Rural and Urban Clinician Well-being and Targeted Improvement Interventions During COVID-19.

The pandemic has amplified physician burnout.

Nurses and physicians responding to the COVID-19 pandemic are facing an extraordinarily high burden of burnout, depression, PTSD, moral distress and other psychological symptoms. The pandemic has amplified the already high level of attention to clinician well-being over the last decade. COVID-19 is the most widespread and longest-running pandemic since the early 1900s, and the pandemic affects many aspects of clinician well-being and their work. These effects vary across rural-urban locations, work settings and over time.

This study will assess nurse and physician wellbeing and the factors in their work environment associated with well-being during the COVID-19 pandemic. We will conduct our analysis across four different inpatient settings (one academic medical center, two rural community hospitals, one critical access hospital), as well as before and after implementation of targeted improvement interventions to the work setting. To inform the development of these interventions, we will gather data from a general medical-surgical unit and an emergency department in each hospital (eight units). We will use an innovative participatory approach that combines data from clinician focus groups and interviews with data from shadowing nurses and physicians (contextual inquiry). Results will be used to identify and rank interventions, which will then be validated and prioritized by the nurses and physicians. We will then collaborate with each hospital leadership team to further prioritize interventions according to organizational feasibility. Ultimately, the local quality improvement team in each of the eight units will implement the interventions, and we will evaluate the impact of the targeted improvement interventions on nurse and physician well-being.