Physician burnout and other forms of occupational distress are a significant problem in modern medicine, especially during the COVID19 pandemic, yet few doctors are familiar with the neurobiology that contributes to these problems. Burnout has been linked to changes that reduce a physician’s sense of control over their own practice, undermine connections with patients and colleagues, interfere with work–life integration, and result in uncontrolled stress. Brain research has demonstrated that uncontrollable stress, but not controllable stress, impairs the functioning of the prefrontal cortex, a recently evolved brain region that provides top-down regulation over thought, action and emotion. The prefrontal cortex governs many cognitive operations essential to physicians, including abstract reasoning, higher order decision-making, insight, and the ability to persevere through challenges. However, the prefrontal cortex is remarkably reliant on arousal state, and is impaired under conditions of fatigue and/or uncontrollable stress when there are inadequate or excessive levels of the arousal modulators (e.g. norepinephrine, dopamine, acetylcholine). With chronic stress exposure, prefrontal gray matter connections are lost, but can be restored by stress relief. Reduced PFC self-regulation may explain several challenges associated with burnout in physicians including reduced motivation, unprofessional behavior, and suboptimal communication with patients. Understanding this neurobiology may help physicians have a more informed perspective to help relieve or prevent symptoms of burnout, and may help administrative leaders to optimize the work environment to create more effective organizations. Efforts to restore a sense of control to physicians may be particularly helpful.
Physician Distress and Burnout, the Neurobiological Perspective
OBJECTIVE: To evaluate the relationships between immediate supervisors' leadership qualities and the subsequent levels and changes in burnout and satisfaction of supervised physicians 2 years later. PARTICIPANTS AND METHODS: In 2015 and 2017 physicians were asked to complete surveys that included the 9-item Mayo Clinic Leadership Score (range, 9 to 45) assessing their supervisor, an item about satisfaction with the organization, and two items from the Maslach Burnout Inventory. Individual participants' responses to the surveys were linked. RESULTS: Among the 3698 physicians invited to complete both the 2015 and 2017 survey, 1795 (48.5%) responded. The mean composite baseline leadership score was 38.1 (SD, 8.4). Lower mean baseline leadership scores were reported by physicians who had burnout (mean [SD], 36.0 [9.7] vs 39.1 [7.3]; P<.001) 2 years later in comparison to those who did not have burnout 2 years later. In multivariable analysis, higher baseline leadership score of supervisors was independently associated with lower odds of physicians having burnout 2 years later (for each 1-point increase, odds ratio, 0.98; 95% CI, 0.96 to 0.99; P=.002) after adjusting for burnout at baseline, age, gender, length of service, and specialty. Baseline composite leadership score of supervisors was also independently associated with physicians' satisfaction with the organization 2 years later (odds ratio, 1.05; 95% CI, 1.03 to 1.07; P<.0001). CONCLUSION: Physicians' ratings of their immediate supervisors' leadership qualities were associated with their subsequent levels and changes in burnout and satisfaction 2 years later. Additional studies are needed to determine the effect of sharing such scores with immediate supervisors and providing additional leadership training to those with low scores, and if doing so ultimately reduces burnout and improves satisfaction of the supervised physicians.
This resource is found in our Actionable Strategies for Health Organizations: Strengthening Leadership.
Physicians' Ratings of Their Supervisor's Leadership Behaviors and Their Subsequent Burnout and Satisfaction: A Longitudinal Study
BACKGROUND: COVID-19 has put extraordinary stress on healthcare workers. Few studies have evaluated stress by worker role, or focused on experiences of women and people of color. METHODS: The “Coping with COVID” survey assessed US healthcare worker stress. A stress summary score (SSS) incorporated stress, fear of exposure, anxiety/depression and workload (Omega 0.78). Differences from mean were expressed as Cohen's d Effect Sizes (ESs). Regression analyses tested associations with stress and burnout. FINDINGS: Between May 28 and October 1, 2020, 20,947 healthcare workers responded from 42 organizations (median response rate 20%, Interquartile range 7% to 35%). Sixty one percent reported fear of exposure or transmission, 38% reported anxiety/depression, 43% suffered work overload, and 49% had burnout. Stress scores were highest among nursing assistants, medical assistants, and social workers (small to moderate ESs, p < 0.001), inpatient vs outpatient workers (small ES, p < 0.001), women vs men (small ES, p < 0.001), and in Black and Latinx workers vs Whites (small ESs, p < 0.001). Fear of exposure was prevalent among nursing assistants and Black and Latinx workers, while housekeepers and Black and Latinx workers most often experienced enhanced meaning and purpose. In multilevel models, odds of burnout were 40% lower in those feeling valued by their organizations (odds ratio 0.60, 95% CIs [0.58, 0.63], p< 0.001). INTERPRETATION: Stress is higher among nursing assistants, medical assistants, social workers, inpatient workers, women and persons of color, is related to workload and mental health, and is lower when feeling valued.
Prevalence and Correlates of Stress and Burnout Among U.S. Healthcare Workers During the COVID-19 Pandemic: A National Cross-Sectional Survey Study
BACKGROUND: Burnout is a major challenge in health care, but its prevalence has not been evaluated in practicing respiratory therapists (RTs). The purpose of this study was to identify RT burnout prevalence and factors associated with RT burnout. METHODS: An online survey was administered at 26 centers in the United States between January and March 2021. Validated quantitative cross-sectional surveys were used to measure burnout and leadership domains. The survey was sent to department directors and distributed by the department directors to their staffs. Data analysis was descriptive, and logistic regression analysis was performed to evaluate risk factors, expressed as odds ratios (OR), for burnout. RESULTS: The survey was distributed to 3,010 RTs; the response rate was 37%. Seventy-nine percent of the respondents reported burnout, 10% with severe, 32% with moderate, and 37% with mild burnout. Univariate analysis revealed that those with burnout worked more hours per week, worked more hours per week in the ICU, primarily cared for adult patients, primarily delivered care via RT protocols, reported inadequate RT staffing, reported being unable to complete assigned work, had more frequent exposure to COVID-19 (coronavirus disease 2019), had a lower leadership score, and fewer had a positive view of leadership. Logistic regression revealed that burnout climate (OR 9.38; P < .001), inadequate RT staffing (OR 2.08 to 3.19; P = .004 to .05), unable to complete all work (OR 2.14 to 5.57; P = .003 to .02), and missed work for any reason were associated with an increased risk of burnout (OR 1.96; P = .007). Not providing patient care (OR 0.18; P = .02) and a positive leadership score (.55; P = .02) were associated with a decreased risk of burnout. CONCLUSIONS: Burnout was common among the RTs in the midst of the COVID-19 pandemic. Good leadership was protective against burnout, whereas inadequate staffing, an inability to complete work, and a burnout climate were associated with burnout.
Prevalence of Burnout Among Respiratory Therapists Amid the COVID-19 Pandemic
PURPOSE: Assess effectiveness of Primary Care 2.0: a team-based model that incorporates increased medical assistant (MA) to primary care physician (PCP) ratio, integration of advanced practice clinicians, expanded MA roles, and extended the interprofessional team.
METHODS: Prospective, quasi-experimental evaluation of staff/clinician team development and wellness survey data, comparing Primary Care 2.0 to conventional clinics within our academic health care system. We surveyed before the model launch and every 6-9 months up to 24 months post implementation. Secondary outcomes (cost, quality metrics, patient satisfaction) were assessed via routinely collected operational data.
RESULTS: Team development significantly increased in the Primary Care 2.0 clinic, sustained across all 3 post implementation time points (+12.2, +8.5, + 10.1 respectively, vs baseline, on the 100-point Team Development Measure) relative to the comparison clinics. Among wellness domains, only “control of work” approached significant gains (+0.5 on a 5-point Likert scale, P = .05), but was not sustained. Burnout did not have statistically significant relative changes; the Primary Care 2.0 site showed a temporal trend of improvement at 9 and 15 months. Reversal of this trend at 2 years corresponded to contextual changes, specifically, reduced MA to PCP staffing ratio. Adjusted models confirmed an inverse relationship between team development and burnout (P <.0001). Secondary outcomes generally remained stable between intervention and comparison clinics with suggestion of labor cost savings.
CONCLUSIONS: The Primary Care 2.0 model of enhanced team-based primary care demonstrates team development is a plausible key to protect against burnout, but is not sufficient alone. The results reinforce that transformation to team-based care cannot be a 1-time effort and institutional commitment is integral.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Optimizing Teams).
Primary Care 2.0: A Prospective Evaluation of a Novel Model of Advanced Team Care With Expanded Medical Assistant Support
OBJECTIVE: The purpose of this study was to understand the physical and psychological impact of high stress clinical environments and contributory factors of burnout in multidisciplinary healthcare workforce during the initial outbreak of COVID-19. METHOD: In-person qualitative interviews informed by an adaptation of Karasek's Job Demand-control model were conducted with a convenience sample of healthcare workforce from March to April 2020. RESULTS: Themes emerging from interviews coalesced around three main areas: fear of uncertainty, physical and psychological manifestations of stress, and resilience building. Shifting information, a lack of PPE, and fear of infecting others prompted worry for those working with Covid-infected patients. Participants reported that stress manifested more psychologically than physically. Individualized stress mitigation efforts, social media and organizational transparency were reported by healthcare workers to be effective against rising stressors. CONCLUSION: COVID-19 has presented healthcare workforce with unprecedented challenges in their work environment. With attention to understanding stressors and supporting clinicians during healthcare emergencies, more research is necessary in order to effectively promote healthcare workforce well-being.
This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Occupational Safety).
Primary Drivers and Psychological Manifestations of Stress in Frontline Healthcare Workforce During the Initial COVID-19 Outbreak in the United States
Ensuring the mental health and well-being of the healthcare workforce globally, especially women healthcare workers (HCWs), is an ongoing challenge that has been accentuated by the novel coronavirus (COVID-19) pandemic. Already at high risk of experiencing symptoms of stress, burnout, and depression, women HCWs are now also facing the psychosocial impacts of the COVID-19 pandemic. Although different types of mental health interventions have been introduced to support HCW well-being, the current needs of women HCWs have not been emphasized and replicable processes for developing and implementing specific emotional support services for women HCWs have not yet been well-described in the literature. Therefore, in this perspective, we discuss the approach our institution (University of California, Los Angeles) took for developing emotional support services for women HCWs that incorporate aspects of disaster behavioral health models and address various barriers to support and treatment. In addition, we describe and illustrate the process that we utilized to develop individual-level and institutional-level emotional support services. Finally, based on our institution's experience, we share recommendations for developing emotional support services for women HCWs during the COVID-19 pandemic and other future crises.
Psychological Distress Among Women Healthcare Workers: A Health System's Experience Developing Emotional Support Services During the COVID-19 Pandemic
[This is an excerpt.] Creating healthy, high-performing fire/EMS departments is a shared responsibility that requires commitment from department leaders and members alike. Fire service leaders who understand the link between the well-being of their members and the performance and success of the department take comprehensive steps to create a positive environment that supports and promotes good health and optimal functioning. In short, they create a psychologically healthy fire department (PHFD). Creating a healthy, high-performing department requires more than simply promoting awareness of health issues or offering wellness activities. Done well, principles of health and well-being become ingrained in the very norms, values, and beliefs that are part of the department’s culture. Core to this approach is a multi-dimensional view of well-being that includes mental health. The PHFD: Implementation Toolkit is based on American Psychological Association’s (APA) Psychologically Healthy Workplace model and adapted to fit the unique characteristics of the fire service. [To read more, click View Resource.]
Psychologically Healthy Fire Departments: Implementation Toolkit
While the health impacts of the COVID-19 pandemic on frontline health care workers have been well described, the effects of the COVID-19 response on the U.S. public health workforce, which has been impacted by the prolonged public health response to the pandemic, has not been adequately characterized. A cross-sectional survey of public health professionals was conducted to assess mental and physical health, risk and protective factors for burnout, and short- and long-term career decisions during the pandemic response. The survey was completed online using the Qualtrics survey platform. Descriptive statistics and prevalence ratios (95% confidence intervals) were calculated. Among responses received from 23 August and 11 September 2020, 66.2% of public health workers reported burnout. Those with more work experience (1–4 vs. <1 years: prevalence ratio (PR) = 1.90, 95% confidence interval (CI) = 1.08−3.36; 5–9 vs. <1 years: PR = 1.89, CI = 1.07−3.34) or working in academic settings (vs. practice: PR = 1.31, CI = 1.08–1.58) were most likely to report burnout. As of September 2020, 23.6% fewer respondents planned to remain in the U.S. public health workforce for three or more years compared to their retrospectively reported January 2020 plans. A large-scale public health emergency response places unsustainable burdens on an already underfunded and understaffed public health workforce. Pandemic-related burnout threatens the U.S. public health workforce’s future when many challenges related to the ongoing COVID-19 response remain unaddressed.
Public Health Workforce Burnout in the COVID-19 Response in the U.S.
[This is an excerpt.] To date, over 710,000 Americans have died due to COVID-19. Nurses report increased levels of stress, exhaustion, and burnout, while healthcare organizations struggle with new surges and growing staffing shortages. As a continuation of the Pulse on the Nation’s Nurses Survey Series, and a follow-up to the first and second Mental Health and Wellness surveys conducted in Spring and Winter of 2020 and the COVID Impact survey conducted in Winter 2021, the American Nurses Foundation has fielded another non-incentivized survey. The goal was to determine any changes and further impact of the pandemic on the mental health and wellness of nurses, with additional enquiries concerning emotional health, post-traumatic stress, resiliency, and stigma around seeking professional mental health support. Between August 20 - September 2, 2021, 9,572 nurses completed or partially completed this survey. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Relational Strategies (Measuring Well-Being & Accountability).
Pulse of the Nation’s Nurses Survey Series: Mental Health and Wellness
[This is an excerpt.] In 2019, 91.0% of office-based physicians spent time outside normal office hours documenting clinical care: 17.0% spent <1 hour, 41.4% spent 1–2 hours, 24.0% spent >2 hours–4 hours, and 8.6% spent >4 hours per day. The percentage of primary care physicians who spent no hours per day documenting clinical care (5.3%) was lower than the percentage of specialist care physicians (12.3%) who spent no hours per day documenting clinical care. In other time categories, there was no statistically significant difference between primary care and specialist care physicians. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Reducing Administrative Burdens).
QuickStats: Distribution of Hours per Day That Office-Based Primary Care and Specialist Care Physicians Spent Outside Normal Office Hours Documenting Clinical Care in Their Medical Record System — United States, 2019
BACKGROUND AND OBJECTIVES: Personal care, home health, and nursing aides provide the majority of care to chronically ill and disabled older adults. This workforce faces challenging working conditions, resulting in high turnover and workforce instability that affect the quality of care for older adults. We examine financial security, work-life balance, and quality of life of Black, Hispanic, and workers of other race/ethnicity compared to White workers. RESEARCH DESIGN AND METHODS: We hypothesize that Black and Hispanic workers experience greater financial insecurity, spend more time on work-related activities and have less time available for leisure activities, and have a lower quality of life compared to White workers. To test these hypotheses, we analyze the American Time Use Survey using descriptive analyses and multivariable and compositional regression. RESULTS: Black and Hispanic individuals were 2-3 times more likely to live in poverty than White individuals. The time use analysis indicated that Black and Hispanic workers spent more time on work-related activities and less time on nonwork-related activities, including longer work commutes and less time exercising. In analyses of aggregated paid/unpaid work and leisure, Black workers were the only group that spent significantly more time working and less time on leisure activities compared to White workers. This may explain the lower quality of life that we only observed in Black workers. DISCUSSION AND IMPLICATIONS: Racial/ethnic disparities in well-being among direct care workers may affect the care older adults receive and contribute to widening inequities in this workforce and society. Policymakers should direct efforts toward securing funding for workers, incentivizing employer provisions, and implementing racial equity approaches.
Racial Disparities in Financial Security, Work and Leisure Activities, and Quality of Life Among the Direct Care Workforce
A nationwide survey conducted by the National Commission to Address Racismin Nursing demonstrates that racism in the nursing profession is a problem
This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Relational Strategies (Improving Diversity, Equity, & Inclusion).
Racism's Impact in Nursing
OBJECTIVE: Test web-based implementation for the science of enhancing resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) burnout. DESIGN: RCT using two cohorts of HCWs of four NICUs each, to improve HCW well-being (primary outcome: burnout). Cohort 1 received WISER while Cohort 2 acted as a waitlist control. RESULTS: Cohorts were similar, mostly female (83%) and nurses (62%). In Cohorts 1 and 2 respectively, 182 and 299 initiated WISER, 100 and 176 completed 1-month follow-up, and 78 and 146 completed 6-month follow-up. Relative to control, WISER decreased burnout (-5.27 (95% CI: -10.44, -0.10), p = 0.046). Combined adjusted cohort results at 1-month showed that the percentage of HCWs reporting concerning outcomes was significantly decreased for burnout (-6.3% (95% CI: -11.6%, -1.0%); p = 0.008), and secondary outcomes depression (-5.2% (95%CI: -10.8, -0.4); p = 0.022) and work-life integration (-11.8% (95%CI: -17.9, -6.1); p < 0.001). Improvements endured at 6 months. CONCLUSION: WISER appears to durably improve HCW well-being.
This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Stress/Trauma & Resilience).
Randomized Controlled Trial of the "WISER" Intervention to Reduce Healthcare Worker Burnout
The current landscape of mental health services reflects both tremendous challenges and opportunities. With the impact of COVID-19 front and center in the national discourse, and the planning for a system involving a 988-crisis response, there is much work ahead. This paper, Ready to Respond, is the umbrella paper for the 2021 technical assistance coalition series developed through the National Association of State Mental Health Program Directors in partnership with the Substance Abuse and Mental Health Services Administration. It aims to lay out a roadmap as states emerge from the pandemic and need, more than ever, a full continuum of psychiatric care. As an outgrowth of a policy framework looking “beyond beds” within inpatient state hospitals as a single solution to improving mental health outcomes, the current discourse centers around access to crisis services. Yet, in order to best respond to demand, an entire array of services is needed both to prevent crises in the first place and to provide longer term supports beyond a crisis period for diverse populations of all ages with mental illness and substance use disorders, as well as those with co-occurring complex conditions. These services will require coordinated funding and planning with a broad group of stakeholders to address among other things equity and reducing the likelihood of suicide, overdose, criminal legal entanglements, homelessness, unemployment, or other untoward outcomes. The paper reviews recent behavioral health system demands and highlights seven key priority areas for consideration to build a sustainable, robust and more complete psychiatric care continuum.
Ready to Respond: Mental Health Beyond Crisis and COVID-19
BACKGROUND: Healthcare work is known to be stressful and challenging, and there are recognised links between the psychological health of staff and high-quality patient care. Schwartz Center Rounds® (Rounds) were developed to support healthcare staff to re-connect with their values through peer reflection, and to promote more compassionate patient care. Research to date has focussed on self-report surveys that measure satisfaction with Rounds but provide little analysis of how Rounds 'work' to produce their reported outcomes, how differing contexts may impact on this, nor make explicit the underlying theories in the conceptualisation and implementation of Rounds. METHODS: Realist evaluation methods aimed to identify how Rounds work, for whom and in what contexts to deliver outcomes. We interviewed 97 key informants: mentors, facilitators, panellists and steering group members, using framework analysis to organise and analyse our data using realist logic. We identified mechanisms by which Rounds lead to outcomes, and contextual factors that impacted on this relationship, using formal theory to explain these findings. RESULTS: Four stages of Rounds were identified. We describe how, why and for whom Schwartz Rounds work through the relationships between nine partial programme theories. These include: trust safety and containment; group interaction; counter-cultural/3rd space for staff; self-disclosure; story-telling; role modelling vulnerability; contextualising patients and staff; shining a spotlight on hidden stories and roles; and reflection and resonance. There was variability in the way Rounds were run across organisations. Attendance for some staff was difficult. Rounds is likely to be a 'slow intervention' the impact of which develops over time. We identified the conditions needed for Rounds to work optimally. These contextual factors influence the intensity and therefore degree to which the key ingredients of Rounds (mechanisms) are activated along a continuum, to produce outcomes. Outcomes included: greater tolerance, empathy and compassion for self and others; increased honesty, openness, and resilience; improved teamwork and organisational change. CONCLUSIONS: Where optimally implemented, Rounds provide staff with a safe, reflective and confidential space to talk and support one another, the consequences of which include increased empathy and compassion for colleagues and patients, and positive changes to practice.
This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Stress/Trauma & Resilience).
Realist Evaluation of Schwartz Rounds® for Enhancing the Delivery of Compassionate Healthcare: Understanding How They Work, for Whom, and in What Contexts
BACKGROUND: The COVID-19 health crisis has disproportionately impacted populations who have been historically marginalized in health care and public health, including low-income and racial and ethnic minority groups. Members of marginalized communities experience undue barriers to accessing health care through virtual care technologies, which have become the primary mode of ambulatory health care delivery during the COVID-19 pandemic. Insights generated during the COVID-19 pandemic can inform strategies to promote health equity in virtual care now and in the future. OBJECTIVE: The aim of this study is to generate insights arising from literature that was published in direct response to the widespread use of virtual care during the COVID-19 pandemic, and had a primary focus on providing recommendations for promoting health equity in the delivery of virtual care. METHODS: We conducted a narrative review of literature on health equity and virtual care during the COVID-19 pandemic published in 2020, describing strategies that have been proposed in the literature at three levels: (1) policy and government, (2) organizations and health systems, and (3) communities and patients. RESULTS: We highlight three strategies for promoting health equity through virtual care that have been underaddressed in this literature: (1) simplifying complex interfaces and workflows, (2) using supportive intermediaries, and (3) creating mechanisms through which marginalized community members can provide immediate input into the planning and delivery of virtual care. CONCLUSIONS: We conclude by outlining three areas of work that are required to ensure that virtual care is employed in ways that are equity enhancing in a post–COVID-19 reality.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Using Technology to Improve Workflows)
Recommendations for Health Equity and Virtual Care Arising From the COVID-19 Pandemic: Narrative Review
While long-term care (LTC) facilities serving older adults have long struggled with low employee morale and high rates of staff turnover, the COVID-19 pandemic brought unprecedented challenges to these facilities and the frontline staff working in them. This study aimed to explore factors that influenced the personal and professional wellbeing of care providers working in LTC facilities across New York City (NYC) during the pandemic. Fourteen semi-structured qualitative interviews were conducted with frontline care providers working in LTC facilities across NYC. Interviews were audio-recorded, transcribed, and systematically coded according to both pre-existing and emergent topics. Four main themes emerged from the data: the toll of the virus; home and work-life balance stressors; workplace stressors; and participants’ recommendations for facility leadership. Findings from this study may inform strategies for supporting the wellbeing of frontline care providers in LTC environments, especially during future public health emergencies.
Reflections From the “Forgotten Front Line”: A Qualitative Study of Factors Affecting Wellbeing Among Long-Term Care Workers in New York City During the COVID-19 Pandemic
BACKGROUND: Nursing practice is highly demanding and has been related to risk of substance use (SU) and SU disorders (SUDs). Despite this, education on registered nurse (RN) SUDs is extremely limited, and this knowledge gap has been related to nurses’ inability to address SU problems among colleagues. PURPOSE: We assessed whether practicing nurses recognized signs of SUDs, what actions they would take if a colleague had a SUD, and their knowledge of RN SUDs interventions. We examined these findings in relation to demographic and work characteristics. METHODS: A mixed modes survey (online, mailed) was conducted between November 2020 and February 2021, with randomly selected RNs in nine states being contacted up to six times. Balanced stratified sampling (balanced to the U.S. RN population), a technique that aims to obtain a nationally representative sample, was used. Measures of potential workplace signs of SUD (seven items), actions one would take (seven items), and attitudes toward RN SUD interventions (10 items) were assessed, and prevalence of these items is described. Logistic regression models were used to assess associations between each item and demographic and work characteristics. RESULTS: Of the 1,215 surveys returned (31% response rate), 1,170 were included in the analyses. Most RNs (82%) correctly selected frequent medication errors, medication wasting, and frequent absences/breaks as potential signs of SU problems, yet only half felt confident in their ability to identify an colleague with a SUD. Although the majority (93%) would tell a supervisor, higher proportions of younger (aged < 45 years) and Asian nurses reported feeling unsure of what to do and were more afraid to get involved with nurse SU problems than older nurses and nurses of other races/ethnicities. Variation in recognition and actions were also found for workplace factors. Charge nurses were more likely to think that nurses with a potential SUD should have their license revoked than those in the reference group (educators/researchers) (adjusted OR = 1.89; 95% CI = 1.03, 3.49). CONCLUSIONS: Findings suggest nurses can benefit from clear guidelines and educational initiatives to address RN SU problems. A culture of safety and accountability could help nurses feel more comfortable addressing these issues.
Registered Nurses’ Awareness of Workplace Signs, Actions, and Interventions for Nurses with Substance Use Disorder
BACKGROUND: In health care, burnout remains a persistent and significant problem. Evidence now exists that organizational initiatives are vital to address health care worker (HCW) well-being in a sustainable way, though system-level interventions are pursued infrequently. METHODS: Between November 2018 and May 2020, researchers engaged five health system and physician practice sites to participate in an organizational pilot intervention that integrated evidence-based approaches to well-being, including a comprehensive culture assessment, leadership and team development, and redesign of daily workflow with an emphasis on cultivating positive emotions. RESULTS: All primary and secondary outcome measures demonstrated directionally concordant improvement, with the primary outcome of emotional exhaustion (0–100 scale, lower better; 43.12 to 36.42, p = 0.037) and secondary outcome of likelihood to recommend the participating department’s workplace as a good place to work (1–10 scale, higher better; 7.66 to 8.20, p = 0.037) being statistically significant. Secondary outcomes of emotional recovery (0–100 scale, higher better; 76.60 to 79.53, p = 0.20) and emotional thriving (0–100 scale, higher better; 76.70 to 79.23, p = 0.27) improved but were not statistically significant. CONCLUSION: An integrated, skills-based approach, focusing on team culture and interactions, leadership, and workflow redesign that cultivates positive emotions was associated with improvements in HCW well-being. This study suggests that simultaneously addressing multiple drivers of well-being can have significant impacts on burnout and workplace environment.
This resource is found in our Actionable Strategies for Health Organizations: Establishing Commitment & Shared Governance (Organizational Infrastructure for Well-Being).
