Advanced Practice Provider Burnout in a Large Urban Medical Center

Advanced Practice Registered Nurse Burnout in Magnet Hospitals: Opportunities for Organizational Intervention

OBJECTIVE

To determine modifiable organizational factors associated with advanced practice RN (APRN) burnout in Magnet ® -designated hospitals to guide organizational interventions to improve APRN well-being and retention.

METHODS

Cross-sectional study of work environments of 50 US Magnet hospitals and the associated well-being of 21 855 of their clinicians (APRNs, physician assistants, physicians [MDs], RNs).

RESULTS

Overall, 37% of APRNs experienced high burnout compared with 34% of MDs ( P < 0.05) and 49% of RNs ( P < 0.001); additionally, 32% of APRNs intended to leave their jobs. APRN burnout was significantly lower in organizations that minimized chaotic working conditions, provided APRNs more control over their workloads, involved APRNs in shared governance, improved clinician and management relations, and improved interprofessional teamwork.

CONCLUSIONS

Well-being and retention of APRNs in Magnet hospitals require their greater engagement in organization processes and systems that improve work environments.

Determining Correlations Between Emergency Department Health Care Workers and their Associated Burnout and Post-Traumatic Stress Disorder Scores: A Pilot Study

INTRODUCTION

Health care workers experience settings that can contribute to burnout and post-traumatic stress disorder. Early identification of health care workers at risk for burnout/post-traumatic stress disorder may allow for quicker implementation of mitigation strategies despite limited research. This pilot study explores associations between burnout and post-traumatic stress disorder with demographic and occupational factors in health care workers.

METHODS

This quantitative, cross-sectional study on burnout and post-traumatic stress disorder was conducted at a single-site urban academic emergency department from 2022 to 2023. Health care workers were split into provider versus non-provider for confidentiality. Burnout and post-traumatic stress disorder were operationalized using the Oldenburg Burnout Inventory and Post-Traumatic Stress Disorder checklist.

RESULTS

In this cohort (n = 72), many identified as non-Hispanic white (54%) females (74%), and were non-providers (75%) who worked 32 to 40 hours/week (75%). Although not significant, non-providers reported higher disengagement (14.8% vs 0%, P = .19). Females had higher exhaustion (64.2% vs 57.9%, P = .63) while males had higher disengagement (15.8% vs 9.4%, P = .43). Participants <40 had higher disengagement and exhaustion (15.8% vs 5.9%, P = .27; 68.4% vs 55.9%, P = .27), while a previous depression diagnosis led to increased moderate-to-severe disengagement, exhaustion, and burnout (26.7% vs 6.9%, P = .05; 80.0% vs 56.9%, P = .14; and 53.3% vs 37.9%, P = .28, respectively).

DISCUSSION

Though these results are not statistically significant, we demonstrate important associations that are clinically relevant. Non-providers under 40 showed higher disengagement, which may be related to competing responsibilities, while depression increased burnout severity across all domains. Importantly, future research with increased samples will allow relevant sub-group comparisons (ie, nurses vs other non-providers) and continued exploration of factors that influence elevated burnout in health care workers.

Wellness and Stress Management Practices Among Healthcare Professionals and Health Professional Students

PURPOSE

Healthcare professionals experience stressors that begin during training and persist into their careers that adversely impact their well-being. This study aims to identify students' and professionals' stress levels, satisfaction with wellness domains, barriers to wellness, and stress management practices.

DESIGN

This study was a cross-sectional self-reported survey study.

SETTINGS AND SAMPLE

The study included students (N = 242) and professionals (N = 237) from medicine, nursing, pharmacy, physical therapy, social work, and counseling/psychology.

MEASURES

The Managing Health & Wellness in Health Professions Training and Practice survey was used to capture wellness practices and barriers among participants. Results: Students reported significantly higher perceived stress compared to professionals (P < 0.001). Total wellness is significantly higher among professionals compared to students (P < 0.001). A higher stress rate is significantly related to being female, having a lower wellness score, and facing more barriers (P < 0.001). Intellectual health is the most valuable wellness domain for providers (M = 3.71, SD = 0.9) and students (M = 3.43, SD = 0.85), followed by spiritual health for providers (M = 3.4, SD = 1.1), and work/learning environment for students (M = 3.33, SD = 0.93). Professionals and students are least satisfied with their physical and financial health. Barriers include fatigue, workload/productivity in clinical practice, work hours, and burnout.

CONCLUSIONS

Healthcare professionals exhibit a variety of stress management practices, encounter barriers, and prioritize different wellness domains. Healthcare systems should incorporate self-care education into their curricula and implement systemic changes to foster a thriving healthcare workforce.

Integration of a nurse practitioner and physician associate leadership structure within an academic cancer center

BACKGROUND

Nurse practitioners and physician associates are an essential part of the multidisciplinary cancer care team with expanding and evolving roles within cancer specialties.

LOCAL PROBLEM

As these clinicians flourish, a parallel need for leadership rises to optimize scope of practice, mentor, and retain this crucial workforce. The purpose of this quality improvement project was to development a nurse practitioner and physician associate leadership structure within an academic cancer center.

METHODS

Development of this nurse practitioner and physician associate leadership structure was guided by transformational leadership theory. In collaboration with nursing, business, and physician leadership, a quad structure was supported.

INTERVENTIONS

Implementation of a leadership structure included the establishment of eight team leaders and two managers. These leaders identified multiple opportunities for improvement including improved communications, offload of nonbillable work, development of incentive programs, provision of equipment, specialty practice alignment, hematology/oncology fellowship, and professional development.

RESULTS

Overall, a nurse practitioner and physician associate leadership structure allowed for representation across the cancer center. Such inclusion supported multiple quality improvement projects developed in partnership with nursing, business, and physician leaders. Cumulatively, these interventions yielded efficient workflows and expansion of services. Consistent with reported evidence, these efforts contributed to nurse practitioner and physician associate retention as well as improved job satisfaction.

CONCLUSIONS

Advanced practice leadership is essential to recruiting, developing, supporting, and retaining nurse practitioner and physician assistant colleagues in cancer care.

Provider moral distress in caring for tracheostomy and ventilator dependent children: A single institution cross-sectional evaluation

OBJECTIVE

To determine levels of moral distress in a pediatric unit caring for patients with tracheostomy/ventilator dependence.

HYPOTHESIS

Moral distress will be significant in a dedicated pediatric trach/vent unit.

METHODS

The Moral Distress Survey-Revised (MDS-R) is a 21-question survey measuring moral distress in pediatrics. The MDS-R was anonymously distributed to medical degree/doctor of osteopathy (MD/DOs), advanced practice practitioners (APPs), registered nurses (RNs), and respiratory therapists (RTs) in a unit caring for tracheostomy/ventilator dependent patients. Descriptive statistics, bivariate and multivariate analysis were performed.

RESULTS

Response rate was 48% (61/127). Mean MDS-R score was 83 (range 43-119), which is comparable to reported levels in the pediatric intensive care unit (ICU). APPs had the highest median rate of moral distress (112, interquartile range [IQR], 72-138), while MD/DOs had the lowest median score (49, IQR, 43-77). RNs and RTs had MDS-R scores between these two groups (medians of 91 and 84, respectively).

CONCLUSIONS

Moral distress levels in a unit caring for long term tracheostomy and ventilator dependent patients are high, comparable to levels in pediatric ICUs. APPs. APPs had higher levels of distress compared to other groups. This may be attributable to the constant stressors of being the primary provider for complex patients, especially in a high-volume inpatient setting.

Well-being and the early-career PA: Influence of the collaborative physician relationship

OBJECTIVE

Recent updates to physician associate/assistant (PA) laws reflect less mandated supervision. Although greater autonomy may inspire experienced PAs, newer PAs may struggle with less required oversight. This study examined the influence of autonomy, career length, and the quality of the collaborative physician (CP) relationship on PA well-being.

METHODS

A secondary analysis of data gathered in 2018 by the American Academy of Physician Associates was conducted using bivariate and multiple linear regression with moderated mediation.

RESULTS

Years of experience positively predicted PA well-being and negatively predicted the percentage of time spent consulting with a CP. The interaction of the percentage of time spent consulting with a CP and the quality of the CP relationship mediated the relationship between years of experience and well-being.

CONCLUSIONS

Findings demonstrate that the quality of the CP relationship is most salient to the well-being of early-career PAs who spend more time in consultation with CPs.

Evaluating the Effectiveness of BREATHE for Nurse Practitioners During COVID Pandemic

The current health care system incorporates multidimensional strategies of improving patients’ care experiences, promoting the health of populations, and reducing per capita cost of health care. These strategies include reducing readmission rates by keeping patients in the community and out of the skilled nursing facilities. Unfortunately, patients’ outcomes were severely threatened during the coronavirus disease 2019 pandemic due to staff burnout. This project evaluates the effectiveness of the BREATHE program on the perceived stress level of nurse practitioners during the coronavirus disease 2019 pandemic. Emotional exhaustion and depersonalization decreased 1 month after nurse practitioners completed the program.

Emergency Medicine Nurse Practitioner and Physician Assistant Burnout, Perceived Stress, and Utilization of Wellness Resources During 2020 in a Large Urban Medical Center

The objectives of this study were to measure perceived stress, burnout, and utilization and perceived benefit of wellness practices among emergency medicine (EM) nurse practitioners (NPs) and physician assistants (PAs). An additional aim was to evaluate attributions of stress to racism and the COVID-19 pandemic. A 28-item electronic survey of ED NPs/PAs at 3 hospitals was used to measure respondents' perceived stress (Perceived Stress Scale), stress attributed to COVID-19 and systemic racism, burnout (2-item measure), and utilization and helpfulness of wellness practices. The sample consisted of 53 ED NPs/PAs respondents (response rate 42.4%). More than one half (58.5%) reported burnout from their job, and a majority (58.5%) reported moderate to high stress. Burnout was reported by 70% of female respondents compared with 30.8% of male respondent (p = 0.002). A large majority (70%) of Black respondents reported concerns about experiencing racism at work, and 58.8% reported higher levels of stress attributed to racism. Respondents reported meals during shifts, community donated personal protective equipment, flexible work hours, and societal offerings of financial support (e.g., Internal Revenue Service stimulus check) as helpful. The COVID-19 pandemic and the impact of systemic racism are significant contributors to the stress and burnout of NPs/PAs. Female ED NPs/PAs disproportionally share the burden of burnout. Strategies to reduce burnout should be prioritized by institutional leadership. In addition, a majority of Black ED NPs/PAs are concerned about experiencing racism at work and report moderate to high stress associated with racism in general. There is an urgent need to address racism in the workplace with training on implicit bias, systemic racism, and allyship behavior.

Burnout and Emotional Intelligence in Neurosurgical Advanced Practice Providers Across the United States: A Cross-Sectional Analysis

OBJECTIVE

Although much research has examined nursing and physician burnout, the advanced practice provider (APP) population has not yet been studied. The goal of the present study was to survey APPs in neurosurgery to determine whether greater emotional intelligence (EI) is protective against burnout.

METHODS

An 80-item survey was created that incorporated the Maslach Burnout Inventory Human Services Survey for Medical Personnel, the Trait Emotional Intelligence Questionnaire-short form, and original questions developed by us. The collective survey was distributed, administered, and collected using the web-based REDCap (Research Electronic Data Capture) platform. Statistical analyses were completed using a comparison between participants with and without burnout.

RESULTS

A total of 106 neurosurgical APPs (26 men, 80 women) completed the survey, of whom, 57 (54%) reported current burnout. High average scores for personal accomplishment and global EI were inversely related to burnout (P = 0.034 and P = 0.003, respectively). In addition, the following factors were associated with burnout: inadequate support staff in the work place (P = 0.008), inadequate time off work (P < 0.001), inadequate administrative time (P = 0.009), not experiencing support from one's supervisor (P = 0.017), insufficient time for continuing medical education (P < 0.001), an inability to separate work from personal time (P < 0.001), and an inability to advance within one's professional field (P = 0.043).

CONCLUSIONS

For neurosurgical APPs, EI is protective against burnout. Many opportunities exist at the individual and organizational level to alleviate burnout among neurosurgical APPs. Targeted strategies to improve work-life balance, EI, support systems, and opportunities for career development among neurosurgical APPs might enhance employment satisfaction and reduce burnout.

Battling Burnout at the Frontlines of Health Care Amid COVID-19

Nursing is a physically and emotionally demanding profession. Grueling job roles and challenging work environments, specifically in acute or critical care settings, place health care professionals at risk of burnout. Burnout in health care professionals results from a chronic negative work experience, leading to job dissatisfaction and, ultimately, poor patient outcomes. Symptoms and prevalence of burnout can be alleviated by implementing individual-focused strategies and minor modifications in work environments, job demands, and responsibilities. Currently, risk for burnout is increasing as COVID-19 challenges health care systems in which advanced practice nurses and other health care professionals struggle continuously to deliver high-quality patient care. In this article, the circumstances surrounding COVID-19 are considered and an overview is provided of burnout phenomenon, its causal factors, and its consequences. With consideration of current evidence in literature, I discuss some suggested strategies to improve resilience and facilitate well-being among health care professionals at individual and organizational levels.

Rapid Cycle Deliberate Practice to Facilitate "Nano" In Situ Simulation: An Interprofessional Approach to Just-in-Time Training

BACKGROUND

Simulation is increasingly used to identify latent threats to patient safety, such as delays in recognition and management of time-sensitive conditions. The Rapid Cycle Deliberate Practice teaching method may facilitate "nano" (brief) in situ simulation training in a critical care setting to improve multidisciplinary team performance of time-sensitive clinical tasks.

OBJECTIVE

To determine whether nano-in situ simulation training with Rapid Cycle Deliberate Practice can improve pediatric intensive care unit team proficiency in identifying and managing postoperative shock in a pediatric cardiac patient.

METHODS

A quality improvement educational project was conducted involving nano-in situ simulation sessions in a combined pediatric and pediatric cardiac intensive care unit. The Rapid Cycle Deliberate Practice method was used with an expert-driven checklist for 30-minute simulation scenarios.

RESULTS

A total of 23 critical care providers participated. The proportion of time-sensitive tasks completed within 5 minutes increased significantly from before to after training (52% [13 of 25] vs 100% [25 of 25]; P ≤ .001). Using a 5-point Likert scale, with higher scores indicating higher levels, the participants reported high degrees of performance confidence (mean, 4.42; SD, 0.20) and satisfaction with the simulation experience (mean, 4.96; SD, 0.12).

CONCLUSION

The Rapid Cycle Deliberate Practice method was used to facilitate nano-in situ simulation training and identify areas requiring additional education to improve patient safety. In situ simulation can educate providers in a cost-effective and timely manner.

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

BACKGROUND

There is a high prevalence of burnout among health care professionals, but little remains known about burnout and satisfaction with work-life integration (WLI) among advance practice nurses (APNs).

PURPOSE

To evaluate burnout and satisfaction with WLI among APNs compared with other US workers.

METHODS

A national sample of APNs and a probability-based sample of US workers completed a survey that measured burnout and satisfaction with WLI.

RESULTS

Of the 976 (47%) APNs who completed the survey 64% had high personal accomplishment, 36.6% had symptoms of overall burnout, and 60.6% were satisfied with their WLI. In multivariable analysis, work hours (for each additional hour odds ratio [OR] 1.03, 95% confidence interval [CI] 1.02-1.04, p < .001) and working in an outpatient setting (overall p = .03; referent hospital: outpatient, OR 1.80, 95% CI 1.17-2.18; other/unknown, OR 1.41, 95% CI 0.90-2.22, p = .13) were independently associated with having higher odds of burnout. Work hours were also independently associated with lower odds of satisfaction with WLI (for each additional hour OR 0.94, 95% CI 0.94-0.95, p < .001). Advance practice nurses were not more likely to have burnout or have greater struggles with WLI than other workers.

IMPLICATIONS FOR PRACTICE

Findings from this study suggest APNs have high levels of personal accomplishment and a favorable occupational health profile. Advance practice nurses do not appear at higher risk of burnout or dissatisfaction with WLI than other US workers.