Resource Library

Public Safety Personnel (PSP; e.g. correctional workers, dispatchers, firefighters, paramedics, police) are frequently exposed to potentially traumatic events (PTEs). Several mental health training program categories (e.g. critical incident stress management (CISM), debriefing, peer support, psychoeducation, mental health first aid, Road to Mental Readiness [R2MR]) exist as efforts to minimize the impact of exposures, often using cognitive behavioral therapy model content, but with limited effectiveness research. The current study assessed PSP perceptions of access to professional (i.e. physicians, psychologists, psychiatrists, employee assistance programs, chaplains) and non-professional (i.e. spouse, friends, colleagues, leadership) support, and associations between training and mental health. Participants included 4,020 currently serving PSP participants. Data were analyzed using cross-tabulations and logistic regressions. Most PSP reported access to professional and non-professional support; nevertheless, most would first access a spouse (74%) and many would never, or only as a last resort, access professional support (43–60%) or PSP leaders (67%). Participation in any mental health training category was associated with lower (p < .01) rates for some, but not all, mental disorders, with no robust differences across categories. Revisions to training programs may improve willingness to access professional support; in the interim, training and support for PSP spouses and leaders may also be beneficial.

‍

This resource is found in our Actionable Strategies for Public Safety Organizations: Actionable Strategies (Providing a Continuum of Support)

‍

‍

Mentoring skills are valuable assets for academic medicine and allied health faculty, who influence and help shape the careers of the next generation of healthcare providers. Mentors are role models who also act as guides for students’ personal and professional development over time. Mentors can be instrumental in conveying explicit academic knowledge required to master curriculum content. Importantly, they can enhance implicit knowledge about the “hidden curriculum” of professionalism, ethics, values, and the art of medicine not learned from texts. In many cases, mentors also provide emotional support and encouragement. It must be noted that to be an effective mentor, one must engage in ongoing learning in order to strengthen and further mentoring skills. Thus, learning communities can provide support, education, and personal development for the mentor. The relationship benefits mentors as well through greater productivity, career satisfaction, and personal gratification. Maximizing the satisfaction and productivity of such relationships entails self-awareness, focus, mutual respect, and explicit communication about the relationship. In this article, the authors describe the development of optimal mentoring relationships, emphasizing the importance of different approaches to mentorship, roles of the mentors and mentees, mentor and mentee benefits, interprofessional mentorships for teams, gender and mentorship, and culture and mentorship.

‍

This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards& Recognition (Career Supports and Development)

‍

BACKGROUND: Many UK military veterans experiencing mental health and well-being difficulties do not engage with support services to get the help they need. Some mental health clinics employ Peer Support Workers to help veteran patients engage, however it is not known how the role influences UK veteran engagement. AIMS: To gain insight into the role of peer support in UK veteran engagement with mental health and well-being services. METHOD: A qualitative study based on 18 semi-structured interviews with veterans, peer support workers, and mental health clinicians at a specialist veteran mental health and well-being clinic in Scotland. RESULTS: Four themes of the Peer Support Worker role as positive first impression,understanding professional friend, helpful and supportive connector, and an open door were identified across all participants. The Peer Support Workers’ military connection, social and well-being support, and role in providing veterans with an easily accessible route to dis-engage and re-engage with the service over multiple engagement attempts were particularly crucial. CONCLUSIONS: The Peer Support role enhanced veteran engagement in the majority of instances. Study findings mirrored existing peer support literature, provided new evidence in relation to engaging UK veterans, and made recommendations for future veteran research and service provision.

‍

This resource is found in our Actionable Strategies for Public Safety Organizations: Actionable Strategies (Providing a Continuum of Support)

‍

[This is an excerpt.] Every day in clinical practice, health care clinicians make difficult decisions about appropriate treatment and care for their patients. Years of training prepare them for this responsibility, to choose the best course of action for a patient based on their clinical knowledge, the patient’s needs and wants, and the clinician’s professional and human values. Such daily decisions may be emotionally laden and are often made in challenging circumstances. There may be pressure from patients and families, burden from chronic understaffing, complicated organizational structures and hierarchies, system inefficiencies that shift attention away from patients, insurance or institutional policies that limit options, differences of opinion about appropriate care, and breakdowns in communication with interprofessional colleagues and administrators. These choices are often complex, and the best course of action may not be clear. [To read more, click View Resource.]

AIM: To identify nurse leaders' strategies to cultivate nurse resilience. BACKGROUND: High nursing turnover rates and nursing shortages are prominent phenomena in health care. Finding ways to promote nurse resilience and reduce nurse burnout is imperative for nursing leaders. METHODS: This is a qualitative descriptive study that occurred from November 2017 to June 2018. This study explored strategies to foster nurse resilience from nurse leaders who in this study were defined as charge nurses, nurse managers and nurse executives of a tertiary hospital in the United States. A purposive sampling method was used to have recruited 20 nurse leaders. RESULTS: Seven strategies are identified to cultivate nurse resilience: facilitating social connections, promoting positivity, capitalizing on nurses' strengths, nurturing nurses' growth, encouraging nurses' self-care, fostering mindfulness practice and conveying altruism. CONCLUSIONS: Fostering nurse resilience is an ongoing effort. Nurse leaders are instrumental in building a resilient nursing workforce. The strategies identified to foster nurse resilience will not only impact the nursing staff but also improve patient outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: The strategies presented are simple and can be easily implemented in any settings. Nurse leaders have an obligation to model and enable evidence-based strategies to promote nurses' resilience.

BACKGROUND: Assisted living facilities (ALFs), unlike nursing homes, have no federal regulations to monitor quality. States create their own regulations, and little is known about their impact on ALF care outcomes. AIM: The purpose of this study was to examine ALF care deficiencies from one state and explore the relationship among such deficiencies and facility characteristics. METHODS: This study analyzed one state’s ALF inspections data from 2015 through mid-2017, with documented violations of state regulations cited as deficiencies (N = 2,689 ALFs). Associations between severe deficiencies (defined by the state as those with potential for immediate harm to residents [e.g., assault by staff member] or causing a direct threat to resident health [e.g., an unsupervised meal for resident with swallowing difficulties, who then choked]) and facility characteristics (e.g., nursing staff availability, facility size, ownership, geographic location, and Medicaid participation) were explored using multivariate logistic regression analysis. RESULTS: Six percent of ALFs reported at least one or more severe deficiencies. Larger ALFs (26–100 beds = large and >100 beds = extra large) had greater odds of severe deficiencies compared to smaller ALFs (4–10 beds) (large versus small: OR = 2.09, 95% CI [1.37, 3.17]; extra large versus small: OR = 4.10, 95% CI [2.56, 6.55]). For all ALFs, only 31.5% had 24-hour nursing staff availability, which included unlicensed nurse aides, certified nursing assistants, licensed practical/vocational nurses, and/or registered nurses. Within large/extra-large facilities, those with part-time or no nursing staff availability had more than twice the odds of severe deficiencies compared to ALFs with 24-hour availability (OR = 2.35, 95% CI [1.31, 4.23]). CONCLUSION: Results support the importance of nursing staff availability to reduce deficiencies, especially in larger ALFs. Conducting periodic resident assessments could facilitate the availability of ALF outcomes data, which, along with detailed staffing information, are needed to evaluate and monitor quality. Universal regulations could improve ALF oversight and ensure that all states are evaluating ALF care using the same standards.

Burnout is highly prevalent among physicians and has been associated with negative outcomes for physicians, patients, staff, and health-care organizations. Reducing physician burnout and increasing physician well-being is a priority. Systematic reviews suggest that organization-based interventions are more effective in reducing physician burnout than interventions targeted at individual physicians. This consensus review by leaders in the field across multiple institutions presents emerging trends and exemplary evidence-based strategies to improve professional fulfillment and reduce physician burnout using Stanford's tripartite model of physician professional fulfillment as an organizing framework: practice efficiency, culture, and personal resilience to support physician well-being. These strategies include leadership traits, latitude of control and autonomy, collegiality, diversity, teamwork, top-of-license workflows, electronic health record (EHR) usability, peer support, confidential mental health services, work-life integration and reducing barriers to practicing a healthy lifestyle. The review concludes with evidence-based recommendations on establishing an effective physician wellness program.

This resource is found in our Actionable Strategies for Health Organizations: Strengthening Leadership.

[This is an excerpt.] Physician burnout is reaching pandemic levels, with highest incidence among primary care and emergency physicians.¹ Both increased clinical effort and excess time using the electronic health record (EHR) are known contributors to physician burnout.² We assessed whether clinical effort is associated with the amount of time ambulatory care physicians in an academic faculty group practice spend working after work in the EHR. [To read more, click View Resource.]

‍This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Reducing Administrative Burdens).

This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Support & Ensure Safe Staffing).

‍

‍

[This is an excerpt.] In 2018, more than 43 million people in the United States held a professional certification or license. The prevalence of occupational licenses, common in fields such as healthcare, law, and education, has risen substantially over the past 50 years.¹ Professional certifications, while less common than licenses, can signal proficiency in fast-changing fields like project management, software development, and financial analysis. Both of these time-limited credentials can serve as alternative forms of educational attainment, demonstrating a level of skill or knowledge needed to perform a specific type of job. As a result, researchers and others have developed an interest in using government surveys to measure the prevalence of certifications and licenses and tying these credentials to labor market outcomes and earnings. To meet this need, in January 2015, the Bureau of Labor Statistics (BLS), working with the federal Interagency Working Group on Expanded Measures of Enrollment and Attainment (GEMEnA), added questions on certifications and licenses to the Current Population Survey (CPS). This article provides an in-depth analysis of CPS data on professional certifications and licenses for 2018. [To read more, click View Resource.]

‍

This resource is found in our Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Support Career Development).

‍

[This is an excerpt.] For more than a decade, the term burnout has been used to describe clinician distress. Although some clinicians in federal health care systems may be protected from some of the drivers of burnout, other federal practitioners suffer from rule-driven health care practices and distant, top-down administration. The demand for health care is expanding, driven by the aging of the US population. Massive information technology investments, which promised efficiency for health care providers, have instead delivered a triple blow: They have diverted capital resources that might have been used to hire additional caregivers, diverted the time and attention of those already engaged in patient care, and done little to improve patient outcomes. Reimbursements are falling, and the only way for health systems to maintain their revenue is to increase the number of patients each clinician sees per day. As the resources of time and attention shrink, and as spending continues with no improvement in patient outcomes, clinician distress is on the rise. It will be important to understand exactly what the drivers of the problem are for federal clinicians so that solutions can be appropriately targeted. The first step in addressing the epidemic of physician distress is using the most accurate terminology to describe it. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Aligning Values (Establish a Culture of Shared Commitment).

[This is an excerpt.] The rate of violence against health care workers has reached epidemic proportions. According to a 2012 report by the U.S. Government Accountability Office (GAO), health care workers in inpatient facilities experienced workplace violence-related injuries requiring days off from work at a rate at least five to 12 times higher than the rate of private-sector workers overall. This type of violence includes incidences of violence against registered nurses (RNs) by patients, patients’ family members and external individuals, and it includes physical, sexual and psychological assaults. Workplace violence has a demonstrable negative impact on the nursing profession and the overall health care field. Multiple studies have shown that workplace violence – including other forms such as bullying and incivility as perpetrated by coworkers or supervisors – can adversely affect the quality of patient care and care outcomes, contribute to the development of psychological conditions, and reduce the RN’s level of job satisfaction and organizational commitment. Moreover, the full scope of the problem is not fully known. As the GAO report noted, “Health care workers may not always report such incidents, and there is limited research on the issue, among other reasons.” In fact, research has variously found that only 20 to 60 percent of nurses report incidents of violence. That being said, in order to address a problem, building on the ANA position statement on incivility, bullying and workplace violence, one must first understand its full scope. Therefore, in addressing workplace violence against health care workers, RNs in particular, the reasons for underreporting incidents of violence must be identified and addressed. Because workplace violence events are difficult to substantiate with physical evidence, a systematic reporting mechanism is warranted. [To read more, click View Resource.]

‍

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

‍

‍

The current article describes a review of U.S. states and the District of Columbia boards of nursing pre-licensure applications, which were collected, summarized, and evaluated to assess compliance with the Americans With Disabilities Act (ADA). Less than one half (n = 21) of RN licensing boards do not ask questions about mental illness on pre-licensure applications. Of the 30 boards that ask questions about mental illness, eight focus on current disability, which is legal under the ADA. The remaining 22 boards ask non-ADA–compliant questions by targeting specific diagnoses, focusing on historical data in the absence of current impairment, and/or requiring a prediction of future impairment. Nursing boards are urged to join colleagues in law, psychology, and medicine in using ADA–acceptable applications by eliminating mental health questions or limiting them to current impairment queries.

BACKGROUND: The role of Nurse Managers (NMs) is dynamic, multifaceted and complex thus, exposing NMs to high levels of work-related stress which seriously impact general wellbeing, and organizational outcomes. METHODS: A quantitative cross-sectional approach was employed to examine the phenomenon of stress among NMs in 38 selected hospitals. Census approach was used to collect data from 267 NMs. Descriptive and inferential statistics were performed to describe the sample and established the predictors of stress. RESULTS: The main causes of stress among NMs are a shortage of staff (94.4%), poor working conditions (91.8%), inadequate management support (89.9%) and heavy workload (89.15%). NMs experienced all the types of stress (psychological, emotional and physical). The major stress coping mechanisms are time management (91.8%), effective communication (91%) and delegation of duties (89.5%) while excessive eating (18.4%) is the least strategy used. Sociodemographic characteristics together explained 6.4% of stress among NMs [R2 = .064, F(6,241) = 2.676, p = .016]. CONCLUSIONS: Senior managers of hospitals should create a favourable working environment for nurses and the appointment of NMs should be based on experience and competence. IMPLICATIONS FOR NURSING PRACTICE: Stress among healthcare managers especially, NMs is very common. This current study has extensively proven that stress among NMs affects their general health as well as patient safety and quality of care. Training on stress management should be organized regularly for hospital staff particularly, NMs to enable them to cope better with stress.

BACKGROUND: Medical-related professions are at high suicide risk. However, data are contradictory and comparisons were not made between gender, occupation and specialties, epochs of times. Thus, we conducted a systematic review and meta-analysis on suicide risk among health-care workers. METHOD: The PubMed, Cochrane Library, Science Direct and Embase databases were searched without language restriction on April 2019, with the following keywords: suicide* AND (« health care worker* » OR physician* OR nurse*). When possible, we stratified results by gender, countries, time, and specialties. Estimates were pooled using random-effect meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Suicides, suicidal attempts, and suicidal ideation were retrieved from national or local specific registers or case records. In addition, suicide attempts and suicidal ideation were also retrieved from questionnaires (paper or internet). RESULTS: The overall SMR for suicide in physicians was 1.44 (95CI 1.16, 1.72) with an important heterogeneity (I2 = 93.9%, p<0.001). Female were at higher risk (SMR = 1.9; 95CI 1.49, 2.58; and ES = 0.67; 95CI 0.19, 1.14; p<0.001 compared to male). US physicians were at higher risk (ES = 1.34; 95CI 1.28, 1.55; p <0.001 vs Rest of the world). Suicide decreased over time, especially in Europe (ES = -0.18; 95CI -0.37, -0.01; p = 0.044). Some specialties might be at higher risk such as anesthesiologists, psychiatrists, general practitioners and general surgeons. There were 1.0% (95CI 1.0, 2.0; p<0.001) of suicide attempts and 17% (95CI 12, 21; p<0.001) of suicidal ideation in physicians. Insufficient data precluded meta-analysis on other health-care workers. CONCLUSION: Physicians are an at-risk profession of suicide, with women particularly at risk. The rate of suicide in physicians decreased over time, especially in Europe. The high prevalence of physicians who committed suicide attempt as well as those with suicidal ideation should benefits for preventive strategies at the workplace. Finally, the lack of data on other health-care workers suggest to implement studies investigating those occupations.

Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care.

Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon two groundbreaking reports from the past twenty years, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which both called attention to the issues around patient safety and quality of care. This report explores the extent, consequences, and contributing factors of clinician burnout and provides a framework for a systems approach to clinician burnout and professional well-being, a research agenda to advance clinician well-being, and recommendations for the field.

OBJECTIVE: Although burnout has been linked to negative workplace-level effects, prior studies have primarily focused on individuals rather than job-related characteristics. This study sought to evaluate variation in burnout between agencies and to quantify the relationship between burnout and job-related demands/resources among emergency medical services (EMS) professionals. METHODS: An electronic questionnaire was sent to all licensed, practicing EMS professionals in South Carolina. Work-related burnout was measured using the Copenhagen Burnout Inventory. Multivariable generalized estimating equations were used to estimate odds ratios (ORs) for specific job demands and resources while adjusting for confounding variables. Composite scores were used to simultaneously assess the relationship between burnout and job-related demands and resources. RESULTS: Among 1271 EMS professionals working at 248 EMS agencies, the median agency-level burnout was 35% (interquartile range [IQR]: 13% to 50%). Job-related demands, including time pressure, were associated with increased burnout. Traditional job-related resources, including pay and benefits, were associated with reduced burnout. Less tangible job resources, including autonomy, clinical performance feedback, social support, and adequate training demonstrated strong associations with reduced burnout. EMS professionals facing high job demands and low job resources demonstrated nearly a 10-fold increase in odds of burnout compared with those exposed to low demands and high resources (adjusted OR [aOR]: 9.50, 95% confidence interval [CI]: 6.39–14.10). High job resources attenuated the impact of high job demands. CONCLUSION: The proportion of EMS professionals experiencing burnout varied substantially across EMS agencies. Job resources, including those reflective of organizational culture, were associated with reduced burnout. Collectively, these findings suggest an opportunity to address burnout at the EMS agency level.

‍

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

‍

BACKGROUND: Technology use can impact human performance and cognitive function, but few studies have sought to understand the electronic health record’s impact on these dimensions of nurses’ work. OBJECTIVE: The purpose of this review was to synthesize the literature on the electronic health record’s impact on nurses’ cognitive work. DESIGN: Integrative review. DATA SOURCES: MEDLINE/PubMed, CINAHL, Embase, Web of Science, and PsycINFO. REVIEW METHODS: The literature search focused on 3 concepts: the electronic health record, cognition, and nursing practice, and yielded 4910 articles. Following a stepwise process of duplicate removal, title and abstract review, full text review, and reference list searches, a total of 18 studies were included: 12 qualitative, 4 mixed-methods, and 2 quantitative studies from the United States (13), Scandinavia (2), Australia (1), Austria (1), and Canada (1). The Mixed Methods Appraisal Tool was used to assess the quality of eligible studies. RESULTS: Five themes identified how nurses and other clinicians used the electronic health record and perceived its impact: 1) forming and maintaining an overview of the patient, 2) cognitive work of navigating the electronic health record, 3) use of cognitive tools, 4) forming and maintaining a shared understanding of the patient, and 5) loss of information and professional domain knowledge. Most studies indicated that forming and maintaining an overview of the patient at both the individual and team level were difficult when using the electronic health record. Navigating the volumes of information was challenging and increased clinicians’ cognitive work. Information was perceived to be scattered and fragmented, making it difficult to see the chronology of events and to situate and understand the clinical implications of various data. The template-driven nature of documentation and limitations on narrative notes restricted clinicians’ ability to express their clinical reasoning and decipher the reasoning of colleagues. Summary reports and handoff tools in the electronic health record proved insufficient as stand-alone tools to support nurses’ work throughout the shift and during handoff, causing them to rely on self-made paper forms. Nurses needed tools that facilitated their ability to individualize and contextualize information in order to make it clinically meaningful. CONCLUSION: The electronic health record was perceived by nurses as an impediment to contextualizing and synthesizing information, communicating with other professionals, and structuring patient care. Synthesizing and communicating information at the individual and team levels are known drivers of patient safety. The findings from this review have implications for electronic health record design.

This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Reducing Administrative Burdens).

BACKGROUND: The medical school learning environment (LE) includes the setting and context in which students develop into physicians. We identified “student navigation” as an opportunity for addressing the LE and describe the development of a student-led, faculty-supported program to improve student navigation. METHODS: A student focus group needs assessment, and a self-regulated learning assessment completed by 139 junior medical students identified four key components to Navigating Medical School (NMS): faculty mentor, near-peer guides, colleague support, and friends and family. The NMS program improves student navigation by facilitating the development of an individualized student navigational team. RESULTS: In its first year, participation was high: 84 (64%) first-years, 105 (79%) second-years, 54 (43%) third-years, and 49 (44%) fourth-years attended at least one seminar. Post-seminar surveys were completed by 89 students and 97% “agreed/strongly agreed” that these seminars improved student navigation. The Guides program enrolled 134 junior medical students who were paired with 45 near-peer guides. An impact on medical student mentoring at all the levels was observed. Near-peer mentoring significantly increased from 46% before to 70% after implementing the NMS program. Students who gained a near-peer mentor demonstrated improved self-directed learning behaviors. CONCLUSION: The NMS program is a feasible model for a student-led, faculty-supported initiative to strengthen the LE by improving student navigation, connection, and promoting self-directed learning.

This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Operational Strategies (Workloads and Workflows).

‍