Resource Library

During recent years, police have suffered from job dissatisfaction, exhaustion, stress, and burnout; this issue has led to shortages of sworn police across the country. A high percentage of police officers leave the job in the first 5 years of service. A goal of this study was to discover how police investigators build resiliency to those challenging factors so that the individual can remain resilient despite exposure to adverse incidents and conditions that lead to severe stress and burnout. A generic qualitative method was used so that police investigators could share their lived experiences during their interviews and describe their beliefs, reflections, and opinions about their exposure to adversities on the job, and how they built resilience to those experiences. The target population for this study was police investigators who had more years of experience on the job than the less experienced sworn police members who were reportedly quitting the job from job-related dissatisfaction and burnout. The sample consisted of seven sworn police investigators from a small urban police department in the northeast region of the United States. I conducted semi-structured interviews of the seven participants, recorded the interviews using a Sony digital voice recorder, and used Descript transcription software to transcribe the audio recorded interviews to text. A thematic analysis approach was taken to find repeating patterns to identify five common themes from the collected data. These emerging themes were: (a) alcohol consumption used as a temporary coping strategy; (b) setting emotions aside; (c) family and nonlaw enforcement friends were perceived as not understanding: (d) exercise used as self-care method of effective coping; and (e) talking and venting to fellow law enforcement members as an effective coping method. During the interviews, the participants discussed several critical adverse incidents and conditions that caused stress and hardship for them. Through those shared experiences, I learned from the participants how they coped with those adversities and what helped them build resiliency.

Pharmacy residents are especially vulnerable to burnout given the professional and personal stressors associated with postgraduate training. Residency programs need to prioritize burnout reduction strategies to support resident health and well-being. This commentary describes a resident-preceptor collaborative approach to encourage wellness and reduce burnout within a large residency program at an academic medical center. Strategies that have been utilized include (1) fostering collaboration among residents and preceptors; (2) assessing resident interests and needs to ensure alignment; (3) leveraging available institutional and community resources; and (4) integrating initiatives within the existing residency program structure. This commentary aims to provide suggestions that can be implemented to address resident burnout for other residency programs, regardless of resource availability.

Training and practicing physicians continue to experience burnout, poor job satisfaction / engagement, high stress, and even depression and suicide. With an understanding of effective and ineffective methods to improve wellness, our team aimed to collect publications with data on the effectiveness of physical activity interventions to address burnout and well-being in physicians. Comprehensive searches for articles related to the impact of exercise on physicians’ well-being were undertaken in March 2022 in PubMed, PsycINFO, and EMBASE. Of 2496 records identified in the databases, the team screened 1,287 and finalized 12 papers for inclusion and review. This study reviews the overall positive benefits of physical activity and exercise interventions in physicians. Despite the wide-ranging utility of an exercise prescription and despite clear evidence that physicians' personal exercise habits affect their patient counseling about exercise, this review shows that (often overburdened) physicians have insufficient physical activity, and are rarely included in studies targeting exercise. Many of the included studies had small sample sizes, leaving possibilities for future research aiming to augment physician wellness.

BACKGROUND: Burnout is a growing problem among medical professionals, reaching a crisis proportion. It is defined by emotional exhaustion, cynicism, and career dissatisfaction and is triggered by a mismatch between the values of the person and the demands of the workplace. Burnout has not previously been examined thoroughly in the Neurocritical Care Society (NCS). The purpose of this study is to assess the prevalence, contributing factors, and potential interventions to reduce burnout within the NCS. METHODS: A cross-sectional study of burnout was conducted using a survey distributed to members of the NCS. The electronic survey included personal and professional characteristic questions and the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI). This validated measure assesses for emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). These subscales are scored as high, moderate, or low. Burnout (MBI) was defined as a high score in either EE or DP or a low score in PA. A Likert scale (0–6) was added to the MBI (which contained 22 questions) to provide summary data for the frequencies of each particular feeling. Categorical variables were compared using χ2 tests, and continuous variables were compared using t-tests. RESULTS: A total of 82% (204 of 248) of participants completed the entire questionnaire; 61% (124 of 204) were burned out by MBI criteria. A high score in EE was present in 46% (94 of 204), a high score in DP was present in 42% (85 of 204), and a low score in PA was present in 29% (60 of 204). The variables feeling burned out now, feeling burned out in the past, not having an effective/responsive supervisor, thinking about leaving one’s job due to burnout, and leaving one’s job due to burnout were significantly associated with burnout (MBI) (p < 0.05). Burnout (MBI) was also higher among respondents early in practice (currently training/post training 0–5 years) than among respondents post training 21 or more years. In addition, insufficient support staff contributed to burnout, whereas improved workplace autonomy was the most protective factor. CONCLUSIONS: Our study is the first to characterize burnout among a cross-section of physicians, pharmacists, nurses, and other practitioners in the NCS. A call to action and a genuine commitment by the hospital, organizational, local, and federal governmental leaders and society as a whole is essential to advocate for interventions to ameliorate burnout and care for our health care professionals.

INTRODUCTION: The personality traits of those who become orthopaedic surgeons may also lead to overwork, work-life balance issues, and burnout. Health and wellness practices of orthopaedic surgeons have not been widely explored. This study evaluated the personal health habits, wellness, and burnout of practicing orthopaedic surgeons in the United States. METHODS: An anonymous self-assessment survey was completed by 234 practicing orthopaedic surgeon alumni from two large residency programs. The survey assessed exercise habits according to Centers for Disease Control and Prevention recommendations, compliance with preventive medical care practices according to the United States Preventive Services Task Force, prioritization of occupational wellness strategies, and the presence of burnout via an adapted Maslach Burnout Inventory. Survey responders' mean age was 52 years, 88% were male, and 93% had a body mass index <30 kg/m2. Surgeons were stratified according to practice type, years in practice, and subspecialty. RESULTS: Among orthopaedic surgeons, compliance with aerobic and strength exercise recommendations was 31%. Surgeons in academic practice were significantly (P = 0.007) less compliant with exercise recommendations (18%) compared with private (34%) or employed (43%) practicing surgeons. Most (71%) had seen their primary care provider within 2 years and were up to date on age-appropriate health care screening including a cholesterol check within 5 years (79%), colonoscopy (89%), and mammogram (92%). Protecting time away from work for family/friends and finding meaning in work were the most important wellness strategies. The overall burnout rate was 15% and remained not significantly different (P > 0.3) regardless of years in practice, practice type, or subspecialty. CONCLUSION: This survey study identifies practicing orthopaedic surgeons' health habits and wellness strategies, including limited compliance with aerobic and strength exercise recommendations. Orthopaedic surgeons should be aware of areas of diminished personal wellness to improve quality of life and avoid burnout.

OBJECTIVE: This systematic review and meta-analysis aims to explore overall prevalence of burnout among physicians during early and late COVID-19 pandemic and geographical differences in burnout. METHODS: This review was registered prospectively with PROSPERO (CRD42022327959). A comprehensive search of several databases, including Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, PsycINFO, and Scopus, spanning from December 2019 to May 2022 was conducted. Eligible studies included physicians or medical professionals including physicians that worked directly or indirectly with COVID-19 patients, whilst reporting burnout outcomes using a validated scale. Literature that did not include physicians or did not occur in a hospital setting were excluded. Literature including medical students were also excluded. RESULTS: Forty-five observational studies were included, all of which were cross-sectional studies. The pooled estimate of overall prevalence of burnout was 54.60% (95% CI: 46.7, 62.2). Mean emotional exhaustion, depersonalization, and personal accomplishment was found to be 22.06% (95% CI: 18.19, 25.94), 8.72 (95% CI: 6.48, 10.95) and 31.18 (95% CI: 27.33, 35.03) respectively. Frontline workers displayed higher rates of burnout than second-line healthcare workers (HCW) (OR: 1.64, 95% CI: 1.13, 2.37). Studies from the early pandemic period reported burnout prevalence of 60.7% (95% CI: 48.2, 72) compared to a prevalence of 49.3% (95% CI: 37.7, 60.9) from the late pandemic period. Geographically, burnout was highest amongst Middle East and North Africa (MENA) studies (66.6%, 95% CI: 54.7, 78.5), followed by Europe (48.8%, 95% CI: 40.3, 57.3) and then South America (42%, 95% CI: –0.4, 84.4). Lastly, burnout prevalence overall (OR = 0.77, 95% CI: 0.36, 1.67) emotional exhaustion (MD = –0.36, 95% CI: –4.64, 3.91), depersonalization (MD = –0.31, 95% CI: –1.80, 1.18), and personal accomplishment (MD = 0.55, 95% CI: –0.73, 1.83) were found comparable between physicians and nurses. CONCLUSION: COVID-19 has had significant consequences on HCW burnout. Further research is needed to examine early signs of burnout and to develop effective coping strategies.

BACKGROUND: Weighing implications of multiple intensive cancer-directed therapies over time, oncology nurses are more prone to intrinsic distress compared to nurses in non-oncologic settings. This vulnerability may give rise to moral distress. Yet, little is known about moral distress experiences of oncology nurses. OBJECTIVE: This systematic review and meta-analysis examined the frequency and intensity of moral distress among oncology nurses with an exploratory focus on nurse-level and work-related characteristics. METHODS: We conducted a systematic search of 7 electronic databases (2000–2020) supplemented by hand-search strategy. Means and standard deviations of moral distress scores in the included studies were extracted and pooled in our meta-analysis. RESULTS: Our sample of 8 cross-sectional studies consisting of 2686 participants with 1654 oncology nurses met criteria for inclusion. A random-effects model was used in our meta-analysis given considerable heterogeneity. Our results suggest that moral distress was of low to moderate frequency, but of high intensity. Moral distress among oncology nurses was a significant predictor for burnout, provider communication, decisions surrounding end-of-life care, work conditions (eg, patient assignment, type of unit), and inability to provide compassionate care. CONCLUSION: Moral distress in oncology nurses is associated with burnout syndrome, compassion fatigue, and secondary traumatic stress syndrome, all of which are linked to poor patient care and outcomes. Robust psychological well-being is critical in minimizing unintended consequences of moral distress. IMPLICATIONS FOR PRACTICE: Oncology nurses are at high risk for moral distress due to the nature of their work. Future studies should examine the prevalence among oncology nurses to help inform targeted interventions.

Ambulance services are changing, and the SARS-CoV-2 pandemic has been a major challenge in the past three years. Job satisfaction and work engagement are important characteristics for a healthy organization and success in one’s profession. The purpose of the current systematic review was to evaluate the predictors of job satisfaction and work engagement in prehospital emergency medical service personnel. Electronic databases, such as PubMed, Ovid Medline, Cochrane Library, Scopus, Web of Science, PsycINFO, PSYNDEX, and Embase, were utilized in this review. Predictors (ß coefficient, odds ratio, rho) of higher job satisfaction and work engagement were examined. Only prehospital emergency medical service personnel were considered. The review included 10 studies worldwide with 8358 prehospital emergency medical service personnel (24.9% female). The main predictor for job satisfaction was supervisors’ support. Other predictors were younger or middle age and work experience. Emotional exhaustion and depersonalization, as burnout dimensions, were negative predictors for higher job satisfaction or work engagement. Quality demands for health care systems are a significant challenge for future emergency medical services. The psychological and physical strengthening of employees is necessary and includes constant supervision of managers or facilitators.

This systematic review investigates the association between coping strategies and burnout in emergency workers. Three electronic databases were searched. Eleven eligible articles were extracted, and quality assessed. Findings were integrated through narrative synthesis, highlighting clear methodological issues around conceptualizing, and measuring coping strategies and burnout with agreed upon tools. This review found no convincing evidence to suggest coping strategies have a meaningful relationship with burnout in emergency workers, questioning the evidence base for psychological interventions focusing on modifying coping strategies to target burnout. To understand the true impact of coping strategies on burnout, more longitudinal designs, and an agreed, validated measure for coping is needed.

From a philosophical standpoint, it is unclear precisely what medical gaslighting is, how it presents, its conditions for success, and how it is differentiated from the more popular interpersonal interpretation of gaslighting. My project aims to remedy this lacuna by developing an account of medical gaslighting as distinguished from that in strictly interpersonal relationships. My approach consists of first exploring the importance of developing a philosophical account of medical gaslighting and providing five criteria that a sufficient account must meet. I then analyze and appraise two accounts of ordinary gaslighting by Kate Abramson and Carla Bagnoli and argue that neither account accurately explains the features and characteristics of medical gaslighting. Further, I describe the key characteristics and identifiable features that make up my account of medical gaslighting. I also address the moral implications of medical gaslighting and argue that it involves two distinct moral harms: the primary moral harm undermines a patient's agency, and the secondary moral harm causes moral injury to doctors. Finally, I call for institutional reform by discussing the policy implications resulting from developing an accounting of medical gaslighting. By developing and identifying the specific nature of medical gaslighting, we will be better equipped to understand patients' experiences and aim toward better quality care.

The hospital association says it is focusing advocacy on workplace violence, Medicare residency slots, the nursing shortage, and workforce diversity.

ANA underscores the urgency for Congressional leaders and the Centers for Medicare Medicaid Services to advance efforts to implement safe staffing standards, including minimum nurse-to-patient ratios.

The American Organization for Nursing Leadership (AONL) led a nationwide strategic initiative during 2022 to cull best practices and strategies for nurse leaders. Two key objectives were targeted: 1) to gain keen insights from nurse leaders through 2 nationwide surveys; and 2) to collect practice-led initiatives, which often are not included in searchable peer-reviewed literature. These practices were gathered in a compendium, organized into 7 sections, which is now available on the AONL website at aonl.org/compendium.

[This is an excerpt.] Workforce, specifically workplace violence, emotional health, and well-being continue to be top issues faced by nursing leaders every day. These were also the common themes I heard recently from nurses at the 2023 International Council of Nurses Congress in Montreal, Quebec, Canada. Through the isolation of the past few years, it was sobering to learn the United States is not alone in dealing with this workforce crisis. As we look at healthcare globally, we share more common challenges than differences. Although our health-systems and payment models vary from coun try to country, we are united in our workforce struggles. [To read more, click View Resource.]

PURPOSE: Results of the 2022 ASHP National Survey of Pharmacy Practice in Hospital Settings are presented. METHODS: Pharmacy directors at 1,498 general and children’s medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. IQVIA supplied data on hospital characteristics; the survey sample was drawn from IQVIA’s hospital database. RESULTS: The response rate was 23.7%. Inpatient pharmacists independently prescribe in 27.1% of hospitals. Advanced analytics are used in 8.7% of hospitals. Pharmacists work in ambulatory or primary care clinics in 51.6% of hospitals operating outpatient clinics. Some level of pharmacy service integration is reported in 53.6% of hospitals. More advanced pharmacy technician roles are emerging. For health systems offering hospital at home services, 65.9% of pharmacy departments are involved. Shortages of pharmacists and technicians were reported but are more acute for pharmacy technicians. Aspects of burnout are being measured in 34.0% of hospitals, and 83.7% are attempting to prevent and mitigate burnout. The average number of full-time equivalents per 100 occupied beds is 16.9 for pharmacists and 16.1 for pharmacy technicians. CONCLUSION: Health-system pharmacies are experiencing workforce shortages; however, these shortages have had limited impact on budgeted positions. Workforce challenges are influencing the work of pharmacists and pharmacy technicians. Adoption of practice advancement initiatives has continued the positive trend from past years despite workforce issues.

[This is an excerpt.] The Forum for Shared Governance, founded more than 20 years ago, is the only clearing house that  identifies, promotes, and disseminates evidence-based information about shared governance within a professional governance continuum and through organizational innovations that empower nurses and other healthcare professionals.

The Forum believes that innovations, such as shared governance, that allow front-line professionals, managers, and patients to share control and influence together over practice and the resources that support it in healthcare organizations can enhance patient, professional, and organizational outcomes. The Forum further believes that staff and managers need ongoing support and education to effectively participate in the governance of their practice. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Establishing Commitment & Shared Governance (Shared Governance).

‍

A revolutionary academic-practice partnership model was implemented at the University of Maryland Medical System (UMMS) with the University of Maryland School of Nursing, through which the preparation and transition to practice of new graduate nurses were reimagined, resulting in intentional support for staffing the nursing workforce. Groups of nursing students were paired with a UMMS-funded clinical instructor to take a full patient assignment for one 12-hour shift in a UMMS hospital each week. This instructor-led cohort is equivalent to one UMMS nurse and was included in the staffing numbers of participating units.

BACKGROUND: Staff working in people-oriented professions are vulnerable to burnout which is negatively associated with professional well-being and service-user care. AIM: To investigate if interventions based on Acceptance and Commitment Therapy (ACT) are effective in reducing staff burnout. METHOD: Systematic database and reference list searches were conducted resulting in the inclusion of 14 quantitative papers. A narrative synthesis, including extraction of individual effect sizes, was performed. RESULTS: All studies were controlled trials. The settings for ACT delivery were varied across health, social care, and public services. The ACT interventions demonstrated statistically significant effects in favour of ACT on the outcome measure subscales across the majority of studies (n = 9). Thirteen studies demonstrated an effect in favour of ACT in at least one outcome measure subscale. Positive aspects of work engagement varied according to a professional role. CONCLUSIONS: The findings suggest that ACT-based interventions using a wide range of formats may have the potential to decrease burnout across a range of professional groups. However, samples were small in the studies reviewed and the interventions were not always defined. Further research would benefit from larger studies, incorporating process measures, with explicit protocols.

The prevalence of suicidal ideation is unknown and limited information exists about depression and anxiety among physician associates/assistants (PAs). We set out to understand the degree of depression, anxiety, and suicidal ideation in PAs and PA students. In total, 728 PAs and 322 PA students took an online survey. Risk of depression and anxiety were present at higher levels in PA students compared with employed PAs. PA students indicated higher levels of suicidal ideation compared with clinically active PAs. One-third of those with suicidal ideation did not reveal it to anyone; among those who did, 16.2% feared the results of disclosure. This study establishes that PAs and PA students are at risk for suicidal ideation and often bypass help. The COVID-19 pandemic may have led to elevated rates of emotional distress, and longitudinal studies are needed to understand the basis for such ideation and if it is transitory.

INTRODUCTION: Physician burnout has been described as more common among women than men.  Even if there are no gender-based differences in prevalence, risk factors, such as work/home integration/conflict and gendered biases, likely differ.  Prior administrations of an annual resident wellness survey at a single urban academic institution confirmed that rates of burnout were higher among women, especially during the PGY-2 year.

METHODS: A series of focus groups of women PGY-3 residents across specialties were organized in 2019 at a single urban academic medical center.  Given the number of participants, demographics were not collected to maintain participant anonymity.  The moderator for all groups used a discussion guide consisting of eight open-ended questions based on a review of the literature.

RESULTS: Ten residents agreed to participate in one of four, hour-long focus group discussions.  While the residents identified some factors that were not gender-specific, they also discussed issues that they faced as women in medicine, including needing to work harder to prove themselves and unconscious gendered biases from faculty and patients.  The residents thought that their wellbeing would be improved if their training programs better understood the experiences and needs of women residents and recommended a series of interventions, including improved mentoring and networking opportunities.

CONCLUSIONS: Interventions to improve wellbeing need to consider gender-based differences.  While mentoring and networking can help all residents, these may be especially useful for women and should be considered as a component of an overarching plan to improve diversity, equity, inclusion, and belonging.