Resource Library

This study examined whether and how listening in the internal communication context may influence the quality of employee-organization relationships. This study proposed employee psychological need satisfaction as the potential underlying mechanism that mediates the relationship between internal listening and employee relational outcomes. An online survey was conducted with 443 employees across various industries in the United States. The key findings of this study showed that employee perceptions of internal organizational listening were positively associated with employees’ perceived relationships with their organization. In addition, employee psychological need satisfaction positively mediated the effects of both organizational and supervisory listening on the quality of employee-organization relationships. This study advances the theorizing of listening from an internal communication perspective and contributes to the growing body of knowledge in relationship management.

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

OBJECTIVE: This study examined the association between workplace exposure and prescription drug misuse in nurses. BACKGROUND: Studies have found RNs and other health providers have higher rates of prescription misuse than the general population and have suggested that workplace exposures along with excessive job demands create circumstances fostering misuse. METHODS: Survey data from 1170 RNs on workplace exposures (availability, frequency of administration, knowledge of substances, and workplace controls) were described by workplace, position, and specialty. Exposures were then related to prescription drug misuse using logistic regression. RESULTS: Each workplace exposure was associated with past year prescription drug misuse. An index combining all exposures was significantly related to misuse (P = 0.001), and odds of misuse increased by 38% for each point increase in the exposure index. CONCLUSIONS: Consideration of the health and well-being of nurses at higher odds of exposure to prescription drugs with misuse potential is warranted. Workplace support to help nurses maintain and restore their health should be a priority.

[This is an excerpt.] Workplace violence against nurses happens every day. In 2022, the rate of assaults in U.S. hospitals increased by 23%. A recent study of RNs found a significant proportion of nurses who cared for patients with COVID-19 experienced more physical violence and verbal abuse, and had more difficulty in reporting the incidents to management. These statistics attest to the magnitude of this serious problem that nurses face every day. Our Presenter is Lynda Enos RN, MS, COHN-S, CPE. Lynda is an occupational health nurse and certified professional ergonomist with over 30 years of work and consulting experience in industrial and health care ergonomics and safety with over 200 companies nationwide. She holds an undergraduate degree in nursing and a graduate degree in human factors/ergonomics from the University of Idaho. In 2017, she completed a 2-year project for the Oregon Association for Hospitals and Health Systems (OAHHS) that included providing assistance to 5 hospitals in Oregon to evaluate and facilitate development of comprehensive workplace violence prevention (WPV) programs. As a result of this project Lynda developed a comprehensive toolkit for prevention violence in healthcare “Oregon Workplace Safety Initiative Workplace Violence in Healthcare: A Toolkit for Prevention and Management” that was published in December 2017 and extensively updated in March 2020. Lynda has since worked with several state hospital associations to conduct WPV prevention workshops that are based on the Oregon WPV toolkit and are offered to hospitals and other healthcare entities throughout a state either in-person and via webinar. In 2019, Lynda assisted the Oregon State Stabilization and Crisis Unit (SACU) to further develop their WPV prevention program for 23 group homes for adults and children. She is a subject matter expert for several regulatory and research entities including, the American Nurses Association and American National Standards Institute and International Standards Organization, and the Joint Commission. [To view, click View Resource.]

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This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Operational Strategies (Ensuring Physical & Mental Health).

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[This is an excerpt.] It was a typically busy Wednesday night. We had 22 people in the waiting room, with admitted patients boarding in the emergency department (ED) due to difficulties with bed availability and staffing. At 3:40 a.m. an 80-year-old woman arrived from a skilled nursing facility after staff found her unresponsive. Emergency Medical Services (EMS) discovered her to be pulseless and in asystole, and after 4 rounds of epinephrine in the field, she arrived in room 2 of my ED. As she was a “full code,” I intubated her and initiated resuscitation measures. A bedside echo revealed cardiac standstill and after 2 more rounds of epinephrine, calcium chloride, and bicarbonate infusion, she was pronounced dead. After a moment of silence, I attempted to contact family members, called the medical examiner and the organ bank, and began entering data required by our electronic health record (EHR). [To read more, click View Resource.]

BACKGROUND: The Association of American Medical Colleges has identified the humanities as fundamental to medical education across all specialties. Evidence from undergraduate medical education (UME) demonstrates the humanities' positive impacts on outcomes that could be relevant to patient care and trainee well-being in emergency medicine (EM) residency training. However, less is known about the humanities' role in graduate medical education (GME). OBJECTIVES: The objectives were to describe EM residents' self-reported exposure to the humanities and its relationship with their empathy, tolerance of ambiguity, and patient-centeredness, and to assess their attitudes toward the humanities in GME. METHODS: This cross-sectional survey-based study was conducted at six U.S. EM residency programs in 2018–2019. Quantitative analyses included linear regressions testing for trends between humanities exposures and outcomes, adjusted for sex, year in training, and clustering within programs; adjunct analysis of free-text responses was performed using an exploratory constructivist approach to identify themes about views on the humanities' role in medicine. RESULTS: Response rate was 54.8% (153/279). A total of 65% of respondents were male and 28.1% of respondents had a preceding humanities degree. Preceding humanities degree and current self-reported humanities exposure were positively associated with performance on empathy subscales (p = 0.02). Seventy-five percent (n = 114) of respondents agreed humanities are important in GME; free-text responses revealed perceived positive impacts of humanities on generating well-rounded clinicians and enhancing patient care. CONCLUSIONS: Engagement with the humanities may be associated with empathy among EM residents. Although the magnitude of associations was smaller than that seen in UME, this study demonstrates resident interest in humanities and suggests that extracurricular engagement with the humanities may be insufficient to prolong positive impacts seen in UME. Further research is needed to explore how to sustain these benefits through integration or addition of the humanities in existing GME curricula.

This paper describes the nature of today's corporatized health care system in the United States, offering examples of the psychological toll it takes on clinicians at all levels. It details corporate practices that disenfranchise practitioners from exercising their clinical judgment and from offering input to system administrators about problematic patient care experiences. It discusses the sense of frustration, resignation and moral injury that can permeate their work lives and disrupt their sense of effectiveness and well-being in this context. Following this background is a psychoanalytic analysis of narratives from two physicians about their corporate health care experiences. Two case studies follow, in which a nurse and a physician entered psychoanalytic psychotherapy to process the destructive psychological impact of their work environments. A third case illustrates the negative impact of automatized insurance practices on one psychologist and her patient.

Labor-Management Partnerships, a new system for structuring hospital care, are based on the recognition that hospitals are complex organizations requiring multiple levels of communication and exchange, and on the premise that front-line workers are best able to identify and pose solutions to problems in their units and departments. They are structured to form creative problem-solving teams of managers and staff supported in their work together to improve their hospital within both in individual areas and systemically. Four extensive examples of such teams are provided from two different hospital settings, one public and one not-for-profit. Their work is then assessed through the lens of organizational and group psychoanalytic theories.

OBJECTIVES: Burnout occurs frequently in emergency medicine (EM) residents and has been shown to have a negative impact on patient care. The specific effects of burnout on patient care are less well understood. This study qualitatively explores how burnout may change the way EM residents provide patient care. METHODS: Qualitative data were obtained from a sample of 29 EM residents in four semistructured focus groups across four institutions in the United States in early 2019. Transcripts were coded and organized into major patient care themes. RESULTS: Residents described many ways in which feelings of burnout negatively impacted patient care. These detrimental effects most often fit into one of four main themes: reduced motivation to care for patients, poor communication with patients, difficult interactions with health care colleagues, and impaired decision making. CONCLUSIONS: According to EM residents, burnout negatively impacts several important aspects of patient care. Resident engagement with clinical care, communication with patients and colleagues, and clinical care may suffer as a result of burnout.

PURPOSE: While police culture typically refers to the culture among sworn police personnel, there are internal cultural differences between subgroups. This has been documented among sworn personnel, such as the difference between street cops and management cops (Reuss-Ianni, 1983). The divide between professional and sworn staff in a law enforcement context has also been discussed at length (Maguire, 1997; Reiss, 1992), specifically the “us versus them” mentality that stems from feelings of isolation among professional and sworn staff. The relationship between dispatchers and officers is vital to public and officer safety; it is imperative that cultural barriers preventing effective collaboration between two of the most critical components of policing are identified, and recommendations to bridge the gap are provided. DESIGN/METHODOLOGY/APPROACH: The authors use semi-structured interview data from a sample of peer-nominated top dispatch de-escalators (TDDs) considered highly skilled at de-escalation with callers and officers. Reflexive coding techniques were used to identify key themes in an area largely unexamined by research. FINDINGS: The authors find that the police culture creates friction between sworn officers and dispatchers in a number of contexts. This diminishes organizational commitment and increases burnout and frustration. PRACTICAL IMPLICATIONS: There are several policy recommendations for both communications centers and sworn staff to foster understanding and increase collaboration, all of which may result in improved outcomes for community members, dispatchers and officers. ORIGINALITY/VALUE: The authors use qualitative methods to explore the implications of the sworn-civilian divide for police practice, such as more effective de-escalation and incident resolution, as well as the conceptualization of police culture writ large.

BACKGROUND: The COVID-19 pandemic has led to the rapid expansion of telehealth service delivery. We explored the experiences of a multidisciplinary palliative care team delivering telepalliative care for oncology inpatients during a 10-weeks COVID-19 surge in New York City. METHODS/PARTICIPANTS: We conducted semi-structured qualitative interviews with a targeted sample, employing a phenomenological approach with applied thematic text analysis. An interdisciplinary coding team iteratively coded data using a mix of a priori and inductive codes. Team members first independently reviewed each category, then met to reach consensus on recurring themes. The sample (n = 11) included a chaplain (n = 1), social worker (n = 1), pharmacist (n = 1), physicians (n = 3), physician assistant (n = 1), and nurse practitioners (n = 4). RESULTS: Participants described multidimensional clinician distress as a primary experience in delivering telepalliative care during the COVD-19 surge, characterized by competing loyalties (e.g., institutional obligations, ethical obligations to patients, resentment and distrust of leadership) and feelings of disempowerment (e.g., guilt in providing subpar support, decisional regret, loss of identity as a provider). Participants provided explicit recommendations to improve telepalliative care delivery for acute oncology inpatients in the future. CONCLUSION: Palliative care clinicians experienced personal and professional distress providing inpatient telepalliative care during this COVID-19 surge. Clinician strain providing telehealth services must be explored further as the pandemic and utilization of telehealth evolves. Telepalliative care planning must include attention to clinician wellbeing to sustain the workforce and promote team cohesion, and a focus on infrastructure needed to deliver high-quality, holistic care for oncology patients and their families when in-person consultation is impossible.

Correctional officers are shouldered with important responsibilities designed to reinforce institutional security, yet work under hazardous conditions that can jeopardize their wellbeing. Among the myriad dangers they confront, COVID-19 has now presented itself as an additional threat to officer wellness. Presently little is known about how the coronavirus pandemic has affected officers, or their respective institutions. Semi-structured interview data collected from correctional officers working in a large, urban county jail located in the southeastern United States (N?=?21) revealed how COVID-19 significantly disrupted institutional operations, compounded health concerns for officers, and created a climate of confusion over procedures designed to contain spread of the virus. Policy implications are discussed.

Encountering racism is burdensome and meeting it in a healthcare setting is no exception. This paper is part of a larger study that focused on understanding and addressing racism in healthcare in Sweden. In the paper, we draw on interviews with 12 ethnic minority healthcare staff who described how they managed emotional labor in their encounters with racism at their workplace. Data were analyzed using thematic analysis. The analysis revealed that experienced emotional labor arises from two main reasons. The ?rst is the concern and fear that ethnic minority healthcare staff have of adverse consequences for their employment should they be seen engaged in discussing racism. The second concerns the ethical dilemmas when taking care of racist patients since healthcare staff are bound by a duty of providing equal care for all patients as expressed in healthcare institutional regulations. Strategies to manage emotional labor described by the staff include working harder to prove their competence and faking, blocking or hiding their emotions when they encounter racism. The emotional labor implied by these strategies could be intense or traumatizing as indicated by some staff members, and can therefore have negative effects on health. Given that discussions around racism are silenced, it is paramount to create space where racism can be safely discussed and to develop a safe healthcare environment for the bene?t of staff and patients.

[This is an excerpt.] Most readers will recognize the main title of this editorial, a curse of sorts that was apparently coined by a British politician in the 1930s. Of course, the irony is that this curse is actually calling for the recipient to experience dangerous or troubling times. We in the pharmacy profession are currently experiencing “interesting times”, with all the various connotations entailed by the term “interesting”. [To read more, click View Resource.]

The pandemic helped politicize the exam room and exacerbate long-festering systemic problems. Discover how the AMA helps reduce physician burnout.

BACKGROUND: Trainees in graduate medical education are affected by burnout at disproportionate rates. Trainees experience tremendous growth in clinical skills and reasoning, however little time is dedicated to metacognition to process their experiences or deliberate identity formation to create individualized definitions of success and wellbeing. The purpose of this study was to understand the perspectives and experiences of trainees who participated in a 6-month, web-based, group coaching program for women residents in training. METHODS: Better Together Physician Coaching is a six-month, self-paced, online, asynchronous, coaching program with multiple components including live coaching calls, unlimited written coaching, and self-study modules. Semi-structured interviews of seventeen participants of Better Together from twelve GME programs within a single institution in Colorado were conducted from May to June of 2021. All identified as women and had participated in a 6-month coaching program. Both inductive and deductive methods were used in collecting and analyzing the data with an aim to understand learners’ perceptions of the coaching program, including “how and why” the coaching program affected training experiences and wellbeing. RESULTS: Three main themes emerged as benefits to the coaching program from the data: 1) practicing metacognition as a tool for healthy coping 2) building a sense of community, and 3) the value of a customizable experience. CONCLUSIONS: Female trainees who participated in a group coaching program expressed that they found value in learning how to cope with stressors through metacognition-focused coaching. They also described that building a community and being able to customize the experience were positive aspects of the program.

BACKGROUND: Physicians and nurses face high levels of burnout. The role of care teams may be protective against burnout and provide a potential target for future interventions. OBJECTIVE: To explore levels of burnout among physicians and nurses and differences in burnout between physicians and nurses, to understand physician and nurse perspectives of their healthcare teams, and to explore the association of the role of care teams and burnout. DESIGN: A mixed methods study in two school of medicine affiliated teaching hospitals in an urban medical center in Baltimore, Maryland. PARTICIPANTS: Participants included 724 physicians and 971 nurses providing direct clinical care to patients. MAIN MEASURES AND APPROACH: Measures included survey participant characteristics, a single-item burnout measure, and survey questions on care teams and provision of clinical care. Thematic analysis was used to analyze qualitative survey responses from physicians and nurses. KEY RESULTS: Forty-three percent of physicians and nurses screened positive for burnout. Physicians reported more isolation at work than nurses (p<0.001), and nurses reported their care teams worked efficiently together more than physicians did (p<0.001). Team efficiency was associated with decreased likelihood of burnout (p<0.01), and isolation at work was associated with increased likelihood of burnout (p<0.001). Free-text responses revealed themes related to care teams, including emphasis on team functioning, team membership, and care coordination and follow-up. Respondents provided recommendations about optimizing care teams including creating consistent care teams, expanding interdisciplinary team members, and increasing clinical support staffing. CONCLUSIONS: More team efficiency and less isolation at work were associated with decreased likelihood of burnout. Free-text responses emphasized viewpoints on care teams, suggesting that better understanding care teams may provide insight into physician and nurse burnout.

Highlights
• Burnout impacts 50-55% of emergency department nurses; nurse burnout cultural impacts in this setting are under-explored.
• This ethnography revealed an explanatory model of nurse burnout impacts, “The Pathway of Burnout”.
• Cultural clash was identified between pervasive nurse burnout culture and a culture of patient safety.

OBJECTIVE:The objective of this study was to addresses the basic question of whether alternative legislative approaches are effective in encouraging hospitals to increase nurse staffing. METHODS: Using 16 years of nationally representative hospital-level data from the American Hospital Association (AHA) annual survey, we employed a difference-in-difference design to compare changes in productive hours per patient day for registered nurses (RNs), licensed practical/vocational nurses (LPNs), and nursing assistive personnel (NAP) in the state that mandated staffing ratios, states that legislated staffing committees, and states that legislated public reporting, to changes in states that did not implement any nurse staffing legislation before and after the legislation was implemented. We constructed multivariate linear regression models to assess the effects with hospital and year fixed effects, controlling for hospital-level characteristics and state-level factors. RESULTS: Compared with states with no legislation, the state that legislated minimum staffing ratios had an 0.996 (P<0.01) increase in RN hours per patient day and 0.224 (P<0.01) increase in NAP hours after the legislation was implemented, but no statistically significant changes in RN or NAP hours were found in states that legislated a staffing committee or public reporting. The staffing committee approach had a negative effect on LPN hours (difference-in-difference=−0.076, P<0.01), while the public reporting approach had a positive effect on LPN hours (difference-in-difference=0.115, P<0.01). There was no statistically significant effect of staffing mandate on LPN hours. CONCLUSIONS: When we included California in the comparison, our model suggests that neither the staffing committee nor the public reporting approach alone are effective in increasing hospital RN staffing, although the public reporting approach appeared to have a positive effect on LPN staffing. When we excluded California form the model, public reporting also had a positive effect on RN staffing. Future research should examine patient outcomes associated with these policies, as well as potential cost savings for hospitals from reduced nurse turnover rates.

[This is an excerpt.] In 2020, 73.3 million workers age 16 and older in the United States were paid at hourly rates, representing 55.5 percent of all wage and salary workers. Among those paid by the hour, 247,000 workers earned exactly the prevailing federal minimum wage of $7.25 per hour. About 865,000 workers had wages below the federal minimum. Together, these 1.1 million workers with wages at or below the federal minimum made up 1.5 percent of all hourly paid workers.

Data on minimum wage workers for 2020 reflect the impact of the coronavirus (COVID-19) pandemic on the labor market. Comparisons with data on minimum wage workers for earlier years should be interpreted with caution. Large declines in employment in 2020, particularly among low-wage workers, resulted in changes in the hourly earnings distribution. More information on labor market developments in 2020 is available at www.bls.gov/covid19/effects-of-covid-19-pandemic-and-response-on-the-employment-situation-news-release.htm. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards & Recognition (Adequate Compensation) 

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[This is an excerpt.] Addressing clinician well-being has reached a new level of urgency during the COVID-19 pandemic. Record numbers of clinicians are experiencing moral distress from critical resource shortages, emotional distress from delivering care to profoundly ill patients while being socially isolated, and role stress from the loss of child care or other supports. These stressors have been compounded by the deaths of Breonna Taylor, George Floyd, and others, heightening awareness of long-standing, unaddressed structural racism that impacts both clinicians and patients.Work culture heavily influences clinician well-being, and changes that improve organizational work culture and create seamless workflows have been successfully implemented to reduce burnout and increase well-being. Similar arguments can and must be made for health care organizations to adopt antiracist practices that result in sustained meaningful change, because for too many clinicians, racism is a defining component of work culture. [To read more, click View Resource.]