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Caring for a dying child can be an experience full of all kinds of negative emotions, pain and stress for the pediatric nurse. In this study, which was carried out in Turkey, we aimed to determine how nurses working in a pediatric intensive care unit remembered and made sense of their experiences regarding children's deaths. In-depth interviews were held with 13 nurses. The data were analyzed using the content analysis method. Three themes were identified. These were (1) Personal effects of death, (2) Difficulties in care, and (3) Coping with death. It was clear that the nurses were traumatised by their exposure to infant deaths. The findings showed that nurses experienced regret, fatigue and posttraumatic stress disorder. In addition, it was determined that nurses should be supported to cope with child deaths, which is a complicated process involving the child and the family, especially emotionally. Moreover, providing institutional support to nurses and referring them to cognitive-behavioral therapies may make it easier for them to cope with the emotional burden they carry, as well as the burnout they experience.

INTRODUCTION: Protecting health-care provider (HCP) well-being is imperative to preserve health-care workforce capital, performance, and patient care quality. Limited evidence exists for the long-term effectiveness of HCP well-being programs, with less known about physiotherapists specifically. PURPOSE: To review and synthesize qualitative research describing experiences of HCP, generate lessons learned from the greater population of HCP participating in workplace well-being programs, and then to inform programs and policies for optimizing psychological well-being in an understudied population of physiotherapists. METHODS: This qualitative meta-synthesis included a systematic literature search conducted in September 2020; critical appraisal of results; and data reduction, re-categorizing, and thematic extraction (reciprocal translation) with interpretive triangulation. RESULTS: Twenty-five papers met the inclusion criteria. Participants included physicians, nurses, and allied health providers. All programs targeted the individual provider and included psychoeducational offerings, supervision groups, coaching, and complementary therapies. Four themes were constructed: 1) beneficial outcomes across a range of programs; 2) facilitators of program success; 3) barriers to program success; and 4) unmet needs driving recommendations. CONCLUSIONS: The findings enhance our understanding of diverse individual-level programs to address HCP well-being. Beneficial outcomes were achieved across program types with system-level support proving critical; however, HCP described barriers to program success (HCP characteristics, off-site programs, institutional culture) and remaining needs (resources, ethical dissonance) left unaddressed. Organizations should offer individual-level programs to support physiotherapists in the short term while pursuing long-term, system-level change to address drivers of well-being.

[This is an excerpt.] The World Health Organization (WHO) declared 2020 as the Year of the Nurse and Midwife. Originally designated in recognition of Florence Nightingale’s 200th birthday, and intended to draw attention to the critical role of over 28 million nurses and nurse midwives worldwide, the WHO had little foresight into the significance of their declaration when they made their decision in 2019.1 Given the impact of the COVID pandemic, the WHO expanded the Year of the Nurse and Midwife to the Year of Health and Care Workers in 2021.2 The goal of this declaration was an expression of appreciation and gratitude for the unwavering service and dedication of health care workers during the COVID pandemic. Another objective was to engage stakeholders in a dialog focused on the protection of health care workers’ rights and the improvement of work and practice environments. While well intended, progress toward improved nursing workforce conditions has been slow to emerge, with little progress made thus far. [To read more, click View Resource.]

During the COVID-19 pandemic, healthcare workers faced grave responsibilities amidst rapidly changing policies and material and staffing shortages. Moral injury, psychological distress following events where actions transgress moral beliefs/ expectations, increased among healthcare workers. We used a sequential mixed methods approach to examine workplace and contextual factors related to moral injury early in the pandemic. Using a Total Worker Health® framework, we 1) examined factors associated with moral injury among active healthcare professionals (N = 14,145) surveyed between May-August 2020 and 2) qualitatively analyzed open-ended responses from 95 randomly selected participants who endorsed moral injury on the survey. Compared to inpatient hospital, outpatient (OR = 0.74 [0.65, 0.85]) or school clinic settings (OR = 0.37 [0.18, 0.75]) were associated with lower odds of moral injury; while group care settings increased odds (OR = 1.36 [1.07, 1.74]). Working with COVID+ patients (confirmed+ OR = 1.27 [1.03, 1.55]), PPE inadequacy (OR = 1.54 [1.27, 1.87]), and greater role conflict (OR = 1.57 [1.53, 1.62]) were associated with greater odds of moral injury. Qualitative findings illustrate how outside factors as well as organizational policies and working conditions influenced moral injury. Moral injury experiences affected staff turnover and patient care, potentially producing additional morally injurious effects. Worker- and patient-centered organizational policies are needed to prevent moral injury among healthcare workers. The generalizability of these findings may be limited by our predominantly white and female sample. Further research is indicated to replicate these findings in minoritized samples.

[This is an excerpt.] Despite fireworks, midnight kisses, black-eyed peas, and billions of people tuning into the Times Square ball drop, Jan. 1 is not unlike Dec. 31. We wake up in our same beds, find our same slippers, and fill our same coffee mugs. What distinguishes January is our perspective. It's the time of year for self-awareness and self-imposed change as we reflect on the year we've been through and prepare for the year ahead. The year 2023 was a doozy. We experienced the loss of two of my oldest son's best friends in a car crash just weeks before their high school graduation. Months later, I dropped one son off at college and helped the other son apply to go off to college this fall. Then we finished building and moving into our new home, an empty nester's oasis in the country. Looking back at 2023's dramatic events and milestones, I realize the year dialed up my burnout meter. Since well before COVID, I've been among the ever-growing ranks of burned-out EPs. Now I'm missing my son, and I have two friends who will never see their sons again. I see that the time we have with our kids is precious, and I find myself resenting EM for all the lost holidays, birthdays, and school events. [To read more, click View Resource.]

INTRODUCTION: There is a lack of formal palliative care education for surgical trainees, and the demanding nature of surgical training and exposure to challenging clinical scenarios can contribute to moral injury. We developed a palliative care curriculum to promote self-reflection, aiming to address moral injury in residents. METHODS: Five 1-h palliative care sessions were delivered over the academic year to all post-graduate year (PGY) levels covering the following topics: personal awareness, delivering bad news, surgical palliation for cancer pathology, surgical palliation for noncancer pathology, and urgent palliative care. The curriculum focused on reflection and small group discussions. The Moral Injury Symptom Scale-Health Professional was administered to assess feelings of moral injury. Descriptive statistics, chi-squared analysis, and Mann–Whitney U-test were used to compare the demographics and survey responses. RESULTS: 23 participants completed the preintervention survey, and 9 participants completed it postintervention. Over 50% of participants were PGY1 or PGY2 residents. Preintervention, 52% of participants reported feeling guilt over failing to save someone from being seriously injured or dying. 30% of participants reported that the feelings of guilt, shame, or distrust impaired their ability to function in relationships, at work, or other areas of life to at least a moderate degree. CONCLUSIONS: The described palliative care curriculum accomplishes several goals as follows: it educates residents on palliative care topics, teaches communication tools, encourages self-reflection, and provides space for building peer relationships. The ease of implementation makes this curriculum applicable across various types of institutions, offering the potential to positively impact surgical training on a national scale.

Representing the AMA's steadfast commitment to advancing the science of physician burnout, the AMA Joy in Medicine™ Health System Recognition Program empowers health systems to reduce burnout and build well-being so that physicians and their patients can thrive.

This resource is found in our Actionable Strategies for Health Organizations: Establishing Commitment & Shared Governance (Organizational Infrastructure for Well-Being) AND Actionable Strategies for Professional Associations: Spotlights: Professional Associations Relational Strategies (Commitment & Governance AND Measuring Well-Being & Accountability).

The COVID-19 pandemic has been distressing to health care professionals, causing significant burnout. Burnout has resulted in notable rates of mental health symptoms and job turnover. Hospitals have incorporated programming to meet the needs of health care professionals. A previously reported intervention at the study institution was a cognitive behavioral narrative writing program to target job-related stress. On the basis of participant feedback, psychoeducational seminars, psychotherapy drop-in sessions, and complementary interventions (mindfulness, yoga, and acupuncture) were also implemented to alleviate stress. This article is an update based on these year 2 augmentations. Participation in brief psychoeducational seminars and acupuncture was high, but engagement in other programming (individual psychotherapy and mindfulness) was poor. Hospitals should consider multimodal approaches to address pandemic-related stress and burnout. In addition to educational seminars, programs that address lasting distress should be offered to health care professionals. Targeting job-related burnout at organizational and systemic levels may ameliorate distress. This article discusses methods of integrating organizational programs into clinics.

In Measuring Trust: Where are we and where do we need to go? Drs. Platt and Taylor set out to address three issues which have fueled the propagation of trust measures:

1. The lack of conceptual clarity across measures
2. A lack of consensus around a single measure or set of measures
3. Trust may operate differently depending on who is trusting whom, and what the context is

The intended readers for this guide are (1) health system leaders, organizational leaders and others interested in adopting measures at their institutions, (2) health services researchers who may not be focused on the issue of trust as a primary area of expertise, but see it as an important variable or outcome of interest in their work, and (3) those interested in assessing measures to support a convergence of methods and/or processes for choosing how, when, and what aspects of trust are to be measured.  

This resource is found in our Actionable Strategies for Health Organizations: Measurement & Accountability.

BACKGROUND: Strong cultures of workplace safety and patient safety are both critical for advancing safety in healthcare and eliminating harm to both the healthcare workforce and patients. However, there is currently minimal published empirical evidence about the relationship between the perceptions of providers and staff on workplace safety culture and patient safety culture. METHODS: This study examined cross-sectional relationships between the core Surveys on Patient Safety Culture™ (SOPS®) Hospital Survey 2.0 patient safety culture measures and supplemental workplace safety culture measures. We used data from a pilot test in 2021 of the Workplace Safety Supplemental Item Set, which consisted of 6,684 respondents from 28 hospitals in 16 states. We performed multiple regressions to examine the relationships between the 11 patient safety culture measures and the 10 workplace safety culture measures. RESULTS: Sixty-nine (69) of 110 associations were statistically significant (mean standardized β = 0.5; 0.58 < standardized β < 0.95). The largest number of associations for the workplace safety culture measures with the patient safety culture measures were: (1) overall support from hospital leaders to ensure workplace safety; (2) being able to report workplace safety problems without negative consequences; and, (3) overall rating on workplace safety. The two associations with the strongest magnitude were between the overall rating on workplace safety and hospital management support for patient safety (standardized β = 0.95) and hospital management support for workplace safety and hospital management support for patient safety (standardized β = 0.93). CONCLUSIONS: Study results provide evidence that workplace safety culture and patient safety culture are fundamentally linked and both are vital to a strong and healthy culture of safety.

Burnout among providers negatively impacts patient care experiences and safety. Providers at Federally Qualified Health Centers (FQHC) are at high risk for burnout due to high patient volumes; inadequate staffing; and balancing the demands of patients, families, and team members.

[This is an excerpt.] The AMA is committed to ensuring that AI can meet its full potential to advance clinical care and improve clinician well-being. As the number of AI-enabled health care tools continue to grow, it is critical they are designed, developed and deployed in a manner that is ethical, equitable and responsible. The use of AI in health care must be transparent to both physicians and patients. In addition to medical devices, AI is increasingly used in health care administration or to reduce physician burden, and policy and guidance for both device and non-device use of health care AI is necessary. Recognizing this, the AMA has developed new advocacy principles that build on current AI policy. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Health Organizations: Improving Workload &Workflows (Using Technology to Improve Workflows) 

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To solve the nursing shortage and sustain a thriving workforce, it’s essential that new nurses transition to practice successfully. For three health systems, nurse residency programs are not only keeping nurses at the bedside but helping them build confidence and find belonging. Read on to learn how health systems from Los Angeles to Connecticut are forging a path forward for nurses at a time when their presence is needed more than ever.

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

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In addition to pressures typical of other medical professions, family physicians face additional challenges such as building long-term relationships with patients, dealing with patients' social problems, and working at a high level of uncertainty. We aimed to assess the rate of burnout and factors associated with it among family medicine residents throughout Israel.

[This is an excerpt.] Burnout among physicians and health care practitioners is a national crisis. It affects the health and well-being of physicians, health care costs, health care quality, and physician attrition.1-3 Mistreatment is a known correlate of burnout,4 and physicians with disabilities (PWDs), an integral part of the physician workforce, are at an increased risk for mistreatment, placing them at higher risk for burnout.5 Despite known stressors for this population, burnout in PWD has not been studied. To address this gap, we investigated the burnout experiences among PWDs in the US. [To read more, click View Resource.]

[This is an excerpt.] Physician burnout is a growing problem within the healthcare system and sports medicine physicians are not exempt. Burnout is a job-related, long-term stress reaction manifesting as emotional exhaustion, depersonalisation and feelings of decreased personal achievement which may occur simultaneously with depression. Its impact on the healthcare system is not trivial, contributing to decreased patient satisfaction and clinical productivity, and increased occupational/personal distress, medical errors, unprofessional behaviour and physician turnover. The authors approach this topic as physicians within the American Medical Society for Sports Medicine (AMSSM). Burnout is not unique to American physicians, thus, some of these principles will apply to sport and exercise medicine clinicians worldwide. Despite the emerging priority among healthcare organisations to mitigate burnout, rates are not decreasing. Various strategies for screening and addressing burnout exist, yet significant gaps exist in the current framework when applied to sports medicine. We highlight the need to recognise systemic factors contributing to burnout specific to sports medicine physicians, identify action items to address these factors within the healthcare system and provide resources for affected physicians. Sports medicine physicians are experts in non-surgical sports medicine, specialising in medical, musculoskeletal and biopsychosocial issues affecting physically active individuals, including competitive athletes. AMSSM members represent multiple primary specialties (table 1) and provide care across a range of clinical settings, delivering a variety of athlete care, team/event coverage and procedural expertise. [To read more, click View Resource.]

Purpose: To explore the interplay among burnout, moral distress, and moral injury; examine current trends and realities in pharmacy; and call for potential beneficial actions by individuals, the pharmacy profession, and healthcare systems.

Methods: A narrative review of recent events and research into challenges and problems in the pharmacy workplace indicative of burnout, moral distress, and moral injury among pharmacists, pharmacy technicians, and other pharmacy staff.

Results: Burnout in the workplace is caused by chronic stress and results in emotional exhaustion, feelings of cynicism/ detachment from the job, and lack of accomplishment or a sense of ineffectiveness. A growing body of evidence indicates that what is termed burnout may in fact be moral distress, and this can lead to moral injury if not recognized and corrected. Indicators of moral distress are psychological distress, situational impact constraining an ability to act, and the effect of inaction upon doing what is deemed right. Over the long term, moral distress leads to moral injury, which is characterized by pain (psychological, existential, and/or spiritual) and resulting from dissonance from doing and/or seeing actions that violate deeply held moral beliefs and expectations. The intersectionality of burnout, moral distress, and moral injury can produce serious sequelae, including suicidality and death by suicide. In addition to burnout, stressful pharmacy job demands have been linked to patient safety concerns, especially medication errors that are worrisome for pharmacists and other pharmacy personnel, cause injuries to patients, and result in negative media attention focused on the individual and the profession.

Conclusion: Burnout has been well-characterized for healthcare professionals, and continued attention to this matter for pharmacists and pharmacy personnel is warranted. What is critical to deal with now is further consideration of moral distress and moral injury and their impact on the pharmacy profession, as burnout does not adequately characterize all of what pharmacists and pharmacy personnel are experiencing.

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[This is an excerpt.] Since 2011, the Stanford Medicine WellMD & WellPhD Center has worked to advance the well-being of physicians and biomedical scientists. We’re jointly funded by the Stanford School of Medicine, Stanford Health Care, and Stanford Children's Health.

Rather than place the onus of well-being on the individual alone, we work to orient the entire organization around creating the cultures and practices that reduce burnout and drive professional fulfillment. We focus on promoting well-being not only at Stanford but also on advancing the field globally, collaborating with leading healthcare organizations, associations, and societies. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Worker & Learner Engagement).

BACKGROUND: The impact of patient aggression on primary health care employees is underexplored, yet imperative to address, given high rates of burnout. OBJECTIVE: We qualitatively explore perceptions of patient aggression among staff in women's health primary care at the Veterans Health Administration (VA). Our objective is to identify coping strategies that staf devised in response to aggressive behavior. METHODS: We conducted semi-structured interviews with 60 VA women's health primary care employees in 2021 and 2022. Informed by the Job Demands-Resources theoretical model, we used rapid qualitative analysis to identify themes related to patient aggression and employee coping strategies. RESULTS: Disruptive behaviors reported by participants included verbal and physical aggression. Staff cited disruptive patient behavior as emotionally draining and perceived a lack of consequences for low-level aggression. Respondents used coping strategies in response to patient aggression at three time points: before, during, and after a negative interaction. At each point, support from team members emerged as a dominant coping mechanism, as well as rapport-building with patients. CONCLUSION: Patient aggression can negatively impact the work experiences of primary care employees. At VA, women's health primary care staff have devised multiple strategies to cope with these interactions. However, the ability to effectively prevent and manage patient aggression is limited by the lack of meaningful repercussions for aggression at the organizational level, which has important implications for employee well-being and retention. Retention of women's health employees in VA is critical given the need for a highly specialized workforce to address the complex health needs of women veterans.

Objectives: Successful leaders influence the group they represent. Effective surgical care is tied to its leadership climate. However, most surgical providers are not attuned to their individual strengths which if known they could leverage them within their teams. This study identifies leadership types within a department of surgery which may be used to better understand and cultivate their strengths.

Methods: In 2022, 172 providers in an academic surgery department were offered the Gallup^TM CliftonStrengths assessment, a proprietary instrument that maps 34 strengths across 4 domains of leadership. The assessment provides a respondent with their top 5 strengths and the domain in which they naturally “lead”.

Results: Of 172 providers, 127 (74%) completed the assessment. While providers have strengths in multiple domains, they “lead with” a specific domain. Mapped from the providers’ top 10 strengths, the most common “lead with” domain for surgical providers was Executing: the ability to implement ideas and produce results. Strategic Thinking: those who are analytical and push teams forward and Relationship Building: the ability to create strong and effective teams were followed by the least common domain. Influencing: the ability to communicate ideas and lead others. Formal leaders were significantly more likely to lead with Strategic Thinking. There were no significant differences between APPs and physicians.

Conclusion: A majority of surgical providers “lead with” the Gallup^TM Executing domain. Those who lead with executing skills work tirelessly to produce outcomes. Learning to leverage the strengths of our teams to create cohesion and efficiency may improve engagement and retention.

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