[The analysis of demand in pathoanatomists applying staff standards].

The objective analysis of state of medical personnel, along with assessment of real need for specialists, is the basis of improving activities of any health care service. In relation to pathologists, there is unique opportunity to perform similar analysis, based on application of current corresponding staff standards that consider volume of workload of physicians in order to determine required number of positions. The implementation of corresponding original methodology permitted to establish that the actual number of staff positions of pathologists in 2022 amounted up to average 40.6% of the number required according to staffing standards in the Irkutsk Oblast. The physician staffing ratio, calculated on the basis of required number of positions found according to proposed methodology, decreases to 29.1% and staffing with physicians excluding combined jobs to 17.1%. At that, implemented workload per one pathologist reaches 5.9 of standard positions. The deficiency of representatives of this specialty in the region, even if current combined jobs ratio is maintained, is 154 specialists.

A Sex Comparison of the Physical and Physiological Demands of United States Marine Corps Recruit Training.

INTRODUCTION: The U.S. Marine Corps (USMC) recruit training is a 13-week preparatory period for military service men and women. Differences in absolute performance capabilities between sexes may impact physical and physiological responses to the demands of recruit training. The purpose of this study was to monitor U.S. Marine Corps recruits throughout recruit training to comparatively assess workload, sleep, stress, and performance responses in men and women. MATERIALS AND METHODS: A total of 281 recruits (men = 182 and women = 99; age = 19 ± 2 years) were monitored and tested. Workload, sleep, and stress assessments occurred at week 2, week 7/8, and week 11 of training. Workload (energy expenditure per kg body mass [EEREL], distance [DIS], steps) and sleep (continuity and duration) were tracked over 72-hour periods using wearable accelerometry and heart rate technology. Stress responses were determined through salivary cortisol analyses. Performance testing, consisting of countermovement vertical jump (CMJ) and isometric mid-thigh pull (IMTP) performance relative to body mass, occurred at weeks 2 and 11. Linear mixed models were used to test for sex, time, and sex-by-time interactions (α < .05). RESULTS: On average, recruits covered 13.0 ± 2.7 km/day, expended 3,762 ± 765 calories/day, and slept 6.2 ± 1.1 hours/night. Sex-by-time interactions were found for DIS, steps, sleep duration, cortisol, and CMJREL performance (P < .05). Planned contrasts revealed that men covered more DIS than women at week 7/8 (P < .001). Women experienced greater step counts compared to men at week 11 (P = .004). Women experienced no significant change in sleep duration (P > .05), whereas men increased sleep duration from week 2 to week 7/8 (P = .03). Women experienced greater sleep duration at week 2 (P = .03) and week 11 (P = .02) compared to men. Women exhibited higher cortisol levels than men at week 2 (P < .001) and week 11 (P < .001). Women experienced declines in cortisol at week 7 compared to week 2 (P < .001). Men experienced no changes in cortisol response at any timepoint (P > .05). Both sexes experienced declines in CMJREL from week 2 to week 11 (P > .001). Sex main effects were observed for EEREL, DIS, CMJREL, and IMTPREL (P < .05) with men experiencing greater overall workloads and producing greater strength and power metrics. Sex main effects were also found for sleep continuity and cortisol (P < .05), for which men experienced lower values compared to women. Time main effects were observed for EEREL, DIS, steps, cortisol, CMJREL, and IMTPREL (P < .05). CONCLUSIONS: This study not only highlights the known sex differences between men and women but also sheds light on the different physical and physiological responses of each sex to military training. Interestingly, the greatest physical demands incurred earlier in the training cycle. Despite declining workloads, the stress response was maintained throughout the training, which may have implications for adaptation and performance. In addition, average sleep duration fell notably below recommendations for optimizing health and recovery. Effectively monitoring the demands and performance outcomes during recruit training is essential for determining individual fitness capabilities, as well as establishing the effectiveness of a training program. Individual performance assessments and adequately periodized workloads may help to optimize recruit training for both men and women.

Swedish maternity care professionals' perception of labor induction.

BACKGROUND: Sweden recently adopted new labor induction guidelines lowering the threshold for post-term pregnancies to 41+ weeks. Despite evidence-based foundation, these guidelines stirred controversy among maternity care professionals, who voiced concerns about potential risks and unintended consequences, such as a rising Caesarean section rate. Midwives also highlighted potential impacts on their roles, workload, and working environment; implications that could affect obstetricians and gynecologists as well. Investigating Swedish maternity care professionals' views on labor induction could benefit policymakers, managers, and birthing women alike. AIM: The aim of this study was to describe and compare midwives to obstetricians/gynecologists, with regards to their views on labor induction, and how this relates to other work-related variables such as overall job satisfaction, clinical experience, gender, age, personality, and workload. METHODS: Swedish midwives (N = 207, 99 % women, M = 45.2 years), and obstetricians/gynecologists (N = 240, 83 % women, M = 44.3 years) responded to an online questionnaire reflecting aspects of maternity care work. The data was analyzed using Welch's t-test and Pearson's correlation analysis. RESULTS: A large difference was observed in labor induction views between midwives and obstetricians/gynecologists (d = 1.39), as well as lower job satisfaction with midwives (d = -0.26). Overall job satisfaction further correlated negatively with views on labor induction (r = -0.30). CONCLUSIONS: Labor inductions might pose challenges to midwives and could bring to light underlying tensions between obstetricians/gynecologists and midwives. Given the modest response rate of the study, we cautiously suggest that while the development of new maternity care guidelines should be grounded in evidence, they should also embrace concerns and insights from a diversity of professional perspectives.

Low back pain, work overload, and associated factors among hospital caregivers.

BACKGROUND: Caregivers assist patients in treatment based on their care needs and living activities. Very few studies have been conducted specifically on the occupational health and safety of hospital caregivers. OBJECTIVE: This study aimed to investigate the prevalence of excessive workload and low back pain among hospital caregivers and to identify potential associated factors. METHODS: This cross-sectional study included caregivers working at Gazi University Hospital. Socio-demographic and working-life characteristics were assessed. The Role Overload Scale was used to determine excessive workload and the Roland-Morris Disability Questionnaire was used to evaluate low back pain. RESULTS: The study included 528 participants. A total of 18.7% had work accidents in their department. 49.0% had sharp injuries. 68.9% of the participants performed tasks such as positioning, turning, lifting, or helping patients to walk. 72.2% stood for a long time during the workday. 52.8% thought that they worked under stress. 57.6% had low back pain in the last year and 38.6% in the last month, Significant differences exist in low back pain according to gender, body-mass index, standing for a long time and working under stress. Those who worked at night, had a work accident, positioned patients, stood for a long time, and worked under stress had higher mean scores on the Role Overload Scale. CONCLUSION: Tools should be used to lift and transport patients. In addition to occupational health and safety training, awareness of musculoskeletal risks should be increased. Employee well-being can be improved through exercise and stress reduction techniques.

NASA-TLX assessment of workload in resident physicians and faculty surgeons covering trauma, surgical intensive care unit, and emergency general surgery services.

BACKGROUND: Higher workload is associated with burnout and lower performance. Therefore, we aim to assess shift-related factors associated with higher workload on EGS, ICU, and trauma surgery services. METHODS: In this prospective cohort study, faculty surgeons and surgery residents completed a survey after each EGS, ICU, or trauma shift, including shift details and a modified NASA-TLX. RESULTS: Seventeen faculty and 12 residents completed 174 and 48 surveys after working scheduled 12-h and 24-h shifts, respectively (response rates: faculty - 62%, residents - 42%). NASA-TLX was significantly increased with a higher physician subjective fatigue level. Further, seeing more consults or performing more operations than average significantly increased workload. Finally, NASA-TLX was significantly higher for faculty when they felt their shift was more difficult than expected. CONCLUSIONS: Higher volume clinical responsibilities and higher subjective fatigue levels are independently associated with higher workload. Designing shift coverage to expand on busier days may decrease workload, impacting burnout and shift performance.

Original Research: Well-Being and Resilience Among Health Care Workers During the COVID-19 Pandemic: A Cross-Sectional Study.

BACKGROUND: Poor well-being among health care workers, often observed as professional burnout, is a well-documented phenomenon. The coronavirus disease 2019 (COVID-19) pandemic has further stressed the health care workforce, but its specific effects on this workforce remain unknown. This study examined well-being and resilience among health care workers during the COVID-19 pandemic. METHODS: The study used a cross-sectional survey design. Data collection took place through anonymous surveys of nurses (LPNs and RNs), advanced practice providers (NPs, physician assistants, and certified nurse midwives), certified registered nurse anesthetists, respiratory therapists, health care technicians, and therapy service professionals (physical, occupational, and speech therapists). Of the 6,120 health care workers recruited to participate in the study, data from 2,459 participants were analyzed using logistic regression and linear regression. RESULTS: The study found that several factors significantly increased the likelihood of at-risk well-being. These included having a lower level of resilience, using support resources, feeling the organization lacked understanding of the emotional support needs of health care workers during the pandemic, believing the workload had increased, believing there was insufficient personal protective equipment, believing there was inadequate staffing to safely care for patients, and having a lower degree of psychological safety. After controlling for health care workers' role and employment location, several factors were found to be significantly associated with higher levels of resilience. These included having positive perceptions about the organization's understanding of the emotional support needs of health care workers during the pandemic, believing sufficient educational resources were available regarding the care of COVID-19 patients, having positive perceptions of leadership support from direct managers, having positive perceptions of the redeployment policy, and having a higher degree of psychological safety. CONCLUSIONS: This study identified several work environment factors that have significantly affected health care workers' well-being and resilience during the COVID-19 pandemic. This knowledge has practical relevance for health care leaders who aim to better understand and address the well-being and resilience of the health care workforce during this pandemic and beyond.

Beyond the Outbreak of COVID-19: Factors Affecting Burnout in Nurses in Iran.

Background: Nurses working in treating patients with COVID-19 are exposed to various stressors, such as fear of COVID-19, stress, and high workload, leading to burnout. Objectives: This study aimed to identify the level of burnout and its predictors in nurses working in hospitals for COVID-19 patients. Methods: Participants in this study were nurses working in 11 hospitals for COVID-19 patients in the Fars province of Iran. The Maslach burnout and the UK Health and Safety stress questionnaires were used to assess burnout and stress, respectively. Analysis, using multiple regression in the SPSS21 software, aimed to identify the factors affecting burnout. Findings: The mean level of burnout in the nurses at the COVID-19 hospitals was 57 out of 120, and burnout was affected by workload (ß = 0.69, p < 0.001), job stress (ß = 0.25, p < 0.001) and inadequate hospital resources for the prevention of COVID-19 (ß = -0.16, p < 0.001). These three variables explained 87% of the variance in burnout. Conclusions: The burnout of nurses directly exposed to COVID-19 patients is more than nurses in other wards, and workload is the most significant cause of burnout in them. Therefore, necessary measures such as hiring more nurses, reducing working hours and increasing rest periods are necessary to reduce workload. In addition, the job stress of these nurses should be managed and controlled, and the hospital resources needed to prevent this disease should be provided.

Implementation of a triage nurse role and the effect on hospitalist workload.

OBJECTIVES: Hospital medicine groups vary staffing models to match available workforce with expected patient volumes and acuity. Larger groups often assign a single hospitalist to triage pager duty which can be burdensome due to frequent interruptions and multitasking. We introduced a new role, the Triage nurse, to hold the triage pager and distribute patients. We sought to determine the effect of this Triage Nurse on the perceived workload of hospitalists and frequency of pages. METHODS: We partnered with our patient throughput department to implement the Triage Nurse role who took the responsibility of tracking and distributing admissions among three admitting physicians along with coordinating report. We used the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) to measure perceived workload and accessed pager logs of admitters for 3 months before and after implementation. RESULTS: Overall, 50 of an expected 67 NASA-TLX surveys (74.6%) were returned in the pre-intervention period and 64 of 92 (69.6%) were returned in the post-intervention period. We found a statistically significant reduction in the domains of physical demand, temporal demand, effort and frustration from pre- to post-intervention periods (p < 0.01). There was also a significant decrease in the performance domain (p = 0.01) with a lower number indicative of better perceived performance. There was a significant reduction in the mean number of pages received by admitting hospitalists over their 9-h shifts (81.3 + 17.3 vs 52.4 + 7.3; p < 0.01). CONCLUSION: The implementation of the Triage Nurse role was associated with a significant decrease in the perceived workload of admitting hospitalists. Our findings are important because workload and interruptions can contribute to errors and burnout. Future studies should test interventions to improve hospitalist workload and evaluate their effect on patient outcomes and physician wellness.

Association of Annual Intensive Care Unit Sepsis Caseload With Hospital Mortality From Sepsis in the United Kingdom, 2010-2016.

Importance: Sepsis is associated with a high burden of inpatient mortality. Treatment in intensive care units (ICUs) that have more experience treating patients with sepsis may be associated with lower mortality. Objective: To assess the association between the volume of patients with sepsis receiving care in an ICU and hospital mortality from sepsis in the UK. Design, Setting, and Participants: This retrospective cohort study used data from adult patients with sepsis from 231 UK ICUs between 2010 and 2016. Demographic and clinical data were extracted from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme database. Data were analyzed from January 1, 2010, to December 31, 2016. Exposures: Annual sepsis case volume in an ICU in the year of a patient's admission. Main Outcomes and Measures: Hospital mortality after ICU admission for sepsis assessed using a mixed-effects logistic model in a 3-level hierarchical structure based on the number of individual patients nested in years nested within ICUs. Results: Among 273 001 patients included in the analysis, the median age was 66 years (interquartile range, 53-76 years), 148 149 (54.3%) were male, and 248 275 (91.0%) were White. The mean ICNARC-2018 illness severity score was 21.0 (95% CI, 20.9-21.0). Septic shock accounted for 19.3% of patient admissions, and 54.3% of patients required mechanical ventilation. The median annual sepsis volume per ICU was 242 cases (interquartile range, 177-334 cases). The study identified a significant association between the volume of sepsis cases in the ICU and mortality from sepsis; in the logistic regression model, hospital mortality was significantly lower among patients admitted to ICUs in the highest quartile of sepsis volume compared with the lowest quartile (odds ratio [OR], 0.89; 95% CI, 0.82-0.96; P = .002). With volume modeled as a restricted cubic spline, treatment in a larger ICU was associated with lower hospital mortality. A lower annual volume threshold of 215 patients above which hospital mortality decreased significantly was found; 38.8% of patients were treated in ICUs below this threshold volume. There was no significant interaction between ICU volume and severity of illness as described by the ICNARC-2018 score (ß [SE], -0.00014 [0.00024]; P = .57). Conclusions and Relevance: The findings suggest that patients with sepsis in the UK have higher odds of survival if they are treated in an ICU with a larger sepsis case volume. The benefit of a high sepsis case volume was not associated with the severity of the sepsis episode.

Evolution of anatomic pathology workload from 2011 to 2019 assessed in a regional hospital laboratory via 574,093 pathology reports.

OBJECTIVE: Quantify changes in workload in relation to the anatomic pathologist workforce. METHODS: In house pathology reports for cytology and surgical specimens from a regional hospital laboratory over a nine- year period (2011-2019) were analyzed, using custom computer code. Report length for the diagnosis+microscopic+synoptic report, number of blocks, billing classification (L86x codes), billings, national workload model (L4E 2018), regional workload model (W2Q), case count, and pathologist workforce in full-time equivalents (FTEs) were quantified. Randomly selected cases (n = 1,100) were audited to assess accuracy. RESULTS: The study period had 574,093 pathology reports that could be analyzed. The coding accuracy was estimated at 95%. From 2011 to 2019: cases/year decreased 6% (66,056 to 61,962), blocks/year increased 20% (236,197 to 283,751), L4E workload units increased 23% (165,276 to 203,894), W2Q workload units increased 21% (149,841 to 181,321), report lines increased 19% (606,862 to 723,175), workforce increased 1% (30.42 to 30.77 FTEs), billings increased 13% ($6,766,927 to $7,677,109). W2Q in relation to L4E underweights work in practices with large specimens by up to a factor of 2x. CONCLUSIONS: Work by L4E for large specimens is underrated by W2Q. Reporting requirements and pathology work-up have increased workload per pathology case. Work overall has increased significantly without a commensurate workforce increase. The significant practice changes in the pathology work environment should prompt local investment in the anatomic pathology workforce.

User perceptions of automated Truck-Mounted attenuators: Implications on work zone safety.

OBJECTIVE: Automated Truck-Mounted Attenuators (ATMAs) have the potential to improve work zone safety by removing the human driver out of a vehicle that is positioned in work zones to absorb impact from errant vehicles. However, this automated technology is expensive and can be detrimental to safety and project success if operated incorrectly (e.g., operating limitations and procedures not followed). Therefore, it is important to understand users' perceptions of ATMAs and how training can improve appropriate adoption of this technology. The objective of this study was to evaluate how work zone workers perceive the usefulness of and the capabilities of automation in Truck-Mounted Attenuators. METHODS: A survey study was conducted with 13 Department of Transportation (DOT) workers in Colorado and California. Each of the DOT workers in this study had some previous experience with the ATMA, either in real-world applications and/or formal training. The survey collected information on participant job specifications, experience with the ATMA, training received, trust in the ATMA, usability of the HMIs, and operating capabilities of the automation. RESULTS: Workers reported an overall positive acceptance of this technology. This was supported by their expectation that it would reduce crash severity; that there was a reasonable workload associated with operating procedures for the automation; and by their overall trust in the automation's reliability. However, workers noted concerns regarding their trust in the automation under various contexts, such as poor visibility and denser traffic volumes. Further, trust in the technology was greatest among workers with higher levels of ATMA training and longer experience working with the ATMA. CONCLUSIONS: This research presents a novel perspective on user acceptance of ATMA technology. These findings can help jurisdictions achieve the safety improvements that investment and deployment of automation in work zones offers, by identifying the disconnect between operators and technology.

Using performance frontiers to differentiate elective and capacity-based surgical services.

BACKGROUND: Acute care surgery (ACS) model of care delivery has many benefits. However, since the ACS surgeon has limited control over the volume, timing, and complexity of cases, traditional metrics of operating room (OR) efficiency almost always measure ACS service as "inefficient." The current study examines an alternative method-performance fronts-of evaluating changes in efficiency and tests the following hypotheses: (1) in an institution with a robust ACS service, performance front methodology is superior to traditional metrics in evaluating OR throughput/efficiency, and (2) introduction of an ACS service with block time allocation will improve OR throughput/efficiency. METHODS: Operating room metrics 1-year pre-ACS implementation and post-ACS implementation were collected. Overall OR efficiency was calculated by mean case volumes for the entire OR and ACS and general surgery (GS) services individually. Detailed analysis of these two specific services was performed by gathering median monthly minutes-in block, out of block, after hours, and opportunity unused. The two services were examined using a traditional measure of efficiency and the "fronts" method. Services were compared with each other and also pre-ACS implementation and post-ACS implementation. RESULTS: Overall OR case volumes increased by 5% (999 ± 50 to 1,043 ± 46: p < 0.05) with almost all of the increase coming through ACS (27 ± 4 to 68 ± 16: p < 0.05). By traditional metrics, ACS had significantly worse median efficiency versus GS in both periods: pre (0.67 [0.66-0.71] vs. 0.80 [0.78-0.81]) and post (0.75 [0.53-0.77] vs. 0.83 [0.84-0.85]) (p < 0.05). As compared with the pre, GS efficiency improved significantly in post (p < 0.05), but ACS efficiency remained unchanged (p > 0.05). The alternative fronts chart demonstrated the more accurate picture with improved efficiency observed for GS, ACS, and combined. CONCLUSION: In an institution with a busy ACS service, the alternative fronts methodology offers a more accurate evaluation of OR efficiency. The provision of an OR for the ACS service improves overall throughput/efficiency.

Prevalence of burnout risk and factors associated with burnout risk among ICU nurses during the COVID-19 outbreak in French speaking Belgium.

OBJECTIVE: Burnout is a global work-related phenomenon. Intensive care unit (ICU) nurses are at risk of burnout and the COVID-19 pandemic may increase this risk. The objectives of this study were to assess the prevalence of burnout risk and identify risk factors among ICU nurses during the COVID-19 pandemic. RESEARCH METHODOLOGY: Web-based survey performed during the first wave of the COVID-19 pandemic in French speaking Belgium. MAIN OUTCOME MEASURES: Risk of burnout was assessed with the Maslach Burnout Inventory scale. RESULTS: A total of 1135 ICU nurses responded to the questionnaire. The overall prevalence of burnout risk was 68%. A total of 29% of ICU nurses were at risk of depersonalisation (DP), 31% of reduced personal accomplishment (PA), and 38% of emotional exhaustion (EE). A 1:3 nurse-to-patient ratio increased the risk of EE (OR = 1.77, 95% CI: 1.07-2.95) and DP (OR = 1.38, 95% CI: 1.09-2.40). Those who reported having a higher perceived workload during the COVID-19 pandemic were at higher risk for all dimensions of burnout. Shortage of personal protective equipment increased the risk of EE (OR = 1.78, 95% CI: 1.35-3.34) and nurses who reported having symptoms of COVID-19 without being tested were at higher risk of EE (OR = 1.40, 95% CI: 1.68-1.87). CONCLUSIONS: Two-thirds of ICU nurses were at risk of burnout and this risk was associated with their working conditions during the first wave of the COVID-19 pandemic. We recommend monitoring the risk of burnout and implementing interventions to prevent and manage it, taking into account the factors identified in this study.

When Unnecessary Tasks Weigh Heavily on the Back: A Diary Study on Musculoskeletal Pain.

BACKGROUND: Auxiliary tasks such as administrative work often include tasks that are unnecessary in the view of workers but still have to be done. These tasks can threaten a worker's self-esteem. The purpose of this study was to examine the effects of unnecessary and unreasonable tasks on musculoskeletal pain. METHODS: Fifty-five office workers (29 male; mean age = 41.96, SD = 14.2 years) reported their unnecessary and unreasonable tasks at the beginning of the study and kept a diary of their daily musculoskeletal pain over 5 weeks, using a visual analogue scale. Other work-related risk factors (prolonged sitting), job resources (participation in decision-making), and individual risk factors (sex, smoking, exercise, body mass index, maladaptive back beliefs) were controlled for in multilevel regression analysis. FINDINGS: Multilevel regression analysis with 742 reports showed unnecessary tasks (B = 4.27, p = .006)-but not unreasonable tasks (B = 3.05, p = .074)-to predict the daily intensity of musculoskeletal pain, beyond other significant risk factors, such as prolonged sitting (B = 2.06, p = .039), body mass index (B = 1.52, p < .001), and maladaptive back beliefs (B = 3.78, p = .003). Participation in decision-making was not a significant protective factor (B = -1.67, p = .176). CONCLUSIONS/APPLICATION TO PRACTICE: The higher frequency of unnecessary tasks-compared with unreasonable tasks-could place workers at risk for musculoskeletal pain. Work redesign that reduces unnecessary and unreasonable tasks can make a valuable contribution to worker health and safety among office workers.

Relationship Between Shift Intensity and Insomnia Among Hospital Nurses in Korea: A Cross-sectional Study.

OBJECTIVES: This study explored the relationship between shift intensity and insomnia among hospital nurses. METHODS: The participants were 386 female hospital nurses who underwent a special health examination for night workers in 2015. The Korean Insomnia Severity Index (ISI), indices of shift work intensity, and other covariates such as amount of exercise, level of alcohol consumption, employment duration, and hours worked were extracted from the health examination data. The indices for shift intensity were (1) number of 3 consecutive night shifts and (2) number of short recovery periods after a previous shift, both assessed over the prior 3 months. Multiple logistic regression analysis adjusted for the aforementioned covariates was performed to evaluate the association of shift intensity with insomnia, defined as an ISI score of ≥8. RESULTS: The nurses with insomnia tended to be younger (p=0.029), to have worked 3 consecutive night shifts more frequently (p<0.001), to have experienced a greater number of short recovery periods after the previous shift (p=0.021), and to have worked for more hours (p=0.006) than the nurses without insomnia. Among the other variables, no statistically significant differences between groups were observed. Experiences of 3 or more consecutive night shifts (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.29 to 4.20) and 3 or more short recovery periods (OR, 2.01; 95% CI, 1.08 to 3.73) were associated with increased odds of insomnia. CONCLUSIONS: The results suggest that decreasing the shift intensity may reduce insomnia among hospital nurses working rotating shifts.

Prevalence of burnout among intensivists in mainland China: a nationwide cross-sectional survey.

BACKGROUND: Burnout has gained increasing attention worldwide; however, there is a lack of relevant research in China. This study investigated the prevalence and factors associated with burnout in physicians of the intensive care unit (ICU) in mainland China. METHODS: This cross-sectional multicenter study included critical care physicians from all provinces in mainland China (except Tibet). A self-administered survey questionnaire was conducted. It included three parts: demographic information, lifestyle and work information, and the Maslach Burnout Inventory. The levels of burnout were calculated. The factors independently associated with burnout were analyzed by logistic regression. RESULTS: Finally, 1813 intensivists participated in the survey. The participation rate was 90.7%. The prevalence of burnout and severe burnout was 82.1% (1489/1813) and 38.8% (704/1813), respectively. According to the logistic regression analysis, "difficulty in making treatment decisions" was independently associated with burnout [OR = 1.365, CI (1.060, 1.757)]. "Higher number of children" [OR = 0.714, CI (0.519, 0.981)] and higher "income satisfaction" [OR = 0.771, CI (0.619, 0.959)] were independent protective factors against severe burnout. CONCLUSIONS: The burnout rate in ICU physicians in China is high. Difficult treatment decisions, the number of children, and income satisfaction are independently associated with burnout rates among ICU physicians in China. TRIAL REGISTRATION: Burnout syndrome of the Chinese personnel working in intensive care units: a survey in China, ChiCTR-EOC-17013044, registered October 19, 2017. http://www.chictr.org.cn/showproj.aspx?proj=22329 .

Sick leave accessibility in junior doctors at an Australian health service.

BACKGROUND: Doctors commonly continue to work when they are unwell. This norm is increasingly problematic during the COVID-19 (SARS-CoV-2) pandemic when effective infection control measures are of paramount importance. This study investigates the barriers existing before COVID-19 that prevent junior doctors with an acute respiratory illness working in Canberra, Australia, from taking sick leave, and offers suggestions about how to make sick leave more accessible for junior doctors. METHODS: Anonymous online survey study. RESULTS: 192 junior doctors were invited to participate in the study. Fifty-four responded, and only those who had worked whilst unwell with an acute respiratory illness were included, providing a total number of fifty responses. Of these, 72% believed they were infectious at the time they worked whilst unwell. 86% of respondents did not feel supported by the workplace to take sick leave when they were unwell, and 96% identified concerns about burdening colleagues with extra workload and lack of available cover as the main deterrents to accessing sick leave. CONCLUSION: Junior doctors at our health service, pre-COVID-19, do not widely feel empowered to take sick leave when they have an acute respiratory illness. Junior doctors are primarily concerned about burdening their colleagues with extra workloads in an environment where they perceive there to be a lack of available cover. Having more available cover, leadership from seniors, and clearer guidelines around the impact of sick leave on registration may contribute to a culture where junior doctors feel supported to access sick leave.

The quest for workload equity in nurse faculty teaching.

BACKGROUND: While nurse faculty may believe that they teach more than faculty in other academic departments, their perceptions are difficult to corroborate when workload policies are not transparent at institutions. PURPOSE: This descriptive study was designed to examine inequities in teaching workloads between nurse faculty and their academic colleagues from the perspectives of Deans and Directors of Nursing Programs. METHODS: A web-based, investigator-developed survey was emailed to Nurse Unit Leaders in spring, 2019. The final sample included 224 respondents. Data were analyzed with descriptive statistics. FINDINGS: Nurse Unit Leaders perceived that nurse faculty teach larger classes and more courses than their academic peers. Survey respondents attributed these and other variations at their institutions to the complexity of teaching responsibilities in nursing units and the limited understanding of these responsibilities by university administrators. DISCUSSION: Ensuring equitable teaching workloads requires transparent policies and an organizational culture committed to faculty governance.