Nurse Burnout in Hospice and Palliative Care: A Scoping Review

Burnout in hospice and palliative care nurses is a growing issue, especially in light of the COVID-19 pandemic. However, few studies have focused specifically on burnout in this population. A scoping review was undertaken to identify what is known about burnout among hospice and palliative care nurses, and to unify disparate findings. Analysis of eight articles revealed three overarching categories: personal factors, organizational/workplace factors, and nursing professional development factors. Each category was then divided into three cross-cutting subcategories: contributory and noncontributory factors, mitigating factors, and workplace issues. Recommendations for individuals include self-care as well as self-awareness of intrinsic characteristics that can predispose one to burnout. Within the workplace, leaders are challenged to support evidence-based practice and ongoing education. Role modeling positive communication skills, effective conflict mitigation, responsiveness, promotion of equity, and workplace commitment also help to create a culture of wellness. Nursing professional development may aid in resilience-building, and promotion of self-efficacy, self-confidence, and assertiveness. Although all identified recommendations were derived from the literature, no interventional studies have been conducted to test the effects of suggested interventions. Future research should include interventional studies as well as qualitative research to capture nuanced experiences of burnout in hospice and palliative care nurses.

The Great Realization: Nurses Are in the Driver's Seat!

The postpandemic health care environment has reached a pivotal point requiring transformative change among professional nurses working in health care organizations. This article posits that the nurses at the bedside, the true innovators and influencers, are most able to develop solutions that will be effective in this transformation. Appreciative inquiry is offered as a co-creative and possibility-focused model to guide nurses and nurse leaders through the process of holding on to what is good, dreaming of what can be, and charting the course for their future.

Creative Solutions to Assure New Graduate Preparation and On-Boarding

The pandemic has caused nurse leaders to rethink how to best prepare nurses for practice in challenging times. Creative strategies employed by nurse leaders in academia and in community settings can ensure that new graduate nurses are ready for practice. This article discusses ideas for implementation or refocus that are required to meet the needs of the novice nurse and community partners.

Leading Forward: Embracing Feedback and Moving Toward Authentic Positivity

Nurse leaders are discovering a "new normal." In other words, we have normalized the discomfort we find ourselves in because of the pandemic and the disruptions it has caused. Many of us are contemplating how we to lead going forward. How do we inspire exhausted, frustrated, and overworked people? How do we lead with authenticity when so many of our efforts seem to miss the mark or are rejected as not actually solving the problem? This article offers a perspective on these questions and more, providing possible ways nurse leaders can embrace feedback and turn toxic positivity into authentic positivity.

From The National Perinatal Information Center: National Minority Health Month: Amplifying Perinatal Nursing Leadership Disparities through Data

The article presents the discussion on recognizing health disparities impacting people from racial and ethnic minority groups. Topics include frontline nursing leadership positions pivotal for assuring quality outcomes, staff satisfaction, and organizational effectiveness of inpatient care units;and supporting nurse leaders during the pandemic contributing to the stressors.

Living Your Values in Challenging Times

The pandemic has created serious emotional distress for health care workers. Staffing shortages and a fraught political landscape have made it more challenging for health care organizations to honor their core values, whereas burnout, PTSD, and moral injury have made it more difficult, if not impossible, for caregivers to live up to their personal values. This article describes the problem and presents 7 recommendations for health care leaders.

Reviving resuscitation skills: Non-invasive ventilator training for ward nurses

As part of the pro-active response in anticipation of a possible outbreak of COVID-19 in Aotearoa New Zealand, ward nurses at Wellington Regional Hospital were requested by senior nursing leadership to participate and engage in non-invasive ventilation training. The objective of this education was to allow adequate response and provision of lifesaving non-invasive ventilation to critically unwell patients. Identifying potential nurses and ascertaining the amount of training and resources involved in mass training was critical to the success of the programme. The variation in ventilation equipment was a significant detail that had contributed to the mounting challenge of addressing the lack of both human and technological resources. This reflection piece describes the education initiative and the circumstances and practicalities of creating, teaching, and training advanced skills (non-invasive ventilation education) to ward nurses with limited respiratory experience.

The coming of age: Aged residential care nursing in Aotearoa New Zealand in the times of COVID-19

For years aged care nursing has been largely overlooked and marginalised from mainstream healthcare. COVID-19 brought both aged residential care and nursing into sharp focus for Aotearoa New Zealand. This paper provides a commentary on the work of executive nurses within the Nursing Leadership Group of the New Zealand Aged Care Association as COVID-19 spread into some ARC facilities in early 2020 and threatened the health and wellbeing of many residents and nurses. The group influenced the agenda and implementation of policies for Aged Residential Care and brought the voice of nursing and residents of aged care to the forefront at national and regional levels.

Steadfast is the rock: Primary health care Māori nurse leaders discuss tensions, resistance, and their contributions to prioritise communities and whānau during COVID-19

Historical experience from previous pandemics, together with knowledge of significant and perpetuating health inequities, led to predictions that Māori and Pacific peoples would experience greater morbidity and be hardest hit economically. Steadfast is the rock describes the mahi (work and actions) of three Māori nurse leaders through the first COVID-19 lockdown in Aotearoa New Zealand in 2020. Through kōrero (discussion and dialogue), this article draws on their experiences of working in a large mainstream primary health entity working across the Northland region of Aotearoa as they navigated their way within and across health sector providers and organisations to protect the health and wellbeing of whānau (families). They used their knowledge of mātauranga Māori (Māori knowledge and tradition), to ensure Māori whānau were prioritised in the pandemic response in the region. They faced adversity and resistance in a fragmented system where competition and power interfered with collaborative practices. Throughout, they remained courageous and resilient, holding true to mātauranga Māori as nurses and Māori wāhine (women) to promote equity. Yet much of their work went unnoticed and unacknowledged. Māori nurse leaders hold a necessary role in providing an equity- focused response across mainstream and Māori health providers, through their abilities to maintain relationships, find mutually agreeable strategies, and work collaboratively across the health sector.

COVID-19 among Indigenous communities: Case studies on Indigenous nursing responses in Australia, Canada, New Zealand, and the United States

Globally, Indigenous Peoples experience disparate COVID-19 outcomes. This paper presents case studies from Aotearoa New Zealand, Australia, Canada, and the United States of America and explores aspects of government policies, public health actions, and Indigenous nursing leadership for Indigenous communities during a pandemic. Government under-performance in establishing Indigenous-specific plans and resources, burdened those countries with higher COVID-19 cases and mortality rates. First, availability of quality data is an essential element of any public health strategy, and involves disaggregated, ethnic-specific data on Indigenous COVID-19 cases, mortality rates, and vaccination rates. When data is unavailable, Indigenous Peoples are rendered invisible. Data sovereignty principles must be utilised to ensure that there is Indigenous ownership and protections of these data. Second, out of necessity, Indigenous communities expressed their self-determination by uniting to protect their Peoples and providing holistic and culturally meaningful care, gathering quality data and advocating. Indigenous leaders used an equity lens that informed national, state, regional, and community-level decisions relating to their Peoples. Third, at the forefront of the pandemic, Indigenous nursing leadership served as a trusted presence within Indigenous communities. Indigenous nurses often led advocacy, COVID-19 testing, nursing care, and vaccination efforts in various settings and communities. Indigenous nurses performed vital roles in a global strategy to reduce Indigenous health inequities during the COVID-19 pandemic and beyond. Fourth, historically, pandemics have heightened Indigenous Peoples' vulnerability. COVID-19 amplified Indigenous health inequities, underscoring the importance of high-trust relationships with Indigenous communities to enable rapid government support and resources. Holistic approaches to COVID-19 responses by Indigenous peoples must consider the wider determinants of wellbeing including food and housing security. Findings from these case studies, demonstrate that Indigenous self-determination, data sovereignty, holistic approaches to pandemic responses alongside with Governmental policies, resources should inform vaccination strategies and future pandemic readiness plans. Finally, in any pandemic of COVID-19-scale, Indigenous nurses' leadership and experience must be leveraged for a calm, trusted and efficient response.

Encounters with uncertainty and complexity: Reflecting on infection prevention and control nursing in Aotearoa during the COVID-19 pandemic

The disruptiveness of the COVID-19 pandemic created the need for rapid responses in health systems already under pressure and challenged nursing in Aotearoa New Zealand with levels of uncertainty and complexity not previously encountered. For the small number of specialists in the field of infection prevention and control (IPC) nursing nationally, this meant having to adapt to new ways of working and collaborating in situations where the pace of change was extraordinary. This short commentary describes the author's experiences working as an infection prevention and control nurse leader and is underpinned by complex adaptive systems thinking and the concept of collective competence as theoretical frameworks through which to conceptualise and account for the COVID-19 response in the Canterbury region.