Rules of engagement: The role of mistreatment from patients in the nurse, physician and advanced practice provider experience

The objective of this study is to examine the incidence of reported stress due to mistreatment by patients toward clinicians and the role of mistreatment from patients along with organizational factors in clinician distress. A survey of clinicians was conducted at a large academic medical center, resulting in a final analytic sample of 1,682 physicians, nurses, advanced practice providers and clinical support staff. Nurses reported the greatest incidence of mistreatment by patients as a major stressor (18.69%), followed by Advanced Practice Providers (11.26%), Clinical Support Staff (10.36%), and Physicians (7.69%). Logistic regression analysis was conducted to determine the relationship of individual- and organization-level characteristics with the odds of reporting mistreatment from patients as a major stressor. Overall findings indicate that nurses and those who work in the ER and ambulatory or outpatient clinics were more likely to be stressed from mistreatment by patients than other clinicians. Stress due to mistreatment by patients was also associated with higher Well-Being Index (WBI) distress scores, rapid changes in workflows or policies, ongoing care of COVID-19 patients, under-staffing, and low perceived organizational support. Gender or sexual minorities (not identifying as male or female) and younger (18-34 years of age) healthcare workers were also more likely to experience stress from mistreatment by patients. Individual resilience was not statistically significantly associated with reported stress from mistreatment by patients. Organizations must examine expectations for patient and visitor behavior in tandem with service standards for clinicians toward patients. © The Author(s), 2022.

Accountable care team membership and distress: is accountable care team membership associated with lower distress during a crisis?

Background: Hospitals have begun to formally develop and implement structures and processes to further promote interprofessional collaboration and leadership at the microsystem level (unit, service) with the goal to improve care quality, efficiency, and patient and provider experiences. Termed by some as the Accountable Care Team (ACT) model, the core components to date have included: (I) a designated physician-nursemanager leadership dyad, (II) cohorting of patients and team members to the unit as much as possible, (III) daily interprofessional team care planning rounds, (IV) proactive assessment of patient experience, and (V) access to unit-level data for performance improvement. The purpose of this paper is to describe an expanded model of the ACT intervention and understand whether ACT membership was associated with reduced distress during a major crisis, particularly the COVID-19 pandemic. Methods: This cross-sectional survey study was conducted within a large academic medical center in the Southeast United States, which is in the process of implementing ACT interventions across 32 units. A total of 1,130 respondents took the survey with a response rate of 18 percent. Results: ACT members had a greater sense of community at work, felt greater support from the organization, and were less likely to report social isolation and loneliness as a major stressor. However, ACT members were also more likely to report heavy workload and long hours, and increased job demands as major stressors than non-members. ACT members were also more likely to be female, and to indicate childcare as a major stressor. Multivariate regression models indicated no statistically significant association between ACT membership and overall distress scores. Conclusions: Early results suggest that there may be benefits to ACT membership, but these benefits may be counteracted by additional work demands. Organizations must ensure adequate time and resources are allotted for those participating in ACT models. © 2022 Journal of Hospital Management and Health Policy.

Unique stressors in a global pandemic: a mixed methods study about unique causes of distress among healthcare team members during COVID-19

Background: Amid the COVID-19 pandemic, healthcare systems experienced significant challenges, including lower revenues from elective procedures, limited supplies, a massive influx of patients and psychologically distressed employees. National reports of well-being showed striking rates of burnout among healthcare workers. Prior research depicted how the pandemic affected all categories of healthcare workers, yet there is little evidence showing what specific factors hinder each type of employee. Methods: Employees from a large medical center in the Southeastern United States (US) (n=1,130) participated in an online survey, responding to a series of questions about their daily stressors, working conditions, and distress as measured by a 9-item Well-Being Index (WBI), and providing open-ended responses about additional stressors and positive changes in their work. With an analytic sample of 1,037, we used stepwise analysis for each employee group to identify which stressors have a significant association with their overall distress. Using a convergent mixed methods approach, we corroborate our quantitative findings with qualitative themes from the open-ended responses. Results: Among all types of employees i.e., physicians, nurses, Advanced Practice Providers (APPs), Clinical support staff and Non-clinical staff, moral distress was associated with higher WBI distress. Qualitative themes showed employees were mainly concerned with quality of and access to care for patients. Stress triggered by heavy workload in the setting of increased pandemic-related responsibilities and decreased personnel was associated with a high level of WBI distress among all types of employees, whereas other significant stressors differed by role. Conclusions: The COVID-19 pandemic created a myriad of work and non-work-related stressors hindering all healthcare workers' psychological well-being differently. Working conditions and responsibilities for each role are unique. Institutional policies must contemplate the distinctiveness of stressors and distress across employee sub-groups to properly mitigate psychological distress. © 2022 Journal of Hospital Management and Health Policy.

Perceptions of Inequitable Compensation Reductions among Healthcare Workers During Covid-19

Healthcare systems across the United States implemented compensation reductions, layoffs, and furloughs during the early phases of the COVID-19 pandemic. However, there was a wide variety of approaches among health systems. This paper explores the perceived inequity of compensation reductions across the entire healthcare team through the lens of distributive justice. The study was conducted at a large academic hospital in the Southeastern United States. A survey was distributed regarding perceived fairness of compensation reductions, preferred compensation reduction arrangements, work environment, and stressors. Out of 715 respondents, the majority showed a preference for compensation reductions that were lowest for those physically treating patients, or physically treating COVID-19 patients. Ordinal logistic regression was conducted to determine predictors of increased odds of perceived inequity of the compensation reductions. Employees who had greater resiliency, greater exposure to the virus, treated COVID-19 patients and reported reduced income as a major stressor had higher odds of feeling the pay cut was inequitable. Those with a greater sense of perceived organizational support and females were less likely to perceive the pay cuts as inequitable when controlling for other factors. Healthcare organizations need to be mindful of perceptions of inequity on the well-being of their workforce and should engage in inclusive decision-making when allocating scarce resources within the organization. © 2021 Aspen Publishers Inc.. All rights reserved.