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PROBLEM DEFINITION: Moral distress (MoD) is a vital clinical indicator linked to clinician burnout and provider concerns about declining patient care quality. Yet it is not routinely assessed. Earlier, real-time recognition may better target interventions aimed at alleviating MoD and thereby increase provider well-being and improve patient care quality. INITIAL APPROACH AND TESTING: Combining two validated MoD instruments (the Moral Distress Thermometer [MDT] and the Measure of Moral Distress for Healthcare Professionals [MMD-HP]), the authors developed a novel mobile and Web-based application environment to measure and report levels MoD and their associated causes. This app was tested for basic feasibility and acceptability in two groups: graduate nursing students and practicing critical care nurses. RESULTS: The MDT app appears feasible and acceptable for future use. All participants (n = 34) indicated the MDT app was satisfying to use, and 91.2% (n = 31) indicated the app was "very appropriate" for measuring MoD. In addition, 84.2% (n =16) of practicing nurses indicated the app fit either "somewhat well" (47.4%, n = 9) or "very well" (36.8%, n = 7) into their typical workday, and 68.4% (n = 13) said they were either "extremely likely" or "somewhat likely" to use the app daily in clinical practice. KEY INSIGHTS AND NEXT STEPS: Education about moral distress and its associated causes proved important to the MDT app's success. It is ready for future validity and reliability testing, as well as examining usability beyond nursing, longitudinal data monitoring, and possible leveraging to pre- and postintervention evaluation studies.

[This is an excerpt.] We were pleased to read the article by Davis et al examining the association between burnout and professional milestone attainment for family medicine resident physicians.1 We were very surprised by the finding that, in their study of over 2500 family medicine residents, Black, Latinx, and Asian family medicine residents experience burnout at lower rates than their White peers. It defies logic that residents who identify as Black, Indigenous, or a Person of Color (BIPOC) experience lower levels of burnout when they are differentially and systematically burdened by experiences of discrimination, microaggressions, and inequitable access to mentorship and structured opportunity and lack of belonging compared to their non-BIPOC colleagues.2- 4 In the discussion, the authors did not have room to explore why burnout trends show the opposite of what we would expect to see. We offer the following insights as to why these findings might be valid, and we would welcome discussion from the authors on this finding. [To read more, click View Resource.]

BACKGROUND: Vaccination is an important component of the public health response to the pandemic, and a large health care system such as UCLA Health must optimize mechanisms to address questions from patients to expedite vaccine acceptance and administration. Local Problem In 2020-2021, COVID-19 vaccines were developed, studied, and approved at unusual speed, leading to both vaccine hesitancy and requests for urgent availability. This required up-to-date responses from physicians to questions through the online patient portal in the UCLA health care system. There was the additional risk of physician burnout due to the large number of questions. INTERVENTION: We developed a physician strike team that enabled accurate and timely dissemination of vaccine information in response to patient queries. The strike team served a dual purpose of answering patient questions quickly with accurate information, and reducing the workload for other physicians. Using a strike team of 10 early career physicians responding to a collection of patient messages, this large community-based health system was able to provide timely, high-quality responses to COVID-19 vaccine-related questions. RESULTS: After the introduction of the physician strike team program in late January 2021 through April 2021, there was a significant reduction in the average number of messages and calls received by covered providers per month compared to the adjusted number of messages and calls they would have received had the pool not existed. The strike team provided a service with high satisfaction scores from both the participating strike team members and the physicians being covered by the strike team. CONCLUSIONS: The success of this small physician strike team to impact inbasket patient messages and calls in our institution suggests that a similar mechanism can be developed to centralize the replies to certain messages, which may reduce the workload and burnout of physicians.

PURPOSE: Rates of burnout are high during medical training including psychiatric residency. This study examined the impact of improvisational theater training on psychiatry residents’ experiences of burnout and on several outcomes associated with improv training: tolerance of uncertainty, playfulness, and self-compassion. METHODS: Fourteen psychiatry residents with minimal background in improvisational theater participated either in an improv (N = 9) or comparison group (N = 5). The improv group met weekly in 2020 for four weeks in person and two additional weeks online. Surveys were administered before the program, after the first four weeks, and following the complete program. RESULTS: Nine residents participated in the improv program. Eight completed all follow up surveys (100%) as did all five non-participants (100%). Initial results indicated that improv contributed to residents’ self experienced well-being, either through reduced burnout or tolerance of uncertainty, increased playfulness, self-compassion, or some combination thereof. Residents reported that improv affected their work and life in general and that it differed substantially from other types of coursework in their psychiatric curriculum. CONCLUSIONS: This study, utilizing a relatively low-cost six-week program, suggests that improv can help psychiatry residents overcome burnout, increase tolerance of uncertainty, and enhance their playfulness, self- compassion, sense of joy, and connection to others.

RATIONALE AND OBJECTIVES: Few studies have examined what constitutes effective interventions to reduce burnout among radiologists. We compared self-reported burnout among academic medical center radiologists before and after a series of departmental initiatives intended to increase wellbeing and professional satisfaction. MATERIALS AND METHODS: This Institutional Review Board-approved, prospective study took place 2017-2019 in a tertiary academic medical center. In pre- (2017) and post-intervention (2019) periods, we administered the previously-validated Stanford Physician Wellness Survey to faculty in our 11-division radiology department. Faculty rated their burnout level across 8 domains (professional fulfillment, emotional exhaustion, interpersonal disengagement, sleep difficulties, self-compassion, negative work impact on personal relations, organizational/personal values alignment, perceived quality of supervisory leadership). Between the two surveys, departmental initiatives focusing on culture, team building, work-life balance, and personal well-being were implemented (e.g., electronic medical record training, shorter work hours). Pre- and post-survey results were compared, using Whitney-Mann U test to calculate Z scores. RESULTS: Faculty members rated lower professional fulfillment (Z-3.04, p=0.002), higher emotional exhaustion (Z=2.52, p=0.012), increased sleep-related impairment (Z=2.38, p=0.012), and reduced organizational/personal values alignment (Z=-4.10, p<0.0001) between the two surveys. No significant differences were identified associated with interpersonal disengagement (Z=1.82, p=0.069), self-compassion (Z=1.39, p=0.164), negative impact of work on personal relationship (Z=0.89, p=0.372) and perceived supervisory leadership quality (Z=0.07, p=0.942). CONCLUSION: Despite numerous departmental initiatives intended to improve culture, workplace efficiency, work-life balance, and personal wellness, self-reported burnout was unchanged or worsened over time.Physician and employee wellness embedded into institutional culture maybe more effective than departmental improvement initiatives.

BACKGROUND: The purpose of this work was to describe the experiences of EMS personnel in responding to drug overdose-related calls and the impact the pandemic has had to help better inform current response and treatment efforts. METHODS: Semi-structured interviews were conducted with 99 EMS personnel across 18 areas throughout the United States that were designated as Early Warning Network sentinel sites by the National Institute on Drug Abuse-funded National Drug Early Warning System. Participants were asked about topics including the potential burdens from the pandemic and the opioid crisis. We coded the interview responses and identifed themes through qualitative analysis. Multiple cycles of descriptive coding, recoding, subcoding, pattern-coding, and thematic coding of responses were conducted. RESULTS: Responses were categorized into the following themes: 1) being over-worked from increased call volume; 2) increased risk for personal harm when responding to patients; 3) compassion fatigue due to long hours and repeat calls for the same people; 4) conflicting perceptions of the utility of naloxone; 5) the need for better treatment options to respond to opioid crisis on top of COVID-19. CONCLUSIONS: The burden of the substance use disorder (SUD) crisis on EMS personnel has been compounded by the COVID-19 pandemic. These reports from EMS personnel throughout the US can help inform policy and procedures to better protect the mental health of EMS personnel and to ensure better care for patients with SUD. These experiences and recommendations may be of use for other countries as substance use and COVID-19 are global health issues.

OBJECTIVE: The primary objective of this qualitative study was to describe key themes discussed by student pharmacists and preceptors related to recognizing burnout and maintaining wellbeing during an experiential assignment. METHODS: This qualitative study used directed content analysis to examine themes that emerged from discussions between student pharmacists and preceptors as part of a required lifelong learning interview during Introductory Pharmacy Practice Experiences that took place between August 2019 and May 2020. Iterative axial coding was used to develop and redefine codes systematically until consensus was reached and a final codebook was established. All responses were coded using the consensus categories. RESULTS: From the 228 interviews analyzed, 3 overarching themes emerged: causes of burnout, manifestations or symptoms of burnout, and strategies to manage stress and burnout. Preceptors identified the mechanics of the job and feeling extreme pressure or worry as 2 major causes of burnout, which manifest as physical exhaustion, mental exhaustion, and poor work performance. To manage stress, preceptors reported using personal and work-positive coping strategies. CONCLUSION: The major themes derived from the analysis—causes of burnout, manifestations of burnout, and strategies to manage stress—align with what is already known about health care provider wellbeing. Although it remains unknown if this type of wellness intervention is effective at changing student stress management habits, results indicate that the intervention sparked conversations that could assist students in establishing a baseline of knowledge on the topic and supply students with a toolkit of resiliency strategies.

During recent years, police have suffered from job dissatisfaction, exhaustion, stress, and burnout; this issue has led to shortages of sworn police across the country. A high percentage of police officers leave the job in the first 5 years of service. A goal of this study was to discover how police investigators build resiliency to those challenging factors so that the individual can remain resilient despite exposure to adverse incidents and conditions that lead to severe stress and burnout. A generic qualitative method was used so that police investigators could share their lived experiences during their interviews and describe their beliefs, reflections, and opinions about their exposure to adversities on the job, and how they built resilience to those experiences. The target population for this study was police investigators who had more years of experience on the job than the less experienced sworn police members who were reportedly quitting the job from job-related dissatisfaction and burnout. The sample consisted of seven sworn police investigators from a small urban police department in the northeast region of the United States. I conducted semi-structured interviews of the seven participants, recorded the interviews using a Sony digital voice recorder, and used Descript transcription software to transcribe the audio recorded interviews to text. A thematic analysis approach was taken to find repeating patterns to identify five common themes from the collected data. These emerging themes were: (a) alcohol consumption used as a temporary coping strategy; (b) setting emotions aside; (c) family and nonlaw enforcement friends were perceived as not understanding: (d) exercise used as self-care method of effective coping; and (e) talking and venting to fellow law enforcement members as an effective coping method. During the interviews, the participants discussed several critical adverse incidents and conditions that caused stress and hardship for them. Through those shared experiences, I learned from the participants how they coped with those adversities and what helped them build resiliency.

Pharmacy residents are especially vulnerable to burnout given the professional and personal stressors associated with postgraduate training. Residency programs need to prioritize burnout reduction strategies to support resident health and well-being. This commentary describes a resident-preceptor collaborative approach to encourage wellness and reduce burnout within a large residency program at an academic medical center. Strategies that have been utilized include (1) fostering collaboration among residents and preceptors; (2) assessing resident interests and needs to ensure alignment; (3) leveraging available institutional and community resources; and (4) integrating initiatives within the existing residency program structure. This commentary aims to provide suggestions that can be implemented to address resident burnout for other residency programs, regardless of resource availability.

Training and practicing physicians continue to experience burnout, poor job satisfaction / engagement, high stress, and even depression and suicide. With an understanding of effective and ineffective methods to improve wellness, our team aimed to collect publications with data on the effectiveness of physical activity interventions to address burnout and well-being in physicians. Comprehensive searches for articles related to the impact of exercise on physicians’ well-being were undertaken in March 2022 in PubMed, PsycINFO, and EMBASE. Of 2496 records identified in the databases, the team screened 1,287 and finalized 12 papers for inclusion and review. This study reviews the overall positive benefits of physical activity and exercise interventions in physicians. Despite the wide-ranging utility of an exercise prescription and despite clear evidence that physicians' personal exercise habits affect their patient counseling about exercise, this review shows that (often overburdened) physicians have insufficient physical activity, and are rarely included in studies targeting exercise. Many of the included studies had small sample sizes, leaving possibilities for future research aiming to augment physician wellness.

BACKGROUND: Burnout is a growing problem among medical professionals, reaching a crisis proportion. It is defined by emotional exhaustion, cynicism, and career dissatisfaction and is triggered by a mismatch between the values of the person and the demands of the workplace. Burnout has not previously been examined thoroughly in the Neurocritical Care Society (NCS). The purpose of this study is to assess the prevalence, contributing factors, and potential interventions to reduce burnout within the NCS. METHODS: A cross-sectional study of burnout was conducted using a survey distributed to members of the NCS. The electronic survey included personal and professional characteristic questions and the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI). This validated measure assesses for emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). These subscales are scored as high, moderate, or low. Burnout (MBI) was defined as a high score in either EE or DP or a low score in PA. A Likert scale (0–6) was added to the MBI (which contained 22 questions) to provide summary data for the frequencies of each particular feeling. Categorical variables were compared using χ2 tests, and continuous variables were compared using t-tests. RESULTS: A total of 82% (204 of 248) of participants completed the entire questionnaire; 61% (124 of 204) were burned out by MBI criteria. A high score in EE was present in 46% (94 of 204), a high score in DP was present in 42% (85 of 204), and a low score in PA was present in 29% (60 of 204). The variables feeling burned out now, feeling burned out in the past, not having an effective/responsive supervisor, thinking about leaving one’s job due to burnout, and leaving one’s job due to burnout were significantly associated with burnout (MBI) (p < 0.05). Burnout (MBI) was also higher among respondents early in practice (currently training/post training 0–5 years) than among respondents post training 21 or more years. In addition, insufficient support staff contributed to burnout, whereas improved workplace autonomy was the most protective factor. CONCLUSIONS: Our study is the first to characterize burnout among a cross-section of physicians, pharmacists, nurses, and other practitioners in the NCS. A call to action and a genuine commitment by the hospital, organizational, local, and federal governmental leaders and society as a whole is essential to advocate for interventions to ameliorate burnout and care for our health care professionals.

INTRODUCTION: The personality traits of those who become orthopaedic surgeons may also lead to overwork, work-life balance issues, and burnout. Health and wellness practices of orthopaedic surgeons have not been widely explored. This study evaluated the personal health habits, wellness, and burnout of practicing orthopaedic surgeons in the United States. METHODS: An anonymous self-assessment survey was completed by 234 practicing orthopaedic surgeon alumni from two large residency programs. The survey assessed exercise habits according to Centers for Disease Control and Prevention recommendations, compliance with preventive medical care practices according to the United States Preventive Services Task Force, prioritization of occupational wellness strategies, and the presence of burnout via an adapted Maslach Burnout Inventory. Survey responders' mean age was 52 years, 88% were male, and 93% had a body mass index <30 kg/m2. Surgeons were stratified according to practice type, years in practice, and subspecialty. RESULTS: Among orthopaedic surgeons, compliance with aerobic and strength exercise recommendations was 31%. Surgeons in academic practice were significantly (P = 0.007) less compliant with exercise recommendations (18%) compared with private (34%) or employed (43%) practicing surgeons. Most (71%) had seen their primary care provider within 2 years and were up to date on age-appropriate health care screening including a cholesterol check within 5 years (79%), colonoscopy (89%), and mammogram (92%). Protecting time away from work for family/friends and finding meaning in work were the most important wellness strategies. The overall burnout rate was 15% and remained not significantly different (P > 0.3) regardless of years in practice, practice type, or subspecialty. CONCLUSION: This survey study identifies practicing orthopaedic surgeons' health habits and wellness strategies, including limited compliance with aerobic and strength exercise recommendations. Orthopaedic surgeons should be aware of areas of diminished personal wellness to improve quality of life and avoid burnout.

OBJECTIVE: This systematic review and meta-analysis aims to explore overall prevalence of burnout among physicians during early and late COVID-19 pandemic and geographical differences in burnout. METHODS: This review was registered prospectively with PROSPERO (CRD42022327959). A comprehensive search of several databases, including Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, PsycINFO, and Scopus, spanning from December 2019 to May 2022 was conducted. Eligible studies included physicians or medical professionals including physicians that worked directly or indirectly with COVID-19 patients, whilst reporting burnout outcomes using a validated scale. Literature that did not include physicians or did not occur in a hospital setting were excluded. Literature including medical students were also excluded. RESULTS: Forty-five observational studies were included, all of which were cross-sectional studies. The pooled estimate of overall prevalence of burnout was 54.60% (95% CI: 46.7, 62.2). Mean emotional exhaustion, depersonalization, and personal accomplishment was found to be 22.06% (95% CI: 18.19, 25.94), 8.72 (95% CI: 6.48, 10.95) and 31.18 (95% CI: 27.33, 35.03) respectively. Frontline workers displayed higher rates of burnout than second-line healthcare workers (HCW) (OR: 1.64, 95% CI: 1.13, 2.37). Studies from the early pandemic period reported burnout prevalence of 60.7% (95% CI: 48.2, 72) compared to a prevalence of 49.3% (95% CI: 37.7, 60.9) from the late pandemic period. Geographically, burnout was highest amongst Middle East and North Africa (MENA) studies (66.6%, 95% CI: 54.7, 78.5), followed by Europe (48.8%, 95% CI: 40.3, 57.3) and then South America (42%, 95% CI: –0.4, 84.4). Lastly, burnout prevalence overall (OR = 0.77, 95% CI: 0.36, 1.67) emotional exhaustion (MD = –0.36, 95% CI: –4.64, 3.91), depersonalization (MD = –0.31, 95% CI: –1.80, 1.18), and personal accomplishment (MD = 0.55, 95% CI: –0.73, 1.83) were found comparable between physicians and nurses. CONCLUSION: COVID-19 has had significant consequences on HCW burnout. Further research is needed to examine early signs of burnout and to develop effective coping strategies.

BACKGROUND: Weighing implications of multiple intensive cancer-directed therapies over time, oncology nurses are more prone to intrinsic distress compared to nurses in non-oncologic settings. This vulnerability may give rise to moral distress. Yet, little is known about moral distress experiences of oncology nurses. OBJECTIVE: This systematic review and meta-analysis examined the frequency and intensity of moral distress among oncology nurses with an exploratory focus on nurse-level and work-related characteristics. METHODS: We conducted a systematic search of 7 electronic databases (2000–2020) supplemented by hand-search strategy. Means and standard deviations of moral distress scores in the included studies were extracted and pooled in our meta-analysis. RESULTS: Our sample of 8 cross-sectional studies consisting of 2686 participants with 1654 oncology nurses met criteria for inclusion. A random-effects model was used in our meta-analysis given considerable heterogeneity. Our results suggest that moral distress was of low to moderate frequency, but of high intensity. Moral distress among oncology nurses was a significant predictor for burnout, provider communication, decisions surrounding end-of-life care, work conditions (eg, patient assignment, type of unit), and inability to provide compassionate care. CONCLUSION: Moral distress in oncology nurses is associated with burnout syndrome, compassion fatigue, and secondary traumatic stress syndrome, all of which are linked to poor patient care and outcomes. Robust psychological well-being is critical in minimizing unintended consequences of moral distress. IMPLICATIONS FOR PRACTICE: Oncology nurses are at high risk for moral distress due to the nature of their work. Future studies should examine the prevalence among oncology nurses to help inform targeted interventions.

Ambulance services are changing, and the SARS-CoV-2 pandemic has been a major challenge in the past three years. Job satisfaction and work engagement are important characteristics for a healthy organization and success in one’s profession. The purpose of the current systematic review was to evaluate the predictors of job satisfaction and work engagement in prehospital emergency medical service personnel. Electronic databases, such as PubMed, Ovid Medline, Cochrane Library, Scopus, Web of Science, PsycINFO, PSYNDEX, and Embase, were utilized in this review. Predictors (ß coefficient, odds ratio, rho) of higher job satisfaction and work engagement were examined. Only prehospital emergency medical service personnel were considered. The review included 10 studies worldwide with 8358 prehospital emergency medical service personnel (24.9% female). The main predictor for job satisfaction was supervisors’ support. Other predictors were younger or middle age and work experience. Emotional exhaustion and depersonalization, as burnout dimensions, were negative predictors for higher job satisfaction or work engagement. Quality demands for health care systems are a significant challenge for future emergency medical services. The psychological and physical strengthening of employees is necessary and includes constant supervision of managers or facilitators.

This systematic review investigates the association between coping strategies and burnout in emergency workers. Three electronic databases were searched. Eleven eligible articles were extracted, and quality assessed. Findings were integrated through narrative synthesis, highlighting clear methodological issues around conceptualizing, and measuring coping strategies and burnout with agreed upon tools. This review found no convincing evidence to suggest coping strategies have a meaningful relationship with burnout in emergency workers, questioning the evidence base for psychological interventions focusing on modifying coping strategies to target burnout. To understand the true impact of coping strategies on burnout, more longitudinal designs, and an agreed, validated measure for coping is needed.

From a philosophical standpoint, it is unclear precisely what medical gaslighting is, how it presents, its conditions for success, and how it is differentiated from the more popular interpersonal interpretation of gaslighting. My project aims to remedy this lacuna by developing an account of medical gaslighting as distinguished from that in strictly interpersonal relationships. My approach consists of first exploring the importance of developing a philosophical account of medical gaslighting and providing five criteria that a sufficient account must meet. I then analyze and appraise two accounts of ordinary gaslighting by Kate Abramson and Carla Bagnoli and argue that neither account accurately explains the features and characteristics of medical gaslighting. Further, I describe the key characteristics and identifiable features that make up my account of medical gaslighting. I also address the moral implications of medical gaslighting and argue that it involves two distinct moral harms: the primary moral harm undermines a patient's agency, and the secondary moral harm causes moral injury to doctors. Finally, I call for institutional reform by discussing the policy implications resulting from developing an accounting of medical gaslighting. By developing and identifying the specific nature of medical gaslighting, we will be better equipped to understand patients' experiences and aim toward better quality care.

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

ANA underscores the urgency for Congressional leaders and the Centers for Medicare Medicaid Services to advance efforts to implement safe staffing standards, including minimum nurse-to-patient ratios.

The American Organization for Nursing Leadership (AONL) led a nationwide strategic initiative during 2022 to cull best practices and strategies for nurse leaders. Two key objectives were targeted: 1) to gain keen insights from nurse leaders through 2 nationwide surveys; and 2) to collect practice-led initiatives, which often are not included in searchable peer-reviewed literature. These practices were gathered in a compendium, organized into 7 sections, which is now available on the AONL website at aonl.org/compendium.