RESUMO
Background: The Accreditation Council for Graduate Medical Education has tasked residency programs to prioritize resident wellness, reduce trainee stress, and prevent burnout. Grief and bereavement can significantly impact residents' wellness during difficult clinical training schedules. There are no best practices on how to support residents during this time. Methods: In a split academic county emergency medicine (EM) residency, this pilot study documents a resident-driven change to scheduling practices for bereavement leave. An advisory group of residents, chief residents, and program directors informally polled peer institutions to develop bereavement leave guidelines. Considerations were made to balance resident wellness, education, and patient care in developing a bereavement scheduling policy. Results: The bereavement policy was adopted in January 2023, aiming to "support the resident during a difficult time and reduce concerns around shift coverage" following the death of a family member without impacting sick call. The number of covered days depended on the relationship of the resident to the deceased. Residents covering bereavement days for their peers were financially compensated. During the first 7 months following implementation, five residents utilized the policy. These residents noted this to be the most positive impact on the residency during the past year. Based on resident feedback, the scope was expanded to include grave medical illness of a family member as an implementation criterion. Conclusions: This article outlines the creation, implementation, and benefits of a bereavement scheduling policy within an EM residency. Describing this approach will provide guidance for other residencies to adopt similar wellness-focused strategies.
RESUMO
BACKGROUND: Violence directed at healthcare workers (HCWs) is common and may be more frequent in the emergency department (ED). In addition to physical injury, other consequences of workplace violence in the ED include an increased risk of burnout, post-traumatic stress disorder, reduced job satisfaction, and feelings of avoidance and futility. Understanding behaviors underlying workplace violence is the first step to employing mitigation strategies. The objective of this descriptive study was to assess the prevalence and types of violence against HCWs in a large, urban ED. METHODS: This study took place in the ED of an urban hospital with an annual ED census of approximately 100,000. A previously existing general patient safety incident "dropbox" for HCWs was utilized to capture workplace violence reports. At the completion of the study period, all data was collated into the electronic database and each report was categorized based on the nature and severity of the abuse. Further, all events were also coded as either involving or not involving specifically racist, sexist, or homophobic content. The primary outcomes were the number of reported events over the study period, and the percentage of total events that fell into each category. The secondary outcomes were the overall prevalence and ratio of events that included racist, sexist, or homophobic language or provocation. RESULTS: Over the 5-month survey period, 130 reports of workplace violence were recorded, on average 0.85 per day. Perpetrators were mostly male, and most victims were nurses. Hospital security was involved in 26% of cases. At least 37% of incidents involved patients that were intoxicated and/or had history of psychiatric illness. Type I events (swearing provocatively, shouting, and legal threats) were the most common at 44% of encounters while 22% involved physical violence. Racist, sexist, and homophobic comments were involved in 8 (6%), 18 (14%), and 3 (2%) incidents respectively. CONCLUSION: We found that workplace violence against HCWs was common in this study, and sometimes involved a component of racist, sexist, or homophobic bias. Consistent with previous ED literature, we found that abusive events occurred almost daily and that approximately 20% of events involved physical violence. Future efforts toward policy change to address workplace violence in health care is needed at local, state, and national levels.
