The Relationship Between Restrictive Regulation of Midwives, Practice Environment, and Professional Burnout: A 7-State Mixed-Methods Comparison of Autonomous and Restrictive State Regulation.

PURPOSE: The purpose of the study was to investigate the relationship between state regulation of the midwifery workforce, practice environment, and burnout. BACKGROUND: Burnout threatens the US midwifery workforce, with over 40% of certified nurse-midwives meeting criteria. Burnout can lead to poorer physical and mental health and withdrawal from the workforce. Burnout in midwives has been associated with lack of control and autonomy. In the United States, midwives' autonomy is restricted through state-level regulation that limits scope of practice and professional independence. METHODS: A mixed-methods study was conducted using an explanatory sequential approach. Quantitative and qualitative data were collected by online surveys and analyzed in a 2-stage process, followed by data integration. RESULTS: State regulation was not found to be independently associated with burnout (n = 248; P = .250); however, mediation analysis showed a significant association between state regulation, practice environment, and burnout. Qualitative analysis mirrored the importance of practice environment and expanded on its features. CONCLUSION: For midwives, unrestrictive practice regulation may not translate to burnout prevention without supportive practice environments. IMPLICATIONS FOR PRACTICE AND RESEARCH: Interventions should focus on promoting job flexibility, realistic demands, and professional values. While midwives' commitment to patients and the profession can help bolster the workforce, it can also amplify negative experiences of the practice environment.

Not Missing the Opportunity: Improving Depression Screening and Follow-Up in a Multicultural Community.

BACKGROUND: Screening for depression and documenting follow-up is a National Quality Forum-endorsed measure. Yet only seven states report depression screening and follow-up, making it the fourth-least-reported measure on the Medicaid Adult Core Set. In 2016 a multicultural health center found that only 9.1% of clients were screened and followed up for depression. This quality improvement project was conducted to increase the efficacy of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for depression to 75% for screen-positive clients. METHODS: Four Plan-Do-Study-Act (PDSA) cycles in a 90-day period focused on depression screening, patient engagement, population health management, and team building were used. The package of interventions-use of written standardized Patient Health Questionnaire (PHQ) screening tools in six languages, the Option Grid™ for clients with positive PHQ screens, a "right care" tracking log for those clients, and team meetings and in-services to support capacity building-were operationalized using a point-of-care notebook that created a physical reminder and trigger for the use of the intervention tools. Surveys, charts, and registry data were analyzed to evaluate the population health impact of the interventions. RESULTS: Provision of evidence-based care increased to 71.4%, and adherence to follow-up increased from 33.3% to 60.0%. Screening in the client's preferred language increased the rate to 85.2%, identifying a positive PHQ incidence of 45.5%. CONCLUSION: Rapid-cycle improvement with a population health focus demonstrated improved depression screening and follow-up within a multicultural community health center. Outcomes were attributed to team engagement and the use of standardized tools. These processes can be applied to other primary care settings.