1
|
Wood E, King R, Robertson S, Tod A, Senek M, Taylor B, Ryan T. Advanced nurse practitioner well-being: A 4-year cohort mixed methods study. Nurs Open 2024; 11:e2218. [PMID: 38940475 PMCID: PMC11212064 DOI: 10.1002/nop2.2218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 10/03/2023] [Accepted: 06/05/2024] [Indexed: 06/29/2024] Open
Abstract
AIMS To examine changes in advanced nurse practitioner (ANP) well-being, satisfaction and motivation over a four-year period. DESIGN Longitudinal Cohort study. METHODS Surveys were carried out each year from 2019 to 2022 with the same cohort of ANPs in the United Kingdom (UK). The survey consisted of demographics, questions on contemporary issues in advanced practice, National Health Service (NHS) staff survey questions and validated questionnaires. A core set of questions were asked every year with some changes in response to the COVID-19 pandemic. RESULTS Response rate ranged from 40% to 59% and appeared to be affected by COVID-19. Staff satisfaction with pay and the well-being score were stable throughout. Other questions on well-being, job satisfaction and motivation saw statistically significant reductions after 4 years. Open-ended questions about ongoing well-being concerns show participants are concerned about exhaustion levels caused by workload, staffing issues, abuse from patients and colleagues' mental health. CONCLUSION The findings highlight a decline in ANP well-being, job satisfaction and motivation post-COVID-19. Reasons for this, explored in the qualitative data, show that ANPs have faced extremely difficult working conditions. Urgent action is required to prevent a workforce retention crisis as many nursing staff are close to retirement and may not be motivated to remain in post. IMPACT This study has followed ANPs through the most challenging years the NHS has ever seen. Job satisfaction, motivation and enjoyment of the job all significantly reduced over time. In many areas, the ANP role has been used to fill medical workforce gaps, and this will become harder to do if ANPs are dissatisfied, disaffected and struggling with stress and burnout. Addressing these issues should be a priority for policymakers and managers. PATIENT OR PUBLIC CONTRIBUTION None as this study focussed on staff. Staff stakeholders involved in the design and conduct of the study.
Collapse
Affiliation(s)
- Emily Wood
- The School of Medicine and Population HealthThe University of Sheffield, Regent CourtSheffieldUK
| | - Rachel King
- Division of Nursing and Midwifery, The School of Allied Health Professionals, Nursing and MidwiferyUniversity of SheffieldSheffieldUK
| | - Steve Robertson
- Division of Nursing and Midwifery, The School of Allied Health Professionals, Nursing and MidwiferyUniversity of SheffieldSheffieldUK
- Leeds Beckett UniversityLeedsUK
- Waterford Institute of TechnologyWaterford CityIreland
| | - Angela Tod
- Division of Nursing and Midwifery, The School of Allied Health Professionals, Nursing and MidwiferyUniversity of SheffieldSheffieldUK
| | - Michaela Senek
- The School of Medicine and Population HealthThe University of Sheffield, Regent CourtSheffieldUK
| | - Beth Taylor
- Division of Nursing and Midwifery, The School of Allied Health Professionals, Nursing and MidwiferyUniversity of SheffieldSheffieldUK
| | - Tony Ryan
- Division of Nursing and Midwifery, The School of Allied Health Professionals, Nursing and MidwiferyUniversity of SheffieldSheffieldUK
| |
Collapse
|
2
|
John R, Hill M, Kanamori L, Lao R, Sayrs L, Stottlemyre RL, Morphew T. Preventing Inpatient NP Burnout: The Power of Adequate Staffing and Leadership. J Pediatr Health Care 2024; 38:497-504. [PMID: 38703177 DOI: 10.1016/j.pedhc.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Nurse practitioner (NP) burnout related to high patient-to-NP ratios needs to be addressed. OBJECTIVES To survey inpatient pediatric NPs, assess burnout and characterize associated workload and support. DESIGN Online cross-sectional survey conducted in three phases from March 2022 to August 2023. SUBJECTS AND SETTING Inpatient specialty NPs from 32 hospitals. RESULTS Fisher's exact test and logistic regression were implemented. A patient-to-provider (NP or resident) ratio of more than 5:1 was associated with NP burnout (OR = 3.5, 95% CI 1.0, 12.0 and OR = 4.1, 95% CI 1.1, 16.2, respectively, p < .05). Among NPs without burnout, 100% had organizational NP leadership (p = .012). INTERPRETATION Though limited by a small convenience sample, a patient-to-provider ratio over 5:1 was associated with NP burnout, and NP leadership was protective. Further research of cost analysis, retention, and patient quality and safety measures are needed. CONCLUSION Lower patient-to-NP ratios and NP leadership play a pivotal role in preventing burnout.
Collapse
Affiliation(s)
- Rebecca John
- Rebecca John, Melisa Hill, Lauren Kanamori, General and Thoracic Surgery Nurse Practitioner, Division of Pediatric General & Thoracic Surgery, Children's Hospital of Orange County, Orange, CA.
| | - Melisa Hill
- Rebecca John, Melisa Hill, Lauren Kanamori, General and Thoracic Surgery Nurse Practitioner, Division of Pediatric General & Thoracic Surgery, Children's Hospital of Orange County, Orange, CA
| | - Lauren Kanamori
- Rebecca John, Melisa Hill, Lauren Kanamori, General and Thoracic Surgery Nurse Practitioner, Division of Pediatric General & Thoracic Surgery, Children's Hospital of Orange County, Orange, CA
| | - Robyn Lao
- Robyn Lao, General and Thoracic Surgery Nurse Practitioner, Department of Pediatric Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Lois Sayrs
- Lois Sayrs, Director, Research Institute, Biostatistics, Children's Hospital of Orange County Research Institute, Orange, CA
| | - Rachael L Stottlemyre
- Rachael L. Stottlemyre, University of Miami Miller, School of Medicine Student, Miami, FL
| | - Tricia Morphew
- Tricia Morphew, Senior Biostatistician, Children's Hospital of Orange County Research Institute, Orange, CA
| |
Collapse
|
3
|
de Lisser R, Lauderdale J, Dietrich MS, Ramanujam R, Stolldorf DP. The Social Ecology of Burnout: A framework for research on nurse practitioner burnout. Nurs Outlook 2024; 72:102188. [PMID: 38788272 DOI: 10.1016/j.outlook.2024.102188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/08/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND The U.S. health system is burdened by rising costs, workforce shortages, and unremitting burnout. Well-being interventions have emerged in response, yet data suggest that the work environment is the problem. Nurse practitioner (NP) burnout is associated with structural and relational factors in the work environment, practice autonomy, and hierarchical leadership. PURPOSE We explore the unique social, cultural, and political environment in which NPs work through the lens of social ecology and present the Social Ecology of Burnout (SEB) framework. METHODS We review current burnout frameworks in the context of the NP practice environment and discuss the SEB, specifically exploring psychological safety and its influence on burnout. FINDINGS Psychological safety, work environment, and policy are presented within the SEB and solutions which empower NPs are considered. DISCUSSION Our framework can serve as a guide for future nursing research, practice, and policy.
Collapse
Affiliation(s)
- Rosalind de Lisser
- School of Nursing, Vanderbilt University, Nashville, TN; Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA.
| | | | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Rangaraj Ramanujam
- Center for Health Care Programs, Owen Graduate School of Management, Vanderbilt University, Nashville, TN
| | | |
Collapse
|
4
|
Lally RM, Schmidt R, Kupzyk K, Wengel SP, Cordts KP, Mills AC, Richards SE. Implementing Longitudinal Wellbeing Interventions and Evaluation Among Midwestern Healthcare Workers During COVID-19. West J Nurs Res 2024; 46:296-306. [PMID: 38465618 DOI: 10.1177/01939459241237663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on the mental health of healthcare workers throughout the world has been reported, but most studies have been cross-sectional and excluded the Midwestern U.S. healthcare workforce. OBJECTIVE This study aimed to longitudinally assess the psychological wellbeing and wellness strategies used by a Midwestern academic health system's workforce at multiple points throughout waves of the COVID-19 pandemic to inform ongoing implementation of appropriate wellness activities. METHODS An anonymous REDCap survey linked within our team-developed wellness education was posted in the employee online newsletter in April (T1), July (T2), October 2020 (T3), and May 2021 (T4). Surveys were open to all employees (approx. 9000) for approximately 12 days at each time point. Anxiety, depressive symptoms, stress, self-efficacy, and self-care activities were assessed. Following each data collection, team members discussed findings and planned wellness education implementation. RESULTS Response ranged from n = 731 (T1) to n = 172 (T4). Moderate to severe stress was reported by 29.5% (n = 203) of respondents at T1 and 34.0% (n = 108) at T2. At T3, all psychological symptoms significantly increased (p < .001) as COVID-19 surged, with 48.5% (n = 141) of respondents reporting moderate to severe stress. At T4, stress significantly declined (p < .001). Exercise was the most frequently reported coping strategy. CONCLUSIONS Mental health symptoms reported by a Midwestern healthcare workforce increased during surges of COVID-19 hospitalizations. Individuals in non-patient contact roles experienced symptom levels similar to and at times with greater severity than healthcare personnel with patient contact roles.
Collapse
Affiliation(s)
- Robin M Lally
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rachael Schmidt
- Fred & Pamela Buffett Cancer Center, Nebraska Medicine, Omaha, NE, USA
| | - Kevin Kupzyk
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Steven P Wengel
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Adam C Mills
- Department of Psychology, Nebraska Medicine, Omaha, NE, USA
| | - Sarah E Richards
- Nebraska Medicine, Omaha, NE, USA
- Division of Hospital Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
5
|
Nash C. The Health Narratives Research Group (HeNReG): A self-direction process offered to help decrease burnout in public health nurse practitioners. AIMS Public Health 2024; 11:176-208. [PMID: 38617405 PMCID: PMC11007417 DOI: 10.3934/publichealth.2024009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 04/16/2024] Open
Abstract
Founded in accordance with 19th century sex roles and public health concerns, nursing evolved as other-directed, dependent on physician-focused diagnosis, prescription decisions, and public health advancements. The result of this other direction is that public health nurse practitioners have endured significant workplace stress resulting in burnout, especially during COVID-19. To help decrease their burnout, nurses require development of self-direction. The Health Narratives Research Group (HeNReG) has the potential to reduce burnout in nurse practitioners by encouraging the development of self-direction. The HeNReG process is presented through historically analyzed documents regarding reducing burnout in health researchers by developing self-direction including: (1) three years of archived year-end feedback results provided by participants, (2) archived participant responses to specific HeNReG-related writing prompts, and (3) a comparison of HeNReG results with the outcomes of resilience programs. The conclusion-the HeNReG offers an effective option for reducing burnout in health researchers that has the potential to decrease nurse practitioner burnout in a way that resilience programs do not. Tailoring the HeNReG process to public health nurses is discussed, inviting future research for reducing burnout in public health nurses.
Collapse
Affiliation(s)
- Carol Nash
- History of Medicine Program, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1
| |
Collapse
|
6
|
Burt L, Clark L, Park C. Stronger together: learner reactions on a team-based, interprofessional first death simulation experience. J Interprof Care 2024; 38:95-103. [PMID: 37422861 DOI: 10.1080/13561820.2023.2232408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
Patient death is a common experience that may be traumatic for health care providers. Although current rates of burnout are high, evidence supports that interprofessional coping can improve clinician mental health. While health care simulation affords learners freedom of safety to participate in a variety of educational experiences, current application of simulation during patient death is limited to professional duties, without explicitly addressing learner emotional well-being. We designed a patient death simulation scenario within a supportive and reflective interprofessional environment to teach foundational coping and well-being strategies to preclinical nursing, medical, and pharmacy students. Sixty-one students participated in this team-based, First Death simulation experience. Debriefings were analyzed using qualitative inductive content analysis methodology. Students reacted to being part of an interprofessional team after having participated in simulation about the death of a patient as described by five categories: emotional awareness, communication insight, feeling stronger together, with role curiosity, and through reflections on support. Findings suggested that simulation is an effective teaching modality for mentoring interprofessional students on humanistic well-being strategies. Furthermore, the experience fostered reactions transcending interprofessional competencies, which are transferrable to future clinical practice.
Collapse
Affiliation(s)
- Leah Burt
- College of Nursing Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Lou Clark
- M Simulation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christine Park
- College of Medicine, Simulation and Integrative Learning (SAIL) Institute, University of Illinois, Chicago, Illinois, USA
| |
Collapse
|
7
|
Burrowes SAB, Casey SM, Pierre-Joseph N, Talbot SG, Hall T, Christian-Brathwaite N, Del-Carmen M, Garofalo C, Lundberg B, Mehta PK, Mottl-Santiago J, Schechter-Perkins EM, Weber A, Yarrington CD, Perkins RB. COVID-19 pandemic impacts on mental health, burnout, and longevity in the workplace among healthcare workers: A mixed methods study. JOURNAL OF INTERPROFESSIONAL EDUCATION & PRACTICE 2023; 32:100661. [PMID: 37305404 PMCID: PMC10248469 DOI: 10.1016/j.xjep.2023.100661] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/07/2023] [Indexed: 06/13/2023]
Abstract
To explore the mental health impacts of the COVID-19 pandemic on healthcare workers in Massachusetts and identify potential strategies to maintain the healthcare workforce we conducted a sequential exploratory mixed methods study. Fifty-two individuals completed interviews from April 22nd - September 7th, 2021; 209 individuals completed an online survey from February 17th - March 23rd, 2022. Interviews and surveys asked about the mental health impacts of working in healthcare during the COVID-19 pandemic, burnout, longevity in the workplace, and strategies for reducing attrition. Interview and survey participants were predominantly White (56%; 73%, respectively), female (79%; 81%) and worked as physicians (37%; 34%). Interviewees indicated high stress and anxiety levels due to frequent exposure to patient deaths from COVID-19. Among survey respondents, 55% reported worse mental health than before the pandemic, 29% reported a new/worsening mental health condition for themselves or their family, 59% reported feeling burned out at least weekly, and 37% intended to leave healthcare in less than 5 years. To decrease attrition, respondents suggested higher salaries (91%), flexible schedules (90%), and increased support to care for patients (89%). Healthcare workers' experiences with death, feeling unvalued, and overworked resulted in unprecedented rates of burnout and intention to leave healthcare.
Collapse
Affiliation(s)
- Shana A B Burrowes
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Sharon M Casey
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Natalie Pierre-Joseph
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Simon G Talbot
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Taylor Hall
- Graduate Medical Sciences, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | | | - Marcela Del-Carmen
- Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Garofalo
- Department of Family Medicine and Department of Obstetrics and Gynecology at Sturdy Memorial Hospital, Attleboro, MA, USA
- Family Medicine Associates of South Attleboro, South Attleboro, Massachusetts, USA
| | | | - Pooja K Mehta
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
- Cityblock Health, Brooklyn, NY, USA
| | - Julie Mottl-Santiago
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Elissa M Schechter-Perkins
- Department of Emergency Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Ariana Weber
- Department of Emergency Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Christina D Yarrington
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| |
Collapse
|
8
|
Huang SS, Chen CY, Kau K, Tsai JM, Tsay SL. Key determinates of job satisfaction for acute care nurse practitioners in Taiwan. BMC Nurs 2023; 22:6. [PMID: 36604678 PMCID: PMC9814220 DOI: 10.1186/s12912-022-01156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Taiwan is a super-aged society, and the shortage of hospital doctors; nurse practitioners (NPs) became vital healthcare providers to fulfill the healthcare demands of the population. The purpose of this study was to explore the key determinates of job satisfaction for NPs in acute care practices using significant practice variables, such as empowerment and burnout. METHODS Participants of this descriptive survey study were recruited from a national sample of NPs with membership in the Taiwan Association of Nurse Practitioners. The data were collected utilizing an online questionnaire based on demographic and practice variables, the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS), the Condition for Work Effectiveness Questionnaire II (CWEQ II), and the Copenhagen Burnout Inventory (CBI). A total of 1,211 NPs completed the online survey. A multiple regression model with the stepwise selection was used to explore job satisfaction. RESULTS The mean overall satisfaction score indicated that the level of satisfaction was between slightly dissatisfied and slightly satisfied. Regression results indicated that formal power, work-related burnout, access to information, and needed resources were critical components of job satisfaction, and accounted for 63% of the variance. Moreover, NPs who were married, had a higher annual salary, worked only during the day shift, and had lower patients-related burnout showed better job satisfaction. CONCLUSIONS This study provides evidence for healthcare organizations to formulate policies to strengthen NP job satisfaction. Empowerment and burnout are vital factors in NPs' job satisfaction. Healthcare organizations have an obligation to implement policies to empower NPs in practice and provide interventions to mitigate burnout. Implementing these changes will improve job satisfaction and with it the quality of patient care.
Collapse
Affiliation(s)
- Sheng-Shiung Huang
- grid.445025.20000 0004 0532 2244College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - Cheng-Yuan Chen
- grid.412094.a0000 0004 0572 7815National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Kevin Kau
- grid.19188.390000 0004 0546 0241Academic Writing Education Center, National Taiwan University, Taipei, Taiwan
| | - Jung-Mei Tsai
- grid.413593.90000 0004 0573 007XDepartment of Nursing, Mackay Memorial Hospital, Taipei, Taiwan ,grid.445025.20000 0004 0532 2244Department of Nursing, Da-Yeh University, Changhua, Taiwan
| | - Shiow-Luan Tsay
- grid.445025.20000 0004 0532 2244College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| |
Collapse
|
9
|
Cleveland MR, Willis TS, Xu J, Centers G, Gallegos J. Mitigating Burnout in a Team of Pediatric Cardiac Critical Care Advanced Practice Providers: A Team-Building Intervention. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
10
|
Luo D, Song Y, Cai X, Li R, Bai Y, Chen B, Liu Y. Nurse managers' burnout and organizational support: The serial mediating role of leadership and resilience. J Nurs Manag 2022; 30:4251-4261. [PMID: 36205051 DOI: 10.1111/jonm.13852] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/29/2022] [Accepted: 09/30/2022] [Indexed: 12/30/2022]
Abstract
AIMS To investigate the relationship between organizational support and nurse managers' burnout and the serial multiple mediating effects of leadership and resilience. BACKGROUND Nurse managers are at a high risk of burnout, especially during the COVID-19 pandemic. However, no research has been done to examine the associations between nurse managers' organizational support, leadership, resilience and burnout. METHODS This cross-sectional study recruited 458 nurse managers from 13 tertiary public hospitals in Jiangsu, China. They completed the Survey of Perceived Organizational Support, the Clinical Leadership Survey, the Resilience Scale and the Maslach Burnout Inventor-Human Service Survey. The serial mediating effect of individual leadership and resilience was estimated using the structural equation modelling method via Mplus 7.0. RESULTS There were direct and indirect effects of organizational support on burnout, controlling for work variables. Leadership and resilience serially mediate the association between organizational support and burnout (β = -.051, 95% confidence interval: -0.093 to -0.020). CONCLUSIONS Among nurse managers, organizational support may be sequentially associated with improved leadership first and then resilience, which in turn is related to decreased burnout. IMPLICATIONS FOR NURSING MANAGEMENT We recommend that hospital administrators incorporate leadership, resilience and burnout assessment in the routine psychological screening of nurse managers and creatively apply the organizational interventions to decrease nurse managers' burnout.
Collapse
Affiliation(s)
- Dan Luo
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yulei Song
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xue Cai
- Nursing Department, Zhongda Hospital, Southeast University, Nanjing, China
| | - Ruxue Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Yamei Bai
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Baoyun Chen
- Nursing Department, Xuzhou Central Hospital, Xuzhou, China
| | - Ya Liu
- Nursing Department, Xuzhou Central Hospital, Xuzhou, China
| |
Collapse
|
11
|
Vermeesch AL, Coro A, Mattes K, Ostendorff D, Timko Olson E, Garrigues L. Nature-Based Feasibility Intervention to Influence Mitigation Strategies for Perceived Stress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12277. [PMID: 36231578 PMCID: PMC9565025 DOI: 10.3390/ijerph191912277] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
Burnout, compassion fatigue, and perceived stress among undergraduate nursing students are significant factors leading to a poorer quality of life, decreased job satisfaction, and adversely impact patient outcomes. Burnout among undergraduate nursing students is a critical individual and workforce issue with contributing factors including a relentless schedule, academically challenging and rigorous programs, pressure to perform, and the completion of clinical hours caring for patients. This paper describes our feasibility study of a nature-based intervention (NBI) to reduce perceived stress and quality of life as it relates to burnout, and compassion fatigue. Quantitative data was collected through demographics, surveys, and electronic sensor data. The project's aim was to determine the feasibility of NBI monitored by NatureDoseTM to decrease perceived stress burnout and compassion fatigue among undergraduate nursing students.
Collapse
Affiliation(s)
- Amber L. Vermeesch
- Department of Family and Community Nursing, School of Nursing, University of North Carolina Greensboro, Greensboro, NC 27402, USA
| | - Alessandra Coro
- School of Nursing & Health Innovations, University of Portland, Portland, OR 97203, USA
| | - Kira Mattes
- School of Nursing & Health Innovations, University of Portland, Portland, OR 97203, USA
| | - Dylan Ostendorff
- School of Nursing & Health Innovations, University of Portland, Portland, OR 97203, USA
| | - Erica Timko Olson
- School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA
| | - Layla Garrigues
- School of Nursing & Health Innovations, University of Portland, Portland, OR 97203, USA
| |
Collapse
|
12
|
Zhang Y, Guan C, Jiang J, Zhu C, Hu X. Mediating effect of resilience on the relationship between perceived social support and burnout among Chinese palliative nurses. J Clin Nurs 2022. [PMID: 36101490 DOI: 10.1111/jocn.16532] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/17/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To detect the mediating effect of resilience on the relationship between perceived social support and burnout in Chinese palliative nurses. BACKGROUND Palliative nurses are a group that is vulnerable to burnout. Perceived social support may contribute to decreasing palliative nurses' burnout and facilitating their personal resilience, and resilience may be associated with lower levels of burnout. However, these relationships were unclear in the Chinese context. DESIGN A cross-sectional design. METHODS The STROBE guideline was performed to report this study. A mixed sampling method including convenience sampling and stratified sampling was used to recruit participants, and a total of 319 palliative nurses completed the Nursing Burnout Scale, the Perceived Social Support Scale and the Connor-Davidson Resilience Scale from May 2021 to September 2021. Influencing factors were primarily identified using independent-sample t tests and one-way ANOVA. Bootstrap method was used to detect the mediating effect of resilience. RESULTS The level of burnout in palliative nurses (23.4 ± 7.68) was higher than that of general nurses in China. Education level, health condition and monthly income were influencing factors of burnout. Resilience was detected as a mediator in the relationships between perceived social support and dimensions of burnout. CONCLUSIONS Chinese palliative nurses experience a relatively high level of burnout, which may be influenced by several sociodemographic variables. Resilience could mediate the effect of perceived social support on the dimensions of burnout. Problem-oriented and palliative-tailored strategies should be developed to further address burnout in Chinese palliative nurses. RELEVANCE TO CLINICAL PRACTICE Nurse managers and policy makers should support nurse ongoing education, adopt health-promoting interventions and optimise salary systems. In addition, perceived social support resources and resilience training programmes are also warranted. PATIENT OR PUBLIC CONTRIBUTION All participants were invited to complete the informed consent form and paper questionnaires. Human resource managers helped us collect some subjective data through the personnel management system. Nurse managers of palliative units conducted regular staff meetings to promote the data collection process.
Collapse
Affiliation(s)
- Yalin Zhang
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Chang Guan
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Jianjun Jiang
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chuanmei Zhu
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolin Hu
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
13
|
Howie-Esquivel J, Byon HD, Lewis C, Travis A, Cavanagh C. Quality of work-life among advanced practice nurses who manage care for patients with heart failure: The effect of resilience during the Covid-19 pandemic. Heart Lung 2022; 55:34-41. [PMID: 35447467 PMCID: PMC8995301 DOI: 10.1016/j.hrtlng.2022.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/25/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022]
Abstract
Background Clinician burnout, stress and job dissatisfaction among Advance Practice Registered Nurses (APRNS) may have impacted work-related quality of life (WRQoL) during the COVID-19 pandemic. No studies describe burnout and resilience in APRNs who manage care for patients with HF. Objectives Among APRNs who manage care for patients with HF, study aims included: 1) Describe burnout and WRQoL levels; 2) Determine the relationship between burnout and WRQoL; 3) Examine whether resilience moderates the association between WRQoL and burnout. METHODS An online survey of American Association of Heart Failure Nurses and the Heart Failure Society of America APRN members were queried. INCLUSION CRITERIA APRN's who practiced in ambulatory or inpatient cardiology settings at least 8 h weekly. OUTCOMES MEASURED Burnout, WRQoL, and resilience. Results Participants' (N = 101) mean age was 50 (±10) years and 93% identified as female. APRNs worked more than 42 h weekly and reported moderate levels of resilience, high levels of personal (M = 51.7, norm-referenced mean: 35.9) and work-related burnout (M = 50.1, norm-referenced mean: 33.0). Correlations between high levels of burnout and low WRQoL (r range: -0.74 - -0.39 -, p<.001) were found. Burnout moderated the relationships among resilience and WRQoL. Conclusion APRNs had high levels of burnout during the COVID-19 pandemic. Patient-related burnout was not high. Level of burnout influenced the relationships among resilience and WRQoL suggesting that burnout is from workplace and personal sources, and that level of resilience could not overcome the effect of burnout. Interventions are needed regarding systems changes to uplift and support our workforce.
Collapse
Affiliation(s)
| | - Ha Do Byon
- University of Virginia, Charlottesville, VA, United States
| | | | - Arlene Travis
- Mount Sinai Health System, New York, NY, United States
| | - Casey Cavanagh
- University of Virginia School of Medicine, Charlottesville, VA, United States
| |
Collapse
|
14
|
Snapp B, McCutchon EW, Moore TA, Teel D. Neonatal nurse practitioner job satisfaction, workforce environment, and mental well-being. J Am Assoc Nurse Pract 2022; 34:1058-1065. [PMID: 35793282 DOI: 10.1097/jxx.0000000000000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/09/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Increased demand for nurse practitioners emphasizes the importance of consistent and ongoing collection of data to provide a better understanding of the NNP workforce and to promote retention and recruitment of NNPs. PURPOSE To understand how work environment and work hours influence job or career satisfaction. METHODOLOGY The National Association of Neonatal Nurse Practitioners in collaboration with the National Certification Corporation emailed an online survey to all 6,558 certified neonatal nurse practitioners (NNPs) in 2020 with 845 (12.8%) responding. Subjects included those with responsibilities in direct patient care, transport NPs, faculty/directors, and advanced practice registered nurse coordinators/managers/administrators. RESULTS Satisfaction with career choice as an NNP was reported as very satisfied by 58% (n = 493) and mostly satisfied by 37% (n = 310). Satisfaction with current job as an NNP was reported as very satisfied for 30% (n = 252), with 51% being mostly satisfied (n = 435). Age influenced satisfaction scores, with NNPs aged 61 years or older having a higher mean score than NNPs aged 31-40 years ( p = .041). The majority of NNPs did not use all of their available paid time off (72%; n = 609) and respondents worked an additional 248 extra hours per year. NNPs experience bullying (58%) and/or lateral violence (32%). Seventeen percent have called in sick for mental health reasons (n = 147). CONCLUSIONS Neonatal nurse practitioners' satisfaction is multifactorial. Those who reported taking time off for self-prescribed mental health indicated less job satisfaction, more work hours, poor work/life balance, and a less-than-optimum work environment. IMPLICATIONS Overall, NNPs are satisfied with their career choice but are less satisfied with their job choice. Understanding factors that influence mental well-being and job satisfaction will improve recruitment and retention of nurse practitioners.
Collapse
Affiliation(s)
- Barbara Snapp
- Children's National Hospital, Washington, District of Columbia
| | | | | | - Dedra Teel
- Neonatal Intensive Care Unit, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| |
Collapse
|
15
|
Bullock LM, Akintade B, Appleby T, Idenbaum-Bates K. Development and Implementation a Novel Advanced Practice Provider Mentorship Model. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
16
|
Kemp K, Duncan J, Mason I, Younge L, Dibley L. Scoping review with textual narrative synthesis of the literature reporting stress and burn-out in specialist nurses: making the case for inflammatory bowel disease nurse specialists. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000852. [PMID: 35428670 PMCID: PMC9013983 DOI: 10.1136/bmjgast-2021-000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/31/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Inflammatory bowel disease clinical nurse specialists (IBD-CNSs) face increasing pressures due to rising clinical and patient demands, advanced complexity of work role, and minimal specialist management training and support. Stress and burn-out could undermine the stability of this workforce, disrupting clinical provision. We reviewed the literature on stress and burn-out to demonstrate the lack of evidence pertinent to IBD-CNSs and make the case for further research. Design Following Levac et al’s scoping review framework, relevant databases were searched for publications reporting work-related stress and burn-out among specialist nurses. Following screening and consensus on selection of the final articles for review, all authors contributed to data charting. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension guided reporting of the review. Results Of 194 retrieved articles, eight were eligible for review. None focused on IBD-CNSs, were qualitative, or UK-based. Three core themes were identified: Rates of Burn-out, Mitigating and Alleviating Factors, and Preventing and Resolving Burn-out. Risk of burn-out is greatest in novice and mid-career CNSs. Age and duration in role appear protective. Personal achievement is also protective and can mitigate earlier episodes of burn-out; opportunities for career progression are limited. Promoting personal well-being is beneficial. Senior managers have poor understanding of the role and provide inadequate support. Commitment to patients remains high. Conclusion Burn-out arises in CNSs across clinical specialisms in the international literature and has a significant negative effect on the workforce. Further research is needed to address the dearth of evidence on burn-out in IBD-CNSs in the UK.
Collapse
Affiliation(s)
- Karen Kemp
- Department of Gastroenterology, Manchester Royal Infirmary, Manchester, UK
| | - Julie Duncan
- Clinical Nurse Education, Takeda UK Limited, London, UK
| | - Isobel Mason
- Centre for Gastroenterology, Royal Free Hospital, London, UK
| | - Lisa Younge
- IBD Unit, St Mark's Hospital and Academic Institute, Harrow, UK
| | - Lesley Dibley
- Institute for Lifecourse Development, University of Greenwich, London, UK
| |
Collapse
|
17
|
Rogers M, Lamarche K, Miller M, Moore KS, Spies LA, Taylor J, Staempfli S. Global emotional and spiritual well-being and resilience of Advanced Practice Nurses during the COVID-19 pandemic: A cross-sectional study. J Adv Nurs 2022; 78:1483-1492. [PMID: 35266578 PMCID: PMC9111665 DOI: 10.1111/jan.15161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/15/2021] [Accepted: 12/09/2021] [Indexed: 12/19/2022]
Abstract
Aim To evaluate the impact of the COVID‐19 pandemic on the emotional and spiritual well‐being and resilience of a global sample of Advanced Practice Nurses. Design A web‐based cross‐sectional mixed methods study. Survey data were collected from Advanced Practice Nurses globally over a 2‐month period ending on 31 August 2020. Methods The Warwick‐Edinburgh Mental Well‐being Scale, FACIT‐12 Spiritual Well‐being Scale and Connor‐Davidson Resilience Scale 10 were used to quantify emotional and spiritual well‐being and resilience of Advanced Practice Nurses' globally. The survey was distributed internationally using snowball sampling via a secure platform (Qualtrics). Results were analysed using various bivariate tests for associations and group differences. Results Nine hundred and twenty‐eight Advanced Practice Nurses from 53 countries participated in the study. Study participants reported meaningfully lower scores in resilience and emotional well‐being compared with non‐pandemic scores. Participants from countries with well‐developed Advanced Practice Nurses roles reported lower resilience and well‐being scores compared with those from countries where Advanced Practice Nurses roles are still being developed. Each scale revealed significant positive associations with the other scales. Conclusions Emotional and spiritual well‐being and resilience of Advance Practice Nurses has been significantly impacted during the COVID‐19 pandemic. Regardless of their work location, work hours, credential or demographics, the APNs in our study reported lower levels of resilience and mental well‐being compared with typical scores on the instruments.
Collapse
Affiliation(s)
- Melanie Rogers
- School of Nursing, University of Huddersfield, Huddersfield, UK
| | | | - Minna Miller
- BC Children's Hospital, University of British Columbia School of Nursing, Vancouver, British Columbia, Canada
| | - Karen S Moore
- Trudy Busch Valentine School of Nursing, Saint Louis University, St. Louis, Missouri, USA
| | - Lori A Spies
- Louise Herrington School of Nursing, Baylor University, Dallas, Texas, USA
| | - John Taylor
- Trudy Busch Valentine School of Nursing, Saint Louis University, St. Louis, Missouri, USA
| | - Sabina Staempfli
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| |
Collapse
|
18
|
Exploring Stressors Experienced During Graduate Nursing Education. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
19
|
Abstract
Health care providers are experiencing increased stress during the coronavirus disease 2019 pandemic. While it is understood that increased stress leads to burnout, limited research has been conducted to evaluate advance practice nurse response to coronavirus disease 2019, and more specifically, self-identified modalities that may decrease stress in the workplace or at home. This pilot study evaluated advance practice nurse-perceived burnout and evaluated perceived needs and/or perception of modalities aimed at reducing stress and improving well-being, such as essential oils, quiet room, soothing music, art therapy, pet therapy, and mobile applications, that could be easily accessed in the workplace.
Collapse
|
20
|
Hassett MJ, Cronin C, Tsou TC, Wedge J, Bian J, Dizon DS, Hazard-Jenkins H, Osarogiagbon RU, Wong S, Basch E, Austin T, McCleary N, Schrag D. eSyM: An Electronic Health Record-Integrated Patient-Reported Outcomes-Based Cancer Symptom Management Program Used by Six Diverse Health Systems. JCO Clin Cancer Inform 2022; 6:e2100137. [PMID: 34985914 PMCID: PMC9848544 DOI: 10.1200/cci.21.00137] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Collecting patient-reported outcomes (PROs) can improve symptom control and quality of life, enhance doctor-patient communication, and reduce acute care needs for patients with cancer. Digital solutions facilitate PRO collection, but without robust electronic health record (EHR) integration, effective deployment can be hampered by low patient and clinician engagement and high development and deployment costs. The important components of digital PRO platforms have been defined, but procedures for implementing integrated solutions are not readily available. METHODS As part of the NCI's IMPACT consortium, six health care systems partnered with Epic to develop an EHR-integrated, PRO-based electronic symptom management program (eSyM) to optimize postoperative recovery and well-being during chemotherapy. The agile development process incorporated user-centered design principles that required engagement from patients, clinicians, and health care systems. Whenever possible, the system used validated content from the public domain and took advantage of existing EHR capabilities to automate processes. RESULTS eSyM includes symptom surveys on the basis of the PRO-Common Terminology Criteria for Adverse Events (PRO-CTCAE) plus two global wellness questions; reminders and symptom self-management tip sheets for patients; alerts and symptom reports for clinicians; and population management dashboards. EHR dependencies include a secure Health Insurance Portability and Accountability Act-compliant patient portal; diagnosis, procedure and chemotherapy treatment plan data; registries that identify and track target populations; and the ability to create reminders, alerts, reports, dashboards, and charting shortcuts. CONCLUSION eSyM incorporates validated content and leverages existing EHR capabilities. Build challenges include the innate technical limitations of the EHR, the constrained availability of site technical resources, and sites' heterogenous EHR configurations and policies. Integration of PRO-based symptom management programs into the EHR could help overcome adoption barriers, consolidate clinical workflows, and foster scalability and sustainability. We intend to make eSyM available to all Epic users.
Collapse
Affiliation(s)
- Michael J. Hassett
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA,Michael J. Hassett, MD, MPH, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215; e-mail:
| | - Christine Cronin
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA
| | | | | | | | - Don S. Dizon
- Lifespan Cancer Institute and Brown University, Providence, RI
| | | | | | - Sandra Wong
- Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Ethan Basch
- Lineberger Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | - Nadine McCleary
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA
| | | |
Collapse
|
21
|
Burnout and Emotional Intelligence in Neurosurgical Advanced Practice Providers Across the United States: A Cross-Sectional Analysis. World Neurosurg 2021; 155:e335-e344. [PMID: 34425289 DOI: 10.1016/j.wneu.2021.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/22/2022]
Abstract
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.
Collapse
|
22
|
Corby S, Ash JS, Mohan V, Becton J, Solberg N, Bergstrom R, Orwoll B, Hoekstra C, Gold JA. A qualitative study of provider burnout: do medical scribes hinder or help? JAMIA Open 2021; 4:ooab047. [PMID: 34396055 PMCID: PMC8358329 DOI: 10.1093/jamiaopen/ooab047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/07/2021] [Accepted: 06/07/2021] [Indexed: 12/01/2022] Open
Abstract
Objective Provider burnout is a crisis in healthcare and leads to medical errors, a decrease in patient satisfaction, and provider turnover. Many feel that the increased use of electronic health records contributes to the rate of burnout. To avoid provider burnout, many organizations are hiring medical scribes. The goal of this study was to identify relevant elements of the provider–scribe relationship (like decreasing documentation burden, extending providers’ careers, and preventing retirement) and describe how and to what extent they may influence provider burnout. Materials and Methods Qualitative methods were used to gain a broad view of the complex landscape surrounding scribes. Data were collected in 3 phases between late 2017 and early 2019. Data from 5 site visits, interviews with medical students who had experience as scribes, and discussions at an expert conference were analyzed utilizing an inductive approach. Results A total of 184 transcripts were analyzed to identify patterns and themes related to provider burnout. Provider burnout leads to increased provider frustration and exhaustion. Providers reported that medical scribes improve provider job satisfaction and reduce burnout because they reduce the documentation burden. Medical scribes extend providers’ careers and may prevent early retirement. Unfortunately, medical scribes themselves may experience similar forms of burnout. Conclusion Our data from providers and managers suggest that medical scribes help to reduce provider burnout. However, scribes are not the only solution for reducing documentation burden and there may be potentially better options for preventing burnout. Interestingly, medical scribes sometimes suffer from burnout themselves, despite their temporary roles.
Collapse
Affiliation(s)
- Sky Corby
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Joan S Ash
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Vishnu Mohan
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - James Becton
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Nicholas Solberg
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Robby Bergstrom
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Benjamin Orwoll
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Christopher Hoekstra
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey A Gold
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
23
|
Klein CJ, Weinzimmer LG, Dalstrom M, Lizer S, Cooling M, Pierce L. Investigating practice-level and individual factors of advanced practice registered nurses and physician assistants and their relationship to resilience. J Am Assoc Nurse Pract 2021; 34:310-321. [PMID: 34334766 DOI: 10.1097/jxx.0000000000000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gaps in research persist related to practitioners' resilience, although much has been written about the need for strategies to strengthen personal resilience. PURPOSE The study's purpose was to examine practice-level (quality of physician relationship, physician presence, and autonomy) and individual factors and how they affect resilience. METHODOLOGY An online survey invited advanced practice registered nurses (APRNs) and physician assistants (PAs) from four states to participate in a cross-sectional study. Hierarchical ordinary least squares regression was used to test the impact of main effect variables in the context of identified control variables. SAMPLE A sample of 1,138 APRNs and PAs completed the survey questions. RESULTS Findings from the covariate model (model 1) and the main effect model (model 2) show that both models were significant at the p < .01 level, with the adjusted R2 differing from 0.02 to 0.13, respectively. Regression results show a significant positive association between quality of the physician relationship and APRN/PA resilience (b = 0.09, p < .01). A negative association between the lack of autonomy and higher levels of resilience (b = -0.14, p < .01) was also demonstrated. CONCLUSIONS Advanced practice registered nurse/PA resilience is affected by both practice-level and personal factors, suggesting that workplace interventions could increase resilience. IMPLICATIONS FOR PRACTICE Work environments allowing APRNs and PAs to function autonomously and with professional support from physician colleagues are favorable contributors to their resilience. Future studies need to investigate the meaning of physician presence/availability and organizational interventions that extend beyond individual resilience.
Collapse
Affiliation(s)
- Colleen J Klein
- OSF HealthCare, Center for Advanced Practice, Peoria, Illinois
| | - Laurence G Weinzimmer
- Caterpillar, Inc. Endowed Professor of Management, Foster College of Business, Bradley University, Peoria, Illinois
| | | | - Shannon Lizer
- OSF HealthCare, Center for Advanced Practice, Peoria, Illinois
- Caterpillar, Inc. Endowed Professor of Management, Foster College of Business, Bradley University, Peoria, Illinois
- Saint Anthony College of Nursing, Rockford, Illinois
| | - Melinda Cooling
- OSF HealthCare, Center for Advanced Practice, Peoria, Illinois
| | - Lisa Pierce
- OSF HealthCare, Center for Advanced Practice, Peoria, Illinois
| |
Collapse
|
24
|
Howell BAM. Battling Burnout at the Frontlines of Health Care Amid COVID-19. AACN Adv Crit Care 2021; 32:195-203. [PMID: 33882576 DOI: 10.4037/aacnacc2021454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
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.
Collapse
Affiliation(s)
- Beverly Ann M Howell
- Beverly Ann M. Howell is a Lieutenant, Nurse Corps, US Navy, Naval Medical Leader and Professional Development Command, PSC 482, Box 170, FPO, AP 96362
| |
Collapse
|
25
|
Hlubocky FJ, Shanafelt TD, Back AL, Paice JA, Tetzlaff ED, Friese CR, Kamal AH, McFarland DC, Lyckholm L, Gallagher CM, Chatwal M, Saltzman J, Dudzinski D, Burke JM, James TA, Page RD, Boyle DA, Gonzalez MM, Srivastava P. Creating a Blueprint of Well-Being in Oncology: An Approach for Addressing Burnout From ASCO's Clinician Well-Being Taskforce. Am Soc Clin Oncol Educ Book 2021; 41:e339-e353. [PMID: 34061565 DOI: 10.1200/edbk_320873] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Optimizing the well-being of the oncology clinician has never been more important. Well-being is a critical priority for the cancer organization because burnout adversely impacts the quality of care, patient satisfaction, the workforce, and overall practice success. To date, 45% of U.S. ASCO member medical oncologists report experiencing burnout symptoms of emotional exhaustion and depersonalization. As the COVID-19 pandemic remains widespread with periods of outbreaks, recovery, and response with substantial personal and professional consequences for the clinician, it is imperative that the oncologist, team, and organization gain direct access to resources addressing burnout. In response, the Clinician Well-Being Task Force was created to improve the quality, safety, and value of cancer care by enhancing oncology clinician well-being and practice sustainability. Well-being is an integrative concept that characterizes quality of life and encompasses an individual's work- and personal health-related environmental, organizational, and psychosocial factors. These resources can be useful for the cancer organization to develop a well-being blueprint: a detailed start plan with recognized strategies and interventions targeting all oncology stakeholders to support a culture of community in oncology.
Collapse
Affiliation(s)
- Fay J Hlubocky
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medicine, Chicago, IL
| | | | - Anthony L Back
- Seattle Cancer Care, University of Washington, Seattle, WA
| | - Judith A Paice
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Eric D Tetzlaff
- Department of Hematology Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | | | | | - Laurie Lyckholm
- Division of Hematology Oncology, University of Iowa, Iowa City, IA
| | | | | | - Joel Saltzman
- Lake Health, University Hospitals, Seidman Cancer Center, Mentor, OH
| | | | | | - Ted A James
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - Ray D Page
- The Center for Cancer and Blood Disorders, Fort Worth, TX
| | | | | | | |
Collapse
|
26
|
Wu DTY, Xu C, Kim A, Bindhu S, Mah KE, Eckman MH. A Scoping Review of Health Information Technology in Clinician Burnout. Appl Clin Inform 2021; 12:597-620. [PMID: 34233369 PMCID: PMC8263130 DOI: 10.1055/s-0041-1731399] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinician burnout is a prevalent issue in healthcare, with detrimental implications in healthcare quality and medical costs due to errors. The inefficient use of health information technologies (HIT) is attributed to having a role in burnout. OBJECTIVE This paper seeks to review the literature with the following two goals: (1) characterize and extract HIT trends in burnout studies over time, and (2) examine the evidence and synthesize themes of HIT's roles in burnout studies. METHODS A scoping literature review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with two rounds of searches in PubMed, IEEE Xplore, ACM, and Google Scholar. The retrieved papers and their references were screened for eligibility by using developed inclusion and exclusion criteria. Data were extracted from included papers and summarized either statistically or qualitatively to demonstrate patterns. RESULTS After narrowing down the initial 945 papers, 36 papers were included. All papers were published between 2013 and 2020; nearly half of them focused on primary care (n = 16; 44.4%). The most commonly studied variable was electronic health record (EHR) practices (e.g., number of clicks). The most common study population was physicians. HIT played multiple roles in burnout studies: it can contribute to burnout; it can be used to measure burnout; or it can intervene and mitigate burnout levels. CONCLUSION This scoping review presents trends in HIT-centered burnout studies and synthesizes three roles for HIT in contributing to, measuring, and mitigating burnout. Four recommendations were generated accordingly for future burnout studies: (1) validate and standardize HIT burnout measures; (2) focus on EHR-based solutions to mitigate clinician burnout; (3) expand burnout studies to other specialties and types of healthcare providers, and (4) utilize mobile and tracking technology to study time efficiency.
Collapse
Affiliation(s)
- Danny T. Y. Wu
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Catherine Xu
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Ohio, United States
- Medical Science Baccalaureate Program, University of Cincinnati College of Medicine, Ohio, United States
| | - Abraham Kim
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Ohio, United States
- Medical Science Baccalaureate Program, University of Cincinnati College of Medicine, Ohio, United States
| | - Shwetha Bindhu
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Ohio, United States
- Medical Science Baccalaureate Program, University of Cincinnati College of Medicine, Ohio, United States
| | - Kenneth E. Mah
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Mark H. Eckman
- Division of General Internal Medicine, University of Cincinnati College of Medicine, Ohio, United States
| |
Collapse
|
27
|
Abstract
Supplemental Digital Content is available in the text. Objectives: Examine well-being, measured as burnout and professional fulfillment, across critical care healthcare professionals, ICUs, and hospitals within a health system; examine the impact of the coronavirus disease 2019 pandemic. Design: To complement a longitudinal survey administered to medical critical care physicians at the end of an ICU rotation, which began in May 2018, we conducted a cross-sectional survey among critical care professionals across four hospitals in December 2018 to January 2019. We report the results of the cross-sectional survey and, to examine the impact of the coronavirus disease 2019 pandemic, the longitudinal survey results from July 2019 to May 2020. Setting: Academic medical center. Subjects: Four-hundred eighty-one critical care professionals, including 353 critical care nurses, 58 advanced practice providers, 57 physicians, and 13 pharmacists, participated in the cross-sectional survey; 15 medical critical care physicians participated in the longitudinal survey through the coronavirus disease 2019 pandemic. Interventions: None. Measurements and Main Results: Burnout was present in 50% of ICU clinicians, ranging from 42% for critical care physicians to 55% for advanced practice providers. Professional fulfillment was less common at 37%, with significant variability across provider (p = 0.04), with a low of 23% among critical care pharmacists and a high of 53% among physicians. Well-being varied significantly at the hospital and ICU level. Workload and job demand were identified as drivers of burnout and meaning in work, culture and values of work community, control and flexibility, and social support and community at work were each identified as drivers of well-being. Between July 2019 and March 2020, burnout and professional fulfillment were present in 35% (15/43) and 58% (25/43) of medical critical care physician responses, respectively. In comparison, during the coronavirus disease 2019 pandemic, burnout and professional fulfillment were present in 57% (12/21) and 38% (8/21), respectively. Conclusions: Burnout was common across roles, yet differed across ICUs and hospitals. Professional fulfillment varied by provider role. We identified potentially modifiable factors related to clinician well-being that can inform organizational strategies at the ICU and hospital level. Longitudinal studies, designed to assess the long-term impact of the coronavirus disease 2019 pandemic on the well-being of the critical care workforce, are urgently needed.
Collapse
|