Perceived stress, burnout, and resilience among healthcare workers in a multiple disaster-impacted setting during the COVID-19 pandemic.

OBJECTIVE: Current literature on coronavirus disease 2019 (COVID-19) research presents gaps and opportunities to investigate the psychological experiences of healthcare workers (HCWs) serving in mass trauma situations. We aimed to measure perceived stress, burnout, and resilience in Kashmiri HCWs and explore the relationship of burnout with sociodemographic, work-related, and pandemic-related factors. DESIGN, SETTING, AND PARTICIPANTS: This was a cross-sectional descriptive study. Data were collected by circulating a web-based questionnaire among HCWs across primary, secondary, and tertiary healthcare levels in Kashmir, India. The questionnaire consisted of sections on personal, work-related, and pandemic-related variables as well as validated instruments to measure perceived stress, burnout, and resilience. RESULTS: A total of 514 valid responses were received. More than 80 percent of HCWs had moderate to high perceived stress. The prevalence of personal, work-related, and client-related burnouts was 68, 48.6, and 46 percent, respectively. Resilience was negatively correlated with stress and burnout. Younger (18-28 years), unmarried HCWs, especially junior residents and nurses, had higher burnout levels. Redeployment to deliver COVID-19 duties, unpredictability in work schedule, tested positive for COVID-19, and spending time in isolation/quarantine were also found to be significant risk factors for developing burnout. CONCLUSIONS: Nearly half of the HCWs suffered from burnout, and more than half had moderate to high perceived stress. In addition to pre-existing risk factors of burnout, the pandemic seems to have introduced more occupational risk factors in this disaster-affected area. Lessons learnt from COVID-19 pandemic may help guide need-based intervention strategies designed for specific target population rather than a one size fits all approach.

[NEGATIVE AND POSITIVE ASPECTS OF PROFESSIONAL QUALITY OF LIFE AMONG PEDIATRIC RESIDENTS IN ER ROTATION: COMPASSION FATIGUE AND COMPASSION SATISFACTION FROM THE RESIDENTS' PERSPECTIVE].

INTRODUCTION: The article focuses on the professional quality of life of medical residents, and specifically on compassion fatigue and compassion satisfaction. Previous studies have indicated high levels of emotional stress among residents. Most of these studies were conducted within the positivistic paradigm. The qualitative study concentrates on pediatric residents during ER rotations in both routine and pandemic times. AIMS: The research goal is to explore how compassion fatigue and compassion satisfaction are manifested among the residents. METHODS: Conducted in the phenomenological genre, the study included 14 pediatric residents in a large Israeli hospital. The research tool was a semi-structured interview. RESULTS: All residents reported substantial work overloads. About half of the participants indicated signs of compassion fatigue, manifested in negative emotions and diminished empathy and sensitivity, especially towards patients' families. Some exhibited a combination of compassion fatigue and compassion satisfaction. About half of the residents clearly expressed feelings of compassion satisfaction or empathy for patients (without direct expressions of compassion satisfaction). CONCLUSIONS: The research gave pediatric residents a platform to express their voices, shedding light on the complexity of their work. While a substantial number of participants reported compassion fatigue, the findings are encouraging. Despite the reported work overload, most of them maintained their sense of commitment and compassion, which are crucial for their work. However, participants' senses of stress and burnout have negative consequences both individually and organizationally. The study suggests that residents might gain from systematic intervention and recommendations have been offered to hospital administrations.

Burnout in podiatrists associated with individual characteristics, workplace and job satisfaction: A national survey.

BACKGROUND: Burnout is highly prevalent among health practitioners. It negatively impacts job performance, patient care, career retention and psychological well-being. This study aimed to identify factors associated with burnout among Australian podiatrists. METHODS: Data were collected from registered podiatrists via four online surveys administered annually from 2017 to 2020 as part of the Podiatrists in Australia: Investigating Graduate Employment (PAIGE) study. Information was collected about work history, job preferences, personal characteristics, health, personality, life experiences and risk-taking behaviours. Multiple logistic regression analyses were used to determine if (i) individual characteristics, (ii) workplace factors and (iii) job satisfaction measures were associated with burnout (based on the abbreviated Maslach Burnout Inventory). RESULTS: A total of 848 responses were included, with 268 podiatrists (31.6%) experiencing burnout. Participants experiencing burnout were slightly younger, more recent to practice, had poorer health, greater mental distress, lower scores for resilience, extraversion, agreeableness, conscientiousness, emotional stability and openness to experiences. They were less likely to have financial and clinical risk-taking behaviour and more likely to have career risk-taking behaviour. Prediction accuracy of these individual characteristic variables for burnout was 72.4%. Participants experiencing burnout were also more likely to work in private practice, have more work locations, work more hours, more direct patient hours, see more patients, have shorter consultation times, more likely to bulk bill chronic disease management plans, have less access to sick leave and professional development and be more likely to intend to leave patient care and the profession within 5 years than participants not experiencing burnout. Prediction accuracy of these workplace-related variables for burnout was 67.1%. Participants experiencing burnout were less satisfied with their job. Prediction accuracy of these variables for burnout was 78.8%. CONCLUSIONS: Many of the factors associated with burnout in Australian podiatrists are modifiable, providing opportunities to implement targeted prevention strategies. The strength of association of these factors indicates high potential for strategies to be successful.

Sequential mediation analysis of physical activity, healthy diet, BMI, and academic burnout in the Pakistani educational landscape.

Research has indicated a negative impact of physical activity on academic burnout among students, however, there is a paucity of evidence about the underlying mechanism of this association in Pakistani students. The present research seeks to investigate the relationship between physical activity and academic burnout by investigating the potential mediating effects of adherence to the Mediterranean diet (MD) and body mass index (BMI). A sample of 596 students using a cross-sectional survey design was gathered from two public universities (Riphah International University and Mohammed Ali Jinnah University) in Rawalpindi, Pakistan from June to July 2022. The study participants were asked to fill out the Physical Activity Rating Scale-3, the Learning Burnout Scale, and the Test of Adherence to MD questionnaires. The study employed descriptive, bivariate, and path analysis through regression utilizing the SPSS software version 27. The findings demonstrated a negative correlation between academic burnout and BMI, physical activity, and adherence to the MD. The relationship between physical activity and academic burnout was mediated by BMI. Physical activity and academic burnout were inversely correlated, with adherence to the MD and BMI interacting as sequential mediators. The outcomes of this research have expanded our knowledge of the association between physical activity and academic burnout and have suggested crucial and appropriate strategies for addressing student academic burnout.

The effect of commuting time on burnout: the mediation effect of musculoskeletal pain.

OBJECTIVES: This study explores the relationship among commuting, musculoskeletal (MS) pain, and burnout. METHODS: An observational and cross-sectional study was conducted at a medical university-affiliated hospital in Taichung, Taiwan in 2021. The two questionnaire was used and they included the Copenhagen Burnout Inventory (CBI) and the Nordic Musculoskeletal Questionnaire (NMQ). All participants were invited to complete the cross-sectional survey. A multiple linear regression was assessed correlations between commuting, MS pain, and burnout. RESULTS: After excluding those with missing data, 1,615 healthcare workers were deemed valid as research participants. In multiple linear regression, commuting time longer than 50 min was associated with personal burnout (PB) in the presence of adjusted confounders; however, long commuting time was not associated with work-related burnout (WB). Furthermore, the choice of commuting method did not affect PB or WB. Notably, both neck and shoulder pain (NBSP) and ankle pain (BAP) increase the risk of PB and WB. The mediation analysis demonstrated that NBSP is a mediating factor, increasing the level of PB and WB for commuting times longer than 50 min. CONCLUSIONS: Healthcare workers who commute for more than 50 min should be considered part of a high-risk group for burnout and musculoskeletal pain. They should also be provided with resources and programs focused on burnout prevention and MS pain relief.

Emergency Nurses' Reasons for Not Recommending Their Hospital to Clinicians as a Good Place to Work.

Importance: Half of emergency nurses report high burnout and intend to leave their job in the next year. Whether emergency nurses would recommend their workplace to other clinicians may be an important indicator of a hospital's ability to recruit clinicians. Objective: To examine why emergency nurses do not recommend their hospital to other clinicians as a good place to work. Design, Setting, and Participants: This qualitative study used directed content analysis of open-text responses (n = 142) from the RN4CAST-NY/IL survey of registered nurses licensed in New York and Illinois between April 13 and June 22, 2021. Inductive and deductive analytic approaches guided study theme development informed by the Social Ecological Model. The collected data were analyzed from April to June 2023. Main Outcomes and Measures: Nurses who answered "probably not" or "definitely not" to the survey question, "Would you recommend your place of employment as a good place to work?" were prompted to provide a rationale in an open-text response. Results: In this qualitative study of 142 emergency nurses (mean [SD] age, 43.5 [12.5] years; 113 [79.6%] female; mean [SD] experience, 14.0 [12.2] years), 94 (66.2%) were licensed to work in New York and the other 48 (33.8%) in Illinois. Five themes and associated subthemes emerged from the data. Themes conveyed understaffing of nurses and ancillary support (theme 1: unlimited patients with limited support); inadequate responsiveness from unit management to work environment safety concerns (theme 2: unanswered calls for help); perceptions that nurses' licenses were in jeopardy given unsafe working conditions and compromised care quality (theme 3: license always on the line); workplace violence on a patient-to-nurse, clinician-to-nurse, and systems level (theme 4: multidimensional workplace violence); and nurse reports of being undervalued by hospital management and unfulfilled at work in delivering suboptimal care to patients in unsafe working conditions (theme 5: undervalued and unfulfilled). Conclusions and Relevance: This study found that emergency department nurses did not recommend their workplace to other clinicians as a good place to work because of poor nurse and ancillary staffing, nonresponsive hospital leadership, unsafe working conditions, workplace violence, and a lack of feeling valued. These findings inform aspects of the work environment that employers can address to improve nurse recruitment and retention.

Top Factors in Nurses Ending Health Care Employment Between 2018 and 2021.

Importance: The increase in new registered nurses is expected to outpace retirements, yet health care systems continue to struggle with recruiting and retaining nurses. Objective: To examine the top contributing factors to nurses ending health care employment between 2018 and 2021 in New York and Illinois. Design, Setting, and Participants: This cross-sectional study analyzed survey data (RN4CAST-NY/IL) from registered nurses in New York and Illinois from April 13 to June 22, 2021. Differences in contributing factors to ending health care employment are described by nurses' age, employment status, and prior setting of employment and through exemplar nurse quotes. Main Outcomes and Measures: Nurses were asked to select all that apply from a list of contributing factors for ending health care employment, and the percentage of nurse respondents per contributing factor were reported. Results: A total of 7887 nurses (mean [SD] age, 60.1 [12.9] years; 7372 [93%] female) who recently ended health care employment after a mean (SD) of 30.8 (15.1) years of experience were included in the study. Although planned retirement was the leading factor (3047 [39%]), nurses also cited burnout or emotional exhaustion (2039 [26%]), insufficient staffing (1687 [21%]), and family obligations (1456 [18%]) as other top contributing factors. Among retired nurses, 2022 (41%) ended health care employment for reasons other than planned retirement, including burnout or emotional exhaustion (1099 [22%]) and insufficient staffing (888 [18%]). The age distribution of nurses not employed in health care was similar to that of nurses currently employed in health care, suggesting that a demographically similar, already existing supply of nurses could be attracted back into health care employment. Conclusions and Relevance: In this cross-sectional study, nurses primarily ended health care employment due to systemic features of their employer. Reducing and preventing burnout, improving nurse staffing levels, and supporting nurses' work-life balance (eg, childcare needs, weekday schedules, and shorter shift lengths) are within the scope of employers and may improve nurse retention.

Gender and Clinical Status in Burnout in Medicine.

This survey study assesses feelings of satisfaction, stress, and burnout by gender and clinical status among health care workers at a single academic center.

Clinician Burnout and Effectiveness of Guideline-Recommended Psychotherapies.

Importance: Clinician burnout has been associated with clinician outcomes, but the association with patient outcomes remains unclear. Objective: To evaluate the association between clinician burnout and the outcomes of patients receiving of guideline-recommended trauma-focused psychotherapies for posttraumatic stress disorder (PTSD). Design, Setting, and Participants: This cohort study was set at the US Veterans Affairs Health Care System and included licensed therapists who provided trauma-focused psychotherapies and responded to an online survey between May 2 and October 8, 2019, and their patients who initiated a trauma-focused therapy during the following year. Patient data were collected through December 31, 2020. Data were analyzed from May to September 2023. Exposures: Therapists completing the survey reported burnout with a 5-point validated measure taken from the Physician Worklife Study. Burnout was defined as scores of 3 or more. Main Outcomes and Measures: The primary outcome was patients' clinically meaningful improvement in PTSD symptoms according to the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Patient dropout, therapist adherence, and session spacing was assessed through electronic health records. Multivariable random-effects logistic regression examined the association of therapist burnout and clinically meaningful improvement, adjusted for case-mix. Results: In this study, 165 of 180 (91.7%) therapists (89 [53.9%] female) completed the burnout measure and provided trauma-focused psychotherapies to 1268 patients (961 [75.8%] male) with outcome data. Fifty-eight (35.2%) therapists endorsed burnout. One third of patients (431 [34.0%]) met criterion for clinically meaningful improvement. Clinically meaningful improvement in PTSD symptoms was experienced by 120 (28.3%) of the 424 patients seen by therapists who reported burnout and 311 (36.8%) of the 844 patients seen by therapists without burnout. Burnout was associated with lower odds of clinically meaningful improvement (adjusted odds ratio [OR],0.63; 95% CI, 0.48-0.85). The odds of clinically meaningful improvement were reduced for patients who dropped out (OR, 0.15; 95% CI, 0.11-0.20) and had greater session spacing (OR, 0.80; 95% CI, 0.70-0.92). Therapist adherence was not associated with therapy effectiveness. Adjusting for dropout or session spacing did not meaningfully alter the magnitude of the association between burnout and clinically meaningful improvement. Conclusions and Relevance: In this prospective cohort study, therapist burnout was associated with reduced effectiveness of trauma-focused psychotherapies. Studying when and how burnout affects patient outcomes may inform workplace interventions.

Physician Coaching by Professionally Trained Peers for Burnout and Well-Being: A Randomized Clinical Trial.

Importance: Physician burnout is problematic despite existing interventions. More evidence-based approaches are needed. Objective: To explore the effect of individualized coaching by professionally trained peers on burnout and well-being in physicians. Design, Setting, and Participants: This randomized clinical trial involved Mass General Physician Organization physicians who volunteered for coaching from August 5 through December 1, 2021. The data analysis was performed from February through October 2022. Interventions: Participants were randomized to 6 coaching sessions facilitated by a peer coach over 3 months or a control condition using standard institutional resources for burnout and wellness. Main Outcomes and Measures: The primary outcome was burnout as measured by the Stanford Professional Fulfillment Index. Secondary outcomes included professional fulfillment, effect of work on personal relationships, quality of life, work engagement, and self-valuation. Analysis was performed on a modified intention-to-treat basis. Results: Of 138 physicians enrolled, 67 were randomly allocated to the coaching intervention and 71 to the control group. Most participants were aged 31 to 60 years (128 [93.0%]), women (109 [79.0%]), married (108 [78.3%]), and in their early to mid career (mean [SD], 12.0 [9.7] years in practice); 39 (28.3%) were Asian, 3 (<0.1%) were Black, 9 (<0.1%) were Hispanic, 93 were (67.4%) White, and 6 (<0.1%) were of other race or ethnicity. In the intervention group, 52 participants underwent coaching and were included in the analysis. Statistically significant improvements in burnout, interpersonal disengagement, professional fulfillment, and work engagement were observed after 3 months of coaching compared with no intervention. Mean scores for interpersonal disengagement decreased by 30.1% in the intervention group and increased by 4.1% in the control group (absolute difference, -0.94 poimys [95% CI, -1.48 to -0.41 points; P = .001), while mean scores for overall burnout decreased by 21.6% in the intervention group and increased by 2.5% in the control group (absolute difference, -0.79 points; 95% CI, -1.27 to -0.32 points; P = .001). Professional fulfillment increased by 10.7% in the intervention group compared with no change in the control group (absolute difference, 0.59 points; 95% CI, 0.01-1.16 points; P = .046). Work engagement increased by 6.3% in the intervention group and decreased by 2.2% in the control group (absolute difference, 0.33 points; 95% CI, 0.02-0.65 points; P = .04). Self-valuation increased in both groups, but not significantly. Conclusions and Relevance: The findings of this hospital-sponsored program show that individualized coaching by professionally trained peers is an effective strategy for reducing physician burnout and interpersonal disengagement while improving their professional fulfillment and work engagement. Trial Registration: ClinicalTrials.gov Identifier: NCT05036993.

Artificial Intelligence-Generated Draft Replies to Patient Inbox Messages.

Importance: The emergence and promise of generative artificial intelligence (AI) represent a turning point for health care. Rigorous evaluation of generative AI deployment in clinical practice is needed to inform strategic decision-making. Objective: To evaluate the implementation of a large language model used to draft responses to patient messages in the electronic inbox. Design, Setting, and Participants: A 5-week, prospective, single-group quality improvement study was conducted from July 10 through August 13, 2023, at a single academic medical center (Stanford Health Care). All attending physicians, advanced practice practitioners, clinic nurses, and clinical pharmacists from the Divisions of Primary Care and Gastroenterology and Hepatology were enrolled in the pilot. Intervention: Draft replies to patient portal messages generated by a Health Insurance Portability and Accountability Act-compliant electronic health record-integrated large language model. Main Outcomes and Measures: The primary outcome was AI-generated draft reply utilization as a percentage of total patient message replies. Secondary outcomes included changes in time measures and clinician experience as assessed by survey. Results: A total of 197 clinicians were enrolled in the pilot; 35 clinicians who were prepilot beta users, out of office, or not tied to a specific ambulatory clinic were excluded, leaving 162 clinicians included in the analysis. The survey analysis cohort consisted of 73 participants (45.1%) who completed both the presurvey and postsurvey. In gastroenterology and hepatology, there were 58 physicians and APPs and 10 nurses. In primary care, there were 83 physicians and APPs, 4 nurses, and 8 clinical pharmacists. The mean AI-generated draft response utilization rate across clinicians was 20%. There was no change in reply action time, write time, or read time between the prepilot and pilot periods. There were statistically significant reductions in the 4-item physician task load score derivative (mean [SD], 61.31 [17.23] presurvey vs 47.26 [17.11] postsurvey; paired difference, -13.87; 95% CI, -17.38 to -9.50; P < .001) and work exhaustion scores (mean [SD], 1.95 [0.79] presurvey vs 1.62 [0.68] postsurvey; paired difference, -0.33; 95% CI, -0.50 to -0.17; P < .001). Conclusions and Relevance: In this quality improvement study of an early implementation of generative AI, there was notable adoption, usability, and improvement in assessments of burden and burnout. There was no improvement in time. Further code-to-bedside testing is needed to guide future development and organizational strategy.

Primary Care Access for All: A Roadmap for Addressing the Primary Care Crisis in Rhode Island.

BACKGROUND: Primary care in Rhode Island is in crisis. The dearth of primary care providers is already affecting access to services and the situation is likely to worsen unless major steps are taken. There are inadequate numbers of trainees in primary care medical residencies, nurse practitioner (NP) and physician assistant (PA) training programs who plan to practice primary care in our state. The Care Transformation Collaborative of RI (CTC-RI) has assembled a broadly representative task force of physicians, NPs, PAs, and others to build a strong and robust primary care delivery system across the state that recruits, trains, retains, and sustains primary care providers. Study Methods and Design: Program directors from all primary care medical residencies, NP, and PA programs were asked to provide data on their programs, including the number of new trainees per year, total enrollment, and information on recent year graduates, including the total number, the number entering primary care, and the number entering primary care who plan to practice in RI. PRIMARY RESULTS: Of the 106 graduates from primary care residencies in RI in academic year 2002-23, only 15 (14%) planned to provide primary care in Rhode Island. Similarly, of the 144 NP and PA graduates in primary care programs, only 48 (33%) planned to provide primary care in the state. PRINCIPAL CONCLUSIONS: Given the high rate of primary care provider burnout, reduction in patient care hours, and retirement, primary care access will be further eroded unless major steps are taken. The CTC-RI Task Force on Primary Care Provider Workforce has produced a strategic roadmap to address these issues.

Burnout syndrome and its correlation with musculoskeletal disorders among physiotherapists in Saudi: A cross-sectional study.

BACKGROUND AND PURPOSE: There is a significant impact of musculoskeletal disorders (MSDs) on individuals of all ages, professions, and fields from various countries worldwide, leading to a negative impact on quality of life and overall health outcomes. The study was conducted to investigate the association between Burnout syndrome (BS) and MSDs among physiotherapists in Saudi Arabia. METHODS: A cross-sectional study was carried out. Physiotherapists of either gender and with no known co-morbidities and who were not suffering from recent injuries and accidents were included in the study. The Copenhagen Burnout Inventory was used to determine the level of burnout. Musculoskeletal disorders were analyzed using the Standardized Nordic Questionnaire (NMQ). The chi-square test was used to observe the association between two categorical variables and a p-value <0.05 was considered to be statistically significant. RESULTS: A total of 133 participants were recruited and it was observed that 70 (53%) participants had low burnout levels (BoL). It was revealed that 65 (49%) had trouble in the neck and visited a physician clinic, 47 (35%) had trouble in the lower back during the last 12 months, 60 (45%) had trouble in the upper back during the last 12 months that prevented the normal activity and 13 (9.8%) participants had trouble in the shoulders during the last 7 days. History of chronic disease, education, practice setting, and smoking status with Burnout level was statistically significant. Trouble in the upper back, elbow, wrist/hands, hips/thighs, ankle/feet, and neck were also found to be significant. CONCLUSION: The outcomes revealed that a few demographic factors such as education, practice setting, smoking status, and chronic disease history were significantly associated with BS. Furthermore, it was observed that MSD had a significant impact on BoL.

Predictive modeling of burnout based on organizational culture perceptions among health systems employees: a comparative study using correlation, decision tree, and Bayesian analyses.

Burnout is a significant concern, particularly within the healthcare field, affecting both nurses and physicians. It is a common issue in health systems, which encompass a range of healthcare facilities, such as hospitals, physician practices, ambulatory sites, and administrative offices like finance. Despite this, there has not been an extensive exploration of burnout in employees working directly with patients versus those in non-patient-facing roles within these health systems. It is important to note that organizational culture plays a crucial role in influencing various aspects of employees' work-life balance and their experiences of burnout. This study adopts a cross-sectional design, involving the distribution of a 57-question Likert scale survey to employees in health systems. These employees serve in various roles, both patient-facing and non-patient-facing, within jointly owned healthcare organizations, which encompass hospitals, ambulatory sites, and administrative offices. The survey was disseminated through trade organizations and employees at the managerial level and above within these health systems. Data was collected between October 2022 and January 2023, resulting in a total of 67 responses. The study employs correlation analysis to explore the connection between organizational culture and burnout. Furthermore, a decision tree model is constructed to predict burnout scores based on survey responses, specifically the question regarding the perceived positivity of the organizational culture. The decision tree models indicate that perceiving organizational culture as positive, safety-oriented, and supportive predicts various outcomes for individuals, including job retention, positive experiences with patients, increased callousness, and stimulation while working with colleagues. Bayesian analysis, considering the small sample size, reinforces these findings and provides a different perspective, incorporating prior knowledge and credible intervals. An association test suggests a strong link between a positive organizational culture and burnout symptoms, while another test supports a connection with engagement signs. Similar to nurses and physicians, administrative health systems' personnel are susceptible to burnout. Organizational culture can affect burnout. Therefore, health systems' leaders should cultivate an organizational culture that protects against burnout.