Association of Burnout and Other Factors Within Physicians and Advanced Practice Providers in an Academic Surgery Department.

BACKGROUND: Provider burnout is a work-related syndrome that is under-recognized, under-reported, and has negative repercussions on the individual, system, and patients. This study investigated burnout incidence and its association with wellness characteristics such as resilience, psychological safety, and perceptions of the workplace to inform future work in improving well-being. METHODS: Electronic surveys were sent to 153 physicians and advanced practice providers (APPs) in the department of surgery at a single institution. Survey topics included demographics, intention to stay, engagement, and items from validated measures for workplace perceptions including work pace/stress (Mini Z), burnout, psychological safety, and resilience. Descriptive statistics, bivariate associations, and logistic regression were used to evaluate responses. RESULTS: Overall response rate was 47%. The majority of providers reported feeling burned out (56%), and 48% indicated they would probably leave the organization within three years. Additionally, 61% reported being satisfied with their job and 55% felt that they contributed professionally in the ways they value most (meaningful work/engagement). Significant predictors for burnout included negative work environment perceptions (work pace/stress), low resilience, low meaningful work, and professional role (physician vs APP). DISCUSSION: Maintaining a healthy workforce requires investigation into the factors that support workplace well-being. The strongest predictors of burnout were work pace/stress. Protective factors against burnout were psychological safety and resilience. An organizational culture that promotes psychological safety, as well as workplace improvements to enhance providers' sense of meaning in work, and decreasing work pace and stress may contribute to the prevention of burnout and the retention.

Defining Types of Leadership Within an Academic Surgery Department to Promote Change for Decreasing Rates of Burnout.

OBJECTIVES: Successful leaders influence the group they represent. Effective surgical care is tied to its leadership climate. However, most surgical providers are not attuned to their individual strengths which if known they could leverage them within their teams. This study identifies leadership types within a department of surgery which may be used to better understand and cultivate their strengths. METHODS: In 2022, 172 providers in an academic surgery department were offered the GallupTM CliftonStrengths assessment, a proprietary instrument that maps 34 strengths across 4 domains of leadership. The assessment provides a respondent with their top 5 strengths and the domain in which they naturally "lead". RESULTS: Of 172 providers, 127 (74%) completed the assessment. While providers have strengths in multiple domains, they "lead with" a specific domain. Mapped from the providers' top 10 strengths, the most common "lead with" domain for surgical providers was Executing: the ability to implement ideas and produce results. Strategic Thinking: those who are analytical and push teams forward and Relationship Building: the ability to create strong and effective teams were followed by the least common domain. Influencing: the ability to communicate ideas and lead others. Formal leaders were significantly more likely to lead with Strategic Thinking. There were no significant differences between APPs and physicians. CONCLUSION: A majority of surgical providers "lead with" the GallupTM Executing domain. Those who lead with executing skills work tirelessly to produce outcomes. Learning to leverage the strengths of our teams to create cohesion and efficiency may improve engagement and retention.

Redesigning nurse practitioner clinical education with a Dyad/POD model: A feasibility study.

ABSTRACT: Clinical education for nurse practitioner (NP) students is increasingly challenging. With fewer preceptors, lack of resources and time burden, finding clinical placements is a burdensome responsibility. Also, when students have multiple preceptors, there may be inconsistencies when evaluating students. With the change to competency-based education, consistency is crucial when evaluating NP students. Typical preceptorship with students is a 1:1:1 ratio: one student with one preceptor for one semester. The Dyad/Precepting to Optimize Development (POD) model has potential to improve clinical precepting. Precepting to optimize development refers to a consistent team of students, preceptors, and faculty over the course of the students' education. Dyad refers to two students with one preceptor. Students rotate in dyad pairs every 4-8 weeks with a consistent group of preceptors, and see these same preceptors again over the course of their educational journey. Preceptors met monthly to collaborate, discuss, and learn. This article reports on the outcomes of a mixed-methods feasibility study that occurred over a year. The students, preceptors, and faculty report satisfaction with the model. Several themes arose during analysis of focus group sessions. Those themes were as follows: safe learning environment; everyone teaches, everyone learns; growth mindset; teaming culture and the POD structure is essential to the dyad. In conclusion, developing a different approach to precepting is essential to meet national provider needs. The Dyad/POD model provides consistency for development and evaluation of the NP student.

The use of motivational interviewing to overcome COVID-19 vaccine hesitancy in primary care settings.

Vaccine hesitancy is not a new phenomenon. However, the COVID-19 pandemic has highlighted the impact of political, racial, and health disparities on vaccine hesitancy at a global level. With the creation of the COVID-19 vaccine, a resurgence of vaccine hesitancy has emerged and many are reluctant to receive the vaccination. The reluctance varies from concerns about government interference in vaccine development, to the speed of vaccine development, to long-term health outcomes and potential side effects. Health care professionals need to consider evidence-based approaches that are effective in assisting patients with health care decision-making regarding vaccine uptake. Motivational Interviewing (MI) is an effective technique to positively impact behavior change. Definitions and examples of MI techniques are provided to illustrate how MI can be used to support patient autonomy and provide a safe and trusting environment, with the goal of increasing COVID-19 vaccination uptake.

State of Simulation Research in Advanced Practice Nursing Education.

Simulation is used in advanced practice nursing education for both formative learning experiences and summative competency testing. However, there has been a lack of cohesive data to support the use of simulation as a replacement for direct patient care hours. This chapter presents an overview of research designs and the leveled Kirkpatrick framework used in simulation research. Research articles evaluating the effect of simulation on advanced practice learners are presented by research design and Kirkpatrick level. There is evidence that simulation has a positive impact on Kirkpatrick Level 1 (Reactions) and Kirkpatrick Level 2 (Changes in Knowledge, Skills, and Attitudes). However, there is a tremendous need for evidence that simulation can impact Kirkpatrick Level 3 (Behavior) and Level 4 (Results and Outcomes).

Care of the Older Adult With Postoperative Delirium: An Interprofessional Simulation for Undergraduate Nursing Students.

Because of the expanding older adult population, undergraduate nursing students need to be introduced to the unique challenges of taking care of older adults. Using simulation to demonstrate some of these challenges allows these entry-level students to learn in a nonthreatening environment. By focusing on an older adult patient who is experiencing postoperative delirium in a simulation, students can practice not only how to complete a safety assessment but also effective communication skills with the patient, family, and members of the interprofessional health care team.

Progressive Assessment and Competency Evaluation Framework for Integrating Simulation in Nurse Practitioner Education.

Competencies for nurse practitioner students have been published with the goal of preparing graduates who are ready to meet the challenges of an increasingly complex health care system. Standardized preclinical assessment of graduate-level competencies have been suggested as a means to optimize the student experience in clinical rotations and maximize the preceptor's time toward preparing students for the transition to independent practice. The main objectives of this study are to describe progressive assessment and competency evaluation as an integral framework for integration of simulation in graduate-level curriculum and present the feasibility and challenges to consider during implementation of Progressive Assessment and Competency Evaluation-directed simulations.

Using Simulation for Clinical Practice Hours in Nurse Practitioner Education in The United States: A Systematic Review.

OBJECTIVES: The National Organization for Nurse Practitioner Faculty (NONPF) does not allow simulation to be used in lieu of traditional clinical hours. The NONPF cites a lack of empirical evidence related to learning outcomes with simulation as rationale for its stance. The purpose of this systematic review was to search, extract, appraise, and synthesize research related to the use of simulation in Nurse Practitioner (NP) education in order to answer the two following questions: 1) What research related to simulation in NP education has emerged in the literature between 2010 and April 2015?, and 2) Of the research studies that have emerged, what level of Kirkpatrick's Training Evaluation Model (1994) is evaluated? DESIGN: This review was reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). DATA SOURCES: A literature search was completed in PubMed and CINAHL using a combination of medical subject headings, or Mesh terms, as well as keywords to retrieve non-indexed citations. REVIEW METHODS: The inclusion criteria for this review were broad in order to disseminate information on future research needed. The review considered studies related to NP education that included any form of simulation intervention, e.g. role-playing and standardized patients. The review considered studies that described original research, but no other design restrictions were imposed. The review was limited to studies published in the English language. RESULTS: The database search strategy yielded 198 citations. These results were narrowed down to 15 studies based on identified inclusion criteria. CONCLUSIONS: There is a lack of empirical evidence in the literature to support using simulation in lieu of direct patient care clinical hours in NP education. The evidence in this systematic review affirms NONPF's statement. Five years after the inception of NONPF's position statement, research to support learning outcomes with simulation in nurse practitioner education remains lacking. There is a need to produce rigorous scientific studies in the future in order to provide quantitative support to allow simulation to be counted as clinical hours in NP programs.

Transitioning premature infants from gavage to breast.

Breast milk provides physiologic and neurodevelopmental protection for premature infants. Most hospitals are breast-milk friendly, but the number of premature infants breastfeeding successfully at discharge is relatively small. There are evidence-based techniques to improve the odds of premature infants breastfeeding at discharge and into the first year of life. Measures that help the infant make the transition to the breast include kangaroo care, nonnutritive sucking, avoidance of bottles, and consistent and supportive staff. A guide to management of the transition process is provided in this article.