Resource Library

Occupational burnout has become widespread. The syndrome can be especially harmful in health care settings, affecting clinicians, organizational effectiveness, and patient safety. Certain approaches have proven helpful in some cases in combatting the syndrome. The coronavirus pandemic presented physicians with unique challenges, which appeared to have magnified work stress This national survey specifically explored interventions used by health care leaders to reduce burnout and whether these interventions proved effective during a pandemic. We also discuss effective and appropriate organizational measures to reduce physician burnout and its associated risks during crises.

Advanced Practice Providers (APPs) are critical to the hematology workforce. However, there is limited knowledge about APPs in hematology regarding specialty-specific training, scope of practice, challenges and opportunities in APP-physician interactions, and involvement with the American Society of Hematology (ASH). We conducted APP and physician focus groups to elucidate major themes in these areas and used results to inform development of two national surveys, one of APPs and one of physicians who work with APPs. The APP survey was distributed to members of the Advanced Practitioner Society of Hematology and Oncology (APSHO) and the physician survey was distributed to physician members of ASH. 841 APPs and 1334 physicians completed the surveys. APPs reported most hematology-specific knowledge was obtained via on-the-job training, and felt additional APP-focused training would be helpful (as did physicians). Nearly all APPs and physicians agreed that APPs were an integral part of their organizations and that physician-APP collaborations were generally positive. 42.1% of APPs and 29.3% of physicians reported burnout, and over 50% of physicians felt that working with APPs had reduced their burnout. Both physicians and APPs reported interest in additional resources including "best practice" guidelines for APP-physician collaboration, APP access to hematology educational resources (both existing and newly developed resources for physicians and trainees), and greater APP integration into national specialty-specific professional organizations including APP-focused sessions at conferences. Professional organizations such as ASH are well positioned to address these areas.

Law enforcement and child welfare professionals experience ongoing exposure to work-related traumatic events as a natural part of their occupation. This exposure results in a higher level of vicarious trauma in these professions. Many professionals in these professions have also experienced a statistically higher number of adverse childhood experiences. As a result, they are exposed to more cumulative trauma over time. Also associated with other high-stress and high- stakes work environments, like military service members, is moral injury. Adverse childhood experiences, vicarious trauma, and moral injury are correlated with post-traumatic stress symptoms, negative emotions and behaviors, and suicidality. This research examined the relationship between adverse childhood experiences, vicarious trauma, and moral injury in professionals serving in law enforcement and child welfare. The presence of early positive childhood experiences was considered as a buffer from these variables. The association of moral injury and cumulative trauma experiences was examined using the following measures: the Adverse Childhood Experiences Questionnaire (ACE), Vicarious Trauma Scale (VTS), Moral Injury Assessment for Public Safety Personnel (MIA-PSP), and Positive Childhood Experiences Questionnaire (PCE). Data on age, sex, type of profession, size of the organization, military service status, and total years of service experience were collected and analyzed as other potential predictor variables. Individuals currently serving as law enforcement or child welfare professionals were recruited through the distribution of online surveys, with the necessary minimum sample size being 76 participants. The results from the screening measures were analyzed utilizing a Pearson correlation and multiple linear regression analyses to determine the relationship between adverse childhood experiences, vicarious trauma, and moral injury and how they are moderated by positive childhood experiences.

BACKGROUND: Moral injury (MI) has become a research and organizational priority as frontline personnel have, both during and in the years preceding the COVID-19 pandemic, raised concerns about repeated expectations to make choices that transgress their deeply held morals, values, and beliefs. As awareness of MI grows, so, too, does attention on its presence and impacts in related occupations such as those in public safety, given that codes of conduct, morally and ethically complex decisions, and high-stakes situations are inherent features of such occupations. OBJECTIVE: This paper shares the results of a study of the presence of potentially morally injurious events (PMIEs) in the lived experiences of 38 public safety personnel (PSP) in Ontario, Canada. METHOD: Through qualitative interviews, this study explored the types of events PSP identify as PMIEs, how PSP make sense of these events, and the psychological, professional, and interpersonal impacts of these events. Thematic analysis supported the interpretation of PSP descriptions of events and experiences. RESULTS: PMIEs do arise in the context of PSP work, namely during the performance of role-specific responsibilities, within the organizational climate, and because of inadequacies in the broader healthcare system. PMIEs are as such because they violate core beliefs commonly held by PSP and compromise their ability to act in accordance with the principles that motivate them in their work. PSP associate PMIEs, in combination with traumatic experiences and routine stress, with adverse psychological, professional and personal outcomes. CONCLUSION: The findings provide additional empirical evidence to the growing literature on MI in PSP, offering insight into the contextual dimensions that contribute to the sources and effects of PMIEs in diverse frontline populations as well as support for the continued application and exploration of MI in the PSP context.

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This resource is found in our Actionable Strategies for Public Safety Organizations: Drivers (Relational Breakdown) AND Drivers (Operational Breakdown) AND Outcomes

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We examined the relationship between age, coping, and burnout during the peak of the COVID-19 pandemic with nurses in Texas (N = 376). Nurses were recruited through a professional association and snowball sampling methodology for the cross-sectional survey study. Framed in lifespan development theories, we expected that nurse age and experience would be positively correlated with positive coping strategies (e.g., getting emotional support from others) and negatively correlated with negative coping strategies (e.g., drinking and drug use). We also expected age to be negatively related to the emotional exhaustion and depersonalization facets of burnout and positively related to the personal accomplishment facet of burnout. Findings were largely supported in that age was positively associated with positive coping and personal accomplishment and age and experience were negatively correlated with negative coping and depersonalization. Age was not, however, associated with emotional exhaustion. Mediation models further suggest that coping explains some of the effect of age on burnout. A theoretical extension of lifespan development models into an extreme environment and practical implications for coping in these environments are discussed.

A Guide to Relieving Administrative Burden is a series of supplements developed by the American Academy of Family Physicians (AAFP) to provide information about innovations proven to relieve administrative burden and optimize your family medicine experience. It is based on AAFP Innovation Labs conducted with physicians like you, as well as a comprehensive literature review. Whether you have a solo practice or are an employee of a large health system, the guide will help you consider and adopt proven innovations.

This is the first supplement in the series. Subsequent supplements will focus on other critical administrative burdens family physicians face, including prior authorization, quality measurement and reporting, and chart review.

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

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

The COVID-19 pandemic has placed unprecedented strain on global health systems, and the ability to safely and effectively deliver care. Further, it has impacted the mental health of global populations, in particular healthcare providers (i.e., physicians, nurses). In a service delivery context, much can be learned about empathy both from a provider and patient lens. Thus, the literature was explored to see if the concept of journey mapping was used to illustrate the intersections and pain points of the clinical workflow along the physician journey.

[This is an excerpt.] On Monday, August 7, 2023, our beautiful girl, Tristan Kate Smith, ended her life. Tristin was 28 years old, and the youngest of two brothers and three sisters. She was an aunt. She was a daughter. She was a friend. She was a nurse. Tristin was brave and beautiful and smart. She fought depression for a long time. With regret-filled hindsight, we can now see the signs for what they were. She never sought professional help, but her home was filled with evidence that she'd been trying to help herself. Her beloved dog, Calypso, and cat, Sphinx, wanted for nothing; Tristin spent her time and energy with them. We found more dog enrichment toys and contraptions than a single pet store sells. She had written and posted positive affirmations and mantras throughout her house. She displayed photos of herself with her friends, family, and pets. She had reached out to friends. She had reached out to family. She tried so hard to stay alive, but none of it was enough to stop the darkness. You're reading this now because Tristin's story needs to be told. We need to take action. Our nation's healthcare system is broken, and it broke our girl. [To read more, click View Resource.]

BACKGROUND: Violence and aggression is commonly encountered in nursing worldwide and is an increasing concern, although it is largely underreported by staff. Violence and aggression can take many forms, from verbal and physical abuse to sexual assault. This study aims to define agitation, violence, and aggression and to explore the prevalence of violence and aggression among neuroscience patients. This review also examines why violence and aggression occurs for neuroscience patients and to determine the effects on the patients, the environment, and the nursing staff. METHODS: A review of articles was conducted using CINAHL, PubMed, the Cochrane Database, and Google Scholar between 2012 and 2022. DISCUSSION: Agitation can escalate to violence and aggression. The reasons a neuroscience patient may become agitated are multifactorial. An injury to the brain may not cause agitation; however, the effect on the frontal lobe, hypothalamus, and hippocampus may cause a lack of self-control, impulsivity, an inability to control emotions, and an uncontrolled release of hormones, leading to a heightened sympathetic response. The effects of violence and aggression can be detrimental to the patient and include isolation, increased sedation, reduced observations, and even death. The effects on the nurse are profound including a decline in productivity at work, an increased risk of drug errors, and posttraumatic stress disorder or burnout as longer-term consequences. CONCLUSION: Violence and aggression is commonly experienced within neuroscience nursing, and the contributing factors are multifactorial. The effects for the patients and staff can be profound, and this is why prevention of agitation is fundamental to ensure the safety and retention of nursing staff.

OBJECTIVE: This study aimed to longitudinally examine the prevalence and correlates of burnout in frontline healthcare workers (FHCWs) during COVID-19 in New York City. METHODS: A prospective cohort study of 786 FHCWs at Mount Sinai Hospital was conducted during the initial COVID surge in April to May 2020 (T1) and November 2020 to January 2021 (T2) to assess factors impacting burnout. RESULTS: Burnout increased from 38.9% to 44.8% (P = 0.002); 222 FHCWs (28.3%) had persistent burnout, 82 (10.5%) had early burnout, and 129 (16.5%) had delayed burnout. Relative to FHCWs with no burnout (n = 350; 44.7%), those with persistent burnout reported more prepandemic burnout (relative risk [RR], 6.67), less value by supervisors (RR, 1.79), and lower optimism (RR, 0.82), whereas FHCWs with delayed burnout reported more prepandemic burnout (RR, 1.75) and caring for patients who died (RR, 3.12). CONCLUSION: FHCW burnout may be mitigated through increasing their sense of value, support, and optimism; treating mental health symptoms; and counseling regarding workplace distress.

INTRODUCTION: Burnout is a phenomenon that can occur in any occupation, but pharmacists may be more prone to its effects. Because of its relevance to the pharmacy profession, the University of Waterloo School of Pharmacy incorporated an active learning activity to teach pharmacy students about healthcare provider burnout. This activity, named Check-In, was launched in March 2020 and consisted of one-on-one check-ins between pharmacy students and staff. As the first learning activity of its kind, the researchers wished to investigate the ongoing impact of Check-In. METHODS: This qualitative, descriptive study was composed of telephone interviews with 13 students that partook in Check-In. These interviews were held at two different timepoints: six and 18 months post-activity. Participants were recruited until data saturation, and transcripts underwent thematic analysis. RESULTS: Four themes were identified from the interviews: (1) Check-In was a valuable learning activity; (2) students performed some form of checking in post-activity; (3) burnout could be recognized and defined by students; (4) Check-In's place in the pharmacy curriculum still needs to be determined. CONCLUSIONS: Check-In is an innovative learning activity to teach pharmacy learners about healthcare provider burnout. It can be utilized by pharmacy institutions to incorporate wellness and student mental health into curriculum.

Recent major health shocks, such as the 2014–16 Ebola, the Zika outbreak, and, last but not least, the COVID-19 pandemic, have strongly contributed to drawing attention to the issue of resilience in the healthcare domain. Nevertheless, the scientific literature appears fragmented, creating difficulties in developing incremental research in this relevant managerial field.

BACKGROUND: Providing long-term-care for a family member can be a source of severe stress for the untrained caregiver, and is known to cause depression, poor overall health, and lower quality of life for the caregiver. This burden may lead to poorer outcomes for the patient, as well as contribute to overall increasing costs of an already strained healthcare system. The purpose of this quality improvement project was to reduce the stress that accompanies caregiver burden through the intervention of diaphragmatic breathing. METHOD: Diaphragmatic breathing is a low-cost, psychophysiological intervention found to be helpful for reducing stress, which is a significant component of caregiver burden. Caregivers of pediatric patients enrolled in a homecare program were assessed for caregiver burden utilizing the Zarit Burden Interview-12 (ZBI-12). Those who had scored 15 or higher on the ZBI-12 were taught diaphragmatic breathing, and assessed again, two months after using the intervention. RESULTS: A paired dependent t-test revealed that palliative caregivers showed a reduction in ZBI-12 assessment score after implementation of a diaphragmatic breathing intervention (m = 17.4, s = 6.7), compared to before implementation of a diaphragmatic breathing intervention (m = 12.8, s = 8.6), t(11) = 2.513 , P < .05. CONCLUSION: The intervention resulted in less anxiety, stress, depression, and burnout among the pediatric palliative caregivers. Improvement of caregiver well-being was evidenced by decreased ZBI-12 scores in a postintervention assessment.

The COVID-19 pandemic has required close examination of workforce-related stressors that over decades have contributed to widespread burnout, negative health outcomes, including mental health outcomes, and the loss of the well-educated professionals who are the future of the nursing profession. In the United States and globally, evidence points to factors known to diminish well-being, including inequities, issues of minority status, persistent discrimination, and demanding work environments. The American Academy of Nursing (AAN), dedicated to organizational excellence, nursing leadership and evidence-based policy, develops statements reflecting its mission and those of its nursing affiliates and corporate member, The American Nurses Association. Within nursing, despite the efforts of its members toward advancement, professional fulfillment is often constrained by the systems in which nurses practice and workplace factors over which they have little control. Action by key organizations to initiate changes at systems levels in workplace safety, to increase professional mobility, and propel policies that increase access to health care resources could improve nurse well-being. This paper proposes recommendations from the AAN Expert Panels on Building Health Care System Excellence, Psychiatric Mental Health and Substance Use, and Global Health Expert Panels for the American Academy of Nursing to leverage related policy in the arenas of government and professional/healthcare organizations. Transforming health care work environments and advancing nurse well-being and equity can be accomplished through key, innovative policy changes. These will be achieved through collaboration among associations, organizations, nonprofit groups, and with the public and the media.

BACKGROUND: The American College of Radiology (ACR) passed a historic paid family/medical leave (PFML) resolution at its April 2022 meeting, resolving that “diagnostic radiology, interventional radiology, radiation oncology, medical physics, and nuclear medicine practices, departments and training programs strive to provide 12 weeks of paid family/medical leave in a 12-month period for its attending physicians, medical physicists, and members in training as needed.” The purpose of this article is to share this policy beyond radiology so that it may serve as a call to action for other medical specialties. PRINCIPAL FINDINGS: Such a PFML policy (1) supports physician well-being, which in turn supports patient care; (2) is widely needed across American medical specialties; and (3) should not take nearly a decade to achieve, as it did in radiology, especially given increasing physician burnout and the ongoing COVID-19 pandemic. CONTRIBUTION: Supported by information on the step-by-step approach used to achieve radiology-specific leave policies and considering current and normative policies at the national level, this article concludes by reviewing specific strategies that could be applied toward achieving a 12-week PFML policy for all medical specialties.

It is well-established that different leadership styles are associated with followers' mental health. However, little is known about the relative strength of the relationship of different leadership styles with followers' mental health. So far, there is no meta-analysis comparing the incremental contribution of different leadership styles to mental health and studying potentially problematic construct proliferation. We included studies that compared at least two leadership styles in view of their relationships with followers' mental health and directly estimated the relative contribution of seven leadership styles (i.e., transformational, transactional, laissez-faire, task-oriented, relationship-oriented, and destructive leadership, as well as leader-member exchange) to followers' mental health. Using meta-analytical regression models, we compared the strength of the relationships between these leadership styles and followers' overall mental health as well as positive (well-being and psychological functioning) and negative aspects of their mental health (affective symptoms, stress, and health complaints). Fifty-three studies with 217 effect sizes comprising 93,470 participants met the inclusion criteria. Transformational and destructive leadership were the strongest predictors of overall and negative aspects of mental health among followers. In contrast, the strongest predictors of positive mental health outcomes among followers were relations-oriented and task-oriented leadership, followed by transformational leadership. In sum, our results suggest that various leadership styles make unique contributions to explaining followers' mental health and thus construct proliferation mostly does not pose a major problem when predicting relevant outcomes in this domain of leadership research. Our results are relevant for leadership development programs and for future organizational leadership models.

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

This mixed-methods pilot study explored the psychological and emotional experiences of chaplains and the feasibility, acceptability, and impact of workshops designed to support chaplain well-being. After the workshops, scores on a measure of self-compassion increased, while secondary traumatic stress and burnout scores decreased. Qualitative data reflected the range of experiences of chaplaincy as well as the benefits of the workshops. This pilot study supports further exploration of organizational interventions to promote chaplain well-being.

Few career paths are as mentally, physically, and emotionally exhausting as a career in healthcare. Due to the nature of the job responsibilities, healthcare professionals often sacrifice their own wellbeing for the sake of their patients. The COVID-19 pandemic has asked an even greater sacrifice from healthcare professionals and continues today with little end in sight. The majority of healthcare workers report that stress has a negative impact on their work, which can ultimately manifest in poor patient outcomes and decreased work satisfaction. As stewards of wellbeing, it is imperative that healthcare professionals prioritize self-care and find their own individualized way(s) to manage stress. Building resilience, which is the ability to adapt to traumatic or adverse events in a positive manner, can help decrease anxiety, depression, and burnout. Resilience also helps healthcare professionals re-establish meaning in both their professional and personal lives, and has been proven to improve patient safety and job satisfaction. Complementary and integrative modalities treat the whole person by focusing on the physical, emotional, social, economic, and spiritual needs of the individual. Techniques such as meditation, progressive muscle relaxation, 4-7-8 breathwork, acupressure, aromatherapy, and Jin Shin Jyutsu have been used with great success in the workplace setting to help build resilience. Such techniques offer options for stress reduction and can decrease feelings of work-related burnout. These techniques can be used in real time at the moment of a stressful event. They may also help reduce stress when used prior to, or at the end of a workday. Consistent practice can reduce the feelings of stress that contribute to compassion fatigue and burnout. These integrative health modalities do not require any additional tools or extensive training. They are easy to learn and perform, and can be easily incorporated into a daily practice to encourage stress reduction and promote wellbeing.

OBJECTIVE: The objective of this study was to characterize work engagement and burnout as well as potential demographic factors associated with each student and faculty member at 2 pharmacy programs in the US. METHODS: A survey including the Utrecht Work Engagement Scale-9 (UWES-9) and a single-item burnout measure was conducted from April to May 2020. Demographic data including age range, gender, and other characteristics were also collected. Mean UWES-9 scores, scoring category results, and the proportion of the cohorts reporting symptoms of burnout were reported. Point biserial correlation was used to compare the relationship between UWES-9 mean scores and burnout rates. Regression analyses were also performed to assess variables predictive of work engagement and burnout. RESULTS: Students (N = 174) reported a mean UWES-9 score of 3.0 (SD = 1.1), while faculty members (N = 35) reported a mean of 4.5 (SD = 0.7). Over half (58.6%) of the students and 40% of faculty members reported symptoms of burnout. Faculty members demonstrated a strong significant negative correlation between work engagement and burnout (r = −0.35), while students did not (r = 0.04). Regression analyses found no significant demographic factors predictive of UWES-9 scores in students or faculty, while first year students were less likely to report burnout symptoms, and no significant factors for burnout were found in faculty. CONCLUSION: Our study found that work engagement scores and burnout symptoms were inversely correlated in pharmacy faculty members surveyed but lacked correlation in students. Larger, more robust studies should be conducted to further elucidate the relationship between work engagement and burnout.