The Chief Wellness Officer: A long overdue catalyst for systemic change in Emergency Medicine

Toward better prevention of physician burnout: insights from individual participant data using the MD-specific Occupational Stressor Index and organizational interventions

Background

Physician burnout has become a public-health crisis. The need is dire for robust organizational solutions, focusing on reduction of specific stressors. The physician-specific Occupational Stressor Index (OSI) based on cognitive ergonomics can help. Individual-participant data (IPD) from different studies addressing physician burnout are lacking.

Aims

To perform IPD analysis regarding job stressors and their relation to physician burnout and to utilize the IPD results to inform a systematic review of the stressors that show an association with physician burnout, focusing on intervention studies.

Methods

PRISMA guidelines are followed for the IPD analysis and systematic review of intervention studies on the implicated stressors, taking the COVID-19 pandemic into consideration. The IPD analysis is performed on studies using the physician-specific OSI vis-à-vis burnout assessed by the Copenhagen Burnout Inventory (CBI). Odds ratios (OR) ± 95% confidence-intervals (CI) are reported, adjusting for age, gender and caring for patients with suspected COVID-19 infection.

Results

Three studies fulfilled the inclusion criteria, providing complete IPD data for 95 physicians. Thirty-two (33.7%) physicians had total OSI scores >88, for which intervention is urgently needed. Unit-change in the total stressor burden assessed via OSI yielded OR = 1.11 (95%CI: 1.03-1.18) (p = 0.003) for personal burnout, OR = 1.17 (95%CI: 1.08-1.26) (p = 0.0001) for work-related burnout and OR = 1.07 (95%CI: 1.01-1.15) (p = 0.03) for patient-related burnout. Caring for patients with suspected COVID-19 infection showed significant multivariable results (p = 0.04) only for personal burnout. Twenty distinct work stressors revealed multivariable associations with CBI. Systematic examination via PUBMED, CINAHL and OVID Medline yielded 33 publications mitigating those stressors among physicians. Adequate staffing was pivotal. Clerical staff off-loaded administrative burden. Information-technology staff helped diminish interruptions, enhancing workflow. Cross-coverage reduced time constraints, ensured separate periods for non-clinical tasks, and ≥1 work-free day/week. Several interventions impacted physician burnout, as did recognition of physicians' efforts/achievements. Other OSI-identified stressors were insufficiently examined in intervention studies: e.g. vacation; appropriately-timed, cross-covered restbreaks; and counter-measures for emotionally-disturbing aspects of MD's work, particularly during the pandemic.

Conclusions

Further participatory-action research is needed in well-controlled intervention trials to alleviate physician burnout.

A measure of wellness among nursing faculty

BACKGROUND

Nurse faculty play a critical role in sustaining the nursing workforce and meeting the nation's healthcare needs. Given the ongoing concerns about faculty supply, ensuring the well-being of nurse educators is critical concern for academic institutions and the larger nursing profession.

PURPOSE

This study was conducted to assess the level of well-being among nursing faculty in undergraduate and graduate programs.

METHODS

A descriptive cross-sectional research design was employed to examine the level of well-being of nursing faculty. An internet-based survey was administered to faculty in over 1000 schools of nursing in the United States. Well-being was measured using the 100 Million Healthier Lives instrument.

RESULTS

A total of 3489 nursing faculty completed the survey. Among all participants, over 40 % (n = 1532) of the faculty reported that they were struggling or suffering in relation to current and future life evaluation. When faculty ranks were compared for most all variables full professors reported a higher mean score as compared to the more junior faculty and lecturers/instructors.

CONCLUSIONS

The effects of the COVID-19 pandemic have heightened our awareness of the importance of nurse well-being. Creating a culture of wellness in an academic institution will allow faculty, staff, and students to excel in a healthy working and learning environment.