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GOAL: This article explores how broad, contextual factors may be influential in the retention of direct care workers (DCWs; i.e., entry-level caregivers) who provide vital support to patients in healthcare settings. We reflect on lessons learned from an evaluation of a multisite intervention to improve retention among DCWs employed primarily in hospital settings at three health systems. METHODS: We evaluated a multitiered program for entry-level caregivers that included a risk assessment, a 4-day curriculum, and follow-up sessions, as well as workforce coaching at the three health systems. As part of our evaluation, we collected data on roughly 3,000 DCWs from the three health systems; the information included hiring date, any transfer date, and any termination date for each new DCW, as well as demographic information, position characteristics, and termination status and reasons for any termination. In addition, we collected information about organizational characteristics, including staffing and number of employees. We also conducted interviews with 56 DCWs and 21 staff members who implemented a retention program across each of the three health systems and remotely conducted virtual observations of the curriculum sessions at each system. PRINCIPAL FINDINGS: Although the program we evaluated focused on individual-level factors that may affect retention, our findings revealed other broader, contextual challenges faced by DCWs that they said would have an impact on their willingness to stay in their positions. These challenges included (1) job-related factors including limited compensation, aspects of the job itself, and the inability to advance in one's position; (2) health system challenges including the mission, policies, staffing, and organizational culture; and (3) external factors including federal policies and the ongoing COVID-19 pandemic. PRACTICAL APPLICATIONS: As the direct care workforce continues to grow, interventions to improve retention should consider the interconnectedness of these multilevel factors rather than solely individual-level factors. In addition, further research is needed to rigorously evaluate any potential intervention and consider how such an approach can target DCWs in hospital-based settings who are most affected by the multilevel challenges identified. Finally, any intervention to improve retention must be also aligned to ensure equity, especially in this population of low-wage DCWs, many of whom are marginalized women and individuals of color.

[This is an excerpt.] Patient medical advice requests (PMARs) have been increasing over the past decade, with a rapid intensification of this trend during the COVID-19 pandemic that persists. Many primary care practices have workflows in which primary care physicians (PCPs) directly receive these messages, despite data showing that this additional work is linked to clinician burnout and requires team-based care. Most published models discuss registered nurse (RN)-level workflow changes for management of PMARs, but nursing staffing shortages frequently limit implementation of this model. To solve this, we taught certified medical assistants (CMAs) how to manage incoming PMARs utilizing existing telephone call routing guidelines. [To read more, click View Resource.]

Vacation has been shown to be an important restorative activity in the general population; less is known about physicians’ vacation behaviors and their association with burnout and professional fulfillment.To examine the number of vacation days taken per year and the magnitude of physician work while on vacation and their association with physician burnout and professional fulfillment, by individual and organizational characteristics.This cross-sectional survey of US physicians was conducted between November 20, 2020, and March 23, 2021. Data analysis was performed from March to July 2023.Burnout was measured using the Maslach Burnout Index, and professional fulfillment was measured using the Stanford Professional Fulfillment Index. Number of vacation days taken in the last year, time spent working on patient care and other professional tasks per typical vacation day (ie, work on vacation), electronic health record (EHR) inbox coverage while on vacation, barriers to taking vacation, and standard demographics were collected.Among 3024 respondents, 1790 of 3004 (59.6%), took 15 or fewer days of vacation in the last year, with 597 of 3004 (19.9%) taking 5 or fewer days. The majority, 2104 respondents (70.4%), performed patient care–related tasks on vacation, with 988 of 2988 (33.1%) working 30 minutes or more on a typical vacation day. Less than one-half of physicians (1468 of 2991 physicians [49.1%]) reported having full EHR inbox coverage while on vacation. On multivariable analysis adjusting for personal and professional factors, concern about finding someone to cover clinical responsibilities (odds ratio [OR], 0.48 [95% CI, 0.35-0.65] for quite a bit; OR, 0.30 [95% CI, 0.21-0.43] for very much) and financial concerns (OR, 0.49 [95% CI, 0.36-0.66] for quite a bit; OR, 0.38 [95% CI, 0.27-0.54] for very much) were associated with decreased likelihood of taking more than 3 weeks of vacation per year. Taking more than 3 weeks of vacation per year (OR, 0.66 [95% CI, 0.45-0.98] for 16-20 days; OR, 0.59 [95% CI, 0.40-0.86] for >20 days vs none) and having full EHR inbox coverage while on vacation (OR, 0.74; 95% CI, 0.63-0.88) were associated with lower rates of burnout on multivariable analysis, whereas spending 30 minutes or longer per vacation day on patient-related work (OR, 1.58; 95% CI, 1.22-2.04 for 30-60 minutes; OR, 1.97; 95% CI, 1.41-2.77 for 60-90 minutes; OR, 1.92; 95% CI, 1.36-2.73 for >90 minutes) was associated with higher rates of burnout.In this cross-sectional study of 3024 physicians, the number of vacation days taken and performing patient-related work while on vacation were associated with physician burnout. System-level efforts to ensure physicians take adequate vacation and have coverage for clinical responsibilities, including EHR inbox, may reduce physician burnout.

BACKGROUND: The organizational studies' literature suggests that employees' expressions of voice and silence may be distinct concepts with different predictors. Organizational researchers also argue that both employees' voice and silence are related to burnout; however, these relationships have not been adequately examined in the healthcare context. OBJECTIVE: This study aimed to investigate the relationships among nurses' perceived impact, psychological safety, voice behaviors, and burnout using a theoretical model. Voice behaviors were conceptualized as voice and silence. DESIGN: A cross-sectional, correlational study design was employed. SETTINGS: Study data were collected in 34 general hospitals in South Korea. PARTICIPANTS: A total of 1255 registered nurses providing direct care to patients were included in this study. METHODS: Using a convenience sampling method, a web-based survey was conducted to obtain data. All variables were measured using standardized instruments. A structural equation modeling analysis was employed to test a hypothesized model positing that perceived impact and psychological safety have both direct and indirect effects on nurse burnout through voice and silence. The response rate was 72.8 %. RESULTS: The findings supported the hypothesized model. Both perceived impact and psychological safety were positively related to expressions of voice, but both were negatively associated with silence. We also found that perceived impact was more strongly associated with voice than with silence, while psychological safety had a stronger impact on silence than on voice. Furthermore, voice reduced burnout, while silence increased it. Finally, perceived impact reduced burnout through voice (β = −0.10, 95 % confidence interval [−0.143, −0.059]) and silence (β = −0.04, 95 % confidence interval [−0.058, −0.014]), and psychological safety also decreased burnout through voice (β = −0.04, 95 % confidence interval [−0.057, −0.016]) and silence (β = −0.07, 95 % confidence interval [−0.101, −0.033]). Additional analyses revealed that prohibitive voice and silence significantly mediated the associations between psychological safety and burnout and perceived impact and burnout, but the mediating role of promotive voice was not statistically significant. CONCLUSIONS: It is important to recognize that voice and silence are distinct concepts. Moreover, to reduce nurse burnout, nurse managers and hospital administrators should develop separate strategies for promoting nurses' perceived impact and psychological safety, as their influences on voice and silence differ. Registration Not applicable. Tweetable abstract Voice and silence both influence nurse burnout. Separate strategies should be applied to voice and silence, as they are different concepts.

[This is an excerpt.] Moral distress and moral injury have received little attention in radiology, despite increasing focus on burnout. Instead, the conversation continues to emphasize personal wellness to mitigate burnout. Wellness is important to ensure every individual is healthy and able to fully perform their jobs. Wellness committees, group outings, snack carts, and yoga can help to produce a sense of community and provide short term gratification. However, wellness interventions do not address the issues causing moral distress in radiology. Fixing the causes of moral distress will reduce burnout. [To read more, click View Resource.]

Policing worldwide is facing a staffing and retention crisis. If the staffing exodus continues, communities will be left with too few police and large cohorts of inexperienced new recruits on the job. Drawing on 2,669 survey responses collected as part of a national study of law enforcement officers across the USA, we test an integrated theoretical model of the predictors of turnover intentions. We computed a path model using structural equation modelling, finding that job demand stressors (including trauma, organizational, and operational stressors), burnout, psychological distress, and commitment (including organizational commitment and occupational commitment) all play important roles in explaining the intentions of officers to exit the policing profession. Based on the study findings, the importance of trauma, organizational and operational job demand stress, and the differential impact of organizational and occupational commitment on police turnover intentions is established. Addressing burnout and psychological distress through a wellness agenda is likely to assist in stemming the outflow of officers from policing. The current study makes a significant empirical and practical contribution to the small body of existing police turnover research. The current research guides police leaders on the critical factors that must be considered when developing strategies and initiatives that aim to positively impact on the retention of officers within policing.

Poor well-being and burnout among the nursing workforce were heightened by the COVID-19 pandemic. The purpose of this study was to deliver, spread, and sustain an evidence-based wellness program, Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE), for nurse leaders, staff registered nurses (RNs), and patient care technicians (PCTs) to ameliorate or prevent burnout, promote resilience, and improve the work environment. The program included Community Resiliency Model (CRM) training provided by a certified 6-member wellness team. A baseline and 6-month follow-up survey included measures of well-being, moral distress, burnout, resilience, perceived organizational support (POS), job satisfaction, intent to leave (ITL), and work environment. A total of 4900 inpatient RNs, PCTs, and leaders of a 1207-bed academic medical center in the southeastern United States were analyzed. From baseline (n = 1533) to 6-month follow-up (n = 1457), well-being, moral distress, burnout, job satisfaction, and work environment improved; however, resilience, POS, and ITL did not. Although we have seen some improvements in well-being and mental health indicators, it is still early in the intervention period to have reached a critical mass with the training and other interventions. The mental health and work environment issues among nurses are so complex, no one-size-fits-all intervention can resolve.

BACKGROUND: Nurses experience elevated rates of operational stress injuries (OSIs). This can necessitate taking leave from work and subsequently engaging in a workplace reintegration process. An unsuccessful process can have long term impacts on a nurse's career, affecting the individual, their family, and broader community, while contributing to nursing shortages. A knowledge gap regarding the workplace reintegration of nurses experiencing mental health challenges, impedes the development and implementation of initiatives that might increase the success of nurses reintegrating into the workplace. This scoping review explored the existing literature concerning workplace reintegration for nurses experiencing OSIs. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines were utilized. Three key search terms across six databases were employed followed by a qualitative content analysis of the resulting literature. RESULTS: Eight documents were included. The literature exhibited high heterogeneity in objectives, content, and article types. The content analysis revealed five themes: (1) recognizing stigma, (2) elements of successful workplace reintegration, (3) considerations for military nurses, (4) considerations for nurses with substance use disorders, and (5) gaps in the existing literature. CONCLUSION: A paucity of programs, policies, procedures, and research exists regarding workplace reintegration for nurses facing mental health challenges. It is imperative to recognize that nurses may experience OSIs, necessitating mental health support, time off work, and operationally/culturally-specific assistance in returning to work. Innovative and evidence-based approaches to workplace reintegration are needed to enhance the retention of a skilled, experienced, compassionate, and healthy nursing workforce.

An Oxford researcher measured the effect of popular workplace mental health interventions, and discovered little to none.

[This is an excerpt.] A recent survey of 3,000 health care workers revealed that younger clinicians ages 18–29 — nurses, doctors, dentists, medical assistants, and others — were significantly more likely than older clinicians to report witnessing racial discrimination against patients. The survey reported on health care workers’ observations of discrimination against patients, how this discrimination impacts patient care, and how it affects the health care workers who witness it. [To read more, click View Resource.]

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

Policing by its very nature has been widely recognised as being inherently stressful with little that can be done to prevent police officers' exposure to both primary and secondary trauma. Officers involved in the investigation of child abuse and sexual offences have been further recognised as working in some of the most stressful and demanding roles in policing. However, there has been little research within this high-risk group of officers which seeks to understand how they cope with both the organisational and occupational stressors they are exposed to, as well as which strategies help them to 'get up in the morning'. Data were collected through twenty-three (23) semi-structured interviews, with Straussian Grounded Theory used as a framework to develop a model of coping. This study highlighted that although some officers were affected by the traumatic nature of their work, there were other risk factors present which appear to have impacted on them more significantly including 'burnout', 'compassion fatigue' and 'moral injury.' Protective factors were identified as 'being in control', 'organisational, social and peer support' as well as 'having a purpose' all of which impacted on an officer's ability to cope with the work they do. The present findings extend our knowledge of key concepts relating to police officer coping which may help officers working in these high-risk roles to cope with challenges they face daily. Recommendations for further research on how to support this group of officers, as well as implications for practice are discussed.

Medical students are educated through two dichotomous curriculums, the formal, planned curriculum and the hidden curriculum unintentionally taught through socialization within the culture of medicine. As a consequence of shared trauma amongst the physician workforce during the COVID-19 pandemic, moral injury (MoI) and compassion fatigue (CoF) have become prevalent within the health care system, including palliative care medicine, with echoing ramifications on the observing trainee population. Thus, it is imperative to determine risk factors, protective factors and targeted interventions to offset MoI and CoF within the health care workforce and trainee population. Methods of strengthening personal and institutional resilience are vital to developing long-term structural change replacing the hidden curriculum of MoI and CoF with one of resilience and support. As palliative care providers are especially vulnerable to MoI and CoF, this article will examine the impact of the COVID-19 pandemic on MoI, CoF, and resilience within the hidden curriculum through the lens of palliative care.

Social work practice is not a highly paid or high-status occupation. The historical roots of social work lie in charity work directed toward social needs and poverty, with much of this work previously women’s unpaid work. This set the stage for a norm of unpaid labor in the predominantly female occupation. Women who are mature-aged, lone parents, carers and on low income have continuously been the numerical majority within social work. As such, the unpaid field placement disproportionately affects women. This article provides a gendered analysis of qualitative data obtained from women participants in a national survey of social work students from five Australian universities (n=409) following 1000 h of field education placement. Open-ended questions aimed to explore the experiences of financial stress from lengthy unpaid placements on the mental health and well-being of social work students. The findings contribute to a growing body of feminist literature critiquing the current field education model and argue for significant reflection,flexibility, and change. To meet the collective social work goals of social justice and dismantling systemic oppression, a new placement model is needed that is both inclusive and sustainable.

INTRODUCTION: A rise in the incidents of violence against Health Care Workers (HCWS) in recent years calls for improvement in modes of spreading awareness and educating the public. We aimed to conduct a large global cross-sectional survey called VISHWaS- Violence Study of Healthcare Workers and Systems in the departments of Anesthesiology, Critical Care Medicine, and Emergency medicine. METHODS: A global survey after tool validation, was created using REDCap forms and distributed from June 5th to July 24th, 2022. Communication tools including emails, phone calls, SMS, and social media applications like WhatsApp, Twitter, and Linkedin were used in securing responses. This study was deemed eligible for category-2 Institutional Review Board exempt status. RESULTS: Total of 598 responses from 69 countries, out of these 445 (749) were complete. The maximum responses were trom India (N-49), followed by the USA (N=44) and while those from the other 67 countries ranged from N1-30. Out of these, 221 (50%) were female, the majority (569) were in the 26-35 years category, followed by (199) in 36-45 years. The participants encompassed 156 (359) consultants, 97 (229) nurses and the rest were residents/fellows in training, auxiliary/ staff, advanced registered nurse practitioners (ARNP), physician assistants (PA), researcher and others. The vast majority (739) reported facing violence within the past year; Verbal (63%) and physical (3996) were the most commonly reported. Total 126 (28.3%) reported that patient and/or family member as the type of aggressor they/ their colleague encountered most frequently. A majority (7596) reported that the incidence of violence has either stayed the same (39%) or increased (36%) during COVID-19 pandemic. Because of violent episodes, 48% felt less motivated/ had decreased job satisfaction; an additional 259 were willing to quit. Whie half of respondents wore familiar with Occupational Safety and Health standards, only 20% felt prepared to handle aggressive situation. CONCLUSIONS: In this global cross-sectional survey, a majority of HCWs reported to have faced violence. They felt that it either increased or stayed the same during the COVID-19 pandemic. It has led to decreased job satisfaction. Majority of those, who responded, felt unprepared to handle the violence.

[This is an excerpt.] Health plans insist that PA is needed to eliminate unnecessary treatment and keep health care affordable. However, physicians report that PA can lead to overall increased health care resource utilization and can negatively impact patients’ productivity at work. Which begs the question: is PA really a “bargain”? [To read more, click View Resource.]

[This is an excerpt.] For the past decade, the CAQH Index has been a unique and important resource for government and industry decisionmakers, researchers and the media. By tracking automation along the healthcare administrative workflow and identifying opportunities for improvement, report findings have enabled health plans, providers, government, and vendor organizations to benchmark progress and set a course for greater efficiency and cost savings. Given the importance of the Index and the commitment to increasing automation, medical health plans representing204 million members, 60 percent of covered lives, now contribute data to the research. [To read more, click View Resource.]

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

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[This is an excerpt.] Prior authorization (PA) is a health plan cost-control process that requires health care professionals to obtain advance approval from the health plan before a prescription medication or medical service qualifies for payment and can be delivered to the patient.While health plans and benefit managers contend PA programs are necessary to control costs, physicians and other providers find these programs to be time-consuming barriers to the delivery of necessary treatment.To assess the ongoing impact the PA process has on patients, physicians, employers and overall health care spending, the American Medical Association (AMA) annually conducts a nationwide survey of 1,000 practicing physicians (400 primary care/600 specialists) from a wide range of practice settings. As this year’s findings demonstrate, the PA process continues to have a devastating effect on patient outcomes, physician burnout and employee productivity. In addition to negatively impacting care delivery and frustrating physicians, PA is also leading to unnecessary spending (e.g., additional office visits, unanticipated hospital stays and patients regularly paying out-of-pocket for care). [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Reduce Administrative Burden).

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Recruiting and retaining quality staff remains the top healthcare issue. Last year, hospitals were able to recapture 5.65% of the talent lost during the “Great Resignation”, essentially adding 975,000 employees back to the rolls. Of this, 142,375 RNs returned which represents a 4.17% RN add rate. This slower rate begs the question, why are nurses hesitant to return? Although welcome news, the labor gap remains prevalent and hospital turnover continues to be elevated. Nationally, the hospital turnover rate stands at 22.7%, a 3.2% decrease from 2021, and RN turnover is recorded at 22.5%, a 4.6% decrease. Registered Nurses working in surgical services, pediatrics and women’s health recorded the lowest turnover rate, while nurses working in telemetry, step down and medical/surgical services experienced the highest. The cost of turnover can have a profound impact on diminishing hospital margins and needs to be managed. According to the survey, the average cost of turnover for a bedside RN is $52,350, a 13.5% increase, resulting in the average hospital losing between $6.6m – $10.5m. Each percent change in RN turnover will cost/save the average hospital an additional $380,600/yr. The RN vacancy rate remains critical and is 15.7% nationally. While 1.3% lower than last year, over seventy-five percent (75.4%) reported a vacancy rate in excess of ten percent. The RNRecruitment Difficulty Index jumped an extra eight (8) days to an average of 95 days. In essence, it takes over 3 months to recruit an experienced RN, with med/surg presenting the greatest challenge. Feeling the financial stress, hospitals are looking to decrease reliance on supplemental staffing. The greatest potential to offset margin compression is in the top budget line item (labor expense). Every RN hired saves $157,000. An NSI contract to replace 20 travel nurses could save your institution $3,140,000.

[This is an excerpt.] The more than 3,500 nurses who took part in the American Nurse Journal’s seventh annual Trends and Salary Survey helped paint a slightly more hopeful portrait of nursing in 2023 with regard to turnover rates, higher salaries, and personal safety. However, challenges still exist. For example, although a smaller percentage of nurse managers report more open positions in the past 12 months, they told us that recruiting to fill those vacancies has been harder this year than last. And most nurse managers say turnover increased in the past 12 months, though at a lower percentage than in 2022. [To read more, click View Resource.]

[This is an excerpt.] In October 2022, U.S. Surgeon General Vivek Murthy, MD, released the office’s first-ever Surgeon General’s Framework for Workplace Mental Health and Well-Being. The results of APA’s 2023 Work in America Survey confirmed that psychological well-being is a very high priority for workers themselves. Specifically:

• 92% of workers said it is very (57%) or somewhat (35%) important to them to work for an organization that values their emotional and psychological well-being.
• 92% said it is very (52%) or somewhat (40%) important to them to work for an organization that provides support for employee mental health.
• 95% said it is very (66%) or somewhat (29%) important to them to feel respected at work.
• 95% said it is very (61%) or somewhat (34%) important to them to work for an organization that respects the boundaries between work and nonwork time.

Fortunately, the majority (77%) of workers reported being very (36%) or somewhat (41%) satisfied with the support for mental health and well-being they receive from their employers, and more than half (59%) strongly (22%) or somewhat (37%) agreed that their employer regularly provides information about available mental health resources. Further, 72% of workers strongly (30%) or somewhat (42%) agreed that their employer helps employees develop and maintain a healthy lifestyle. [To read more, click View Resource.]

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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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