[This is an excerpt.] This publication describes the standards and key elements used by CCNE in the accreditation of baccalaureate, master’s, DNP, and post-graduate APRN certificate programs. The standards and key elements, along with the accreditation procedures, serve as the basis for evaluating the quality of the educational program offered and to hold the nursing program(s) accountable to the educational community,the nursing profession, and the public. All nursing programs seeking CCNE accreditation, including those with distance education offerings, are expected to meet the accreditation standards presented in thisdocument. The standards are written as broad statements that embrace several areas of expected institutional performance. Related to each standard is a series of key elements. Viewed together, the key elements provide an indication of whether the broader standard has been met. The key elements are considered by the evaluation team, the Accreditation Review Committee, and the Board of Commissioners in determining whether the program meets each standard. The key elements are designed to enable a broad interpretation of each standard in order to support institutional autonomy and encourage innovation while maintaining the quality of nursing programs and the integrity of the accreditation process. Accompanying each key element is an elaboration, which is provided to assist program representatives in addressing the key element and to enhance understanding of CCNE’s expectations. Following each standard isa list of supporting documentation that assists program representatives in developing self-study materials and in preparing for the on-site evaluation. Supporting documentation is included in the self-study document or provided for review on site. CCNE recognizes that reasonable alternatives exist when providing documentation to address the key elements. Supporting documentation may be provided in paper or electronic form. At the end of this document is a glossary that defines terms and concepts used in this document. The standards are subject to periodic review and revision. The next scheduled review of this document will include both broad and specific participation by the CCNE community of interest in the analysis and discussion of additions and deletions. Under no circumstances may the standards and key elements defined in this document supersede federal or state law. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Operational Strategies (Workloads and Workflows).
Standards for Accreditation of Baccalaureate and Graduate Nursing Programs
BACKGROUND: A growing body of literature has identified a range of beneficial physiological and psychological outcomes from the regular practice of mindfulness meditation. For healthcare professionals, mindfulness meditation is claimed to reduce stress, anxiety and burnout, and enhance resilience. OBJECTIVE: The objective of this integrative review was to critically appraise the literature that related to the effectiveness of mindfulness meditation programs for nurses and nursing students. DESIGN: This review was conducted using Whittemore and Knafl's framework for integrated reviews. DATA SOURCES: Using the terms mindfulness, mindfulness-based-stress reduction, Vipassana, nurses, and nurse education a comprehensive search of the following electronic databases was conducted: CINAHAL, Medline, PsycINFO, EMBASE. EMCARE, ERIC and SCOPUS. REVIEW METHODS: The initial search located 1703 articles. After screening and checking for eligibility 20 articles were critically appraised using the Critical Appraisal Skills Program checklist for qualitative papers and McMaster's Critical appraisal form for quantitative papers. The final number of papers included in the review was 16. RESULTS: The results of this review identified that mindfulness meditation has a positive impact on nurses' and nursing students' stress, anxiety, depression, burnout, sense of well-being and empathy. However, the majority of the papers described small scale localised studies which limits generalisability. CONCLUSION: Contemporary healthcare is challenging and complex. This review indicated that mindfulness meditation is an effective strategy for preventing and managing the workplace stress and burnout, which so often plague nursing staff and students. Further studies with larger sample sizes using rigorous research methods would be useful in extending this work.
This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Stress/Trauma & Resilience).
The Effectiveness of Mindfulness Meditation for Nurses and Nursing Students: An Integrated Literature Review
OBJECTIVE: Racial disparities exist in health care, even when controlling for relevant sociodemographic variables. Recent data suggest disparities in patient-physician communication may also contribute to racial disparities in health care. This study aimed to systematically review studies examining the effect of black race and racial concordance on patient-physician communication. METHODS: A comprehensive search using the PRISMA guidelines was conducted across seven online databases between 1995 and 2016. The search resulted in 4672 records for review and 40 articles for final inclusion in the review. Studies were included when the sample consisted of black patients in healthcare contexts and the communication measure was observational or patient-reported. Data were extracted by pairs of authors who independently coded articles and reconciled discrepancies. Results were synthesized according to predictor (race or racial concordance) and communication domain. RESULTS: Studies were heterogeneous in health contexts and communication measures. Results indicated that black patients consistently experienced poorer communication quality, information-giving, patient participation, and participatory decision-making than white patients. Results were mixed for satisfaction, partnership building, length of visit, and talk-time ratio. Racial concordance was more clearly associated with better communication across all domains except quality, for which there was no effect. CONCLUSIONS: Despite mixed results due to measurement heterogeneity, results of the present review highlight the importance of training physicians and patients to engage in higher quality communication with black and racially discordant patients by focusing on improving patient-centeredness, information-giving, partnership building, and patient engagement in communication processes.
The Effects of Race and Racial Concordance on Patient-Physician Communication: A Systematic Review of the Literature
PURPOSE: Burnout has been shown to develop due to chronic stress or distress, which has negative implications for both physical and mental health and well-being. Burnout research originated in the “caring-professions.” However, there is a paucity of research which has focused specifically on how job demands, resources and personal characteristics affect burnout among practitioner psychologists. METHODS: This PRISMA review (Moher et al., 2009) involved searches of key databases (i.e., Web of Knowledge, SCOPUS and Google Scholar) for articles published prior to 1st January, 2017. Articles concerning the prevalence and cause(s) of burnout in applied psychologists, that were published in the English language were included. Both quantitative and qualitative investigative studies were included in the review. The Crowe Critical Appraisal Tool (CCAT; Crowe, 2013) was used to appraise the quality of each paper included in this review. An inductive content analysis approach (Thomas, 2006) was subsequently conducted in order to identify the developing themes from the data. RESULTS: The systematic review comprised 29 papers. The most commonly cited dimension of burnout by applied psychologists was emotional exhaustion (34.48% of papers). Atheoretical approaches were common among the published articles on burnout among applied psychologists. Workload and work setting are the most common job demands and factors that contribute to burnout among applied psychologists, with the resources and personal characteristics of research are age and experience, and sex the most commonly focused upon within the literature. CONCLUSIONS: The results of the current review offers evidence that burnout is a concern for those working in the delivery of psychological interventions. Emotional exhaustion is the most commonly reported dimension of burnout, with job and personal characteristics and resources also playing important roles in the development of burnout in the mental health care profession. Finally, tentative recommendations for those within the field of applied psychology.
The Prevalence and Cause(s) of Burnout Among Applied Psychologists: A Systematic Review
[This is an excerpt.] Policymakers frequently approach the question of developing the workforce to meet the needs of the 21st century. Despite today’s historically low unemployment rates, wages for typical workers have barely budged for decades. While productivity has increased, gains have largely trickled to the richest Americans, exasperating persisting income inequality and painting an ominous picture of middle-class living standards. Furthermore, gaps in both wealth and income by race and gender have caused disproportionate labor market penalties for certain groups. Wage gaps and growing income inequality along racial lines have persisted despite higher educational attainment. For example, earning a bachelor’s degree or higher has not proven to reduce either the black-white or the Latinx wage gap. Meanwhile, employers are spending less on worker training than they used to. And too often, the training that they do provide is firm-specific, meaning that those skills do not translate well to other firms. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Support Career Development).
Wage Gaps and Outcomes in Apprenticeship Programs: The Effects of Gender, Race, and Region
Since the introduction of the concept of workplace bullying (WPB), there has been a great deal of scientific and popular press literature building awareness of the concept and the need for protection of employees in the workplace. WPB policies provide a crucial part of this employee protection. The presence and content of WPB policies may be prescribed by law, but in many countries, this is not the case. Nevertheless, as policies have been developed, tried and tested through complaints, grievance procedures and court cases, best practices have been studied and introduced.
These developments notwithstanding, the research on the effectiveness of WPB policies lags behind research on best practices. For example, WPB policies have been suggested to act as a preventive strategy through raising awareness, yet the literature examining implementation and awareness penetration of WPB policies is currently very limited. This chapter explores the extant literature on the need for WPB policies, the relationship between law and policies and the best practice content and practices associated with developing WPB policies. It also provides reference information helpful in developing practical and effective policies and reviews current research examining the impact and effectiveness of WPB policies and governance practices. The chapter sets out a research agenda for the future to address gaps in the literature. Finally, it acknowledges that WPB policies are only one of a range of interventions and initiatives required to address this concern and outline other methods of prevention and remediation.
Workplace Bullying Policies: A Review of Best Practices and Research on Effectiveness
[This is an excerpt.] The Center for Medicare and Medicaid Innovation (CMMI), also known as the “Innovation Center,” was authorized under the Affordable Care Act (ACA) and tasked with designing, implementing, and testing new health care payment models to address growing concerns about rising costs, quality of care, and inefficient spending. Congress specifically directed CMMI to focus on models that could potentially lower health care spending for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) while maintaining or enhancing the quality of care furnished under these programs. CMMI is part of the U.S. Department of Health and Human Services and is managed by the Centers for Medicare and Medicaid Services (CMS). [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Advance Team-Based Care).
“What is CMMI?” and 11 other FAQs about the CMS Innovation Center
The US health care system is rapidly changing in an effort to deliver better care, improve health, and lower costs while providing care for an aging population with high rates of chronic disease and co-morbidities. Among the changes affecting clinical practice are new payment and delivery approaches, electronic health records, patient portals, and publicly reported quality metrics—all of which change the landscape of how care is provided, documented, and reimbursed. Navigating these changes are health care professionals (HCPs), whose daily work is critical to the success of health care improvement. Unfortunately, as a result of these changes and resulting added pressures, many HCPs are burned out, a syndrome characterized by a high degree of emotional exhaustion and high depersonalization (i.e., cynicism), and a low sense of personal accomplishment from work [1, 2].
Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care
Burnout is a significant concern that results in negative outcomes for both mental health practitioners (MHPs; e.g. counselors, psychologists, social workers) and their clients. Viehl and Dispenza (2015) found that sexual-minority-identified MHPs reported higher rates of burnout when compared to heterosexual-identified MHPs. To continue understanding what factors contribute to burnout among sexual-minority-identified MHPs, we used Internet survey procedures to explore possible correlates and predictors of burnout among 84 sexual- minority-identified MHPs. MHPs were recruited and sampled from across the U.S. Perceptions of reasonable workload, perceptions of workplace heterosexism, perceptions of workplace support, and identity concealment were all explored in this study as specific factors that could lead to burnout. All of the aforementioned factors correlated with burnout, and to some degree, uniquely predicted burnout among the MHPs sampled for this study. Perceptions of workplace support also mediated the relationship between workplace heterosexism and burnout. The data supports the need for MHPs, MHP educators, and clinical supervisors to address the stigma related to sexual minority identity as a potential contributor to burnout, as well as ways to navigate this marginalized identity within the mental health field.
Burnout Among Sexual Minority Mental Health Practitioners: Investigating Correlates and Predictors.
Quality improvement in healthcare is an ongoing challenge. Consideration of the context of the health care system is of tantamount importance. Staff resilience and teamwork climate are key aspects of context that drive quality. Teamwork climate is dynamic, with well-established tools such as TeamSTEPPS available to improve teamwork for specific tasks or global applications. Similarly, burnout and resilience can be modified with interventions such as cultivating gratitude, positivity, and awe. A growing body of literature has shown teamwork and burnout to relate to quality of care, with improved teamwork and decreased burnout expected to produce improved patient quality and safety.
Context in Quality of Care: Improving Teamwork and Resilience
Electronic Health Records (EHRs) have been quickly implemented for meaningful use incentives; however these implementations have been associated with provider dissatisfaction and burnout. There are no previously reported instances of a comprehensive EHR educational program designed to engage providers and assist in improving efficiency and understanding of the EHR. Utilizing adult learning theory as a framework, Stanford Children’s Health designed a tailored provider efficiency program with various inputs from: (1) provider specific EHR data; (2) provider survey data; and (3) structured observation sessions. This case report outlines the design of this individualized training program including team structure, resource requirements, and early provider response.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Reducing Administrative Burdens).
Designing an Individualized EHR Learning Plan for Providers
BACKGROUND: As caregivers in high-pressure environments, critical care nurses are at risk for burnout and secondary trauma—components of compassion fatigue. Recent findings have increased understanding of the phenomena, specifically that satisfaction and meaningful recognition may play a role in reducing burnout and raising compassion satisfaction; however, no large multisite studies of compassion fatigue have been conducted. OBJECTIVES: To examine the effect of meaningful recognition and other predictors on compassion fatigue in a multicenter national sample of critical care nurses. METHODS: A quantitative, descriptive online survey was completed by 726 intensive care unit nurses in 14 hospitals with an established meaningful recognition program and 410 nurses in 10 hospitals without such a program. Site coordinators at each hospital coordinated distribution of the survey to nurses to assess multiple predictors against outcomes, measured by the Professional Quality of Life Scale. Cross-validation and linear regression modeling were conducted to determine significant predictors of burnout, secondary traumatic stress, and compassion satisfaction. RESULTS: Similar levels of burnout, secondary traumatic stress, compassion satisfaction, overall satisfaction, and intent to leave were reported by nurses in hospitals with and without meaningful recognition programs. Meaningful recognition was a significant predictor of decreased burnout and increased compassion satisfaction. Additionally, job satisfaction and job enjoyment were highly predictive of decreased burnout, decreased secondary traumatic stress, and increased compassion satisfaction. CONCLUSIONS: In addition to acknowledging and valuing nurses’ contributions to care, meaningful recognition could reduce burnout and boost compassion satisfaction.
This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards& Recognition (Meaningful Recognition)
Effect of Meaningful Recognition on Critical Care Nurses’ Compassion Fatigue
Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians’ use of time. We used data on physicians’ time allocation patterns captured by over thirty-one million EHR transactions in the period 2011–14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients’ EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Desktop medicine consists of activities such as communicating with patients through a secure patient portal, responding to patients’ online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated to desktop medicine. Staffing and scheduling in the physician’s office, as well as provider payment models for primary care practice, should account for these desktop medicine efforts.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Reducing Administrative Burdens).
Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients and Desktop Medicine
Despite substantial evidence documenting the social patterning of disease, relatively little information is available on how the health care system can best intervene on social determinants to impact individual and population health. Announced in January 2016, the Centers for Medicare and Medicaid Innovation's (CMMI) Accountable Health Communities (AHC) initiative provides an important opportunity to improve the evidence base around integrated social and medical care delivery. To maximize learning from this large-scale demonstration, comprehensive evaluation efforts should focus on effectiveness and implementation research by supporting local, regional, and national studies across a range of outcomes. Findings from this demonstration could transform how, when, and which patients' health-related social needs are addressed within the health care delivery system. Such findings would strongly complement other initiatives to address social factors outside of health care.
Evaluating the Accountable Health Communities Demonstration Project
First responders are often exposed to multiple potentially traumatic incidents over the course of their career. However,scientific research showed that first responders are more resilient compared with the general population. In addition, experience of life-threatening situations and acute stress may lead first responders to the development of posttraumatic stress disorder (PTSD) or posttraumatic stress symptoms. Current clinical research and practice has developed evidence-based treatments shown to be effective in helping first responders ameliorate their PTSD symptoms and perform their duties effectively. Literature showed that cognitive–behavioral therapy (CBT) entails multiple evidence-based techniques that lead those suffering from PTSD toward symptom improvement and trauma recovery. The current article aims to (a) provide readers with rigorous information about stress and trauma experienced by first responders, (b) present PTSD symptomatology as well as risk and protective PTSD factors prevalent among first responders, (c) provide information about the psychophysiology of PTSD, and (d) explore the efficacy of CBT treatment for first responders diagnosed with PTSD. The author highlights the necessity for psychophysiological measurement of CBT treatment efficacy for first responders diagnosed with PTSD; also, potential gaps in the current scientific literature regarding this issue are highlighted. Recommendations for future research and clinical practice are discussed so that health professionals and researchers continue to serve those who serve our communities.
This resource is found in our Actionable Strategies for Public Safety Organizations: Actionable Strategies (Mental Health & Stress/Trauma Supports)
Examining the Psychophysiological Efficacy of CBT Treatment for First Responders Diagnosed With PTSD: An Understudied Topic
These are challenging times for health care executives. The health care field is experiencing unprecedented changes that threaten the survival of many health care organizations. To successfully navigate these challenges, health care executives need committed and productive physicians working in collaboration with organization leaders. Unfortunately, national studies suggest that at least 50% of US physicians are experiencing professional burnout, indicating that most executives face this challenge with a disillusioned physician workforce. Burnout is a syndrome characterized by exhaustion, cynicism, and reduced effectiveness. Physician burnout has been shown to influence quality of care, patient safety, physician turnover, and patient satisfaction. Although burnout is a system issue, most institutions operate under the erroneous framework that burnout and professional satisfaction are solely the responsibility of the individual physician. Engagement is the positive antithesis of burnout and is characterized by vigor, dedication, and absorption in work. There is a strong business case for organizations to invest in efforts to reduce physician burnout and promote engagement. Herein, we summarize 9 organizational strategies to promote physician engagement and describe how we have operationalized some of these approaches at Mayo Clinic. Our experience demonstrates that deliberate, sustained, and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Many effective interventions are relatively inexpensive, and small investments can have a large impact. Leadership and sustained attention from the highest level of the organization are the keys to making progress.
This resource is found in our Actionable Strategies for Health Organizations: Strengthening Leadership.
Executive Leadership and Physician Well-being
BACKGROUND: In health care, burnout has been defined as a psychological process whereby human service professionals attempting to positively impact the lives of others become overwhelmed and frustrated by unforeseen job stressors. Burnout among various physician groups who primarily practice in the hospital setting has been extensively studied; however, no evidence exists regarding burnout among hospital clinical pharmacists. OBJECTIVE: The aim of this study was to characterize the level of and identify factors independently associated with burnout among clinical pharmacists practicing in an inpatient hospital setting within the United States. METHODS: We conducted a prospective, cross-sectional pilot study utilizing an online, Qualtrics survey. Univariate analysis related to burnout was conducted, with multivariable logistic regression analysis used to identify factors independently associated with the burnout. RESULTS: A total of 974 responses were analyzed (11.4% response rate). The majority were females who had practiced pharmacy for a median of 8 years. The burnout rate was high (61.2%) and largely driven by high emotional exhaustion. On multivariable analysis, we identified several subjective factors as being predictors of burnout, including inadequate administrative and teaching time, uncertainty of health care reform, too many nonclinical duties, difficult pharmacist colleagues, and feeling that contributions are underappreciated. CONCLUSIONS: The burnout rate of hospital clinical pharmacy providers was very high in this pilot survey. However, the overall response rate was low at 11.4%. The negative effects of burnout require further study and intervention to determine the influence of burnout on the lives of clinical pharmacists and on other health care-related outcomes.
Factors Associated with Burnout Among US Hospital Clinical Pharmacy Practitioners: Results of a Nationwide Pilot Survey
Private industry hospital workers exhibit a higher incidence of injury and illness—6.0 cases per 100 full-time workers— than employees working in other industries traditionally considered dangerous, such as manufacturing and construction. Hospital workers routinely face hazards related to lifting, moving, or otherwise physically interacting with patients. Workplace injuries and illnesses among hospital workers reflect common risks of hospital jobs and differ by type of hospital.
Hospital Workers: An Assessment of Occupational Injuries and Illnesses
OBJECTIVE: In 2006, Ohio changed its Medicaid reimbursement methodology for nursing homes (NHs) to promote more efficient staffing levels. This study examines the impacts of this policy change on quality. RESEARCH DESIGN AND SUBJECTS: Ohio NHs were categorized based on their anticipated change in reimbursement under a new reimbursement system initiated in 2006. Linear regressions were utilized to determine how quality changed from 2006 to 2010 relative to a group of NHs that were not anticipated to experience any significant change in reimbursement. We examine resident outcomes constructed from the Minimum Data Set, deficiency citations, staffing levels, and satisfaction scores for residents and families as measures of quality. PRINCIPAL FINDINGS: Nursing homes in the group receiving increased reimbursement showed an increase in nursing and nursing aide staffing levels. NHs in the group receiving a reduction in reimbursement did lower staffing levels. None of the nonstaffing quality outcomes were impacted by changes in Medicaid reimbursement. CONCLUSION: Increased Medicaid reimbursement was found to increase staffing levels, but it had a limited effect, at least in the short run, on an array of nonstaffing quality outcomes.
This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Support & Ensure Safe Staffing).
How Does Medicaid Reimbursement Impact Nursing Home Quality? The Effects of Small Anticipatory Changes
Little research has explored burnout and its causes in the American fire service. Data were collected from career firefighters in the southeastern United States (n = 208) to explore these relationships. A hierarchical regression model was tested to examine predictors of burnout including sociodemographic characteristics (model 1), work pressure (model 2), work stress and work–family conflict (model 3) and interaction terms (model 4). The main findings suggest that perceived work stress and work–family conflict emerged as the significant predictors of burnout (both p< .001). Interventions and programs aimed at these predictors could potentially curtail burnout among firefighters.
