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Yu S, Zhao M, Li Y, Liu C, Fu Y, Jiang Y, Guan S. The interaction of occupational stress and job burnout on depressive symptoms in railway workers in Fuzhou city. BMC Public Health 2024; 24:1432. [PMID: 38811897 PMCID: PMC11134703 DOI: 10.1186/s12889-024-18902-2] [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: 11/08/2023] [Accepted: 05/21/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND To explore the relationship between occupational stress, burnout and depressive symptoms among railroad workers in Fuzhou, and to analyze the interaction of burnout and occupational stress on depressive symptoms. METHODS In this study, 861 railway employees of Fuzhou railway bureau were randomly selected from January to April, 2022. Occupational stress inventory revised edition (OSI-R), China job burnout inventory (CMBI) and Symptom Checklist-90 (SCL-90) were used to investigate the occupational stress, job burnout and depressive symptoms of railway workers. Interactions associated with depressive symptoms were assessed by linear hierarchical regression analysis and SPSS macros (PROCESS). RESULTS Occupational stress, job burnout and depressive symptoms accounted for 50.58%, 93.47%, and 11.19% of the study population, respectively. There were intergroup differences between age, marriage status, and length of service (P < 0.05). Occupational stress and job burnout are the main risk factors for depressive symptoms (OR: 2.01, 95% CI: 1.17-3.45; 1.94, 1.69-2.23, respectively). More importantly, further analysis of the interaction between occupational stress and job burnout showed that those with high levels of job burnout had a high-risk effect on depressive symptoms at high levels of occupational stress. CONCLUSION Occupational stress and job burnout are risk factors for depressive symptoms among railroad workers in Fuzhou City. The interaction of job burnout and occupational stress increases the risk of depressive symptoms.
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Affiliation(s)
- Shuangjie Yu
- School of Public Health, The Key Laboratory of Environmental Factors and Chronic Disease Control of Ningxia, Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Min Zhao
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, 350122, China
| | - Ye Li
- School of Public Health, The Key Laboratory of Environmental Factors and Chronic Disease Control of Ningxia, Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Can Liu
- School of Public Health, The Key Laboratory of Environmental Factors and Chronic Disease Control of Ningxia, Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Youjuan Fu
- School of Public Health, The Key Laboratory of Environmental Factors and Chronic Disease Control of Ningxia, Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Yu Jiang
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, 350122, China.
| | - Suzhen Guan
- School of Public Health, The Key Laboratory of Environmental Factors and Chronic Disease Control of Ningxia, Ningxia Medical University, Yinchuan, Ningxia, 750004, China.
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Sever MS, Luyckx V, Tonelli M, Kazancioglu R, Rodgers D, Gallego D, Tuglular S, Vanholder R. Disasters and kidney care: pitfalls and solutions. Nat Rev Nephrol 2023; 19:672-686. [PMID: 37479903 DOI: 10.1038/s41581-023-00743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
Patients with kidney disease, especially those with kidney failure, are particularly susceptible to the adverse effects of disasters because their survival depends on functional infrastructure, advanced technology, the availability of specific drugs and well-trained medical personnel. The risk of poor outcomes across the entire spectrum of patients with kidney diseases (acute kidney injury, chronic kidney disease and kidney failure on dialysis or with a functioning transplant) increases as a result of disaster-related logistical challenges. Patients who are displaced face even more complex problems owing to additional threats that arise during travel and after reaching their new location. Overall, risks may be mitigated by pre-disaster preparedness and training. Emergency kidney disaster responses depend on the type and severity of the disaster and include medical and/or surgical treatment of injuries, treatment of mental health conditions, appropriate diet and logistical interventions. After a disaster, patients should be evaluated for problems that were not detected during the event, including those that may have developed as a result of the disaster. A retrospective review of the disaster response is vital to prevent future mistakes. Important ethical concerns include fair distribution of limited resources and limiting harm. Patients with kidney disease, their care-givers, health-care providers and authorities should be trained to respond to the medical and logistical problems that occur during disasters to improve outcomes.
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Affiliation(s)
- Mehmet Sukru Sever
- Istanbul University, Istanbul School of Medicine, Department of Nephrology, Istanbul, Turkey.
| | - Valerie Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Renal Division, Brigham and Women's Hospital, Harvard, Medical School, Boston, MA, USA
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rumeyza Kazancioglu
- Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Darlene Rodgers
- Independent Nurse Consultant, American Society of Nephrology, Washington, DC, USA
| | - Dani Gallego
- European Kidney Health Alliance, Brussels, Belgium
- European Kidney Patient Federation, Wien, Austria
| | - Serhan Tuglular
- Marmara University, School of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
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McGoldrick J, Molina-Ochoa D, Schwab P, Edwards ST, Barton JL. An Evaluation of Burnout Among US Rheumatology Fellows: A National Survey. J Rheumatol 2023; 50:1185-1190. [PMID: 36921966 DOI: 10.3899/jrheum.221114] [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] [Accepted: 03/02/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To evaluate levels of burnout and correlates of burnout among US rheumatology fellows. METHODS US rheumatology fellows were invited to complete an electronic survey in 2019. Burnout was assessed using the Maslach Burnout Inventory. Measures of depression, fatigue, quality of life, and training year were also collected. Open-ended questions about perceived factors to promote resiliency and factors leading to increased burnout were included. Bivariate and multivariate regression analyses were used to examine correlates of burnout. Open-ended responses were analyzed using thematic analysis. RESULTS The response rate was 18% (105/582 pediatric and adult rheumatology fellows). Over one-third (38.5%) of postgraduate year (PGY) 4 and 16.7% of PGY5/6 fellows reported at least 1 symptom of burnout. Of PGY4 fellows, 12.8% met criteria for depression compared with 2.4% of PGY5/6 fellows. PGY4 fellows reported worse fatigue and poorer quality of life compared with PGY5/6. In multivariable models controlling for training year and gender, older age (> 31 years) was associated with lower odds of burnout. Thematic analysis of open-ended responses identified factors that help reduce burnout: exercise, family/friends, sleep, support at work, and hobbies. Factors contributing to burnout: pager, documentation, long hours, demands of patient care, and presentations and expectations. CONCLUSION This national survey of US rheumatology fellows reveals that early trainee level and younger age are associated with worse levels of fatigue, quality of life, and burnout. Although awareness of and strategies to reduce burnout are needed for all fellows, targeted interventions for younger fellows and those in their first year of training may be of highest yield.
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Affiliation(s)
| | - Diego Molina-Ochoa
- D. Molina-Ochoa, BS, University of Maryland School of Medicine, Baltimore, Maryland
| | - Pascale Schwab
- P. Schwab, MD, S.T. Edwards, MD, MPH, J.L. Barton, MD, MCR, Oregon Health & Science University, and VA Portland Health Care System, Portland, Oregon, USA
| | - Samuel T Edwards
- P. Schwab, MD, S.T. Edwards, MD, MPH, J.L. Barton, MD, MCR, Oregon Health & Science University, and VA Portland Health Care System, Portland, Oregon, USA
| | - Jennifer L Barton
- P. Schwab, MD, S.T. Edwards, MD, MPH, J.L. Barton, MD, MCR, Oregon Health & Science University, and VA Portland Health Care System, Portland, Oregon, USA
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Plantinga LC, Rickenbach F, Urbanski M, Hoge C, Douglas-Ajayi C, Morgan JC, Bender AA, Jaar BG. Professional Fulfillment, Burnout, and Turnover Intention Among US Dialysis Patient Care Technicians: A National Survey. Am J Kidney Dis 2023; 82:22-32.e1. [PMID: 36906216 PMCID: PMC10293091 DOI: 10.1053/j.ajkd.2022.12.017] [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: 07/18/2022] [Accepted: 12/27/2022] [Indexed: 03/12/2023]
Abstract
RATIONALE & OBJECTIVE High professional fulfillment and low burnout and staff turnover are necessary for a stable dialysis workforce. We explored professional fulfillment, burnout, and turnover intention among US dialysis patient care technicians (PCTs). STUDY DESIGN Cross-sectional national survey. SETTING & PARTICIPANTS National Association of Nephrology Technicians/Technologists (NANT) members in March-May 2022 (N=228; 42.6% aged 35-49 years, 83.9% female, 64.6% White, 85.3% non-Hispanic). EXPOSURE Likert-scale items (range, 0-4) related to professional fulfillment and 2 domains of burnout (work exhaustion and interpersonal disengagement) and dichotomous items related to turnover intention. ANALYTICAL APPROACH Summary statistics (percentages, means, medians) were calculated for individual items and average domain scores. Burnout was defined by combined work exhaustion and interpersonal disengagement scores of≥1.3 and professional fulfillment by a score≥3.0. RESULTS Most respondents (72.8%) worked ≥40 hours per week. Overall scores for work exhaustion, interpersonal disengagement, and professional fulfillment (median [IQR]) were 2.3 (1.3-3.0), 1.0 (0.3-1.8), and 2.6 (2.0-3.2), respectively; 57.5% reported burnout, and 37.3% reported professional fulfillment. Important contributors to burnout and professional fulfillment included salary (66.5%), supervisor support (64.0%), respect from other dialysis staff (57.8%), sense of purpose about work (54.5%), and hours worked per week (52.9%). Only 52.6% reported that they plan to be working as a dialysis PCT in 3 years. Free text responses reinforced perceived excessive work burden and lack of respect. LIMITATIONS Limited generalizability to all US dialysis PCTs. CONCLUSIONS More than half of dialysis PCTs reported burnout, driven by work exhaustion; only about one-third reported professional fulfillment. Even among this relatively engaged group of dialysis PCTs, only half intended to continue working as PCTs. Because of the critical, frontline role of dialysis PCTs in the care of patient receiving in-center hemodialysis, strategies to improve morale and reduce turnover are imperative.
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Affiliation(s)
| | - Fran Rickenbach
- National Association of Nephrology Technicians/Technologists, Dayton, Ohio
| | - Megan Urbanski
- Department of Surgery, Emory University, Atlanta, Georgia
| | - Courtney Hoge
- Department of Medicine, Emory University, Atlanta, Georgia
| | | | | | | | - Bernard G Jaar
- Department of Medicine, Department of Epidemiology, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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Graham-Brown MP, Beckwith HK, O'Hare S, Trewartha D, Burns A, Carr S. Impact of changing medical workforce demographics in renal medicine over 7 years: Analysis of GMC national trainee survey data. Clin Med (Lond) 2022; 21:e363-e370. [PMID: 35192479 DOI: 10.7861/clinmed.2020-1065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Increasing numbers of doctors in training are taking career breaks, with burnout cited as a potential cause. This study analysed General Medical Council (GMC) national training survey data (renal medicine) to understand the impacts of changing workforce demographics on trainee outcomes and wellbeing. Increasing proportions of female, Black, Asian and minority ethnic (BAME), and international medical graduates are entering the workforce. Specialty exam pass rates have fallen and are lower for BAME and international medical graduates in renal medicine. Time to complete higher specialty training has increased for female trainees. Self-reported burnout rates for renal trainees were higher than other medical specialties and highest for male BAME trainees. Burnout was only partially mitigated by less-than-full-time working, but had no impact on progression, sick-leave or time out of training. It is important to recognise changes to the workforce and proactively plan to effectively support a more diverse group of trainees, to enable them to succeed and reduce differential attainment.
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Affiliation(s)
- Matthew Pm Graham-Brown
- University of Leicester, Leicester, UK, Glenfield Hospital, Leicester, UK, and University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | | | - Aine Burns
- University College London, London, UK and Royal Free Hospital, London, UK
| | - Sue Carr
- University Hospitals of Leicester NHS Trust, Leicester, UK and General Medical Council, London, UK
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Abstract
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.
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Saeed F, Duberstein PR, Epstein RM, Lang VJ, Liebman SE. Frequency and Severity of Moral Distress in Nephrology Fellows: A National Survey. Am J Nephrol 2021; 52:487-495. [PMID: 34153971 PMCID: PMC10073901 DOI: 10.1159/000516575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Moral distress is a negative affective response to a situation in which one is compelled to act in a way that conflicts with one's values. Little is known about the workplace scenarios that elicit moral distress in nephrology fellows. METHODS We sent a moral distress survey to 148 nephrology fellowship directors with a request to forward it to their fellows. Using a 5-point (0-4) scale, fellows rated both the frequency (never to very frequently) and severity (not at all disturbing to very disturbing) of commonly encountered workplace scenarios. Ratings of ≥3 were used to define "frequent" and "moderate-to-severe" moral distress. RESULTS The survey was forwarded by 64 fellowship directors to 386 fellows, 142 of whom (37%) responded. Their mean age was 33 ± 3.6 years and 43% were female. The scenarios that most commonly elicited moderate to severe moral distress were initiating dialysis in situations that the fellow considered futile (77%), continuing dialysis in a hopelessly ill patient (81%) and carrying a high patient census (75%), and observing other providers giving overly optimistic descriptions of the benefits of dialysis (64%). Approximately 27% had considered quitting fellowship during training, including 9% at the time of survey completion. CONCLUSION A substantial majority of nephrology trainees experienced moral distress of moderate to severe intensity, mainly related to the futile treatment of hopelessly ill patients. Efforts to reduce moral distress in trainees are required.
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Affiliation(s)
- Fahad Saeed
- Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Public Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Paul R. Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Ronald M. Epstein
- Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Valerie J Lang
- Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Division of Hospital Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Scott E. Liebman
- Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Sever MS, Ortiz A, Maggiore U, Bac-García E, Vanholder R. Mass Disasters and Burnout in Nephrology Personnel: From Earthquakes and Hurricanes to COVID-19 Pandemic. Clin J Am Soc Nephrol 2021; 16:829-837. [PMID: 33414153 PMCID: PMC8259469 DOI: 10.2215/cjn.08400520] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Mass disasters result in extensive health problems and make health care delivery problematic, as has been the case during the COVID-19 pandemic. Although COVID-19 was initially considered a pulmonary problem, it soon became clear that various other organs were involved. Thus, many care providers, including kidney health personnel, were overwhelmed or developed burnout. This review aims to describe the spectrum of burnout in mass disasters and suggests solutions specifically for nephrology personnel by extending previous experience to the COVID-19 pandemic. Burnout (a psychologic response to work-related stress) is already a frequent part of routine nephrology practice and, not surprisingly, is even more common during mass disasters due to increased workload and specific conditions, in addition to individual factors. Avoiding burnout is essential to prevent psychologic and somatic health problems in personnel as well as malpractice, understaffing, and inadequate health care delivery, all of which increase the health care burden of disasters. Burnout may be prevented by predisaster organizational measures, which include developing an overarching plan and optimizing health care infrastructure, and ad hoc disaster-specific measures that encompass both organizational and individual measures. Organizational measures include increasing safety, decreasing workload and fear of malpractice, optimizing medical staffing and material supplies, motivating personnel, providing mental health support, and enabling flexibility in working circumstances. Individual measures include training on coping with stress and problematic conditions, minimizing the stigma of emotional distress, and maintaining physical health. If these measures fall short, asking for external help is mandatory to avoid an inefficient disaster health care response. Minimizing burnout by applying these measures will improve health care provision, thus saving as many lives as possible.
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Affiliation(s)
- Mehmet Sukru Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | - Umberto Maggiore
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy,UO Nefrologia, Azienda-Ospedaliero Universitaria di Parma, Parma, Italy
| | - Enrique Bac-García
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain,Department of Psychiatry, Universidad Autonoma de Madrid, Madrid, Spain
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium,European Kidney Health Alliance, Brussels, Belgium
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Pivert KA, Boyle SM, Halbach SM, Chan L, Shah HH, Waitzman JS, Mehdi A, Norouzi S, Sozio SM. Impact of the COVID-19 Pandemic on Nephrology Fellow Training and Well-Being in the United States: A National Survey. J Am Soc Nephrol 2021; 32:1236-1248. [PMID: 33658283 PMCID: PMC8259681 DOI: 10.1681/asn.2020111636] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/21/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic's effects on nephrology fellows' educational experiences, preparedness for practice, and emotional wellbeing are unknown. METHODS We recruited current adult and pediatric fellows and 2020 graduates of nephrology training programs in the United States to participate in a survey measuring COVID-19's effects on their training experiences and wellbeing. RESULTS Of 1005 nephrology fellows-in-training and recent graduates, 425 participated (response rate 42%). Telehealth was widely adopted (90% for some or all outpatient nephrology consults), as was remote learning (76% of conferences were exclusively online). Most respondents (64%) did not have in-person consults on COVID-19 inpatients; these patients were managed by telehealth visits (27%), by in-person visits with the attending faculty without fellows (29%), or by another approach (9%). A majority of fellows (84%) and graduates (82%) said their training programs successfully sustained their education during the pandemic, and most fellows (86%) and graduates (90%) perceived themselves as prepared for unsupervised practice. Although 42% indicated the pandemic had negatively affected their overall quality of life and 33% reported a poorer work-life balance, only 15% of 412 respondents who completed the Resident Well-Being Index met its distress threshold. Risk for distress was increased among respondents who perceived the pandemic had impaired their knowledge base (odds ratio [OR], 3.04; 95% confidence interval [CI], 2.00 to 4.77) or negatively affected their quality of life (OR, 3.47; 95% CI, 2.29 to 5.46) or work-life balance (OR, 3.16; 95% CI, 2.18 to 4.71). CONCLUSIONS Despite major shifts in education modalities and patient care protocols precipitated by the COVID-19 pandemic, participants perceived their education and preparation for practice to be minimally affected.
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Affiliation(s)
- Kurtis A. Pivert
- Data Science and Public Impact, American Society of Nephrology, Washington, DC
| | - Suzanne M. Boyle
- Section of Nephrology, Hypertension, and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Susan M. Halbach
- Department of Pediatrics, Division of Nephrology, University of Washington and Seattle Children’s Hospital, Seattle, Washington
| | - Lili Chan
- Charles Bronfman Institute of Personalized Medicine, Department of Genetics and Genomics; Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hitesh H. Shah
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
| | - Joshua S. Waitzman
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ali Mehdi
- Department of Nephrology and Hypertension—Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sayna Norouzi
- Department of Nephrology, Loma Linda University Medical Center, Loma Linda, California
| | - Stephen M. Sozio
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine; and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Bansal N, Hall YN, Sambandam KK, Leonberg-Yoo AK. Lessons Learned: Nephrology Training Program Adaptation in the Time of COVID. Am J Kidney Dis 2021; 78:9-12. [PMID: 33887434 PMCID: PMC8054509 DOI: 10.1053/j.ajkd.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/19/2021] [Indexed: 01/20/2023]
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Abstract
OBJECTIVE The provision of end-of-life (EOL) care has complex effects on both the professional and personal well-being of medical health personnel (MHP). Previous studies have mostly focused on negative or positive influences as mutually exclusive effects. This study offers a new conceptualization by applying a dialectical lens, looking at secondary traumatic stress (STS) and post-traumatic growth (PTG) as dual possible coexisting phenomena. The creation of four theoretically possible profiles, based on the combinations of high or low levels in each dimension, offers a practical translation of this idea toward intervention development. METHOD Data were collected at a large tertiary pediatric medical center (n = 1,123) aiming at assessing all personnel. Research methods included collecting demographic data and using validated scales to assess STS, PTG, burnout, compassion satisfaction, and both personal and professional social support. RESULTS We classified four response profiles according to the STS and PTG levels: (1) Dialectical-impact, high STS/high PTG, (2) Growth-dominant, high PTG/low STS, (3) Stress-dominant, high STS/low PTG, and (4) Limited-impact, low STS/low PTG. The four profiles differed based on profession, but not other demographics. Physicians were represented significantly higher in the Stress-dominant profile; nurses were highly represented in the Dialectical-impact profile. A significant difference was found when adding reported EOL care as a distinct factor with a higher relative proportion of the "dialectical" response among those reporting providing EOL care. SIGNIFICANCE OF RESULTS Findings from this study point toward the recognition and understanding of the complexity resulting from the provision of EOL care. A more complex profile classification, including the dialectical profile, may reflect a broader tendency to ways that MHP are affected by their work. Introducing "dialectical thinking" can lead to more personalized and precise intervention planning for MHP. Tailored interventions promoting personal and professional well-being, based on individual profiles, can contribute to more effective interventions and better resource utilization.
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Moura-Neto JA. "To Be, or Not to Be" a Nephrologist: Students' Dilemma and a Strategy for the Field. Blood Purif 2021; 50:696-701. [PMID: 33503624 DOI: 10.1159/000513155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022]
Abstract
The attractiveness of a career in nephrology has diminished over the past decades, leading to global concerns about the future of the specialty's workforce. The reasons physicians choose (and do not choose) a career in the field must be identified in order to boost recruitment of new nephrologists. In this article, a multilevel strategy is proposed to deal with the declining interest in the specialty: (1) increasing contact and providing early exposure to nephrology; (2) promoting mentoring and role models in medical schools; (3) improving the experience of trainees and medical students; (4) incorporating procedural skills and combined fellowship training with critical care in nephrology; (5) facilitating exchanges between trainees and young and senior nephrologists; (6) adopting an active approach to identify reasons for dissatisfaction, reduce burnout, and encourage a suitable work-life balance among nephrologists; (7) increasing remuneration; and (8) incentivizing advances in the field. Finally, a positive perspective for nephrology is presented to the next generation.
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Lederer E, Lebowitz J. Current State of the Workforce in Nephrology. Adv Chronic Kidney Dis 2020; 27:281-290.e1. [PMID: 33131640 DOI: 10.1053/j.ackd.2020.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 12/26/2022]
Abstract
The number of individuals with CKD and end-stage kidney disease continues to rise as the interest in nephrology as a career choice is declining among internal medicine residents. Simultaneously, the emergence of integrated healthcare delivery models encompassing multiple levels of nonphysician healthcare workers plus advanced technological capabilities offer innovative mechanisms for the delivery of optimal care for patients at risk for and suffering from CKD. Critical to the success of these models is the identification of aspects of nephrology care specific to and appropriate for each type of kidney care professional and the development of organizational structures that both define and facilitate the flow of patient care. However, several factors in addition to the declining interest in nephrology pose significant obstacles to the development of the optimal nephrology work force including gender imbalance in leadership and nonleadership positions, gender disparity in compensation, inadequate diversity in ethnicity of nephrologists, and perceptions of inadequate compensation and a poor work life balance. Recent studies suggest that some, but not all, of these challenges are being addressed, though full resolution will require creative and concerted efforts.
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