Resource Library

BACKGROUND: Nursing faculty and clinicians are leaving the profession due to increased workload and burnout. Evidence-based interventions to build skills in resilience and well-being are encouraged; however, strategies to implement them in nursing curricula and nurse residency programs (NRPs) are not well known. PURPOSE: To understand the current state of resilience, well-being, and ethics content in the curriculum in schools of nursing and NRPs in the state of Maryland as part of a statewide initiative for Renewal, Resilience and Retention of Maryland Nurses (R3). METHODS: A descriptive survey was distributed to leaders of all Maryland nursing schools and NRP directors. RESULTS: Respondents (n = 67) reported minimal resilience, well-being, and ethics content. Teaching modalities included lecture, journaling, mindfulness, and the code of ethics. Barriers included lack of faculty knowledge, low priority, time constraints, and limited resources. CONCLUSION: Resilience, well-being, and ethics content is limited in nursing curricula. Developing educator skills and best practices to foster resilience and ethical practice are needed.

BACKGROUND: The aim of this study was to examine sex differences in academic rank and productivity among members of the American Society of Transplant Surgeons in the United States. METHODS: Cross-sectional, focusing on current board-certified abdominal transplant surgeons in the United States. Demographic factors such as sex, region, and faculty rank were collected from institutional websites. Academic metrics, including H-index, total publications, and relative citation ratio, were collected from Scopus and iCite. RESULTS: We identified 536 surgeon members of the American Society of Transplant Surgeons with an academic institution. The majority were men (83%). Men were in practice longer than women (17.9 ± 11 vs 11.7 ± 9 years, P < .0001) and had higher academic metrics, including H-index (25.6 ± 20 vs16.4 ± 14, P < .0001) and total publications (110 ± 145 vs 58.8 ± 69, P < .0001). There was a significant difference in faculty appointments by sex (P < .05), with men showing evidence of increased academic advancement. After adjusting for academic rank, PhD status, and location of medical school and residency, women remained associated with a lower H-index on multivariate analysis (P < .01). CONCLUSION: Sex disparities in academic rank and achievement are present among transplant surgical faculty in the United States, and future efforts are needed to promote sex equity in transplant surgery academia.

Sex-based research in medicine has revealed inequities against females on almost every metric at almost every career stage; ophthalmology is no exception. To systematically review the experiences of females in ophthalmology (FiO) from training through practice in high-income countries (HICs). A systematic review of English-language studies, published between January 1990 and May 2022, relating to FiO in HICs was performed. PubMed, MEDLINE, and Embase electronic databases were searched, as well as the Journal of Academic Ophthalmology as it was not indexed in the searched databases. Studies were organized by theme at each career stage, starting in medical school when an interest in ophthalmology is expressed, and extending up to retirement. A total of 91 studies, 87 cross-sectional and 4 cohort, were included. In medical school, mentorship and recruitment of female students into ophthalmology was influenced by sex bias, with fewer females identifying with ophthalmologist mentors and gender stereotypes perpetuated in reference letters written by both male and female referees. In residency, females had unequal learning opportunities, with lower surgical case volumes than male trainees and fewer females pursued fellowships in lucrative subspecialties. In practice, female ophthalmologists had lower incomes, less academic success, and poorer representation in leadership roles. Female ophthalmologists had a greater scholarly impact factor than their male counterparts, but this was only after approximately 30 years of publication experience. Pervasive throughout all stages of training and practice was the experience of greater sexual harassment among females from both patients and colleagues. Despite these disparities, some studies found that females reported equal overall career satisfaction rating with males in ophthalmology, whereas others suggested higher burnout rates. Ophthalmology is approaching sex parity, however, the increase in the proportion of females in ophthalmology had not translated to an increase in female representation in leadership positions. Sex disparities persisted across many domains including recruitment, training, practice patterns, academic productivity, and income. Interventions may improve sex equity in the field.

National work is urgently needed.

PHENOMENON: Burnout is prevalent amongst long-practicing physicians. For medical educators, it has deleterious effects not only on the educator themselves, but also the students they are teaching. Though significant research has focused on factors associated with burnout, there is limited understanding of its counter: how physicians, particularly medical educators, derive joy from their work. APPROACH: This qualitative study included 15 highly-rated clinician educators in Internal Medicine who took part in individual semi-structured interviews. Participants were invited to discuss their sources of professional joy. After transcription, we used thematic content analysis: 50 themes were identified. Themes were then coded using the domains of the PERMA (Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment) model of positive psychology, assigning each theme a best fit domain. Forty-five themes were mapped into the PERMA model. FINDINGS: When describing professional joy, highly-rated clinician educators displayed high levels of overlap with all domains of the PERMA model. Interaction with the learner was a prominent source of professional joy, particularly within Positive Emotion, Engagement, and Relationship domains. INSIGHTS: Our findings indicate that the PERMA model appropriately defines the sources of professional joy for these educators. Future research could employ this model to identify targets for interventions aimed at amplifying joy at work for this group.

As spine surgeons continue to strive for high-quality patient care in an ever-changing health care environment, their individual health can often be put on the back burner. Under the stress of caring for and operating on the spine patient, surgeons must juggle additional hardships in the form of occupational exposures such as intraoperative radiation, degenerative conditions secondary to ergonomics and the inherent physical tax of spine surgery, and an increasing incidence of mental health disorders. In this review, we discuss the current body of literature as it relates to physical, mental, and occupational tolls placed on surgeons.

The 2024 State of U.S. Nursing Report provides insights into the current landscape of nursing in the United States, highlighting both positive developments and significant challenges.

[This is an excerpt.] Student incivility in nursing programs is a growing and urgent problem. Nursing faculty increasingly struggle to manage its impact on effective teaching and learning in classroom and clinical settings. The extent of this incivility, which includes derogatory language and physical confrontations with peers and faculty, reflects the divergence in worldviews and complex stressors observed in our daily news cycle and acted out on social media platforms, contributing to the perception that it is permissible in our educational and professional spheres. These behaviors, likely multi-factorial in their origins, could reflect student burnout, feeling overwhelmed by academic and personal demands, and the inability to effectively negotiate personal stressors and relationships. Student burn-out is associated with lower self-concept, self-confidence, self-esteem, and engagement, negatively affecting learning and motivation (Wei et al., 2021). The student with burnout usually conveys anxiety, depression, aggression, frustration, reluctance to do schoolwork, despair, and inefficiency (Wei, 2021). The 2023 Stress in America Survey supports the overwhelming stress reported by adults age 18 to 34 years. Seventy-one percent of respondents do not discuss stress to avoid burdening others, 67% indicate stress makes it hard to focus, and 55% report it is difficult to do anything when stressed (American Psychological Association, 2023). Fifty percent report having a mental health diagnosis, and 51% report a chronic illness. [To read more, click View Resource.]

[This is an excerpt.] For transgender and nonbinary individuals, early and continued access to gender-affirming care is critical to improving confidence and allowing people to use their focus for transitioning socially while navigating the complex and sometimes unwelcoming healthcare system. Gender-affirming care can include social affirmation, puberty blockers, hormone therapy, and gender-affirming surgeries. This care can be life-saving, as it improves the mental health and overall well-being of gender-diverse children, adolescents, and adults.

Gender non-conforming students can find access to gender-affirming treatment at many colleges in the United States and abroad, and healthcare providers working in these schools receive training on gender-affirming, patient-centered care. For younger students, school nurses play an important role in supporting gender non-conforming students by directing them to resources and assuring them that their identities and feelings are valid and meaningful. For adults, healthcare provider education is crucial since many gender diverse individuals report discrimination within the healthcare system.

These resources are made available to anyone in the healthcare field, preparing as a student to work with diverse populations, including gender non-conforming youth, allies, educators, the transgender community, and more. You'll find research articles, helpful websites, links to organizations, and even legal and healthcare resources here. We hope you find these resources informative and helpful, no matter what part of your journey. [To read more, click View Resource.]

‍

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Little is known about the relationship between learner load and pharmacist and pharmacy technician burnout. Therefore, the purpose of this study was to examine the association between burnout and the number of learners (residents, students, and new employees) assigned to pharmacists or pharmacy technicians. A validated survey to measure burnout and professional fulfillment was administered to employees of a university health system’s pharmacy service in 2019. A threshold analysis determined the optimal cutoff for number of learners trained that maximized the ability to predict binary outcomes. Chi-square and Fisher’s exact tests were used, and effect size between percentages were reported. Finally, the adjusted associations between number of learners and outcomes were assessed using logistic regression. A total of 448 pharmacy staff members were included in the analysis. Of those, 57% (n = 254) worked in ambulatory care, 27.4% (n = 122) worked in an inpatient setting, and 15.7% (n = 70) worked in infrastructure. Pharmacists working in an inpatient setting who reported training 4 or more learners per year indicated significantly higher rates of burnout than those training fewer learners on both a single-item burnout assessment (64.3% vs 31.0%; P = 0.01; effect size, 0.68) and a 10-item burnout assessment (54.8% vs 13.8%; P = 0.01; effect size, 0.91). Similar results were not observed in pharmacists working in ambulatory care and infrastructure positions or in pharmacy technicians.Added precepting and training responsibilities may be associated with higher levels of burnout among pharmacy team members, particularly inpatient pharmacists.

BACKGROUND: Emergency Medical Services (EMS) is a challenging profession. Little is known if there are gender differences in the experiences among EMS clinicians. Therefore, our aim was to understand and characterize the occupational experiences of female EMS clinicians. METHODS: A mixed methodological study was conducted among currently licensed female EMS clinicians via focus group and self-report survey data. Three focus groups (n = 5, 4, 13, respectively) were conducted with participants purposively recruited from primarily Northeastern EMS agencies. Through ongoing collaborations, a recruitment advertisement was provided to EMS leadership at respective agencies for distribution among their female staff. Sessions were recorded and transcribed for thematic analysis. A six-phase inductive analytical approach was utilized to evaluate focus group data. Qualitative findings were utilized to inform a cross-sectional, self-report survey consisting of occupational specific experiences, such as harassment and pregnancy, and validated measures of mental wellbeing. Descriptive statistics were used to describe the study sample and female EMS clinician occupational and personal experiences. RESULTS: A total of 22 female EMS clinicians participated across the three focus group sessions. Four major themes were identified: 1) the female EMS experience; 2) impact on personal wellbeing; 3) impact on occupational wellbeing; and 4) coping mechanisms. Each theme had multiple subthemes. There were 161 participants that attempted the 72-item survey, 13 partial and 148 competed surveys. Median age was 32 years (IQR: 25-42), and the majority were EMT-Bs (55.1%). Approximately 70.0% met the criteria for probable anxiety, 53.9% probable depression and 40.9% elevated symptoms of burnout. Almost 73.0% reported workplace harassment, with most experiences being perpetrated by patients and coworkers. Over 61.0% reported reconsideration of their career in EMS. Overall, survey data indicated interactions with peers and leadership, and social support were positive. CONCLUSIONS: Findings highlight the need to improve the occupational experiences of female EMS clinicians to preserve and encourage the continuation of their participation in this workforce. Specifically tailored interventions aimed at protecting and improving their overall wellbeing are critical, particularly considering the increased occupational burden resulting from the pandemic. Future research should aim to understand specific predictors of adverse mental health outcomes among this population.

PURPOSE: The Fortify Resilience Initiative focuses on building and sustaining a culture of wellbeing for Residents and Fellows (R/Fs) at The University of Texas Rio Grande Valley (UTRGV) School of Medicine’s (SOM) Graduate Medical Education (GME) residency and fellowship programs. In order to address the multitude of threats to physician wellness and to mitigate the silent, but pernicious effects of burnout on these physician learners serving in the RGV, this Initiative from the Office of GME will strengthen existing wellbeing pathways while expanding additional solutions that will work to sustain wellbeing. Utilizing a combination of prevention, promotion, and intervention strategies targeted at the individual, program, and system levels, this initiative increases resilience by addressing existing gaps that only further propagate the spread of risk and vulnerability to the community. DESCRIPTION: The Fortify Resilience Initiative maintains three key drivers (Access Strategy, Empowerment Initiatives, and System Redesign) that all work to address and enhance components central to wellbeing management. Within the Access Strategy is continuous access to direct online clinical and coaching services, annual opt-out wellness check-ins, monthly live online learning sessions with embedded didactics as well as skill development practical labs. Launch of a Wellbeing Mobile Application (WMA), allowing users to periodically self-assess and receive suggestions to improve self-management as well as the establishment of Program Specific Wellness Committees (PSWC), constitute the Empowerment Initiatives. Consultations with each partnered program’s leadership, along with the introduction of a faculty development pathway to train faculty to full competency over current wellbeing methodologies, aim at establishing a presence of institutional expertise and represent the System Redesign driver. Partners: The Fortify Resilience Initiative at UTRGV is illuminated through a vital partnership with Tend Health (TH). TH is an innovative company specialized in the care and well-being of health professionals, with a history of successful partnerships with GME programs offering mental health and well-being focused services. TH is an essential partner in two of the key drivers – Access Strategy and System Redesign. LOOKING AHEAD: By year 2024, the Fortify Resilience Initiative seeks to impact 249+ UTRGV R/Fs and clinical faculty, as demonstrated by: Graduating all R/Fs with self-management of well-being competencies, Embedding access strategy services as routine part of UTRGV GME programs, Integrating technology solutions – WMA – as a core strategy for resilience for GME programs, Enrolling 100% of new R/Fs as users on the WMA via GME on-boarding each program year, Sustaining PSWC’s across 11+ GME programs with routine use of the WMA, Establishing a scalable culture of wellbeing strategy for the UTRGV SOM, Building resilience supporting policies within programs and institution, Developing a UTRGV Faculty Affairs sustained Master Trainer Faculty Development (MTFD) track to continue delivery of resilience trainings by MTFD scholars

Goal: Burnout, decreased professional fulfillment, and resultant attrition across the medical professions are increasingly recognized as threats to sustainable and cost-effective healthcare delivery. While the skill level of leaders as perceived by their direct reports has been correlated with rates of burnout and fulfillment, no studies, to our knowledge, have directly evaluated whether intervention via leadership training impacts burnout and fulfillment among direct reports. The goal of this study was to evaluate the effectiveness of a leadership training intervention on direct reports’ perceptions of the leadership skills of supervising residents and subsequently on the well-being of the direct reports.

Methods: We implemented a leadership training program with supervising (i.e., chief) resident volunteers in two surgical residency programs. The leadership training included two sessions of approximately 2 hours each that consisted of interactive didactic and small group activities. The training focused on the following themes: defining leadership (i.e., characteristics and behaviors), team building, fostering trust, managing conflict, navigating difficult conversations, and feedback. We administered pretraining and posttraining surveys to the direct reports (i.e., junior residents) to assess the perceived leadership skills of supervising residents, as well as burnout and professional fulfillment.

Principal Findings: Leadership scores significantly improved following the leadership training intervention. Additionally, improvement in leadership scores following training was positively correlated with professional fulfillment among the junior residents (direct reports).

Practical Applications: The results of this study suggest that incorporating leadership training into residency programs may serve as an appropriate initial intervention to improve the leadership skills of supervising residents, and in turn, improve professional fulfillment and retention among medical professionals. This intervention involved minimal cost and time investment, with potentially significant returns in combating the well-being and attrition crisis. These findings may be applicable across the healthcare field to tackle the impending healthcare worker crisis.

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

BACKGROUND: Research has shown sleep problems, elevated fatigue, and high cases of burnout, as well as signs of post-traumatic stress and psychological distress among nurses during the COVID-19 pandemic. Many US hospitals attempted to minimise its impact on staff by providing basic resources, mental health services, and wellness programs. Therefore, it is critical to re-evaluate these well-being indices and guide future administrative efforts. PURPOSE: To determine the long-term impact of the COVID-19 pandemic after 18 months on hospital nurses' insomnia, fatigue, burnout, post-traumatic stress, and psychological distress. DESIGN: Cross-sectional. METHODS: Data were collected online mainly through state board and nursing association listservs between July–September 2021 (N = 2488). The survey had psychometrically tested instruments (Insomnia Severity Index, Occupational Fatigue Exhaustion Recovery Scale, Maslach Burnout Inventory, Short Post-Traumatic Stress Disorder, and Patient Health Questionnaire-4) and sections on demographics, health, and work. The STrengthening the Reporting of Observational studies in Epidemiology checklist was followed for reporting. RESULTS: Nurses had subthreshold insomnia, moderate-to-high chronic fatigue, high acute fatigue, and low-to-moderate intershift recovery. Regarding burnout, they experienced increased emotional exhaustion and personal accomplishment, and some depersonalisation. Nurses had mild psychological distress but scored high on post-traumatic stress. Nurses who frequently cared for patients with COVID-19 in the past months scored significantly worse in all measures than their co-workers. Factors such as nursing experience, shift length, and frequency of rest breaks were significantly related to all well-being indices. CONCLUSION: Nurses' experiences were similar to findings from the early pandemic but with minor improvements in psychological distress. Nurses who frequently provided COVID-19 patient care, worked ≥12 h per shift, and skipped rest breaks scored worse on almost all well-being indices. Relevance to clinical practice Administration can help nurses' recovery by providing psychological support, mental health services, and treatment options for insomnia, as well as re-structure current work schedules and ensure that rest breaks are taken.

Background: Addressing threats to the nursing and public health workforce, while also strengthening the skills of current and future workers, requires programmatic solutions. Training programs should be guided by frameworks, which leverage nursing expertise and leadership, partnerships, and integrate ongoing evaluation.

Purpose statement: This article provides a replicable framework to grow, bolster, and diversify the nursing and public health workforces, known as the Nurse-led Equitable Learning (NEL) Framework for Training Programs. The framework has been applied by several multipronged, federally funded training programs led by investigators embedded in an academic nursing institution.

Methods: The NEL framework focuses on: (1) increasing equitable access to the knowledge, skills, and competencies needed to prepare a diverse workforce to deliver effective interventions; (2) fostering academic-practice linkages and community partnerships to facilitate the deployment of newly gained knowledge and skills to address ongoing and emerging challenges in care delivery; and (3) continuously evaluating and disseminating findings to inform expansion and replication of programs.

Results: Ten programs using this framework have successfully leveraged $18.3 million in extramural funding to support over 1000 public health professionals and trainees. Longitudinal evaluation efforts indicate that public health workers, including nurses, are benefiting from the programs' workplace trainings, future clinicians are being rigorously trained to identify and address determinants of health to improve patient and community well-being, and educators are engaging in novel pedagogical opportunities to enhance their ability to deliver high quality public health education.

Conclusions: Training programs may apply the NEL framework to ensure that the nursing and public health workforces achieve equitable, sustainable growth and deliver high quality evidence-based care.

This resource is found in our Actionable Strategies for Health Organizations: Promoting Diversity, Equity, & Inclusion.

The relationship between burn out and organizational culture have not been thoroughly investigated in non-patient-facing health systems’ employees, such as analysts and administrative managers. Therefore, the relationship between organizational culture and burn out among health systems’ employees is investigated. A 57-question Likert scale survey was sent to health systems’ employees. A total of 67 responses were collected. Two factor analysis models about and canonical correlation between burnout and organizational culture are presented. The results show that organizational culture factors and burnout factors are related. There is an 83% correlation between burn out and organizational culture among health systems’ employees. This research contributes to the literature by being among the first to study non-patient-facing health systems’ employees’ perceptions of organizational culture and experiences of burn out. Additionally, this research has several practical implications for health systems’ leaders. For example, leaders should focus on improving organizational culture to alleviate burn out in health systems’ employees.

[This is an excerpt.] Unsafe staffing levels in New York’s hospitals undermine the quality of care patients receive. All New Yorkers — from patients, community members, healthcare workers and their unions to legislators and regulators — have a stake in ensuring that the laws and regulations meant to protect patient safety are working well. New York took a major step forward to address patient safety and the nurse staffing crisis when legislators passed a safe staffing law in 2021. The Clinical Staffing Committees and Disclosure of Nursing Quality Indicators law directed all hospitals to set minimum safe staffing standards and established a universal 1:2 nurse-to-patient staffing ratio for critical care patients. Nearly three years after the law was enacted and two years after it became enforceable, New York is at a critical point. The law established an independent advisory commission, which was tasked with releasing a report on the law’s impact in October 2024 and making recommendations to
the legislature in 2025. The Commission has yet to release a report due to the lack of data available to evaluate staffing law progress. To fill the gap in evaluating the safe staffing law, New York State Nurses Association (NYSNA) members and staff took the work of gathering staffing data into their own hands, conducting staffing surveys at more than 60 facilities across the state. NYSNA members working in intensive care units (ICUs) and caring for critical patients conducted staffing reports for 532 shifts from 32 critical care units from 20 hospitals across the state. The data from these staffing surveys was compiled to create this report on the current state of the staffing crisis and how well the staffing law is working to address that crisis. [To read more, click View Resource.]

In this fourth installment of Vivian Health’s annual Healthcare Workforce report, we once again examine the attitudes of healthcare professionals about their careers, well-being and lifestyle to better understand rapidly changing employment dynamics. This survey was conducted December 12, 2023 –January 11, 2024, and includes responses from 863 clinicians.

Over the past several years, the ongoing coronavirus disease 2019 pandemic has contributed to challenging working and life conditions. As a result, the midwifery and health care workforce has faced significant shortages due to burnout. Increased societal awareness of historical trauma and systemic racism embedded within US culture has also led to increased anxiety and signs of trauma among midwifery and health profession students. Now more than ever, innovative teaching strategies are needed to support students, reduce the risks of burnout, and increase diversity in the workforce. One strategy is to adopt a trauma-informed pedagogy within midwifery education. Trauma-informed pedagogy is founded on core assumptions of trauma-informed care and thus supports student success by recognizing that the student cannot be separated from their own life experiences. Faculty and preceptors can develop empathetic, flexible supports that communicate care and concern regarding students’ personal and social situations, and emotions. Empathetic behavior from teachers also increases student learning motivation, making it easier for students to actively engage in learning thereby reducing their distress. The purpose of this State of the Science review, therefore, was to describe the literature surrounding trauma-informed pedagogy and to offer concrete educational strategies that faculty members and educational programs can employ to increase the success of a diverse student body. This can be accomplished through flexibility in curriculum design and outcome measurement to ensure attainment of end of program learning outcomes. Institutional and administrative support are essential to develop a faculty who realize the benefit and value of trauma-informed pedagogy underpinning student success.

Public service employees are often those in front-line positions, and face stress due to their boundary spanning job requirements. During the Covid 19 pandemic, additional strain was felt by these front-line workers as they were required to continue close contact with others. For police officers, stress may lead to psychological effects such as burnout, lower levels of job satisfaction, and higher levels of turnover intentions. Additionally, some occupational groups such as policing are at a higher risk of developing mental health problems. This is becoming increasingly important for many cities and their police department budgets, as increasing labor costs for staffing and turnover has become a major concern. This study seeks to better understand how these specific factors influence turnover intentions for police officers in a mid-size suburban US police department, how organizations can help address mental health, and make practical suggestions on how to impact these staffing decisions.