Literature Review

From heroes to burnout: How we failed our frontline health workers MedPage Today's KevinMD.com, and excerpt from Health Care Nation; by Tom Lawry; 3/15/25 Of all the lessons learned from fighting a pandemic, none was more frightening or important than discovering how dependent the system is on how we treat our doctors, nurses, and frontline caregivers.  They were already in short supply, with burnout on the rise, when the pandemic hit. As multiple waves of COVID-19 variants washed over us, frontline health workers stepped in at great risk and personal sacrifice to care for highly infectious patients. ... Some witnessed more deaths on a double shift than they did in a normal year. They delivered the bad news to families and managed end-of-life care. They were often the last face and warm voice a COVID-19 victim saw and heard. In the end, they not only saved lives but saved the system from total collapse. ... We called them heroes. And we promised to do better in how we treated them once the COVID-19 crisis passed. Promises made should be promises kept. While we continue to talk about workforce burnout using polite terms with concern in our voices, let us be clear: A system with a mission of healing continues to harm in record numbers the very people in short supply who are there to take care of the rest of us. ... [Click on the title's link for more.]

Nurse leaders can take the lead in promoting civility in the workplace Oncology Nurse Advisor; by Susan Rux, PhD, DNP, RN, FACHE; 2/28/25 Civility, the act of respecting others, especially in situations where disagreement or disparity may arise, occurs by intentionally displaying kindness and empathy. These behaviors help people to understand differences as well as uphold common ground across all social contexts. A stable foundation, afforded through civil actions, serves as a catalyst in achieving environments that promote diversity, equity, and inclusivity — the underpinnings of a culture of belonging. Nurse leaders can play a key role in creating this culture. Contrary to civility, in the healthcare setting, acts of incivility lead to increased levels of staff disengagement and turnover. Researchers have noted that a civil nursing workplace provides a safeguard against numerous professional issues, including but not limited to increased turnover rates, burnout, job dissatisfaction, and stress.

Relaxing licensing, training requirements during pandemic didn’t improve nursing home staffing: study McKnights Long-Term Care News; by Zee Johnson; 2/24/25 A new study of more than 15,000 nursing homes found no link between relaxed certified nurse aide training and licensing protocols during the pandemic and improved staffing levels. During COVID-19, 19 states loosened their training requirements (the “treatment” group), and 31 states did not (“control” group). However, both recorded nearly the same CNA hours per resident per day, according to the study by researchers at the University of Iowa. ... During the pandemic, direct caregivers were at extreme risk for contracting the deadly virus, which killed more than 200,000 nursing home residents and workers. But more often than not, they were left without basic benefits such as paid sick leave, Mehboob said. 

Who cares for the caregivers? The push for laws to protect nurses’ mental health Medscape; by Jodi Helmer; 2/5/25 ... More than 67% of nurses reported feeling depressed or anxious, and two thirds said they were not receiving mental health support. Nurses cite lack of time and financial resources among the reasons for not seeking treatment, but fears about losing their jobs and the impact on their nursing licenses were also top issues. ... Registered nurses (RN) and advanced practice RN (APRNs) can be required to answer invasive questions about their mental health as part of their state licensure and advanced credentialing applications. The questions can be stigmatizing and could require nurses to submit letters from their healthcare providers addressing their mental health status. ... There is a movement to urge licensing and credentialing organizations to remove invasive and stigmatizing mental health questions from their applications. The National Council of State Boards of Nursing is working on national recommendations ...

‘Severe understaffing and sharp cuts’: 2,000 health care workers to picket Providence on Wednesday Euraka Times-Standard, Eureka, CA; by Robert Schaulis; 2/11/25 More than 2,000 health care workers will picket Providence hospitals and health care facilities throughout Northern California this Wednesday. The day of action will take place across six sites throughout the region — four hospitals and two hospices across Humboldt, Napa and Sonoma counties — including Providence St. Joseph Hospital in Eureka. More than 2,000 health care workers represented by the National Union of Healthcare Workers have elected to picket, citing “severe understaffing and sharp cuts to health services in communities that are dependent on Providence for their medical care.” ... Layoffs have also resulted in increased caseloads in areas like Sonoma County, where Providence has laid off hospice workers.

How can we cultivate happiness in medicine? The Hospitalist; by Nikhil Sood, MD and Marjorie Bessel, MD; 2/3/25 Burnout has led to early physician retirements and clinicians leaving the profession, resulting in an unprecedented physician shortage and access challenges. This jeopardizes our ability to meet the community’s needs and fulfill our mission of making healthcare more accessible to improve quality of life. The question is, how can we, as a healthcare system, tackle this issue head-on? ... The CHIM strategy is a comprehensive, evidence-based approach, driven by clinicians, that supports wellness from an individual and organizational perspective. ... The six dimensions of the strategy include the following:

How to build a company culture that sticks HR Brew; by Mikaela Cohen; 1/30/25 Figuring out how to craft a company culture can sometimes feel like figuring out what to eat for dinner. What you have isn’t working ...,  creating something from scratch is a lot of work ..., so you end up going with the quick-and-easy fix ... Perhaps there’s a better solution for HR pros trying to build a company culture that sticks with employees ... HR leaders from SiriusXM, Fanatics, Aveanna Healthcare, and DailyPay shared their strategies for creating a strong company culture, especially during times of change and uncertainty.

Maine communities struggle with nurse practitioner shortage NBC News Center Maine; by Brianna Bush; 1/29/25 According to U.S. News & World Report, nurse practitioner is the No.1 ranked job for 2025. The study says that's because of work-life balance, high pay, and job growth potential. Despite this, communities in Maine are lacking enough nurse practioners to support patients. ... According to the Maine Nurse Practitioner Association, there are more than 3,100 nurse practitioners in Maine. 

2025 ushers new era in physician unions Becker's Hospital Review; by Kelly Gooch; 1/17/25 While unionization among healthcare workers and professionals is a familiar phenomenon, resident physicians and fellows joining unions has only grown in recent years. Indeed, since the start of 2025 alone, at least five groups of resident physicians and fellows have opted to form unions at their health systems. "Physician unionization has massively increased since 2020, especially among interns and residents," Rebecca Givan, PhD, associate professor of labor studies and employment relations at Rutgers in New Brunswick, N.J., told Becker's. ... Dr. Givan pointed to an increasing number of staff physicians unionizing as well. In 1998, the American Medical Association estimated that between 14,000 and 20,000 physicians belonged to unions. That number grew to 46,689 in 2014, and reached 67,673 in 2019. 

Sierra Hills strike ends, negotiations ongoing with parent company Wyoming Tribune Eagle; by Noah Zahn; 1/9/25 Employees of Sierra Hills Assisted Living concluded their strike on Jan. 2, and on Tuesday, the union met with Edgewood Healthcare, which owns Sierra Hills, for another contract bargaining session. ... Throughout the strike, employees said they were fighting for a better contract primarily for the health and safety of the residents and the employees, claiming the existing working conditions are unsafe. ... Wilkinson said the primary concern of the employees is safety issues that result from employees performing out-of-scope duties. ... For Sierra Hills staff, [being required to provide out of scope care] began when Edgewood introduced hospice care at Sierra Hills a few years ago, shortly after the pandemic. There are hospice nurses who are at the facility a couple of hours per week to care for the residents, but the rest of the time, the burden of care often falls to the CNAs and RNs on the clock. In situations where timely care is needed, employees have said it can be difficult to get the help of a hospice nurse in time.

4 new healthcare laws in 2025 Becker's Hospital Review; by Kristin Kuchno; 1/3/25 Through recently passed ballot initiatives and legislation, states across the U.S. are implementing healthcare and workforce-related changes in 2025.

Sierra Hills employees strike for safer conditions to live and work Wyoming Tribune-Eagle, Cheyenne, WY; by Noah Zahn; 12/26/24 Employees at Sierra Hills Assisted Living protested Thursday outside the facility after Edgewood Healthcare, which owns Sierra Hills, has refused to budge in negotiations for safer working conditions for employees and residents after more than 10 months of negotiation. “We did include many things in our contract proposal that we feel will really benefit the residents,” said Taylor Ewig, who has been a CNA at Sierra Hills for around 10 years. ... There are currently between 70 and 80 residents at the facility and around eight under hospice care. Ewig and other CNAs participating in the strike said that many of the Sierra Hills residents are supportive of the strike. The issues began at the facility when Sierra Hills implemented a hospice care service a few years ago, shortly after the onset of the COVID-19 pandemic. ... The company hires hospice nurses who are only on the facility about two hours per week, according to Sierra Hills staff. The rest of that time, the burden of care for the resident falls to the staffed CNAs and RNs.

Sierra Hills assisted living employees in Cheyenne to strike over staffing issues' Wyoming Tribune-Eagle, Cheyenne, WY; by Noah Zahn; 12/18/24 In March, a resident at Sierra Hills Assisted Living in Cheyenne fell and hurt their hip and shoulder. A CNA at the facility reported that the resident could not be moved without causing shoulder pain, noting that they had likely broken their shoulder and hip, according to a report from the Wyoming Department of Health. The resident was bed-bound, in “excruciating pain” and screamed for hours, which frightened the other residents. The CNA stated this was “the worst thing she had ever experienced.” At the time, the resident was one of six hospice patients at the assisted-living facility. Sierra Hills made hospice care available at the facility shortly after the COVID-19 pandemic. When hospice nurses were unavailable, the burden of care fell to the CNAs and RNs on staff. The CNA caring for this resident in March stated it was difficult to get hospice to respond on the weekends, saying that there was an 80% chance hospice would answer a phone call and a 50% chance a hospice nurse would come to the facility. Six days later, the resident died. Editor's note: Click on the title's link to continue reading. This strike--reportedly related to staffing--appears to be related extra responsibilities on the staff, because of the hospice's limited responses on weekends. This is 2024; not 1974. How does this scenario relate to your hospice triage, hours, staffing, incident reports, community partnerships?