Resource Library

[This is an excerpt.] Burnout is associated with depression and attrition in the physician workforce. Recent studies have found that Asian, Black, and Hispanic students and students with disabilities experience increased risks of burnout.1,2 However, little is known about the risk of burnout among racial and ethnic underrepresented students with a disability, or among students who have cooccurring disabilities. Here, we examined the prevalence of burnout among students underrepresented in medicine by race and ethnicity (URiM; American Indian or Alaska Native, Black, Hawaiian Native, Hispanic, Pacific Islanders) with multiple disability types. [To read more, click View Resource.]

[This is an excerpt.] The term “microaggression” was coined by psychiatrist Chester Pierce, MD, in 1970 and was further developed and popularized by psychologist Derald Sue, PhD, in 2007. Microaggressions are “brief, everyday exchanges that send denigrating messages to certain individuals because of their group membership.” There are three types of microaggressions: microassaults, microinsults, and microinvalidations. Microassaults are conscious and deliberate actions or slurs against marginalized groups and most closely resemble blatant discrimination. For example, a senior resident might ask an intern: “Why can't you people ever listen?” In contrast, microinsults and microinvalidations are subtle and thought to be unconscious. Microinsults are verbal and nonverbal communications characterized as being insensitive, rude, and demeaning to a person's identity. A microinsult might include: “Are you a real doctor? You look like a child!” Microinvalidations are communications that exclude, negate, and/or nullify a person's experience as a person of color. One example might be to promote “All Lives Matter” (during the ”Black Lives Matter” movement). Though race/ethnicity is often considered the target of microaggressions, they can also be aimed at a person's gender, sexual orientation, religion, or other marginalized status. All microaggressions are particularly harmful in medicine and can interfere with patient care and the professional interactions and development of resident physicians. [To read more, click View Resource.]

[This is an excerpt.] The multiple challenges facing the current nursing workforce should concern anyone in need of healthcare – in other words, everyone. Nurses play an essential role in helping people live their healthiest lives, addressing the root causes of poor health, and managing teams that bring together clinical care, public health, and social services. They are often the first and most frequent line of contact for patients and families entering the healthcare system. National surveys have revealed nurses as the most trusted professionals. However, as the United States emerges from the prolonged impact of the COVID-19 pandemic [2020-2023], the U.S. healthcare system faces a severe shortage of nurses to meet the health needs of the population, while the stresses of the pandemic have led many nurses to consider changing roles away from patient care or even changing professions. [To read more, click View Resource.]

INTRODUCTION: Healthcare clinicians are often at risk of psychological distress due to the nature of their occupation. Military healthcare providers are at risk for additional psychological suffering related to unique moral and ethical situations encountered in military service. This scoping review identifies key characteristics of moral distress and moral injury and how these concepts relate to the military healthcare clinician who is both a care provider and service member. METHODS: A scoping review of moral distress and moral injury literature as relates to the military healthcare clinician was conducted on the basis of the Joanna Briggs Institute scoping review framework. Databases searched included CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), Embase (Ovid), PsycInfo, 2 U.S. Defense Department sources, conference papers index, and dissertation abstracts. Reference lists of all identified reports and articles were searched for additional studies. RESULTS: A total of 573 articles, published between the years 2009 and 2021, were retrieved to include a portion of the COVID-19 pandemic period. One hundred articles met the inclusion criteria for the final full-text review and analysis. DISCUSSION: This scoping review identified moral distress and moral injury literature to examine similarities, differences, and overlaps in the defining characteristics of the concepts and the associated implications for patients, healthcare clinicians, and organizations. This review included the unfolding influence of the COVID-19 pandemic on moral experiences in health care and the blurring of those lines between civilian and military healthcare clinicians. Future directions of moral injury and moral distress research, practice, and care are discussed.

Moral injury is a serious concern among first responders. Not only does moral injury occur with notable frequency among first response groups such as police, fire safety, and emergency medical personnel, but it also poses considerable mental health challenges. Despite a recent explosion of research on moral injury, the literature would benefit from a systematic investigation of how first responders describe their experiences in their own words. We conducted semistructured interviews with 36 graduates of a first responder trauma healing course. Participants described moral injury as (a) a byproduct of being a first responder, (b) occurring frequently but being difficult to identify, and (c) involving feelings of helplessness and guilt. Effects of moral injury included (a) wide-ranging negative consequences, (b) diminished self-esteem, (c) isolation from and suspicion of others, and (d) spiritual distress. When asked about the advice they would give to other people experiencing moral injury, first responders recommended (a) talking openly about the experience of moral injury, (b) being proactive in seeking help, (c) breaking free from the stigma of needing assistance, and (d) building a network of support. Taken together, these results suggest important guidelines for helping first responders cope with the aftermath of moral injury. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

The COVID-19 pandemic has and continues to impact the world affecting all aspects of life. Healthcare workers have been hit especially hard and, in many cases, experience negative impacts not only on their physical health but also on their mental and emotional well-being. Additionally, the COVID-19 pandemic has not affected populations equally and this is true in the USA, including healthcare workers. However, these workers have also persevered, drawing on moral resilience to push through challenging situations throughout this pandemic. In this scoping review, we analyzed studies to assess the role of race, ethnicity, and/or culture on the moral resilience of healthcare workers throughout the COVID-19 pandemic. Our aim was to understand the research that has assessed these potential connections and determine best practices for building moral resilience in the face of this global catastrophe. Fourteen articles met inclusion criteria and were analyzed in this review. Following a thematic analysis, several themes emerged including (1) moral resilience and the COVID-19 pandemic; (2) race, ethnicity, and culture among healthcare workers; and (3) building moral resilience. In sum, the findings from the literature indicate a paucity of studies that analyze the role played by race, ethnicity, and/or culture in connection to moral resilience during the COVID-19 pandemic.

In response to heightened burnout and moral distress among nurse leaders post-coronavirus disease 2019 pandemic, the Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment program was initiated at our medical center. One aspect of the program was the implementation of Community Resiliency Model® training. This article explores the impact of a 3-hour Community Resiliency Model session on nurse leaders' resilience, burnout, and moral distress. Results indicate positive changes in resilience, burnout, and moral distress. These findings suggest that Community Resiliency Model training is an effective intervention for enhancing nurse leader well-being and suggests broader implications for organizational well-being initiatives in health care settings.

Artificial intelligence (AI) is a rapidly advancing field that is beginning to enter the practice of medicine. Primary care is a cornerstone of medicine and deals with challenges such as physician shortage and burnout which impact patient care. AI and its application via digital health is increasingly presented as a possible solution. However, there is a scarcity of research focusing on primary care physician (PCP) attitudes toward AI. This study examines PCP views on AI in primary care. We explore its potential impact on topics pertinent to primary care such as the doctor-patient relationship and clinical workflow. By doing so, we aim to inform primary care stakeholders to encourage successful, equitable uptake of future AI tools. Our study is the first to our knowledge to explore PCP attitudes using specific primary care AI use cases rather than discussing AI in medicine in general terms.

BACKGROUND: COVID-19 was devastating for many frontline nurses embroiled in health care's response. Most media outlets reported from several large metropolitan areas in New York, California, and Florida, leaving other regions to wonder about the extent to which their nurses were suffering. OBJECTIVE: The purpose of this article was to understand the specific needs and experiences of Northeast Ohio nurses caring for patients with COVID-19 before designing interventions targeting negative mental outcomes. METHODS: This phenomenological study interviewed 16 Northeast Ohio nurses to understand their experiences of caring for patients with COVID-19. RESULTS: Although not asked about it directly, the participants' stories consistently included details that could be linked to moral distress. Two themes describing their lived experiences included "acquiring moral distress" and "living with moral distress." Additional findings are also reported separately because although they do not represent the lived experience of COVID-19 nursing, they did represent significant concerns that participants had for the future and are reported here to assist other researchers with the intervention design. Furthermore, these participants thought that participation in support groups with other nurses who cared for COVID-19 patients and possibly led by mental health advanced practice nurses offered the best intervention to process their trauma from the pandemic. CONCLUSIONS: The long-term effects of moral distress have been discussed routinely in recent literature and are further complicated by the effects of the COVID-19 pandemic. Threats to the shrinking workforce of nurses must be taken seriously and interventions to improve the mental health and morale of frontline nurses must be prioritized and tested.

BACKGROUND: Improving retention of nurses working in critical care is an urgent priority. Ideas on how to do this abound, but actual data are inconclusive. One common theory is that simply increasing nurse resiliency will minimize turnover. OBJECTIVE: To determine whether knowledge and application of compassionate self-care practices can significantly improve nurses' professional quality of life and thereby promote their retention. METHODS: This pilot study had a mixed-methods design. A training program in self-care techniques was implemented in a level IV trauma care secondary hospital, with data collected before and after the intervention by means of written surveys. Study participants were 40 nursing professionals working in an intensive care unit and a medical/surgical unit. The underlying theory was Jean Watson's framework of human caring. RESULTS: The study results showed that, although the participants evaluated the training program positively and reported improved work-life balance, they did not experience a statistically significant change in professional quality of life from before the intervention to after the intervention. CONCLUSIONS: The study findings are consistent with current literature indicating that prevention of compassion fatigue and burnout cannot be achieved by the efforts of individuals alone but requires collaboration between professionals and their institutions, with special attention to 3 elements: (1) a healthy work environment, (2) organizational support, and (3) nurse resiliency.

[This is an excerpt.] Artificial Intelligence (AI) is a hot topic in health care for its potential to both alleviate and exacerbate the challenges faced by health workers, particularly for clinician burnout and well-being. To discuss how to navigate this rapidly evolving field, the NAM’s Clinician Well-Being Collaborative held a hybrid event on Orienting AI Toward Health Workforce Well-Being: Examining Risks and Opportunities, co-hosted with UC San Diego Health, on December 9, 2024. This free public convening brought together experts, clinicians, and technology innovators to address burnout and other pressures on the health workforce by exploring how AI can enhance clinical practice, streamline workflows, and improve overall job satisfaction. [To read more and view the slides and recording, click View Resource.]

BACKGROUND: Nurse staffing committees offer a means for improving nurse staffing and nursing work environments in hospital settings by giving direct care nurses opportunities to contribute to staffing decision-making. These committees may be mandated by state law, as is the case currently in nine U.S. states, yet little is known about the experiences of staff nurses who have served on them. PURPOSE AND DESIGN: This qualitative descriptive study was conducted to explore the experiences of direct care nurses who have served on nurse staffing committees, and to better understand how such committees operate. METHODS: Participants were recruited by sharing information about the study through online nursing organization platforms, hospital nurse leadership, state chapters of national nursing organizations, social media, and nonconfidential nursing email lists. A total of 14 nurses from five U.S. states that have had nurse staffing committee legislation in place for at least three years were interviewed between April and October 2022. RESULTS: Four themes were identified from the data—a “well-valued” committee versus one with “locked away” potential: committee value; “who benefits”: staffing committee beneficiaries; “not just the numbers”: defining adequate staffing; and “constantly pushing”: committee members' persistence. CONCLUSIONS: The results of this study highlight the importance of actualizing staff nurse autonomy within nurse staffing committees—and invite further exploration into how staff nurses' perspectives can be better valued by nursing and nonnursing hospital leadership. Nurse staffing committees generally recommend staffing-related policies and practices that address the needs of patients and nurses, and work to find areas of compromise between nursing and hospital entities. But to be effective, the state laws that govern nurse staffing committees should be enforceable and evaluable, while committee practices should contribute to positive patient, nurse, and organizational outcomes; otherwise, they're just another form of paying lip service to change.

IMPORTANCE: Dialysis patient care technicians (PCTs) play a critical role in US in-center hemodialysis (HD) care, but little is known about the association of PCT staffing with patient outcomes at US HD facilities.

OBJECTIVE: To estimate the associations of in-center HD patient outcomes with facility-level PCT staffing.

DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study, with data analysis performed from March 2023 to January 2024. Data on US patients with end-stage kidney disease and their treatment facilities were obtained from the US Renal Data System. Participants included patients (aged 18-100 years) initiating in-center HD between January 1, 2016, and December 31, 2018, who continued receiving in-center HD for 90 days or more and had data on PCT staffing at their initial treating HD facility.

EXPOSURE: Facility-level patient-to-PCT ratios (number of HD patients divided by the number of PCTs reported by the treating facility in the prior year), categorized into quartiles (highest quartile denotes the highest PCT burden).

MAIN OUTCOMES AND MEASURES: Patient-level outcomes included 1-year patient mortality, hospitalization, and transplantation. Associations of outcomes with quartile of patient-to-PCT ratio were estimated using incidence rate ratios (IRRs) from mixed-effects Poisson regression, with adjustment for patient demographics and clinical and facility factors.

RESULTS: A total of 236 126 patients (mean [SD] age, 63.1 [14.4] years; 135 952 [57.6%] male; 65 945 [27.9%] Black; 37 777 [16.0%] Hispanic; 153 637 [65.1%] White; 16 544 [7.0%] other race; 146 107 [61.9%] with diabetes) were included. After full adjustment, the highest vs lowest quartile of facility-level patient-to-PCT ratio was associated with a 7% higher rate of patient mortality (IRR, 1.07; 95% CI, 1.02-1.12), a 5% higher rate of hospitalization (IRR, 1.05; 95% CI, 1.02-1.08), an 8% lower rate of waitlisting (IRR, 0.92; 95% CI, 0.85-0.98), and a 20% lower rate of transplant (IRR, 0.80; 95% CI, 0.71-0.91). The highest vs lowest quartile of patient-to-PCT ratio was also associated with an 8% higher rate of sepsis-related hospitalization (IRR, 1.08; 95% CI, 1.03-1.14) and a 15% higher rate of vascular access–related hospitalization (IRR, 1.15; 95% CI, 1.03-1.28).

CONCLUSIONS AND RELEVANCE: These findings suggest that initiation of treatment in facilities with the highest patient-to-PCT ratios may be associated with worse early mortality, hospitalization, and transplantation outcomes. These results support further investigation of the impact of US PCT staffing on patient safety and quality of US in-center HD care.

This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Safe & Appropriate Staffing).

BACKGROUND: Peer support programs have evolved to train physicians to provide outreach and emotional first aid to their colleagues when they experience the inevitable challenge of a serious adverse event, whether or not it is related to a medical error. Most pediatric surgeons have experienced the trauma of a medical error, yet, in a survey of APSA membership, almost half said that no one reached out to them, and few were satisfied with their institution's response to the error. Thus, the APSA Wellness Committee developed an APSA-based peer support program to meet this need. METHODS: Peer supporters were nominated by fellow APSA members, and the group was vetted to ensure diversity in demographics, practice setting, and seniority. Formal virtual training was conducted before the program went live in 2020. Trained supporters were surveyed 6 months after the program launched to evaluate their experiences with providing peer support. RESULTS: 15 referrals were made in the first year, 60 % of which were self-initiated. Most referrals were for distress related to adverse events or toxic work environments (33 % each). While only about 25 % of trained supporters had provided formal support through the APSA program, more than 80 % reported using the skills to support colleagues and trainees within their own institutions. CONCLUSION: Our experience in the first year of the APSA peer support program demonstrates the feasibility of building and maintaining a national program to provide emotional first aid by a professional society to expand the safety net for surgeons who are suffering.

Current literature validates the magnitude of physician burnout as a complex challenge affecting physicians, patients, and healthcare delivery that mandates science-informed intervention. Physician burnout affects both individual practitioners and patient care delivery. Interventions, defined as roadmaps, to prioritizing and supporting personal wellbeing encompass organizational, individual, and moral injury, with virtually no consensus on optimal approaches. The purpose of this conceptual review is to present evidence-based innovative insights on contributing factors, mitigation, and designing adaptive systems to combat and prevent burnout. Science-informed policy initiatives that support long-term organizational changes endorsed by both leadership and institutional stakeholders are keys to sustaining personal wellbeing and ending burnout.

Burnout is a prolonged response to chronic stressors, characterized by emotional exhaustion, feelings of cynicism and depersonalization, and low sense of personal accomplishment. Burnout is well documented among physicians. Additionally, numerous studies have demonstrated a higher prevalence of burnout among women-identifying physicians compared to men-identifying physicians. Recently, multiple randomized controlled trials have shown that professional coaching for physicians significantly decreased burnout and emotional exhaustion and improved resilience, quality of life, work engagement, self-compassion, and psychological capital. To begin addressing the unique drivers of women physicians, specifically physician mothers, we designed and implemented a group coaching program that addressed drivers of burnout for physician mothers. We found that group coaching is an affordable and well-received intervention that can help address burnout drivers of physician mothers and begin to narrow the burnout gender gap. [Psychiatr Ann. 2024;54(1):e14–e18.]

The article titled "Physician ignition: Promoting physician wellness through CME" discusses the importance of physician wellness and the role of continuing medical education (CME) in promoting it. The author shares their personal experience as a family doctor and emphasizes the benefits of setting boundaries and practicing self-care. The article also highlights the 69th Annual St. Paul's Hospital CME Conference for Primary Care Physicians, which focused on physician wellness and included various initiatives to engage and energize participants. The author concludes by expressing their hope for future CME conferences to further address physician burnout and promote physician well-being.

Team-based care models such as the Patient-Centered Medical Home are associated with improved patient health outcomes, better team coordination and collaboration, and increased well-being among health care professionals. Despite these attributes, hindrances to wider adoption remain. In addition, some health care professionals have sought to practice independent of the physician-led health care team, potentially undermining patient access to physicians who have the skills and training to deliver whole-person, comprehensive, and longitudinal care. In this paper, the American College of Physicians reaffirms the importance of the physician-led health care team and offers policy recommendations on professionalism, payment models, training, licensure, and research to support the expansion of dynamic clinical care teams.

The Federal Trade Commission hosted a public workshop, Private Capital, Public Impact: An FTC Workshop on Private Equity in Health Care, aimed at examining the role of private equity investment in health care markets.

The FTC is dedicated to fostering competition in health care markets. In recent years, the Commission has become increasingly concerned about the effects of private equity investment in this sector. We are convening a workshop bringing together experts and affected individuals to discuss their insights. The workshop will consist of several panels and feature remarks from government officials, academics, economists, and practitioners, as well as members of the public who have experienced, first-hand, the effects of private equity investment in the health care system.

The workshop recording and transcript are available online.

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This resource is found in our Actionable Strategies for Government AND Aligning Values & Improving Diversity, Equity & Inclusion (Aligning Values).

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Many argue that the concept of “work-life balance” is impossible to achieve for busy physicians. After spending years in medical training and building a career in health care, physicians often find their work encroaching upon other aspects of day-to-day life. Over the past decade, studies have shown that physician burnout, stress, depression, mental health, and general lack of well-being affect productivity, efficiency, and patient care. In this article, we will discuss the concept of “work-life balance” and recommend strategies to strive for a meaningful balance.