Using acceptance and commitment therapy in everyday conversations to support staff well-being.

Healthcare organisations implement a range of staff well-being initiatives and increasingly focus on compassionate leadership. While formal interventions aimed at maintaining and enhancing staff well-being can be beneficial, they have practical limitations, such as staff turnover and challenges in meeting demand. Therefore, everyday conversations between nurses in leadership positions and their team members also have an important role in supporting staff well-being. One psychological model that nurse leaders may wish to use is acceptance and commitment therapy (ACT), which involves techniques such as mindfulness, acceptance and values clarification. This article outlines the principles of ACT and explains how leaders can use these to guide well-being conversations with staff.

Developing a talent management framework for domestically and internationally trained nurses and midwives in healthcare organizations: A mixed-methods research protocol.

AIM: The aim of this study is to gather evidence on talent management practices for nurses and midwives in an Irish hospital group, to identify any shortcomings in the current practices and to develop an evidence-based talent management framework for the hospital group. DESIGN: This paper details a protocol for a mixed methods research study that will be used to (1) identify, critically evaluate and summarize academic scholarship on talent management strategies for both domestically and internationally trained nurses and midwives, leading to the development of a model of talent management for this study, (2) gather evidence from both domestic and internationally trained nurses and midwives, via questionnaires and focus groups within the hospital group on current talent management practices and (3) use the model previously developed to organize our findings and develop a talent management framework for the hospital group. METHODS: The study will adapt a mixed methods approach. Quantitative data will be analysed using SPSS, and qualitative data will be analysed using NVivo. RESULTS: Our findings will support a stakeholder approach to the development of talent management practices for both domestic and internationally trained nurses and midwives in healthcare organizations. Doing so should improve the pipeline of suitably qualified nurses and midwives for future roles, by assisting nurses and midwives to identify career paths and future educational opportunities. From an organizational perspective, this research will allow healthcare organizations to adapt their current workforce planning strategies, tailoring them to the needs of the current workforce, which should reduce turnover, ensuring a highly skilled workforce, with the appropriate numbers to provide the care required within that healthcare setting. NO PATIENT OF PUBLIC CONTRIBUTION: Contributions will be sought from nursing and midwifery staff and management within the hospital group.

Applying the Worker Well-Being Framework to Identify Factors that Impact Turnover Among Long-Haul Truck Drivers.

BACKGROUND: Drivers in the long-haul trucking industry have chronic health conditions, engage in unhealthy behaviors, and leave the industry at high rates. Previous work has not considered the health and safety outcomes resulting from the conditions of work in the trucking industry and their role in turnover. The goal of this study was to understand the expectations of an incoming workforce, explore how work conditions impact their well-being, and identify strategies for retention. METHODS: Semi-structured interviews were conducted among current long-haul drivers and supervisors at trucking companies, and students and instructors at trucking schools (n = 33). Participants were asked about why they decided to enter the industry, their health challenges related to being in the trucking industry and whether these challenges were related to turnover, and strategies for retention. FINDINGS: Health conditions, differences in job expectations, and work demands were associated with leaving the industry. Workplace policies and culture (e.g., lack of supervisor support, schedules that limited home time, company size, and lack of benefits) were associated with workers' intention to leave an organization. Strategies identified to improve retention included integrating health and wellness into onboarding, creating realistic job expectations for those entering the industry, establishing relationships with drivers and dispatchers, and developing policies to limit time away from family. CONCLUSION/APPLICATION TO PRACTICE: Turnover in the trucking industry is a persistent problem and leads to a shortage of skilled workers, increases the workload, and reduces productivity. Understanding the relationship between the conditions of work and well-being provides a more holistic approach to address the health, safety, and well-being of long-haul truck drivers. Health conditions, differences in job expectations, and work demands were associated with leaving the industry. Workplace policies and culture (e.g., supervisor support, schedules that limited home time, lack of benefits) were associated with workers' intention to leave an organization. These conditions provide an opportunity for occupational health interventions to promote the physical as well as psychological health of long-haul truck drivers.

Investigation of key domains associated with worker well-being and burnout and turnover in the early care and education workforce.

PURPOSE: The early care and education (ECE) workforce provides care for children aged zero to five. This critical segment of the workforce experiences significant burnout and turnover rates resulting from extensive demands, including job stress and poor overall well-being. Factors associated with well-being in these settings and the resulting impacts on burnout and turnover are understudied. The purpose of this study was to investigate associations between five well-being domains and burnout and turnover outcomes among a large sample of Head Start ECE staff in the United States. METHODS: An 89-item survey based off the National Institutes of Occupational Safety and Health Worker Wellbeing Questionnaire (NIOSH WellBQ) was administered to ECE staff employed in five large urban and rural Head Start agencies. The WellBQ is made up of five domains intended to measure worker well-being as a holistic construct. We utilized linear mixed-effect modeling with random intercepts to investigate associations between sociodemographic characteristics, well-being domain sum scores and burnout and turnover. RESULTS: After controlling for sociodemographic variables, the well-being Domain 1 (Work Evaluation and Experience) (ß = - .73, p < .05) and Domain 4 (Health Status) (ß = - .30, p < .05) were significantly and negatively associated with burnout; the well-being Domain 1 (Work Evaluation and Experience) (ß = - .21, p < .01) was significantly and negatively associated with turnover intent. CONCLUSIONS: These findings suggest that multi-level well-being promotion programs could be critical to mitigate ECE teacher stress and address individual-, interpersonal-, and organizational-level predictors of overall ECE workforce well-being.

Recommendations to improve recruitment and retention of underrepresented in medicine trainees in neonatal-perinatal medicine.

Physicians who identify as Black, Latinx, American Indian, Pacific Islander, and certain Asian subgroups represent racial and ethnic populations that are underrepresented in medicine (URM). While the proportion of URM pediatric trainees has remained unchanged, that of Neonatal-Perinatal Medicine (NPM) fellows has decreased. Informed by the medical literature and our lived experiences, we compiled and developed a list of recommendations to support NPM fellowship programs in the recruitment, retention, and promotion of URM trainees. We describe ten recommendations that address 1) creating a culture of inclusivity and psychological safety, 2) the critical appraisal of recruitment practices and climate, and 3) an inclusive and holistic fellowship application process. The first two themes lay the foundation, while the final theme spotlights our recommendations for URM recruitment. Each recommendation is a step towards improvement in recruitment and inclusion at a program.

Systematic evaluation of influencing factors for Chinese rural doctors' job satisfaction and turnover intention: based on the two-factor theory.

OBJECTIVE: In China, rural doctors (RDs) perform crucial health care missions. However, they have received less attention than their colleagues in urban public hospitals. In this specific group, a severe challenge occurs in sync with a high turnover rate and deficient job satisfaction. MATERIALS AND METHODS: This study aims to systematically summarize and evaluate the influencing factors of job satisfaction and turnover intention among Chinese rural doctors. Seven databases, including PubMed, EMBASE, and China National Knowledge Infrastructure (CNKI), were systematically retrieved, and several experts were consulted to acquire holistic publications in this domain. RESULTS: A total of 20 full-text papers and 22,721 samples were included. In addition, 53 influencing factors were evaluated, of which 38 factors may play a significant role. Based on Herzberg's two-factor theory, together with China's cultural tradition and national conditions, we classified these influencing factors into sociodemographic characteristic factors (n=13), incentive factors (n=18), and health care factors (n=22). Meanwhile, we discussed and analyzed the influencing factors of turnover intention and job satisfaction in detail and put forward corresponding measures and suggestions for the government. CONCLUSIONS: We are confident that this research provides a holistic perspective to systematically evaluate the factors influencing the job satisfaction and intention to leave of Chinese rural doctors. Importantly, we hypothesize that the illumination of cases among Chinese rural physicians applies to other countries or regions, which has significant implications for the reformation of the medical system by governments or decision-makers worldwide.

Estimating the costs of physician turnover in hospital medicine.

BACKGROUND AND OBJECTIVE: Costs of physician turnover are lacking for specialties organized around a site of care. We sought to estimate the cost of physician turnover in adult hospital medicine (HM). DESIGN, SETTING, PARTICIPANTS: A retrospective cohort study within a large integrated health system between July 2017 and June 2020. To understand likely variation across the country, we also simulated costs using national wage data and a range of assumptions. MAIN OUTCOME AND MEASURES: Direct costs of turnover borne by our department and institution and indirect costs from reduced hospital billing. In our simulation, we measured costs per hired hospitalist. RESULTS: Between July 2017 and June 2020, 34 hospitalists left the practice, 97 hospitalists were hired, and a total of 234 hospitalists provided adult care at six hospitals. Direct costs of turnover totaled $6166 per incoming physician. Additional clinical coverage required at times of transition was the largest expense, followed by physician time recruiting and interviewing prospective candidates. The salary difference between outgoing and incoming hospitalists was cost-saving, while reduced billing would add to indirect costs per hire. In our simulation using national wage data, programs hiring one hospitalist would spend a mean of $56,943 (95% CI: $27,228-$86,659), programs hiring five hospitalists would spend a mean of $33,333 per hospitalist (95% CI: $9375-$57,292), and programs hiring 10 hospitalists would spend a mean of $30,382 per hospitalist (95% CI: $6877-$53,887). CONCLUSIONS: The financial cost of turnover in HM appears to be substantially lower than earlier estimates of the cost of turnover from non-hospitalist specialties.

The Effect of Creative Arts Therapy on Psychological Distress in Health Care Professionals.

BACKGROUND: Work-related psychological distress is common among health care professionals. We determined whether 4 creative arts therapy (CAT) programs were acceptable, feasible, and improved psychological distress and job turnover intention in health care professionals with burnout symptoms. METHODS: Health care professionals were enrolled during the coronavirus disease (COVID-19) pandemic from September 2020 until July 2021. Participants attended in-person weekly 90-minute group session for 12 consecutive weeks. Intervention and control subjects completed surveys before the beginning and after the end of their cohort. The study outcomes were session attendance (feasibility), program satisfaction (acceptability), and change in symptoms of anxiety, depression, burnout, posttraumatic stress disorder (PTSD), and job turnover intention. RESULTS: We randomized 165 participants into 4 CAT interventions and 1 common control group across 3 sequential cohorts. Thirty-five randomized participants dropped out before the start of the cohort, and 16 were replaced from a waiting list. Therefore, the cohort consisted of 146 participants. On average, participants were 35 years old, white (85%), and female (92%). Overall, 52% were nurses, 10% were doctors, and 16% were behavioral health specialists. Participants attended a median of 9.5 [8-11] sessions. Program satisfaction was high with a median Client Satisfaction Questionnaire (CSQ-8) score of 31 [17-32] out of a possible score of 32. Participants randomized to the intervention had improvements in anxiety (P < .0001) and depression scores (P = .0007), total posttraumatic stress disorder score (P =.0002), burnout scores (P = .001, .003, .008), and turnover intention (P = .001). CONCLUSIONS: A CAT program is feasible, acceptable, and may reduce psychological distress and turnover intention for health care professionals.

Job satisfaction in midwives and its association with organisational and psychosocial factors at work: a nation-wide, cross-sectional study.

BACKGROUND: Midwives report a challenging work environment globally, with high levels of burnout, insufficient work resources and low job satisfaction. The primary objective of this study was to identify factors in the organisational and psychosocial work environment associated with midwives' job satisfaction. A secondary objective was to identify differences in how midwives assess the organisational and psychosocial work environment compared to Swedish benchmarks. METHODS: This nation-wide, cross-sectional web survey study analysed midwives' assessment of their organisational and psychosocial work environment using the COPSOQ III instrument. A multivariable, bi-directional, stepwise linear regression was used to identify association with job satisfaction (N = 1747, 99.6% women). A conventional minimal important score difference (MID ± 5 as a noticeable difference with clinical importance) were used to compare midwives' results with Swedish benchmarks. RESULTS: A multivariable regression model with 13 scales explained the variance in job satisfaction (R2 = .65). Five scales, possibilities for development, quality of work, role conflict, burnout and recognition, explained most of the variance in midwives' job satisfaction (R2 = .63) and had ß values ranging from .23 to .10. Midwives had adverse MID compared to Swedish benchmarks with higher difference in mean values regarding quantitative demands (8.3), work pace (6.0) emotional demand (20.6), role conflicts (7.9) and burnout (8.3). In addition, lower organisational justice (-6.4), self-rated health (-8.8), influence (-13.2) and recognition at work (-5.8). However, variation and meaning of work showed a beneficial difference in mean values with 7.9 and 13.7 respectively. CONCLUSIONS: Midwives reported high levels of meaningfulness in their work, and meaningfulness was associated with job satisfaction. However, midwives also reported adversely high demands and a lack of influence and recognition at work and in addition, high role conflict and burnout compared to Swedish benchmarks. The lack of organisational resources are modifiable factors that can be taken into account when structural changes are made regarding organisation of care, management and resource allocation. Midwives are necessary to a high quality sexual, reproductive and perinatal health care. Future studies are needed to investigate if job satisfaction can be improved through professional recognition and development, and if this can reduce turnover in midwives.

Being "low on the totem pole": What makes work worthwhile for medical assistants in an era of primary care transformation.

BACKGROUND: Primary care is undergoing a transformation to become increasingly team-based and multidisciplinary. The medical assistant (MA) is considered a core occupation in the primary care workforce, yet existing studies suggest problematic rates and costs of MA turnover. PURPOSE: We investigated what MAs perceive their occupation to be like and what they value in it to understand how to promote sustainable employability, a concept that is concerned with an employee's ability to function and remain in their job in the long term. APPROACH: We used a case of a large, integrated health system in the United States that practices team-based care and has an MA career development program. We conducted semistructured interviews with 16 MAs in this system and performed an inductive analysis of themes. RESULTS: Our analysis revealed four themes on what MAs value at work: (a) using clinical competence, (b) being a multiskilled resource for clinic operations, (c) building meaningful relationships with patients and coworkers, and (d) being recognized for occupational contributions. MAs perceived scope-of-practice regulations as limiting their use of clinical competence. They also perceived task similarity with nurses in the primary care setting and expressed a relative lack of performance recognition. CONCLUSION: Some of the practice changes that enable primary care transformation may hinder MAs' ability to attain their work values. Extant views on sustainable employability assume a high bar for intrinsic values but are limited when applied to low-wage health care workers in team-based environments. PRACTICE IMPLICATIONS: Efforts to effectively employ and retain MAs should consider proactive communications on scope-of-practice regulations, work redesign to emphasize clinical competence, and the establishment of greater recognition and respect among MAs and nurses.

'The WOW factors': comparing workforce organization and well-being for doctors, nurses, midwives and paramedics in England.

BACKGROUND: High rates of poor mental health in healthcare staff threatens the quality and sustainability of healthcare delivery. Multi-factorial causes include the nature and structure of work. We conducted a critical review of UK NHS (England) data pertaining to: doctors, nurses, midwives and paramedics. SOURCES OF DATA: Key demographic, service architecture (structural features of work) and well-being indicators were identified and reviewed by a stakeholder group. Data searching prioritized NHS whole workforce sources (focusing on hospital and community health services staff), which were rated according to strength of evidence. FINDINGS: Key differences between professions were: (i) demographics: gender (nursing and midwifery female-dominated, doctors and paramedics more balanced); age (professions other than doctors had ageing workforces); ethnicity (greater diversity among doctors and nurses); (ii) service architecture: despite net staffing growth, turnover and retention were problematic in all professions; 41.5% doctors were consultants but smaller proportions held high grade/band roles in other professions; salaries were higher for doctors; (iii) well-being: all reported high job stress, particularly midwives and paramedics; sickness absence rates for nurses, midwives and paramedics were three times those of doctors, and presenteeism nearly double. GROWING POINTS: Sociocultural factors known to increase risk of poor mental health may explain some of the differences reported between professions. These factors and differences in service architecture are vital considerations when designing strategies to improve well-being. AREAS TIMELY FOR DEVELOPING RESEARCH: Multi-level systems approaches to well-being are required that consider intersectionality and structural differences between professions; together with inter-professional national databases to facilitate monitoring.

Memes and Poetry: A Descriptive Analysis on Creative Arts Therapy to Reduce Health Care Worker Burnout.

BACKGROUND: Health care workers (HCWs) face high levels of burnout, which can lead to workforce turnover and poor patient outcomes. Health care leaders should identify strategies to improve staff resilience. PURPOSE: The purpose of this study was to describe HCWs' perspective on using creative arts therapy to reduce burnout and improve resiliency. METHODS: During Infection Prevention week, staff were encouraged to submit and vote on educational memes and haikus. Staff were asked their perspectives on how this activity could be used to reduce burnout and improve resiliency using a 4-point Likert scale. RESULTS: Twenty-two staff members submitted 26 memes and 27 haikus. Staff felt this activity could be an effective strategy to help reduce burnout and improve resiliency. CONCLUSIONS: Further research is warranted to better understand the correlation between this form of art therapy and burnout and resiliency; however, health care leaders may consider using this as a tool for staff well-being.

Health human resources challenges during COVID-19 pandemic; evidence of a qualitative study in a developing country.

BACKGROUND: One of the main forthcoming challenges of healthcare systems against preparedness and management of the pandemic is the challenge of procurement and recruitment of the human resources. This study is aimed to explore the health human resources challenges during COVID-19 pandemic in Iran. METHODS: This qualitative content analysis study was conducted in 2020. The study population includes all the Iranian human resources managers affiliated in Universities of Medical Sciences, hospitals and health centers managers and the health networks managers all over the country. 23 participants were included via purposeful sampling considering the inclusion criteria and were interviewed individually. After 23 semi-structured interviews, data were saturated. Then the data were analyzed through content analysis approach applying MAXQDA10. RESULTS: Three main themes of "organizational challenges", "legal challenges", and "personal challenges" were explored as the main challenges of health human resources management during COVID-19. On the one hand, organizational challenges include restricted financial resources, compensation discrimination, staffing distinction points, imbalance in the workload, weak organizational coordination, inefficient inter-sectoral relationships, parallel decisions, inefficient distribution of the human resources, lack of applied education, lack of integrated health protocols, lack of appropriate evaluation of performance, employee turnover, lack of clear approaches for staffing, and shortage of specialized manpower, and on the other hand, the personal challenges include insufficient knowledge of the employees, psychological disorders, reduction of self-confidence, burnout, workload increase, reduced level of job satisfaction, effects of colleague and patients bereavement and unsafety sense against the work place. Finally, the legal challenges that mostly related to the governments laws and regulations include lack of protocols for continuous supportive services, inappropriate approaches and instructions for teleworking, and lack of alternative plans and regulations for the human resources. CONCLUSION: Organizational, legal and personal challenges are among three main challenges of health human resources management during COVID-19 pandemic. Serious attention to these challenges should be considered by health policymakers in order to be prepared for facing new probable outbreaks and managing the present condition. The integrated comprehensive planning of human resources management for COVID-19 along with supportive packages for the personnel can be helpful.

Workplace spirituality and organizational justice in turnover intention of mental health professionals at small-sized centres.

AIM: To investigate the influence of workplace spirituality and organizational justice on the turnover intentions of mental health professionals working in small-sized communities. BACKGROUND: Many community mental health facilities in Korea are consist of the small size of members, and the turnover rate of mental health professionals is high. However, the influence of individual and organizational factors for lowering the turnover is not clearly identified. METHOD: This was a descriptive study. Data of 168 participants were collected through a self-reported online questionnaire using a convenience sample, June 2020. RESULT: Multiple regression analysis uses interactional justice (ß = -.437, p = .002), distributional justice (ß = -.190, p = .011) and age (ß = -.152, p = .033) that were the most important predictors of turnover intention. CONCLUSION: Orgnisational factors such as distributional and interactional justice affect to reduce turnover intention more than an individual factor like the workplace spirituality of professionals. IMPLICATIONS FOR NURSING MANAGEMENT: Small-sized mental health institutions in the community should establish a clear working guideline that can make the distribution, procedure and interactional justice. Because only a small percentage of nurses work at community mental health facilities, it is necessary to reduce turnover by creating a work environment where young nurse practitioners can work long-term and grow into leaders.

Job Demands, Resources, and Burnout in Social Workers in China: Mediation Effect of Mindfulness.

Internationally, human service professionals, including social workers, experience high burnout and turnover rates. Despite the recent and rapid development of contemporary social work in China, Chinese social workers similarly experience significant rates of burnout. Therefore, there is a need to investigate the factors that contribute to social work burnout. This study applied the job demands and resources (JD-R) model to examine the effects of JD-R on burnout in social workers (n = 897) from Chengdu, China, and whether these relations are mediated by state mindfulness. Structural equation modeling results supported the previously hypothesized dual process by which JD-R affect burnout, specifically in a sample of social workers in China. Job demands (JD) were positively associated with burnout, while job resources (JR) were negatively associated with burnout. These relations were partially mediated by state mindfulness. JR had a strong, positive direct effect on mindfulness (ß = 0.38), and its total effect on burnout was high (ß = -0.56). Meanwhile, JD had a slight negative direct effect on mindfulness (ß = -0.09), and its total effect on burnout was 0.42. The results suggest that the implementation of mindfulness-based interventions for social workers can potentially mitigate the effect of JD on burnout, as well as increase the effect of JR on burnout.

Individual and environmental factors that influence longevity of newcomers to nursing and midwifery: a scoping review protocol.

OBJECTIVE: The objective of this review is to identify and map the literature that describes the individual and environmental factors that influence nurses and midwives to stay in or leave their discipline within the first three years of practice. INTRODUCTION: The turnover rate of newcomers within their first three years of nursing and midwifery is higher than in later years and is contributing to a worldwide shortage. Both individual and environmental factors, often in combination, contribute to this attrition. Many studies demonstrate the associations of factors with turnover or intention to stay; however, the scope of factors has not been documented. INCLUSION CRITERIA: Newcomers are defined as registered nurses and registered midwives within the first three years of entering their discipline. Quantitative and qualitative studies and systematic reviews that explore individual or environmental factors that influence the decision to leave or to remain in nursing and midwifery in any context will be considered. Factors may include coping, anxiety, mindfulness, practice environment, or combinations such as resilience, satisfaction, and burnout. Articles must have been peer reviewed. Literature published since 1974 in English will be considered. Newcomers who have completed skills-based training will be excluded. METHODS: The JBI method for scoping reviews will be followed. An extensive search of multiple databases and gray literature will be undertaken. Retrieval of full-text studies and data extraction will be performed independently by two reviewers. Data extracted will be synthesized and results reported using a mind map, tables, and narrative form.

Job satisfaction, work environment and intent to stay of Jordanian midwives.

AIM: The aims of this study were to (1) assess the levels of Jordanian midwives' job satisfaction, intention to stay and work environment; (2) examine the relationship between work environment and intention to stay, and the level of job satisfaction among midwives working in Jordanian hospitals and maternal and child health centres and (3) to investigate the associations between job satisfaction and selected demographic variables among Jordanian midwives. BACKGROUND: The shortage, turnover and retention of midwives are global problems and Jordan is one of the countries thathas a shortage of midwifery workforce. Job satisfaction is well studied among nurses worldwide; however, there are inadequate studies that have assessed the job satisfaction among midwives including Jordan. METHODS: A descriptive, correlational design survey was used and a sample of 413 midwives were recruited from 14 different hospital settings (12 governmental and 2 teaching hospitals) and 8 health centres. RESULTS: The levels of job satisfaction of Jordanian midwives were neither satisfied nor unsatisfied. The overall mean intent to stay at work was between neutral to agree in general. A positive significant correlation was found between job satisfaction, work environment and intent to stay. The work environment was neither a favourable nor an unfavourable. CONCLUSION AND IMPLICATIONS FOR NURSING, HEALTH AND EDUCATION POLICY: Jordanian midwives have neutral job satisfaction and work environment. Managerial plans and interventions are needed to improve midwives' job satisfaction and to create a favourable work environment which might reflect positively on their work and performance and improve their retention. Policymakers and mangers should enhance midwives' job satisfaction through external reward via salary, vacation and benefits packages. Engaging in research activities, publication and more collaboration with academic staff may improve midwives' professional development. Midwives should take more active roles in hospital affairs and receive more support by their management in Jordan.

Preserving Organizational Resilience, Patient Safety, and Staff Retention during COVID-19 Requires a Holistic Consideration of the Psychological Safety of Healthcare Workers.

During the COVID-19 pandemic, healthcare workers are fighting a lethal virus with acute shortages of Personal Protective Equipment (PPE). These unprecedented circumstances have amplified the sources of emotional distress and worker burnout. However, many healthcare organizations (HCOs) in the United States, have opted for a "stoic approach" to healthcare worker support, i.e., no additional support beyond federal and state policy protections for the licensing and liability of healthcare workers. In this scenario, a key public health concern is sustaining an adequate healthcare workforce, both by way of quantity (adequate numbers) and quality (maximizing clinician resilience to provide safe care to large volumes of patients under challenging conditions). Therefore, it is imperative for HCO leaders to recognize that a limited view of worker psychological safety, without due consideration for the broader emotional distress created by the pandemic, could have the effect of restricting organizational resilience and adversely impacting patient safety and staff retention during and beyond the pandemic. This paper uses the organizational resilience framework to discuss the potential impact of a stoic approach to healthcare worker support on patient safety and staff retention in a hospital intensive care unit (ICU) during COVID-19. The discussion in turn, helps to develop recommendations for HCOs to overcome these challenges.

The Whole-of-Person Retention Improvement Framework: A Guide for Addressing Health Workforce Challenges in the Rural Context.

People living in rural places face unique challenges due to their geographic isolation and often experience poorer health outcomes compared to people living in major cities. The struggle to attract and retain an adequately-sized and skilled health workforce is a major contributing factor to these health inequities. Health professionals' decisions to stay or leave a rural position are multifaceted involving personal, organisational, social and spatial aspects. While current rural health workforce frameworks/models recognise the multidimensional and interrelated influences on retention, they are often highly complex and do not easily support the development of strategic actions. An accessible evidence-informed framework that addresses the complexity but presents the evidence in a manner that is straightforward and supports the development of targeted evidence- and place-informed retention strategies is required. The 'Whole-of-Person Retention Improvement Framework' (WoP-RIF) has three domains: Workplace/Organisational, Role/Career and Community/Place. The necessary pre-conditions for improving retention through strengthening job and personal satisfaction levels are set out under each domain. The WoP-RIF offers a person-centred, holistic structure that encourages whole-of-community responses that address individual and workforce level needs. It is a significant response to, and resource for, addressing avoidable rural health workforce turnover that rural health services and communities can harness in-place.

Diet, physical activity, and emotional health: what works, what doesn't, and why we need integrated solutions for total worker health.

BACKGROUND: Current research advocates lifestyle factors to manage workers' health issues, such as obesity, metabolic syndrome, and type II diabetes mellitus, among other things (World Health Organization (WHO) Obesity: preventing and managing the global epidemic, 2000; World Health Organization (WHO) Obesity and overweight, 2016), though little is known about employees' lifestyle factors in high-stress, high turnover environments, such as in the long term care (LTC) sector. METHODS: Drawing on qualitative single-case study in Ontario, Canada, this paper investigates an under-researched area consisting of the health practices of health care workers from high-stress, high turnover environments. In particular, it identifies LTC worker's mechanisms for maintaining physical, emotional, and social wellbeing. RESULTS: The findings suggest that while particular mechanisms were prevalent, such as through diet and exercise, they were often conducted in group settings or tied to emotional health, suggesting important social and mental health contexts to these behaviors. Furthermore, there were financial barriers that prevented workers from participating in these activities and achieving health benefits, suggesting that structurally, social determinants of health (SDoH), such as income and income distribution, are contextually important. CONCLUSIONS: Accordingly, given that workplace health promotion and protection must be addressed at the individual, organizational, and structural levels, this study advocates integrated, total worker health (TWH) initiatives that consider social determinants of health approaches, recognizing the wider socio-economic impacts of workers' health and wellbeing.