure below. These domains apply to workers across the health care spectrum, including home healthcare, support staff, allied health professionals, public health, physicians, nurses, and many others.This series reviews existing literature on the nature and magnitude of each problem, the impact of this problem on health equity, and the policies and programs that affect it. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards& Recognition (Adequate Compensation) AND Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Strengthen Worker Compensation and Benefits).
Under What Working Conditions? An Examination of Health Worker Occupational Health and Compensation
Internet-delivered cognitive behavioral therapy (ICBT) is effective when tailored to meet the needs of public safety personnel (PSP). Nevertheless, there is limited research on the nature of the occupational stressors faced by PSP who seek ICBT and how PSP use ICBT to address occupational stressors. We provided tailored ICBT to PSP (N = 126; 54% women) and conducted a qualitative content analysis on clinicians’ eligibility screening notes, clients’ emails, and clients’ survey responses to understand the occupational stressors faced by PSP and their use of ICBT to address such stressors. Clients described several occupational stressors, including operational stressors (e.g., potentially psychologically traumatic events and sleep/shiftwork issues) and organizational stressors (e.g., issues with leadership, resources, and workload). More clients shared occupational concerns during the screening process (97%) than during treatment (58%). The most frequently cited occupational stressor was exposure to potentially psychologically traumatic events. Clients reported using course skills (e.g., controlled breathing and graduated exposure) to manage occupational stressors (e.g., responding to calls, workplace conflict, and work–family conflict). Thought challenging was the most frequently reported strategy used to manage occupational stressors. The current results provide insights into the occupational stressors PSP experience and endeavor to manage using ICBT, which can inform further efforts to tailor ICBT for PSP (e.g., adapting course materials and examples to take into account these operational and occupational stressors).
This resource is found in our Actionable Strategies for Public Safety Organizations: Actionable Strategies (Mental Health & Stress/Trauma Supports)
Understanding and Addressing Occupational Stressors in Internet-Delivered Therapy for Public Safety Personnel: A Qualitative Analysis
[This is an excerpt.] Clinician burnout has become a dominant concern for health systems leaders, policymakers, and clinicians. In a 2022 Advisory,United States Surgeon General Dr. Vivek Murthy sounded the alarm and underscored the urgent need to address the rising levelsof burnout in the health care workforce across the country, laying out recommendations for health care organizations, policymak-ers, researchers, and other stakeholders to address this crisis. The Department of Veterans Affairs (VA), Veterans Health Admin-istration (VHA) has similarly acted to address burnout among VA clinicians, establishing the Task Force to Reduce EmployeeBurnout and Optimize Organizational Thriving (REBOOT) in 2021. The REBOOT Task Force worked with VA researchers toreview the existing evidence on burnout and develop a comprehensive set of recommendations for immediate action. At thesame time, recognizing that there are gaps in the existing evidence overall and within VA settings specifically, the VA HealthServices Research and Development (HSR&D) program launched an effort in collaboration with AcademyHealth, the nationalorganization for health services research and policy, to establish a research agenda to guide future investments in research onthe drivers of burnout as well as effective interventions at all levels to prevent, mitigate and eliminate clinician burnout. With overnine million Veterans enrolled, the VHA is the nation’s largest integrated health care system, and its mission is to honor America’sVeterans by providing exceptional health care that improves their health and well-being. As such, VHA is in a unique position toevaluate solutions and interventions across multiple levels of the organization.
Building upon previously published research and activities, AcademyHealth collaborated with a national advisory committee and a multidisciplinary group of experts and stakeholders from across and outside the VA to generate a set of priority research questions to address clinician burnout. Using an adaptation of The Stanford Model of Professional Fulfillment TM resulted in an agenda that includes research questions related to the design, implementation and evaluation at 1) the national level; 2)individual VA Medical Centers (VAMCs) in three domains: (a) enhancing the efficiency of clinical practice; (b) promoting a culture of wellness; and (c) ensuring institutional support for professional well-being; and 3) improving research and its impact. [To read more, click View Resource.]
VA Clinician Burnout Research Agenda: Summary Report
A key organizational strategy to improving clinician well-being is to measure it, develop and implement interventions, and then re-measure it. A variety of dimensions of clinician well-being can be measured including burnout, engagement, and professional satisfaction. Below is a summary of established tools to measure work-related dimensions of well-being. Each tool has advantages and disadvantages and some are more appropriate for specific populations or settings. This information is being provided by the Research, Data, and Metrics Working Group of the National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience.
This resource is found in our Actionable Strategies for Health Organizations: Measurement & Accountability.
Valid and Reliable Survey Instruments to Measure Burnout, Well-Being, and Other Work-Related Dimensions
[This is an excerpt.] For decades, the level and growth of US health care spending has diverged from both international and domestic norms, leading many to characterize rising health expenditures as “unsustainable.” Between 1970 and 2019, total US health spending grew from 6.9 percent of gross domestic product (GDP) to 17.7 percent of GDP, according to the Centers for Medicare and Medicaid Services (CMS). In 2020, amid unique strain on the health care system and a dramatic economic downturn due to the COVID-19 pandemic, health spending accounted for nearly one-fifth (19.7 percent) of US GDP. According to prepandemic analysis, health spending was not projected to reach this level until 2028, and it remains to be seen how the pandemic will affect the long-term trajectory of health spending. Meanwhile, the Organization for Economic Cooperation and Development (OECD) estimated that total health spending averaged 8.8 percent of GDP among member countries in 2019 compared with 16.8 percent in the US. In 2019 Health Affairs launched the nonpartisan Council on Health Care Spending and Value to study excessive health spending in the US and recommend strategies to address it. The council, which plans to release its recommendations in early 2023, defines excessive spending as that which both diverges from a norm and is not commensurate with the health it produces. This research brief is one in a series of briefs that provides snapshots of key literature that informed the council’s inquiry into health spending drivers and interventions. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Advance Team-Based Care).
Value-Based Payment as a Tool to Address Excess US Health Spending
[This is an excerpt.] You might be asking: why do we need "virtual" nurses when we don't even have enough physical nurses at the bedside? That's exactly why we do need them. Virtual RNs can support the team at the bedside to alleviate the workload and provide greater satisfaction for both the patients and the nursing staff. We are all aware of the current and future staffing challenges in healthcare, and this is one way to address it. It also provides opportunities for nurses that are not wanting to leave the workforce but have years of great experience and knowledge to continue their career in a less physical role. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Safe & Appropriate Staffing).
Virtual Nursing: What is it?
BACKGROUND: The mental health of healthcare professionals is reaching a breaking point, and the COVID-19 pandemic has exacerbated current mental health issues to unprecedented levels. Whilst some research has been carried out on the barriers that doctors face when seeking mental health help, there is little research into factors which may facilitate seeking help. We aimed to expand the research base on factors which act as barriers to seeking help, as well as gain insight into facilitators of help-seeking behaviour for mental health in NHS doctors. METHODS: We conducted a systematic literature review which identified the barriers and facilitators to seeking help for mental health in healthcare professionals. Following this, we conducted semi-structured interviews with 31 NHS doctors about their experiences with mental health services. Finally, through thematic analysis, key themes were synthesised from the data. RESULTS: Our systematic literature review uncovered barriers and facilitators from pre-existing literature, of which the barriers were: preventing actions, self-stigma, perceived stigma, costs of seeking treatment, lack of awareness and availability of support, negative career implications, confidentiality concerns and a lack of time to seek help. Only two facilitators were found in the pre-existing literature, a positive work environment and availability of support services. Our qualitative study uncovered additional barriers and facilitators, of which the identified barriers include: a negative workplace culture, lack of openness, expectations of doctors and generational differences. The facilitators include positive views about mental health, external confidential service, better patient outcomes, protected time, greater awareness and accessibility, open culture and supportive supervisors. CONCLUSION: Our study began by identifying barriers and facilitators to seeking mental health help in healthcare workers, through our systematic literature review. We contributed to these findings by identifying themes in qualitative data.. Our findings are crucial to identify factors preventing NHS doctors from seeking help for their mental health so that more can be done on a national, trust-wide and personal level to overcome these barriers. Likewise, further research into facilitators is key to encourage doctors to reach out and seek help for their mental health.
This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Mental Health).
What Are the Barriers and Facilitators to Seeking Help for Mental Health in NHS Doctors: A Systematic Review and Qualitative Study
The physician burnout discourse emphasises organisational challenges and personal well-being as primary points of intervention. However, these foci have minimally impacted this worsening public health crisis by failing to address the primary sources of harm: oppression. Organised medicine's whiteness, developed and sustained since the nineteenth century, has moulded training and clinical practice, favouring those who embody its oppressive ideals while punishing those who do not. Here, we reframe physician burnout as the trauma resulting from the forced assimilation into whiteness and the white supremacy culture embedded in medical training's hidden curriculum. We argue that 'ungaslighting' the physician burnout discourse requires exposing the history giving rise to medicine's whiteness and related white supremacy culture, rejecting discourses obscuring their harm, and using bold and radical frameworks to reimagine and transform medical training and practice into a reflective, healing process.
White Supremacy Culture and the Assimilation Trauma of Medical Training: Ungaslighting the Physician Burnout Discourse
[This is an excerpt.] The diversity of the health workforce is critical for health equity. It has implications for access, quality, health equity, and job opportunities in low-income communities. This evidence review focuses specifically on racial/ethnic population groups that have been historically identified as underrepresented in healthcare professions that require higher education. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Health Organizations: Promoting Diversity, Equity, & Inclusion.
