Good morning, everyone. I'm Sean Thompson. I'm a critical care anesthesiologist at the University of Nebraska Med Center in Omaha, also the fellowship director. And so this is a topic that's pretty close to home, so I don't have any relevant disclosures for today's talk at all. And so the objectives of my talk is to kind of review the workforce update that we wrote over the summer that got published in Critical Care Connections this past fall, discuss the shortage concerns that we all know are prevalent and present right now in the current workforce state, discuss fellowship programs and how that growth is hopefully going to help relieve those things from the physician standpoint, and then also review efforts that are being undertaken in the realms of the nursing, APP pharmacy, and also the respiratory therapy workforce. Because again, multidisciplinary teams have been shown to be ideal for patient care, and so we want to make certain that we have all realms accounted for going forward to maintain this nice, strong workforce to care for our patients. And so when it comes to shortage issues, it's really difficult to know because of how things are kind of delineated, but we know that there are shortages across the country, and in particular probably more in underserved and rural areas. Because Pastores and his group reviewed the American Hospital Association data sets and found that there were about 48% of acute care hospitals that did not have intensivist coverage. And with hospitals that did have major large ICUs, that was about 78% of those hospitals had intensivist coverage with again, predominant amount of places that did not have intensivist coverage were in more rural areas as well. And so we've obviously, the other thing that's probably leading to some of the shortage or big part of the shortage is burnout and effects from the pandemic that I think all of us really took on for those couple of years as well. And so, and there's a continued increase for critical care as the population continues to age. And so all of these things are kind of snowballing that's going to lead us to need more and more providers going forward in the future. And so happy to report that fellowship programs continue to increase year after year. This is looking at the past four years, and this is across all different varieties of training, whether that be from PEDS, surgical critical care, pulmonary care. And what's nice too, is that that second to bottom one is a standalone critical care medicine residency basically. And so they don't have to do the traditional route of training where you do, you know, internal medicine, anesthesia, surgery, what have you. They do a critical care three-year training program and then enter the workforce as trained intensivists from that standpoint. So that's been a nice addition and training avenue for folks to travel down as well and should help to improve and increase the amount of providers available. The applications remain steady. And so we still have about a one-to-one ratio. Pulmonary care has a little bit above one or about one and a half applicant per position. And so despite having the growth in these programs, we still have a fair amount of applicants that are still applying, still showing that there is quite a really good interest in critical care medicine from trainees going forward. And so that's really a good sign. And this next slide and kind of the bottom two ones are more of the signal that we have more physicians entering the workforce as well. According to the American Association of Medical Colleges, we were at about just over 13,000 board certified intensivists in the United States. And now that number is over 14,000, it's about 14,200 total. So even during the pandemic, that number continued to grow and the forecast is that it's going to continue in the future as well, which again, from the workforce standpoint should be beneficial. So nursing obviously took a very large hit during the pandemic, had over 100,000 nurses leave the workforce during the course of the pandemic and afterwards. And in an effort to try to pull and get new grads into the ICU, more academic centers are standing up nurse residency programs to get these new graduates into the ICU, get the training and resources that they require to help take care of these really complex and difficult patients. And then it also provides areas for leadership and advancement within their roles in the ICU as well. And these programs have been shown to actually not only increase nursing into the realm of critical care, but actually helps with retention as well because it gives them a path forward. So they're just not in a stagnant position, they have room to advance and move forward as well. And then obviously the other retention things is healthy work environment, good, safe patient to nurse ratios, and then obviously competitive pay. For APPs, it's really uncertain what the exact number is just because of how the demographics are laid out, but there's currently about 30,000 nurse practitioners that are listed as critical care nurse practitioners and just over 2,000 physician's assistants that are listed as critical care. But again, there's probably more so on the physician's assistant side of things because some of them just kind of list what department they work for, not necessarily critical care. And so similar to nursing, there are specialized programs for PAs and nurse practitioners to get more specialized training in particular with critical care, and that will hopefully improve and get more folks into the realm of critical care from the APP standpoint as well and should helpfully help to increase the amount of folks in the workforce. Pharmacy again, big important cog in the wheel for a big multidisciplinary team. And this is continuing to grow as well. And so we had 143 training programs in 2019, and now we had 223 as of last year. And the number of board certified critical care pharmacists is actually expected to double almost up to over 5,000 by the year 2025. So still probably not enough, but we're heading in the right direction when we look at the pharmacy workforce. Respiratory therapy also took a big hit, and they are still seeing declining numbers. And the American Association of Respiratory Care is working really hard to try to recruit folks in and work on retention strategies as well, really focusing on the workplace environment, having the tools that the respiratory therapists need at the bedside to care for their patients on a day to day basis as well. And so obviously the pandemic and burnout was a major factor for folks leaving the realm and critical care was the one area that took a big brunt of the hit on this as well. So 27% of nurses worldwide left the profession during the pandemic or shortly thereafter with burnout listed as one of the major mitigating factors as well. And so things that we need to do is, you know, rebuild, regroup, retool, and do what we do and do best, and that's take care of really, really sick folks. And the Society of Critical Care Medicine actually has a lot of really great resources on the website that can deal with moral injury, well-being, and those types of things, and looking at things in the workplace that you potentially could be missing, that could be learning to burn out, and, you know, things like drug shortages and those types of things can all lead to burnout as well. And so the society has these really great resources for you to utilize online if that's something that you're dealing with at your home base. And so we keep seeing continued growth, which is great. We suspect that we're going to have a supply in the forecast of increased physicians in the workplace of about 57% by 2025. Nurse practitioners about by 73% by 2025. And this Health Resources Service Administration paper back in 2016 was only forecasting about a 16% increase for providers. So forecast-wise, it seems that we're going to have enough folks going forward to fill those gaps and fill those needs going forward as well. And so very strong job prospects for new grads and for most folks that are in the realm and want to practice in the area of critical care, need to continue aggressive recruitment, getting to trainees as soon as possible. I have med students that I'm at home that I mentor, and they have already told me that they, like, want to do critical care, so I'm trying to foster those things and keep them involved and excited about it. And I think that kind of, it goes across all realms of the multidisciplinary team as well. And really having that strong work environment where, you know, we work together, we take care of the sickest of the sick, and we get folks better, I think is going to really help with hopefully mitigating burnout and avoiding those things. So thank you for your time. Sean. Thinking of your questions and comments that you might want to make, maybe around the issues of, like, traveling nurses, et cetera, the things that it solves and the issues that it brings up, et cetera, when we get into the Q&A session. Marilyn. All right. Good morning, everybody. I'm going to shift gears a little bit and talk about one of the challenges in the critical care workforce, which is violence against clinicians in the ICU. There we go. Okay. I don't have any disclosures relevant to this topic. I should tell you, I do have two first-degree black belts. I got them when I was a teenager. I don't know how well they would serve me now. I have not had to employ them in my practice. Not in the hospital. When I was in retail, that was a whole other story. But I figured it would be a fun disclosure in what will otherwise be, you know, a little There we go, okay. I just want to start with my story. When I was a critical care resident in West Virginia, that's towards the latter end of my residency program, and I was working on the weekend. It was a routine weekend, and all of a sudden there was this big commotion. A woman had found out something unpleasant about her husband, and she went home, and she got a gun, and she came back to the ICU. This was the days before security was there, so you could just walk in. And her husband was one of our patients. Where's he gonna go? He's in the bed, and she shoots him. We didn't know what was going on. Thankfully, none of us were ever going to be her intended victim, because she was only aiming for her husband. She comes back out. She calmly puts the gun on the nurse's station, and she waits for the police to come. But you know what's fascinating about that event? We talked about it jokingly. You know, like, oh yeah, guess what happened today at work? But nobody ever sat us down. Nobody debriefed us. We never talked about it, and looking back, that was probably not the healthiest of reactions to it. In our world, when violence occurs in the hospital, about half the time, it's in the critical care setting. Unfortunately, our nursing colleagues do bear the brunt of it. Just in our talk today, two nurses will be assaulted. A few years ago, SCCM actually sent out a survey to members. Some of you in the audience may have responded to this, and about 86% of people said, yeah, I think it could occur in my ICU, and 44% actually said they'd been threatened, and a similar number said they'd been attacked, and most people who had actually been attacked had been threatened before. And it sort of confirmed what we know. Nurses are significantly more likely to be threatened and attacked than physicians and some of our other colleagues, and so are women, those who are working in bigger ICUs than smaller facilities. But you know what? Most of us have not had training in how to deal with this, and unfortunately, we're not very comfortable with our security at our institutions that they would be able to respond and keep us safe either. There was another study that came out just a couple of years ago. It was a big study, 5,400 professionals, very similar data. You see that across the board, you have a lot of verbal, emotional, physical, even cyber violence that is occurring against clinicians. Most of it is gonna be the patient or somebody accompanying them, but it's also our colleagues. We're getting it from our supervisors, from the people we work with, and I was astounded at how frequent this is happening. There are people, over a third of people are dealing with this a couple of times a year, a little under a fourth, one to two times a quarter, but there are people who are dealing with this every single day, and some of you probably have had to deal with that as well. It takes a hit on your motivation, and that trickles down to the type of quality that we can care, but you know what? We're also not reporting it. We're not telling hospital administration, we're not reporting it to the police. Most people, well, half, said they knew that there were reporting processes at their institution, but they're just not using them, but again, this sort of reiterated, most people have not had training in how to deal with it, but they're worried about what would happen if somebody comes into my ICU with a gun and shoots somebody, what do we do? That's stressful. Again, I don't know that I processed it at the time, but certainly, that was a one and done, thankfully, situation, but what happens when it's repetitive and you work in a toxic environment? That gets to you emotionally. You don't want to work there. That impacts the type of care that we provide to our patient, and unfortunately, we're talking about shortages. That doesn't help the situation in terms of turnover. We are a prime environment. We are, as has been kind of pointed out, we're understaffed and overworked. We don't have always the time that we know we need to provide in terms of communication to our patients and to their families, and times, these are the sickest of the sick. The families and the patients, tensions are running high, both individually and even between families, right? It's just a ripe environment for this to occur, not to mention the fact that our patients themselves either come to us with issues that set them up for maybe behavior that leads to this, or we're doing it to them, whether it's delirium and agitation, they have cognitive disabilities. We have lots of patients with substance disorders. It is just a prime environment, which probably explains why half of the environments occur in our world. Unfortunately, there's surprisingly little research out there about, you know, that's evidence based on what do we do? How do we deescalate this? And I would say a lot of the solutions are really common sense. I really wanna advocate for educating. The biggest statistic that we've seen is most of us don't know what to do if something happens. We have to make sure that our clinicians know what to do. There are some programs out there. Some of them are proprietary, like the Management of Aggressive Behavior. I don't have any involvement within, but I did think it was a very nice structured program. There's also some simple behavioral coaching. Simulation is becoming very popular. I know a lot of hospitals have done this with active shooting drills. Maybe expand it more into what do you do when you have an aggressive patient who's raising a ruckus while you're also got a code in the background, or you have a new admission coming up, or something along those lines, so that people can, you know, you get overstimulated and being able to practice before it occurs in the real world. There have been a couple of studies. I will go through them very briefly. One was a sort of a PhD study where they took the English Modified Deescalating Scale and tailored it to the ICU. Now, this is a scale that's sort of, it's like a Likert scale. It rates you on how well you're doing. You know, the best is you're really in tune with that patient, and the worst is you are just as bad as they are. That fight is probably half your fault. And they took, they had a database where they track all these incidents, and they took what they considered to be the most violent incidents that happened frequently at their institution. I don't know what's going on there. But they made simulations, and they did pre and post. So they put everybody through these simulations, and then they went into the classroom, gave them good debriefing skills, gave them resources like badge buddies on how to deal with it, put them back through the simulation later, and as you would kind of expect, their ability to deescalate situations improved. But of course, they sort of realized this is one study, we do need to do more work in this area. There's some, as I mentioned before, there's a lot of practical things. You'd be surprised at the number of our colleagues, even, that don't realize you can't hit a person in the hospital. You can't yell at them in the hospital. And so just having little things like signage, I think, can be very helpful. I would, again, going back to communication, pause and listen. Most of the time, when we're talking about violence against clinicians, it all boils down to communication. People don't feel like they've been heard, they don't feel like they are important to you, and sometimes they just want to be listened. So stop and say something like, I just wanna make sure I understand what you're trying to say so that I can make sure that I help you as best as I possibly can. Also, be aware of how fast and how loud you're talking. I'm from the South, I tend to talk fast, right? I'm a little lower key, but I went to school in New Jersey, so I'm used to sort of that. You have to remember, it's not how you think you're coming across, but how the patient or their loved one, particularly when they're stressed out, right? So try to take a deep breath, check yourself, and just remember, try to be as kind as you possibly can, and always allow time for questions. The other, really the only other big study that has been published in this area was something where they actually developed a multidisciplinary behavioral response team. We all have co-teams, a lot of us have sepsis teams. This is a behavior team that they can call. They did disseminate it through four two-hour training sessions, just a heads up in terms of added workload that we don't have. They did realize you have to go to all eight hours before it really was effective. But I think some of their strategies were interesting. I apologize, I know that this is a little bit grainy, it's the best I could do. They have a nice little algorithm that people can follow. I think it does a good job at taking into consideration clinical aspects of, you know, is this intentional? Does our patient have comorbidities dealing? So a very practical way of dealing with it. They also have a box. You know, we have our code blue boxes, they have a code gray. Everything you need to do to respond to these behavioral situations. If that's not enough, they have a rapid sedation protocol for the most violent of patients to be able to safely sort of sedate them so that they don't cause more harm. And then one thing that I particularly like, they added a new member to their ICU team. They have a customer service representative in the ICU whose only job is to put out fires, right? They're there, they're watching, they're an extra hand to provide the communication that we don't have. They're a resource for patients. So I thought that that was a really nice addition. Some of the others, practical consideration. If you can't have that case, that customer service representative, we all have case workers in our hospital. Are we under utilizing them? Can we help use them in our ICU? I know we are using them in our ICU a lot more to provide resources. Compromise, pick your battles, right? Not everything do we have to win as clinicians. Sometimes if it's not a deal breaker, maybe we can meet the patient halfway. Maybe it's just because I'm in Alabama, we have found food works wonderful. But sometimes again, one of the things we found over the years is light noise control. And then from a protection standpoint, a lot of facilities are starting to explore wearable techs where nurses and other clinicians can push a button if they really feel uncomfortable to call security without it being so obvious and making the situation worse. The other thing I just wanna point out, and I think this goes back to my own story, debrief, debrief everyone. Everyone that was involved, the colleagues, like a med safety meeting almost. But also don't forget there are secondary victims. The patient next door and their family members heard this too. And if you don't go address this with them, they're gonna also be left with some of those aftermath situations. It's also really important to make sure that there is a clear and expected reporting procedure. Because remember, most of us, we're just dealing with it. We're just like, oh, this happened at work today. That does not need to be the norm. We need to make sure that we as a team feel supported, encouraged. I'm very sorry this happened to you. We're gonna work to make sure this doesn't happen again. Again, much in the same way, if we have a near miss with our patient care, we try to prevent that. And then finally, as I leave you today, we need to be our own advocates. Most of you flew in here on a plane. If you were to have missed with one of the flight attendants or the pilots, that's automatically a federal offense. You could go to jail, there's big fines. There is, and while 40 states have laws on the books making this a felony, not all do. There's nothing at the federal level to advocate for us. There is a law, it's a bipartisan law that's being proposed as we speak that would make it a federal offense. I think it's not political, it's just safety, right? And so again, we have to be able to speak up for ourselves so that we do have the type of environment that we want that we'll feel safe and we'll enjoy coming to every day. All right, and that's how I'm gonna turn it over. Thank you, Maren. Thank you. Thank you. Well, thank you. So we've heard a little bit about the pipeline. We've heard about some of the egregious sort of violence and some of the perturbations that are making burnout more. But now we're gonna hear two perspectives and we recognize that it's a multidisciplinary discussion. We've chosen and we've actually asked Teresa to focus on the nursing aspects and then we're gonna ask Chris to focus on the physician aspects just as exemplars of healthy work environments. So Teresa, take it away. Great. Hi, I'm so happy to be here. I'm Teresa Davis, also known as Terry, and I'm the President of the American Association of Critical Care Nurses. I also am from Inova Health System in Falls Church, Virginia and I'm the AVP of the High Reliability Center. So I'm gonna be talking. So we're going to, we really want to recognize the signs of an unhealthy work environment. We kind of heard some in the violence talk, and really think about those intentional efforts to create and sustain a healthy work environment, and then also look at what are the opportunity for organizations, individuals, and medical societies to improve the workforce issues. Okay, so in the healthy work environment standards, there are six standards. So skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership. And what we saw was, so what we did, we do surveys, AACN since 2006 has been doing a survey multiple years. And in 2021, they did a survey purposely during COVID to really look to see where nursing was and how they were feeling about things. And what we saw was, we really saw some changes in the survey, and every element of the standards had dropped in their outcomes in the 2020-21 survey. So the largest being staffing. So in staffing levels, they say that staffing still remains critical. We only saw 25% who said that they had appropriate staffing levels. And then as far as satisfaction goes, nurses' satisfaction with being with the profession, it's the first time that we saw such a significant decline. It went from 92% in 2018 to 76% in 2022. So that was a significant change that we had not seen before, and we really felt it was a call to action to look and see, what can we do? The other piece that was really strongly reflected in that survey was that 67% of nurses planned to leave the profession over the next three years, since 2022. So all of those things caused us to really say, we can't ignore this. This is really, really important. And so when you look at these ratings, this just shows the scores from 2006 through 2021, and we really saw the drops from 2018 to 2021. We know that we had issues in 2018 before COVID ever came, but they were really exacerbated during COVID. Another study that was out there looked at the quality of life and self-care. And this was done by Watson, and this was a mixed, multi-mixed study. And it looked, they wanted to test a pilot of intervention to address self-care and to look at the professional quality of life. So the nurses supported some satisfaction with intervention and improved work-life balance, but the scores and the quality did not improve. And so what we said was, the author said, was that, you know, really addressing individual well-being and resilience is insufficient, that we have to look at the work environments. We have to make sure that organizational issues, such as violence, are addressed. So the things that we have done this year, I'm really excited about. I've been with AACN, like, my whole critical care career. There really been an organization that has helped me really find my path during my critical care career. And healthy work environment is something that I have taught over the years for many, many years. And even in my own environment, I was a director of a tele-ICU nurse back in 2004, and we were outside of the hospital, so we had never done anything like this before. And I was like, oh, my gosh, how am I going to lead this team in this environment that is not a hospital? And so I use the healthy work environment elements as the foundation for how to run my unit and how to move things forward. And our survey results in our patient or employee engagement and employee satisfaction went through the roof after we implemented the healthy work environment. And my HR person called me and said, what are you doing? Like, what did you change? How did you increase these numbers so much? But it was really the attention to these six standards that made a difference. So what I'm really excited about is this year we've had a lot of action around this. And we're using our CSI and healthy work environment, we're using an implementation program to really look at implementing within cohorts. So we have seven cohorts across the country, and there's multiple units in those cohorts. And they are specifically looking at how to implement the healthy work environment standards. And then another really exciting element that's there is the healthy work environment national collaborative. So that's a 24-month program, and that will come out in 2024, in the spring of 2024. It is an interprofessional program, because if you implement the healthy work environment standards and you don't include your physicians, your respiratory therapists, your pharmacy, all of those that you work with, it won't be a successful program. It has to be everyone you interact with and across the board. And so it is an interprofessional program. And applications are coming in now, and we're really, really excited to see this work done. And this will really be around implementation science. So we all know that when you do research, you don't see it come out for several years. Implementation science teaches you how to bring the research to the bedside in a very rapid way. And so we're using those elements of implementation science to use in this implementation work that we're doing. So another big piece, of course you heard about the 25% feeling that they had appropriate staffing. That's really important. A lot of national work has been done to address staffing. And we worked with ANA, AONL, and HFMC in the Partners for Nursing Staffing Think Tank. And that was like, what can we do right now? And the focus was on organization and policy. And the priorities that came out of that, number one being healthy work environment, diversity, equity, and inclusion, the work schedule, flexibility, you know, nurses want to be flexible. It's a new generation of nurses. They're not interested always to be in those solid 12-hour shifts. Stress injury continuum, the innovative care delivery models. You know, you have virtual nursing out there. You have different ways of working. We're exploring all new ways to transform the work environment to make it a healthier place to work. And then total compensation. Compensation, of course, has played a part all through the nurse's career. And then after that work came the Nursing Staffing Task Force for long-term sustainable solutions. So we asked about, you know, how do we handle the ongoing challenges? And it mostly focuses on policy and some on organization. But it did bring in more of the nursing piece, more of the direct care nurse piece of the work. So we had five imperatives. Again, you saw to reform the work environment. And again, you saw to innovate the models for care delivery, establishing staffing standards that ensure quality care, improve regulatory efficiency, and value the unique contribution of nurses. When you ask nurses what's important to them, it is important that they are valued for the work that they do. So when you're working with the nurses, don't forget to say, well, you know, that was amazing. It goes a long, long way. In my career, I've been lucky enough to work with surgeons and trauma surgeons throughout my career. And they really, really respected the work we did, and that's what kept me there. I've been in the same organization for 37 years. So I really love my docs, and I love the work, the collaborative work that we do. The other things that are coming up in the future is creating the staffing standards for adult critical care, and that will be published soon. And then staffing resources on our webpage. We have blogs, journals, and articles and innovations from our community. And then advancing the implementation of the AACN standards for establishing and sustaining the healthy work environment. So that is what we have. Thank you. Well, thank you, Terri. And Terri, that's a really good high-level view. As we start the discussion, I might ask you just to think about a couple of specific things at Inova you did to start to implement, like the first steps that you went through to start the healthy work environment in your hospital. Absolutely. Excellent. I got it. You got it, Chris? They got it. They got it. Okay. Got it. And, you know, in my defense, I only knew about the slides about an hour ago. So my name is Chris Carroll. Thank you for inviting me to do this. I'm building off of Dr. Davis' presentation quite a bit and talking about healthy work environment and how that relates to physicians and how physicians can be a part of that, as well as how physicians can benefit from that. I recently moved to Florida. And so this is my new address. One of my adult children said to me, this is really nice. I can see why people come down here to die. Just to be clear, Dan, only 50 years old. They did not come down here to die. But anyway, Florida's lovely. So I have no disclosures other than this slide talk is less than an hour old. So this could apply to the fact that I just did this talk or to the fact that physicians have a huge part to play in creating a healthy work environment. We create, for better or for worse, we create the tone in an ICU. When the ICU, you can, I've talked to, you've all been in ICUs before. You can tell within seconds of walking in an ICU how well that ICU is run. If it is quiet and calm when you walk in the door, you know this is a well-run ICU. If people are running around and doing things, you know that this is probably not a well-run ICU. And all that starts with leadership. And physicians are leaders in the ICU, but everyone is a leader in the ICU. It's a multidisciplinary team. The nurses are leaders, the pharmacists are leaders, respiratory therapists are leaders. And we're all obligated to provide this level of calmness as we approach a very, very chaotic situation. And alternatively, this is how you can be in, this is how another ICU might. That's an old gift from community. One of those. It just goes on and on. So this is the AACN's healthy work environment. There are, as you can see, there are six different aspects to their healthy work at creating that healthy work environment. It's not just about staffing. It's not just about safe staffing ratios. But it's also about these other aspects. Oops, went back and forward. Sorry. Sorry. Everyone wants to really wants to see that. The authentic leadership is an important part of creating a healthy work environment. For a physician standpoint, that can mean setting the tone about having a respectful, professional, compassionate, as well as self-aware leader. It takes a great deal of emotional intelligence and a great deal of introspection to be able to be a good intensive care unit leader. And I don't, you know, that takes some work and some practice, at least it did for me. Some people are very good at that right from the beginning. But it can also be something that is taught. Effective decision making is another part that the physicians can have in creating a healthy work environment. It is very important that everyone's, everyone on the team is heard in making a decision. It doesn't mean everybody gets to make a decision, but everybody needs to be heard. Ultimately someone needs to make a final decision, but everyone should be heard. Real communication and true collaboration are another important part of creating a healthy work environment. For physicians, that means you also ensure everyone's heard, but also is an important part about psychological safety. It is important that everyone can approach a physician with a concern. So you need to have low barriers for talking to you. If people feel that they can't approach you or they can't escalate their concerns about a patient, then that's going to adversely impact the quality of care provided in an intensive care unit. So the healthy work environment, though, is a small part of the care that's provided. And you can see how, look, I used all your slides, Jack Davis. There's also optimal patient outcomes and clinical excellence. So you need to look at the quality of care you're providing critically and re-examine how there are opportunities for improvement. And clinical excellence physicians really are obligated to educate themselves as well as help educate their team in the latest and greatest of what's going on in an intensive care unit. And a big part of that is coming to meetings like this, coming to the site of growth care medicine, American College of Chest Physicians, American Thoracic Society, the AACN annual meeting, and learning about all these new updates. So healthy work environments, as people have said here, can result at a nursing level with more engaged staff, decreased burnout, lower turnover rate, and better patient care. But what about docs? What is this, what is creation of a healthy work environment do to, how does it benefit docs? I've talked a lot about how it's the responsibility of doctors to create a healthy work environment. So we have nurses and respiratory therapists and pharmacists and everyone else to help care for the patients. But how does creating a healthy work environment benefit doctors? Well, as everyone said, we are a very burnt out specialty. This is from a survey in the middle of the pandemic where more than half of critical care physicians are burnt out. I'm a PEDS intensivist, as are a number of people in the audience. I've seen surveys saying as much as 75% of us pediatric intensivists are burnt out. So it's a big issue. So how does this help? Well, excuse me, there's some other data that showed that physicians may be experiencing delayed effects from the pandemic. You know, we heard about a hundred thousand nurses who quit during the pandemic. How about physicians? Physicians, it may be that we're starting to leave a little later. 35% of physicians reported significantly increased feelings of burnout in 2022, more than half of physicians said they've considered leaving their profession, 40% of medical practices said they had a physician resign or retire due to burnout, and 117,000 physicians left the profession between the first quarter of 2020 and the fourth quarter of 2021. So this may be a coming wave. So in conclusion, I think physicians have an important role to play in a healthy work environment for nurses and the multidisciplinary team, especially in the areas of communication, collaboration, and authentic leadership. But these healthy work environments probably benefit physicians as well, although there's a lot less discussion about how they specifically benefit physicians, and I do think it's an important thing that we should be discussing more. I thank you for this invitation to discuss it.

critical care workforce

workplace violence

burnout

COVID-19 impact

multidisciplinary team

healthy work environments

staffing challenges