Phoebe Xoxakos, MS, Clemson University Katelyn N. Hedrick, MA, Clemson University Riley L. McCallus, MA, Clemson University Jordan G. Smith, MS, Clemson University Marissa L. Shuffler, PhD, Clemson University Zachary Klinefelter, PhD, Clemson University William H. Jackson, MD, MBA, Department of Emergency Medicine, Prisma Health, University of South Carolina School of Medicine Greenville Ronald G. Pirrallo, MD, MHSA, Department of Emergency Medicine, Prisma Health, Clemson University School of Health Research, University of South Carolina School of Medicine Greenville Cassie B. Mueller, MSN, Department of Emergency Medicine, Prisma Health Thomas W. Britt, PhD, Clemson University Emily L. Hirsh, MD, FACEP, Department of Emergency Medicine, Prisma Health, University of South Carolina School of Medicine Greenville
The overarching purpose for the current project was to utilize the scientist-practitioner relationship between the research team and emergency medicine (EM) leadership to implement best practices into the organization. Perceptions of schedules, value to the organization, and well-being were examined for EM Advanced Practice Clinicians (APCs; i.e., nurse practitioners, physician assistants). Specifically, we examined 1) the number of sustainable shifts per month; 2) the number of sustainable hospital/urgent care locations to work at per month; 3) if one felt valued by their organization; 4) why one did/didn?t feel valued by their organization; 5) how one defined their role as an EM APC; and 6) how schedule preferences and feeling valued related to well-being.
EM APCs? schedules impact their circadian rhythm and overall quality of sleep. Poor overall sleep quality negatively affects clinicians? psychological well-being and job performance, resulting in more errors made in the workplace (Leonard et al., 1998; Sugden et al., 2012). Harrison and Horne (2000) further explain that the effects of sleep deprivation or poor overall sleep quality on clinicians? skills and abilities are especially relevant during emergency situations. Thus, EM APCs? schedules are of great importance. It is especially important to measure their work schedule perceptions during the COVID-19 pandemic because the more the clinical environment changes, the more job demands develop, and more support is needed. Thus, it is crucial to bring science and practice together to analyze and understand EM APCs? well-being in relation to their schedules and value through data analysis and implement best practices in the emergency department to ameliorate negative outcomes. For the current project, clinicians were monitored at a large southeastern hospital system in the US. During this time, multiple changes were made to EM APCs? schedules. Originally (prior to data collection), EM APCs worked fixed shift schedules (e.g., 7:00 AM – 7:00 PM, Monday, Wednesday, Friday) with twelve, 12-hour shifts per month, then EM APCs? schedules were no longer fixed shift schedules, but EM APCs still worked twelve, 12-hour shifts per month. Recently, during data collection, EM leadership changed the twelve, 12-hour shifts to eighteen, 8-hour shifts per month because literature indicates clinicians lose efficiency the longer they work (Ferguson et al., 2019).
The current project, which utilized a mixed methods approach, is part of a larger ongoing study. Forty-five EM APCs participated, with a response rate of about 35%. In addition to demographics, quantitative and qualitative data were collected longitudinally over the span of 16 months (March 2020 – June 2021), including 20 waves of data. EM APCs received an email to voluntarily participate in each brief online survey. EM APCs were assured of confidentiality and provided consent prior to completing each survey. To ensure confidentiality, individual-level data were not provided to the organization, rather, group-level data were shared. EM APCs were asked five questions about their schedule preferences, if they feel valued, and about their role as an EM APC in the department (see Table 1 for items). EM APCs were asked an additional six questions (see Table 2) adapted from the Mayo Clinic Physician Well-Being Index (Dyrbye et al., 2013), in which the mean was calculated where higher scores indicated greater strain on mental health. Note, the data have been collected; however, all analyses are not complete, though preliminary analyses have been completed and the work is near completion.
Preliminary findings indicate that EM APCs believe that on average 13.1 (range 9 – 15) shifts and 2.41 (range 1 – 4) hospital/urgent care locations to work at per month is sustainable for their schedules. Further, 78% of EM APCs do not feel valued by their organization. Preliminary analyses indicate that EM APCs do not feel valued in part due to the schedule changes. Additional analyses will be conducted with the qualitative data to 1) develop a deeper understanding of why EM APCs do not feel valued as members of the EM team, 2) analyze the relationship of feeling valued and well-being, and 3) analyze how they define their role as an EM APC.
As a result of EM APCs not feeling valued by their organization due to schedule changes, the research team presented preliminary findings to EM leadership and provided best practice suggestions. The EM leadership team responded by changing the eighteen, 8-hour shifts to fourteen and a half, 10-hour shifts per month. After additional analyses are completed, the interpretations, strengths, and limitations will be discussed.
It is important for organizational leadership to understand how policies and procedures, such as schedule changes, affect EM APCs? well-being, especially during high-stress and unpredictable times like the COVID-19 pandemic. Maintaining and working toward high well-being for clinicians is incredibly important, not only for oneself, but for the patients, organizational outcomes, and for the community as a whole (West et al., 2018).