A national study of personal accomplishment, burnout, and satisfaction with work-life integration among advance practice nurses relative to other workers

A highly effective mindfulness intervention for burnout prevention and resiliency building in nurses

Objectives

Healthcare workers, most notably nursing professionals, face high levels of recurrent stress that lead to symptoms of burnout and other negative mental health outcomes. This indicates the need for greater individual and organizational health system support, including implementation of effective, evidence-based interventions for burnout reduction in this population. Organizationally supported mindfulness-based interventions can be used to build individual resilience, buffering the detrimental effects of occupational stress and enhance professional well-being. Our aim was to evaluate the effect of an evidence-based mindfulness intervention on perceived stress, burnout, resilience, and work engagement in nursing professionals.

Methods

A non-randomized single arm, pre/post design was used for this study. Healthcare workers (n = 631), including Registered Nurses and Advanced Practice Nurses (n = 128), physicians (n = 105), social workers (n = 21), pharmacists (n = 8), chaplains (n = 30), physician and occupational therapists (n = 39), patient care assistants (n = 13), other clinical staff (n = 26), non-clinical staff (n = 229), and 32 others participated in Mindfulness in Motion, an 8-week evidence-based worksite mindfulness intervention. Validated self-report measures assessing burnout (Maslach Burnout Inventory), perceived stress (Perceived Stress Scale), resilience (Connor Davidson Resiliency Scale), and work engagement (Utrecht Work Engagement Score) were given pre and post program. Total burnout was determined by scores on the subscales of emotional exhaustion, depersonalization, and personal accomplishment of the Maslach Burnout Inventory: Emotional exhaustion >27 or depersonalization >13 or personal accomplishment <31.

Results

Significant reductions in burnout (p < 0.00001), perceived stress (p < 0.00001), with significant increases in resilience (p < 0.00001), and work engagement (p < 0.00001) were observed among Registered and Advanced Practice Nurses comparing pre-post measures. Notably, the number of nursing professionals who no longer qualified as burned out was 10% higher than the other participants.

Conclusion

Our results suggest that nursing professionals could greatly benefit from organizationally supported mindfulness-based interventions such as Mindfulness in Motion and may benefit them most compared to other health system employees.

Full practice authority and burnout among primary care nurse practitioners

BACKGROUND

Full practice authority (FPA) improves clinical autonomy for nurse practitioners (NPs). Autonomy may reduce burnout.

PURPOSE

Estimate the effect of changing from reduced or restricted practice authority to FPA on NP burnout.

METHODS

In this quasi-experimental study, we compared NP burnout before (2016) and after (2018) a Veterans Health Administration (VHA) regulation authorized NP FPA. Burnout proportions were estimated for VHA facilities by aggregating responses to the VHA's All Employee Survey from 1,352 primary care NPs.

DISCUSSION

Seventy-seven percent of facilities changed to FPA postregulation. Burnout was six points lower among NPs in facilities that changed to FPA compared to facilities that had FPA prior to the regulation; however, this association was not statistically significant.

CONCLUSION

NPs are increasingly working under independent practice. While changing to FPA did not reduce NP burnout, this association may vary by health care setting or when burnout is measured for individuals or teams.

Joy in the Workplace: The Mayo Clinic Experience

The COVID-19 pandemic has changed dynamics in the healthcare setting, through social distancing guidelines and new protocols to promote safety for employees and patients. Although some find themselves more productive in this spread out or virtual environment, the social aspect of the work day has dramatically changed. Staying connected during the day or week comes with additional efforts to seek out opportunities to network and collaborate with colleagues with this work environment shift. Healthcare workers are already at high risk of occupational burnout. In addition, the COVID-19 pandemic has brought additional stressors to individuals outside of their workload compromising a balanced work-life integration. Consequently, personal well-being may become jeopardized due to physical, mental, and social constraints brought on by the pandemic. Mayo Clinic has implemented a joy in the workplace structure to support individual well-being and create space for healthcare workers to be energized in order to put the needs of the patient first and deliver excellent care. Joy at Mayo Clinic contributes to joy in the workplace, reduced burnout, and personal well-being.

A Movement to Redefine our Relationship With Work

The Great Resignation ushered in a new world of work and fostered the growth of Quiet Quitting. Employers stand at a crossroads: Meet this moment head-on or risk losing the best and brightest. How we address this new dynamic will influence the way we work for years to come.

Well-being in the Workplace: A Book Club Among Health Care Workers During the COVID-19 Pandemic

INTRODUCTION/OBJECTIVES

A culture of joy in the workplace supports well-being, but less is known about the effect of a shared experience on well-being and burnout in a health care setting. This pilot study investigated personal well-being and occupational burnout among primary care staff who participated in a 3-month virtual book club.

METHODS

In December 2021, health care workers from a primary care practice were invited to participate in a 3-month virtual book club. Participants were emailed a preintervention survey with questions regarding well-being and burnout, the pandemic's influence on emotional health, and demographic information. The book club met virtually every month from January 2022 through March 2022. After the March 2022 book club meeting, a paired postintervention survey was sent to participants with additional questions regarding their participation in the book club. Well-being and burnout were measured with the 11-point Well-Being Index, and the pandemic's influence on emotional health was assessed with the 64-point Pandemic Emotional Impact Scale.

RESULTS

Of 12 book club participants, 9 participants (6 physicians and 3 nurses) completed surveys before and after the intervention. Postintervention improvement in the median score of the Pandemic Emotional Impact Scale was significant (7 points, P = .04). Although Well-Being Index results uniformly favored improved well-being after book club participation, the median improvement of 1 point was not significant (P = .69).

CONCLUSIONS

Social connection through a virtual workplace activity such as a book club may contribute to well-being and may decrease occupational burnout.

Organization-Wide Approaches to Foster Effective Unit-Level Efforts to Improve Clinician Well-Being

Health care delivery organizations are positioned to have a tremendous impact on addressing the variables in the practice environment that contribute to occupational distress and that, when optimized, can promote clinician well-being. Many organizations are committed to this work and have clarity on how to address general, system-wide issues and provide resources for individual clinicians. While such top of the organization elements are essential for success, many of the specific improvement efforts that are necessary must address local challenges at the work unit level (department, division, hospital ward, clinic). Uncertainty of how to address variability and the unique needs of different work units is a barrier to effective action for many health care delivery systems. Overcoming this challenge requires organizations to recognize that unit-specific improvement efforts require a system-level approach. In this manuscript, we outline 7 steps for organizations to consider as they establish the infrastructure to improve professional well-being and provide a description of application and evidence of efficacy from a large academic medical center. Such unit-level efforts to address the unique needs of each specialty and occupation at the work unit level have the ability to address many of the day-to-day issues that drive clinician well-being. An enterprise approach is necessary to systematically advance such unit-level action.

Assessing Professional Fulfillment and Burnout Among CEOs and Other Healthcare Administrative Leaders in the United States

GOAL

The objective of this study was to evaluate the prevalence of burnout and professional fulfillment among healthcare administrative leaders and examine the association between burnout and professional fulfillment and personal and professional characteristics.

METHODS

Between June 7 and June 30, 2021, we performed a national survey of CEOs and other senior operational leaders to evaluate their personal work experience. Burnout and professional fulfillment-as well as a sleep-related impairment and self-valuation-were assessed using standardized instruments.

PRINCIPLE FINDINGS

Of the 5,994 members of the American College of Healthcare Executives who were sent an invitation to participate, 1,269 (21.2%), including 279 CEOs, submitted usable responses. The mean overall burnout score was 2.71 (range: 0-10), and 33% of participants had burnout scores that fell in the high range (unfavorable). Mean professional fulfillment score was 7.29 (range: 0-10), with 56.6% scoring in the high range (favorable). Burnout and professional fulfillment scores varied by role. On multivariable analysis, sleep-related impairment (OR for each 1-point increase = 1.29, 95% CI [1.19-1.41]; p < .001) and self-valuation (OR for each 1-point increase = 0.63, 95% CI [0.57-0.68]; p < .001) were independently associated with burnout after adjusting for all other variables.

APPLICATIONS TO PRACTICE

Results of this study suggest that healthcare leaders had lower burnout and professional fulfillment scores than clinicians. Nonetheless, one third of healthcare leaders had burnout scores that fell in the high range. At the individual level, improved sleep health and self-valuation appear to reduce risk of burnout and promote professional fulfillment.

Investigating How Auditory and Visual Stimuli Promote Recovery After Stress With Potential Applications for Workplace Stress and Burnout: Protocol for a Randomized Trial

Background

Work-related stress is one of the top sources of stress amongst working adults. Relaxation rooms are one organizational strategy being used to reduce workplace stress. Amongst healthcare workers, relaxation rooms have been shown to improve perceived stress levels after 15 min of use. However, few studies have examined physiological and cognitive changes after stress, which may inform why relaxation rooms reduce perceived stress. Understanding the biological mechanisms governing why perceived stress improves when using a relaxation room could lead to more effective strategies to address workplace stress.

Objective

The purpose of this research study is to understand how physiological measures, cognitive performance, and perceived stress change after acute stress and whether certain sensory features of a relaxation room are more effective at promoting recovery from stress.

Methods

80 healthy adults will perform a stress induction task (Trier Social Stress Test, TSST) to evaluate how physiological and cognitive responses after stress are affected by sensory features of a relaxation room. After the stress induction task, participants will recover for 40 min in a MindBreaks™ relaxation room containing auditory and visual stimuli designed to promote relaxation. Participants will be randomized into four cohorts to experience auditory and visual stimuli; auditory stimuli; visual stimuli; or no stimuli in the room. Measures of heart rate and neural activity will be continuously monitored using wearable devices. Participants will perform working memory assessments and rate their perceived stress levels throughout the experiment. These measures will be compared before and after the stress induction task to determine how different sensory stimuli affect the rate at which individuals recover.

Results

Recruitment started in December 2021 and will continue until December 2022 or until enrollment is completed. Final data collection and subsequent analysis are anticipated by December 2022. We expect all trial results will be available by early 2023.

Discussion

Findings will provide data and information about which sensory features of a relaxation room are most effective at promoting recovery after acute stress. This information will be useful in determining how these features might be effective at creating individualized and organizational strategies for mitigating the effects of workplace stress.

Differences in psychosocial distress among rural and metropolitan health care workers during the COVID-19 pandemic

Objective

The Australian COVID‐19 Frontline Healthcare Workers study examined the prevalence and severity of mental health symptoms during the second wave of the COVID‐19 pandemic. This substudy examined the differences in psychological well‐being between rural and metropolitan health care workers (HCWs).

Design

A nationwide survey conducted between August and October 2020.

Setting and Participants

Australian HCWs were recruited through multiple strategies.

Main outcome measures

Demographics, mental health outcomes (anxiety, depression, post‐traumatic stress disorder [PTSD] and burnout).

Results

Complete responses were included from 7846 participants, with 1473 (18.8%) in regional or remote (‘rural’) areas and 81.2% in metropolitan areas. Rural participants were older, more likely to work in allied health, nursing or in health administration, and had worked longer in their profession than metropolitan participants. Levels of resilience were similar (p = 0.132), but there was significantly higher prevalence of pre‐COVID‐19 pandemic mental illness in the rural workforce (p < 0.001). There were high levels of current mental health issues: moderate–severe PTSD (rural 38.0%; metropolitan 41.0% p = 0.031); high depersonalisation (rural 18.1%; metropolitan 20.7% p = 0.047); and high emotional exhaustion (rural 46.5%; metropolitan 43.3% p = 0.002). Among rural participants, mental health symptoms were associated with younger age, worry about being blamed if they contracted COVID‐19, fear of transmitting COVID‐19 to their family, experiencing worsening relationships and working in primary care or allied health.

Conclusion

Despite having low COVID‐19 case numbers in rural Australian health services compared with metropolitan counterparts over the course of 2020, there were widespread mental health impacts on the workforce. Rural health services need specific and flexible training, education, work policies and practices that support psychological well‐being now in preparedness for ongoing or future crises.

Demographic Factors and Job Characteristics Associated With Burnout in Chinese Female Nurses During Controlled COVID-19 Period: A Cross-Sectional Study

Background: To investigate the prevalence of burnout syndrome among Chinese female nurses during the controlled coronavirus disease 2019 (COVID-19) period and explore its associated socio-demographic factors and job characteristics. Methods: With the multistage, stratified sampling method, a cross-sectional online survey was conducted from September to October 2020 in China. The survey tool included revised Maslach Burnout Inventory (MBI) with 15 items, socio-demographic and job characteristics. Univariate logistic regression analysis and multivariate factor logistic regression analysis were used to identify the risk factors for burnout of female nurses. Results: During controlled COVID-19 period in China, the overall prevalence of burnout symptoms among Chinese female nurses was 60.2% with a breakdown in severity as follows: 451 (39.8 %) mild, 163 (14.4%) moderate, and 68 (6.0%) severe burnout. Little variance was reported for burnout symptoms according to job tenure (Waldχ ² = 14.828, P < 0.05,odds ratio [OR] <1), monthly salary income (Waldχ ² = 12.460, P < 0.05, OR <1), and night shift (Waldχ ² = 3.821, P < 0.05, OR > 1). Conclusion: Burnout symptoms among Chinese female nurses were prevalent and associated with job tenure, monthly salary income, and night shift. Female nurses who were with shorter job tenure, worked at night shifts, and had lower monthly salaries tended to exhibit increasing high-level burnout than their counterparts. This study serves as an implication for administrators and policy-makers to improve the work conditions of nurses for promoting overall healthcare service quality.

Burnout Among Nephrologists in the United States: A Survey Study

Rationale & Objective

Burnout decreases job satisfaction and leads to poor patient outcomes but remains underinvestigated in nephrology. We explored the prevalence and determinants of burnout among a sample of nephrologists.

Study Design

Cross-sectional.

Setting & Participants

The nephrologists were approached via the American Medical Association Physicians Masterfile, National Kidney Foundation listserv, email, and social media between April and August 2019. The predictors were demographics and practice characteristics. The outcome was burnout, defined as responding “once a week” or more on either 1 of the 2 validated measures of emotional exhaustion and depersonalization or both.

Analytical Approach

Participant characteristics were tabulated. Responses were compared using χ² tests. Multivariable logistic regression was used to estimate the odds ratios (ORs) of burnout for risk factors. Free text responses were thematically analyzed.

Results

About half of 457 respondents were 40-59 years old (n=225; 49.2%), and the respondents were more predominantly men (n=296; 64.8%), US medical graduates (n=285; 62.4%), and in academic practice (n=286; 62.6%). Overall, 106 (23.2%) reported burnout. The most commonly reported primary drivers of burnout were the number of hours worked (n=27; 25.5%) and electronic health record requirements (n=26; 24.5%). Caring for ≤25 versus 26-75 patients per week (OR, 0.34; 95% confidence interval [95% CI], 0.15-0.77), practicing in academic versus nonacademic settings (OR, 0.33; 95% CI, 0.21-0.54), and spending time on other responsibilities versus patient care (OR, 0.32; 95% CI, 0.17-0.61) were each independently associated with nearly 70% lower odds of burnout after adjusting for age, sex, race, and international medical graduate status. The free text responses emphasized disinterested health care systems and dissatisfaction with remuneration as the drivers of burnout.

Limitations

Inability to precisely capture response rate.

Conclusions

Nearly one-quarter of the nephrologists in our sample reported burnout. Future studies should qualitatively investigate how the care setting, time spent on electronic medical records, and hours of clinical care drive burnout and explore other system-level drivers of burnout in nephrology.