Strategies of Advanced Practice Providers to Reduce Stress at Work.

Background: High levels of stress and burnout, documented among healthcare professionals, result in high levels of job turnover. However, little is known about personal strategies employed by advanced practice providers (APPs) to mitigate stress. Methods: 3,939 APPs were invited to complete an online, anonymous, cross-sectional survey to examine work stress and burnout among APPs using quantitative and qualitative analyses. The Maslach Burnout Inventory (MBI) served as the measure for burnout. Work-stress reduction strategies were identified by an open-ended question. Findings: 854 APPs (70% of 1,218 respondents) (nurse practitioners, physician assistants, nurse midwives, anesthetists, and clinical nurse specialists) from four different United States health systems completed the free text portion of the survey. Qualitative analyses revealed that almost all of the APPs (94%) reported at least one stress reduction strategy. Four main themes were derived from the free-text responses: "Self-focused" (67.5%), "relational-focused"(16.1%), "job-focused" (11.5%) and "nothing" (4.9%). Quantitative results from the MBI revealed high levels of burnout among APPs with insignificant differences between those who provided a response to the qualitative question and those who did not: emotional exhaustion (p = .188); depersonalization (p = .265); personal accomplishment (p = .213). Conclusion/Application to Practice: Qualitative results highlighted strategies, many evidence-based, that APPs use to mitigate stress. Further research is needed to determine the frequency and consistency of APPs' enactment of personal strategies. These initial findings provide insights for occupational health practitioners and researchers planning primary prevention and secondary interventions for improving workplace health, enhancing personal wellness, and reducing job-related stressors.

Winter Texans and the re-creation of the American medical experience in Mexico.

Rising medical costs and decreasing health insurance coverage are fueling the health care crisis in the United States. Often, patients have to make tough decisions about whether to forgo care or risk bankruptcy. This conundrum has encouraged some patients to use Mexican health care as an alternative to the high costs in the United States. While medical travel enables some patients to access affordable care, others perceive it as risky and thus not a viable option. This article explores how those concerns are mitigated and Mexican health care usage is increased by (1) outlining how Mexican health care information is disseminated and used within a community of winter Texans living along the US/Mexico border; and (2) discussing how Mexican pharmacies and dental clinics have broadened their appeal through association with US health care standards and practices. Research for this article was conducted during 11 months of fieldwork in the Lower Rio Grande Valley.