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“Working five days a week, nine to five. Charting patient information after work hours at home. Now my boss wants me to be on call for my patients two weekends a month. Oh wait, what about my husband and my 18-month-old child?” These were the protests left by a healthcare provider on a recent social media post. Burnout.

 Let’s face it, working as a healthcare provider is not getting any easier. It seems nearly impossible to pair that with raising a family, juggling friends and social obligations. It’s a perfect recipe for burnout.

In a survey conducted in 2021, 52% of US workers stated that they are experiencing burnout. Work from home employees or virtual workers said they are working “much more” than before the pandemic. Unplugging after work is a challenge for many workers, with 27% reporting that they keep working at home. Many workers state that working more hours is due to the increased pressures from management, customers, and clients.

Burnout- It’s a Socio-Psychological Phenomena

Burnout can creep up on you slowly. One day you might wake up to find yourself transformed into a monstrous cockroach, much like the character Gregor Samsa in Franz Kafka’s famous play The Metamorphosis. Gregor’s transformation was blamed on his dreary job as a traveling salesman and his obligations to provide for his family. Basically, he was burnt out.

Believe it or not, burnout is considered a ‘syndrome,’ a socio-psychological phenomenon that includes physical, motivational, and emotional exhaustion. The cause: chronic occupational stress. The clinical picture of burnout is multifaceted. It’s not just about your job or your family. It’s also related to the role you are playing in society. Is your work and home life bringing you joy? Are you being a productive member in society? Are you living life unconsciously on someone else’s terms?

Negative Consequences

Burnout is a set of somatic and psychosomatic disorders which are symptoms of social dysfunction. Healthcare providers commonly suffer from burnout due to the dedication and increased levels of empathy felt for their patients.

Healthcare providers suffering from burnout are susceptible to increased medical errors and potentially higher malpractice rates. Poor work performance can also decrease patient satisfaction scores and lower quality care. Burnout can also have devastating effects with high healthcare staff turnover rates, increased alcohol and drug addiction, and a high risk for suicide.

Signs 

Exhaustion

Low emotional and energy levels are proceeding in a downward spiral. Healthcare providers may be running on fumes and asking themselves how long they can continue.

Depersonalization

Being detached from one’s mind, body, and mental processes. Subsequently, you may be observing your life from the outside. You may be using synoecism and sarcasm to talk about your patients. Emotionally you are unavailable to your patients and perhaps even your family.

Lack of Efficacy

Doubting the meaning of your work. You may question the purpose of your work, in addition, you may be critical of yourself, worrying that you may make increased errors.

Causes of Job Burnout

• Chronic Work Overload. Daily increases in patients seen on a daily basis.  Nurses handle significantly higher ratios of patients per person at the bedside, creating unsafe staffing. Burnout is inevitable with work politics, personality clashes, workplace bullying, and sloppy management.

• Work-Life Imbalance. Work may take up most of your time, leaving very little time spent on family and personal activities that satisfy you. 

• Monotonous Environment. Albert Einstein coined the phrase, “Insanity is doing the same thing repeatedly and expecting different results.” When a job is chaotic and dull extra energy is needed to remain focused and motivated.

• Unclear Role Expectations/ Lack of Support. Insufficient resources, inability to influence job scheduling, and lack of resources needed to do your job safely can increase burnout. Lack of social support on the job and at home  can also increase your risk for burnout.  

•  Speaking a Non-Native Language On the Job. Having to speak in a language on the job that is not your native language can cause increased fatigue. Non-native speakers experience increased fatigue from having to constantly monitor their actions on the job.

Recognize the Physical Signs Before It’s Too Late

Burnout may creep up on you slowly. You may start missing work deadlines, delay updating your licensing credentials, and attending continuing education courses to update your certificates. Recognizing the symptoms of burnout before you start turning into a “Kafka cockroach,” is key to shifting your reality and staying focused on the Job and your life. Some physical symptoms of burnout include insomnia, headaches, chronic fatigue, stomach aches, isolation, increased irritability, struggling with daily tasks, and depression. Ignoring physical signs of burnout may, in time, lead to more significant physical and mental health issues. These include elevated blood pressure, type 2 diabetes, low immune system, and increased susceptibility to various other illnesses.

Tips to Stop Burnout

Re-Evaluate Your Life

Taking a self-inventory of your personal and professional goals is an excellent way to evaluate your life for balance. Some questions you can ask yourself include: Are you happy at your current Job? Additionally, what changes can you make to increase your happiness and satisfaction with your work? Are you working at home once your work day is complete? Can you disconnect easily from work and spend quality time with family and friends?

Better Sleep

Examine your sleep hygiene to optimize your sleep cycle. All things considered, treating sleep as a priority in your life is crucial to combating burnout.

Exercise

Various aerobic exercises like running can help increase mental focus and clarity. New research suggests that aerobic exercise helps you to recover from mental exhaustion and burnout.

Take a Vacation

Vacations can provide you with mental and physical rest. If you cannot take a whole one-week or more extended vacation, ‘microvacations’ may be a solution. Microvactions like a ‘normal’ vacation offer a change of scenery, even if it’s just for one day. They can reinvigorate your senses by sitting on a local beach, going on a hike, or sitting at a trendy café people watching. It’s best to be mindful when taking either a vacation or a microvacation so that you do not pick a venue that may trigger you to work.

Mental Health

The best therapies to help combat burnout include: psychotherapy and cognitive behavioral therapy (CBT), physiotherapy, pharmacotherapy, music therapy, hypnotherapy, and mind-body therapies. Telehealth services for mental health are also an option. They are gaining in popularity and are easier to access.

Creative Outlet

Studies show that engaging in creative outlets like music, visual arts therapy, movement-based creative expression, and expressive writing reduce psychological and physiological effects of burnout.

Mindfulness

The best way to start practicing mindfulness is to pay attention to something you do daily. Stopping in the middle of your day to take deep breaths can also bring you greater awareness of your surroundings. Courses on mindfulness-based stress reduce stress and burnout.

Start a New Adventure and Give Locum Tenens a Shot

Considering your options in your current work-life situation is key to combating burnout. Maybe you need to make a change and see new places. MedCare Staffing can provide a change of scenery, potentially clearing away the burnout in your work life. Click here to speak to a staffing representative today.

Covid-19 shined a light on the problematic healthcare system in America with over 83 million people lacking adequate access to primary care. Due to the growing Physician shortage, more states are granting Full Practice Authority (FPA) to Nurse Practitioners. According to The Complexities of Physician Supply and Demand: Projections from 2019 to 2039 the American Medical Colleges (AMC) states there will be a shortage of 37,800 to 124,000 physicians with in the next 12 years.

Nurse Practitioners Bridging the Gap

The NP role has been ranked  the number one “best healthcare job” for 2022 by U.S. News. NPs are registered nurses who are licensed by the Board of Registered Nursing in the state where they may be practicing. With an expanded scope of practice, the NP’s role can vary from state to state depending on the Full Practice Authority laws in that state.

If it wasn’t for the great visionary Dr. Loretta Ford, the nurse practitioner role would not exist. Dr. Ford discovered that there was a need for healthcare providers in underprivileged communities. She then realized that nurses with expanded roles who gained specialized training to make clinical decisions on their own would be the perfect solution.

With the passage of the Medicare and Medicaid legislation in 1965, the need for NP’s increased. A major barrier to practice was direct reimbursement due to NP’s not being licensed. NP’s started advocate for themselves at the state level beginning in the late 1980’s and early 1990’s. 

Full Practice Authority

NP’s have been lobbying for FPA and advocating for the expansion for their role since 1994. According to the American Association of Nurse Practitioners, Full Practice Authority (FPA) authorizes nurse practitioners to evaluate patients, diagnose, interpret and order diagnostic labs, initiate and manage treatments. This includes prescribing medications exclusively under the licensure under the authority of the state board of nursing.

Current states with FPA include: Alaska, Arizona, Colorado, Connecticut, Delaware, District of Columbia, Guam, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts. Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Northern Mariana Islands, Oregon, Rhode Island, South Dakota, Vermont, Washington. and Wyoming.

The Newcomers

The Golden State

Due to the serious shortage of primary care physicians in California, AB290 granting FPA to NP’s was signed into law on September 29, 2020 by Governor Gavin Newsom. The main focus of AB290 is to improve quality access to healthcare. California’s FPA will go into full effect in January 2023. AB290 requires the California Board of Registered Nursing to define the minimum standards for an NP to transition to independent practice. Once that has been met, the NP can prescribe specific functions which include “ordering and interpreting diagnostic procedures, certifying disability, prescribing, administering, dispensing and furnishing controlled substances.”

The Big Apple

New York is now the 25^th state to grant NP’s full practice authority. On April 9, 2022 Governor Kathy Hochul signed into the state budget of New York that NPs who have more than 3,600 hours of experience no longer are required to have a formal relationship with a medical doctor to practice. According to the AANP, NP’s in the state of New York can now evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage patient treatments as well as prescribe medications.

Prior to waiving this law, New York NP’s had a “reduced” practice authority. NP’s were required to have a ‘written practice agreement’ with a physician in their specialty area. This stated that the physician would review patient records, make referrals, be on hand for consultations. Furthermore, if there was a disagreement, the physician would have the final word. Stephen Ferrara, DNP FNP-BC, president-elect of the AANP stated: “NP’s in New York, often times were required to pay physicians in order to have this contract agreement which did not serve the healthcare system very well. New Yorkers now have a greater advantage to access healthcare for both their physical and mental well-being.

The Sunflower State

Kansas is experiencing a healthcare shortage in its rural areas. On April 22, 2022 Governor Laura Kelly signed Senate Substitute for House Bill 2279, a bipartisan bill, which expands the role of advanced practice registered nurses (APRN’s) removes barriers for them to practice independently. Governor Kelly stated that House Bill 2279 “will empower APRN’s to decrease local and reginal care gaps.” Under HB2279, APRN’s are required to comply with the Federal Drug Enforcement Administration requirements for safely prescribe controlled substances, as well as maintaining malpractice insurance and national certification for licensure as an APRN.

The First State

Governor John Carney signed HB141 and H21 into law on August 4, 2021, improving access to primary healthcare to the 1 million residents of Delaware. Bethany Hall is Delaware’s Lt Governor and a nurse. When both HB141 and H21 were approved by 20-1 votes, Lt. Governor Hall was present presiding over the state senate.

HB141 allows NP’s and APRN’s to practice to the full extent of their training removing the prior oversight contract previously needed between a physician and an NP. Some employers in Delaware may still require a physician NP practice contract. HB 21 allows for a ‘multistate” licensure entering the APRN interstate licensing compact. North Dakota and Delaware are the only 2 states to pass legislation even though 37 states are members of the Nurse Licensure Compact for both Registered Nurses and Licensed Vocational Nurses. AARP recently conducted a study in Delaware and found that 86 percent of the senior residents of Delaware stated that having greater access to healthcare was important to them.

States on the FPA Horizon

The Great Lakes State

Michigan introduced SB680, a bill allowing FPA to NP’s on October 5, 2021. The bill is sponsored by Senator Rick Otman and co-sponsored by Senator Jeff Irwin, Senator Sylvia Santana, Senator Jim Runestad, and Senator Tom Barett. The bill will amend Public Act 368 0f 1978, inserting and changing language which states “The administrator may issue a controlled substances license to an individual licensed as a registered nurse under part 172 if the individual has been granted a specialty certification as a nurse practitioner by the Michigan board of nursing under section 17210.”

Improving Access to Healthcare Through FPA

The U.S. is facing a significant healthcare crisis with physician shortages in primary care and psychiatry. Currently, there are more than 355,000 licensed NP’s in the U.S. who provide healthcare in communities of various sizes and demographics nationwide. NP’s are known to provide a high level of service and care to over 1 billion patients a year. Research shows that states who adopt FPA have a better advantage to improve access to healthcare, address healthcare disparities as well as increase their workforce.

MedCare Staffing Providing the Highest Quality of Healthcare Providers

MedCare Staffing provides a hands-on professional leadership team. Whether you are a healthcare provider looking to work locum tenens or you are looking to hire healthcare coverage, MedCare Staffing offers dedicated professional support through the entire tenure. With 70 years of combined recruiter experience, we have a reputation for success. To speak to a recruiter today click here.

A brief review of a very hot topic!

In the past few years, climate change took center stage as we watched how our planet was ravaged by uncontrollable wildfires, torrential downpours, and ever-increasing record-breaking heat waves.

It is fair to say that in order to live our lives, raise our families, and take part in activities that give our lives meaning, we are now forced to plan around volatile weather systems.

Who among us have not experienced the frustration of a delayed flight, due to unstable weather? While we all know that we must make changes in how we grow our food and fuel our lives to decelerate climate change, we also need practical short-term solutions to an ever-growing quandary. In other words, what steps can we take to protect our health while we live, work, and play in the summer heat?

For starters, we must know some basic but useful information: We should be able to recognize the difference between heat exhaustion and heat stroke. Both heat exhaustion and heat stroke need to be taken seriously as they, according to the CDC, account for the leading cause of death in athletes. Heat related illnesses also account for many cases of morbidity in the notably young, older athletes, construction workers, military personnel, and firefighters. 

Who is at risk?

A big part of successfully identifying and treating heat exhaustion and heat stroke is the ability to recognize who is at risk in the first place. In this regard, lifestyle is a crucial factor when it comes to the degree of vulnerability and simply knowing the professions most at risk of succumbing to heat related illnesses is not enough.

Major risk factors

Important predisposing factors include poor baseline physical fitness, lack of proper baseline hydration, improper clothing, and, even, alcohol intoxication. Other risk factors include acute illnesses such as severe gastroenteritis or a recent upper respiratory tract infection and unfortunately, the chronically ill are not spared either. Many are at increased risk of yielding to heat related illness. Some acquired and congenital conditions to keep in mind are disorders of anhidrosis, sickle cell anemia, heart disease, asthma, chronic obstructive pulmonary disease (COPD), and diabetes mellitus.

Keep in mind that it is not just the conditions that pose the greatest risk, but the prescription and over the counter drugs taken as part of the treatment and management of these conditions that increase the likelihood of heat related illnesses. In particular, diuretics, heart disease and anti-hypertensive prescriptions, antidepressant medications, especially those belonging to the tricyclic antidepressant category all increase the risk of heat related illnesses. Other psychiatric drugs such as Lithium can pose a potential threat as well.

Other factors

Even simple over the counter antihistamines and decongestants can set anyone up for heat related illness. For example, it is not uncommon for a person with an underlying pulmonary condition who has an acute upper respiratory tract infection, to take multiple doses of over-the-counter cold medications in order to get through his/her workday as a construction worker, only to suddenly experience heat exhaustion.

Lastly, those who have alcohol or substance abuse problems can definitely be more prone to quickly becoming ill when exposed to high ambient temperatures.

In short, almost everyone you will come into contact with today can be at increased risk. 

How to protect ourselves and others

Now that we have established who is at risk, we must know how we can protect ourselves. If we provide patient care, how do we stratify the severity of illness and render the correct treatment?

Differentiating illnesses

Health care providers can distinguish between heat stroke and heat exhaustion through parameters such as core body temperature, mental status, airway and breathing, circulation, and by taking note of the skin of the affected person. We will discuss key differences that can help quickly differentiate between heat stroke and heat exhaustion. 

With heat stroke the skin will appear dry whereas a person suffering from heat exhaustion will continue to sweat.

People affected with heat stroke have very notable mental status changes, such as slurred speech and/or ataxia (loss of normal balance). They may appear obtunded or be hallucinating. They can present with seizures, delirium, and even coma. Thankfully, those experiencing heat exhaustion may only report headache, dizziness, and mild confusion that improves upon treatment. 

Other factors include airway and breathing: Those with heat exhaustion may have tachypnea (rapid breathing rate), but there will be no airway compromise.

With heat stroke however, there can be airway compromise due to altered mental status. 

Other signs

Other obviously critical signs include pulse, blood pressure, and temperature. People in heat stroke will have core body temperatures of 104  F to 105  F and have tachycardia (fast heart rate) and be hypotensive (have low blood pressure). On the other hand, those with heat exhaustion will have core body temperatures of less than 104  F and will have stable blood pressure despite having tachycardia. 

Heat stroke will often present with vomiting and diarrhea, whereas only nausea and vomiting accompany heat exhaustion. Further, those with the latter may complain of headache and weakness due to electrolyte abnormalities but will not present with systemic shock as can happen with heat stroke. Other distinguishing features between heat stroke and heat exhaustion are that the former is complicated by rhabdomyolysis (the destruction of striated muscle cells); acute renal and hepatic failure; and disseminated intravascular coagulation (DIC) which is the condition that inhibits the body’s ability to clot and stop bleeding. 

Treatment

Given the many complications associated with these illnesses, prompt treatment is essential. According to the Wilderness Medical Society Guidelines, severity of illness can be mild, which includes cramps and edema. In this case oral fluid and electrolyte replacement along with passive cooling measures suffice. Elevation of extremities are helpful if there is edema. When heat exhaustion is the diagnosis, prompt removal from the offending environment, followed by evaporative cooling or conduction cooling is recommended. Conjointly, hypertonic fluid hydration is essential for fast recovery. Concurrent lab testing should be performed and should include complete blood count (CBC), electrolyte panel, renal and hepatic function panels, CK (creatine kinase), urinalysis, and coagulation studies (PT, PTT, INR). This set of lab data can correctly guide treatment, disposition, and  prognosis. 

With severe signs and symptoms seen in heat stroke, prompt removal/evacuation from extreme temperatures is warranted while simultaneously supporting air way, breathing, and circulation. Intravenous hydration should begin immediately along with whole body conductive cooling or cold-water immersion. Consider  that cold water immersion can slow cooling if severe vasoconstriction and shivering ensue. Again, CBC, electrolyte panel, CK, troponin, renal and hepatic function panels, urinalysis, coagulation studies, drug screen panel, and cardiac monitoring will be required. Treatment of concomitant rhabdomyolysis, acute pancreatitis, acute liver and renal failure, gastrointestinal bleeding, encephalopathy, DIC, and other complications that can arise from systemic inflammatory responses will likely be necessary. 

Prevention

As with all illnesses, prevention is paramount. In the case of heat related illness, preparation is the best preventative measure to date.

Here is a brief list of preventative measures to consider:

1. Focus on optimizing overall fitness.
2. Know  historical weather temperatures and plan accordingly.
3. Avoid extreme heat and humidity. This is especially helpful for those with acute and chronic illnesses.
4. If exercise or outdoor activity cannot be avoided, be sure to hydrate well before exposure and wear clothing with pre-cooling technology (cooling vests). Take frequent brakes and drink water.
5. Recognize early symptoms such as excessive thirst, dizziness, fatigue, muscle cramps, and headache.
6. When working outdoors consider cooling vests, hats, and other protective gear that can aid the body’s heat loss mechanism. Make use of wearable basal  body thermometers that are useful in both hot and cold climates. They may be able to alert the wearer before the onset of symptoms. Many of the aforementioned equipment can be made available to small and large businesses through various OSHA programs. 

To recap, heat related illnesses account for days lost from work and school, morbidity, and even death. Recognition of mild to moderate illness and timely treatment can reverse many, if not all of the early signs and symptoms. Prompt evacuation and stabilization  of the heat stroke victim can mean the difference between life and death in many cases.

As always, consider the health of our planet when purchasing food, goods, and services.

Stay cool out there!!

Ela Grigorian, MD

thevitaminchannel.com

Please be sure to listen to our Medcare Business Network podcast featuring Dr. Ela Grigorian and other great guests here!

It’s no coincidence that on the first day of National Nurse Practitioner Week, I ended up having coffee with one of my old grad school NP buddies. He just moved back to California after spending almost 15 years in the Philippines, where he completed his medical degree among various other adventures. “There are so many opportunities for Nurse Practitioners in the United States,” he said as we discussed his new job as an NP at a Men’s health clinic.

The evolution of the Nurse Practitioner role

“If Dr. Ross, from the television show ‘ER’ and Nurse Jackie, from the show ‘Nurse Jackie’ had a baby it would be a Nurse Practitioner.” That’s what I would tell people when they asked me what an NP was. I frequently used the opening line when I gave lectures to high school students regarding the NP role.

A Nurse Practitioner is a nurse who has a master’s degree and has completed a graduate level of education at a university. All NPs are registered nurses who are licensed by the Board of Registered Nursing in the state where they may be practicing. NP’s have an expanded scope of practice over the traditional registered nurse role and may vary from state to state.

Loretta Ford and Dr. Henry Silver created the NP role in the 1960’s in Colorado due to a need to increase access to pediatric patient care. Dr. Ford believes that NP’s providing primary care of high quality can solve the access to patient care issues in America.

Dr. Ford and her colleagues  initially started as public health nurses setting up clinics at various community centers, schools, and churches in Boulder Colorado. Like a true innovator Dr. ford noticed that only her colleagues and herself were taking care of public health issues in the underprivileged community setting. She realized that nurses needed to have expanded roles and specialized training to make basic decisions on their own.

Full practice authority

According to the American Academy of Nurse Practitioners, there are 22 states and the District of Colombia where NP’s are permitted full practice authority. Full practice authority permits NP’s to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances indecently. The National Academy of Medicine and the National Council of State Boards of Nursing recommend this model.

NP’s do more than just prescribe medications and diagnose health issues

If you’ve ever had the opportunity to see a nurse practitioner, you’ve probably figured out they are amazing educators. That’s my favorite part of being a nurse practitioner, teaching. Straight from Dr. Loretta Ford’s mouth, teaching patients and to ultimately empower them to advance to self-care is the goal of the NP.

Types of NP’s

Pediatric Nurse Practitioner

Neonatal Nurse Practitioner

Family Nurse Practitioner

Adult Gerontology Nurse Practitioner

Psychiatric Mental Health Nurse Practitioner

Women’s Health Nurse Practitioner

Subspecialties

Many NP’s choose to pursue a subspecialty and acquire training outside of traditional nurse practitioner programs. These may include:

Emergency NP

Cardiology NP

Dermatology NP

Orthopedic NP

Aesthetic NP

Nurse Practitioners as business owners

Many nurse practitioners have found their niche and started their own businesses. Much like Dr. Loretta Ford, NP’s who have started their own businesses where they noticed there was a problem, and they came up with the solution. In many states, NP’s can open their own clinical practices.

Are you a Nurse Practitioner searching for a fresh start?

Have you thought about quitting your job or selling your house to move to a rural town? Or are you wanting to do the opposite and seek new adventures in a big city?

It sounds like a scene right out of the Netflix binge worthy show ‘Virgin River.’ Why not make it a reality and work locum tenens? You too can have a ‘fresh start,’ and work in a new town. You never know who you’re going to meet in places like North Carolina, Georgia, California, New York, Texas, Louisiana, Montana, or Tennessee. Some of these assignments offer incredible perks like housing, loan repayment and special bonuses.

 Medcare staffing places physicians, advanced practitioners, pharmacists and dentist in locum tenens, contract positions and permanent jobs. Contact us now by filling out this form or by calling 888-474-3380. Click here to view assignments.

Workplace burnout in healthcare has been going viral for quite a while. Covid-19 only exacerbated burnout symptoms suffered by many healthcare providers. Could self-care really be the answer to keep burn out symptoms at bay?

What is burnout?

Emotional, mental, and physical exhaustion caused by high amounts of long-term stress is what burnout is all about. American psychologist Herbert Fruedenberger started using the term ‘burnout’ in the 1970’s when he was describing the severe stress and high ideals he noticed being exhibited by nurses and doctors. Fruedenberger further concluded that many healthcare professionals, who sacrifice themselves to care for others, were exhausted, listless, and unable to cope.

Highest risk for burnout

According to various studies, 35% to 54% of healthcare providers suffer from burnout. Approximately 50% of American Physicians  alone suffer from burnout. Due to the increased stress levels and emotional strain, healthcare professionals are in the highest risk group to struggle with workplace burnout.

Burnout and the brain

Believe it or not burnout can change the brains anatomy. Chronic psychosocial stress from burn out can damage a person’s personal and social functioning and overwhelm cognitive functioning as well as the neuroendocrine system.

A study found that people who suffered from workplace burnout had a large amygdala along with brain areas linked to emotional distress. The more stress a person reported in their work life, the weaker the connectivity between brain regions appeared on their MRI’s. Further studies done on occupational stress was linked to reductions in gray matter in the hippocampus as well as cortical thinning which effects memory, attention and emotions.

Signs and symptoms of workplace burnout

Burnout is a medical disorder and has its own ICD 10 code ICD-10 (Z730.0-Burn-out state of vital exhaustion). It is imperative that healthcare providers recognize the signs and symptoms of burnout before potentially life-threatening mistakes can occur. Signs and symptoms of burn out  include:

• Feeling sinical
• Having resentments towards your workplace and patients
• Feeling helpless
• Low energy levels
• Reduced productivity
• Feeling tired and drained
• Frequent illnesses like cold or flue
• Unclear job expectations
• Loss of motivation or moral
• Procrastination
• Self-isolation
• Change in appetite
• Inability to sleep
• Poor eating habits
• Self-medicating with alcohol or other substances
• Lack of social support
• Work life imbalance
• High blood pressure

15 Selfcare hacks to combat burnout

1. Know your breaking point

            To avoid getting to the “burnout” breaking point, it’s best to stop and do a self-    evaluation of how you are feeling. Do you keep getting triggered in a negative way by            your spouse, children and or dog? Are you having trouble focusing and concentrating?            It’s probably a             sign to take a day off.

• Re-evaluate your goals

            Is your work bringing you passion and fulfillment? Do you dread waking up in the             morning to go to work? It’s best to write a list of ‘life goals’ and perhaps challenge      yourself by taking a creative course like stand-up comedy or improvisation. Believe it or             not, stand-up comedy and improvisation classes can help make your work life fun and            entertaining.

• Take a vacation

            You do not have to take a lengthy vacation trip somewhere far far away. You can always plan a staycation where you live and focus on self-care activities full of exercise, mediation, and massages with a focus on relaxation.

• Change your environment

Your personal environment which includes work colleagues, friends, family, personal habits and where you live can all impact your daily life. Sometimes you must move out of a negative space and move into a more positive one. Maybe you have to get rid of negative co-workers and colleagues who bring you down.

• Find the “Magic” in your daily life

            Finding the ‘magic’ in your everyday life can help to alleviate burnout and give you a        more positive outlook on life. Take pleasure in watching sunsets and sunrises. Talk to a             new person every day. Take a minute and smell the flowers before you start your day.

• Take a nap

            Studies show that a short nap in the afternoon enhances mood, improves job       performance, makes you alert and eases stress.

• Exercise

            Exercise helps to increase your endorphins which puts you in a better mood. Taking a      brisk walk on your lunch break can help you finish off your day on a happier note.

• Follow your passion

            What do you love to do? Have you explored areas that add a spark to your daily life?       You can develop a skill in a particular area and use it to contribute to something beyond   yourself to make your life much more fulfilling.

• Find a creative outlet

            Dancing, doodling, and coloring are all great creative outlets. A creative outlet helps you             to express your feelings and ideas in a positive way.

1. Practice mindfulness

            Developing a mindfulness practice helps you to be aware of your thoughts and feelings   without interpretation or judgment. Mindfulness brings greater relaxation to the body      and mind.

1. Meditate daily

            Daily meditation helps to decrease stress, have better focus, as well as decreasing           negative emotions.

1. Organize your space

            Letting go of things that no longer serve a purpose in your life can create a massive shift.             Placing things in easy to find spaces helps to decrease stress.

1. Practice positive self-talk

            Positive self-talk makes you feel good about yourself. Waking up in the morning and        greeting yourself in the mirror can have a tremendous positive effect on the rest of your   day. Creating an optimistic voice in your head encourages you to look at the bright side           of things picking yourself up when you fall.

1. Start a gratitude journal

            Giving thanks and counting blessings helps you get better sleep, lowers stress, and           improves relationships. Starting a gratitude journal and outlining 3 things in your life you    are grateful for everyday can also help you decrease daily workplace burnout and give          you a more positive outlook in life.

1. Buy yourself some flowers.

            Flowers brighten up any space. Don’t wait for someone to buy you flowers start a            weekly flower budget. This will not only brighten up your space but will also brighten up your mood and put a smile on your face.

Dr. Richard Gunderman, professor of Radiology at Indiana University, explains that “the incremental onset of burnout is due to the accumulation of hundreds of tiny disappointments.” Burnout suffered by healthcare providers can have negative effects on patient care.

MedCare Staffing places physicians, advanced practitioners, pharmacists and dentists in locum tenens positions and permanent jobs.

If your current work situation causing you burnout? Stop those hundreds of tiny disappointments today and change your work environment by calling MedCare Staffing  (888)474-3380 and book your next Locum Tenen assignment by clicking here.

“Should I sell my home, all my personal belongings, pay off all my personal debt, buy an RV (recreational vehicle) and travel across the United States working as a Locum Tenens provider?”

On a recent Facebook rant, an unhappy healthcare provider asked the above question. She also stated that her husband was feeling unfulfilled in his career.

Most of the feedback she received shouted “Go for it!” and “You only live once!”

Is work and travel throughout the United States a possibility or is it merely just a dream?

Selling your home, all your personal belongings, traveling throughout the United States and maybe even the world, for the average human being, can seem like a dream only alive on Netflix.

In the blockbuster movie “The Secret Life of Walter Mitty,” the protagonist ‘Walter Mitty,’ played by actor Ben Stiller, spends most of his mundane life daydreaming of extraordinary adventures. One day, his daydreams become a reality when he is asked to travel across the globe on a special work assignment that changes his life forever.

True. You’ve got family. You’ve got friends. You’ve got responsibilities holding you back.

Unfortunately, all these ‘things’ kept George Baily tied to his little hometown of ‘Bedford Falls,’ in the popular Christmas movie “It’s A Wonderful Life.” Throughout the beginning of the film, every time George packs his bags and is ready to embark on a great travel adventure, some type of life drama tends to get in the way of his ‘Wanderlust.’ Eventually, George succumbs to what society wants him to do and never travels outside of ‘Bedford Falls.’

Don’t be a George Baily. Get your ‘Wanderlust’ on and go on a ‘Workation!’

Are you tired of your regular healthcare gig? Need a change of scenery? Need some spice in your life and a new adventure? It’s time for you to take a #Workation.

Workation: work and do the touristy thing on weekends or after work.

Life is short. Why not live it on vacation? Planning a vacation while working a fulltime healthcare job can be challenging these days. Locum tenens makes planning a #Workation possible.

Is a ‘Workation’ aka Locum Tenens gig right for you?

The word “locum” comes from the Latin term meaning ‘place holder.’ A provider working as locum tenens, is a person who temporarily fulfills the obligations of another. In healthcare, a locum’s provider is usually employed at a hospital, private practice clinic, or community healthcare facility that may be short staffed or need temporary coverage when a provider is on leave.

Locums providers are employed by private agencies. Working as a locums offers many opportunities to experience working in a variety of environment’s and specialties which may include: for profit agencies, academic health centers, state agencies, federal sites such as Indian Health Service, individual hospitals, and or international staffing companies.

Flexibility is a key advantage to working as a locum tenens healthcare provider. This ‘gig’ can help to fulfill your career and economic goals. Locum tenens offers short term assignments that can turn into a long-term assignment, possibly ending in a permanent assignment.

Top 3 ‘Workation’ destinations trending at MedCare Staffing this summer

1. Montana… The ‘Treasure State’

Majestic Montana also known as the “Treasure State,” due to its abundance in natural minerals such as gold, silver, copper, lead, zinc, coal and oil. The word ‘Montana’ means ‘mountainous,’ and captures the true essence of the ‘big sky’ state.

Montana is home to seven State Forests and fifty-three State Parks. Its wide-open spaces include Glacier National Park, featuring snowcapped peaks, lakes and hiking alpine style. Montana has 2 main openings to Yellowstone National Park diving deep into the natural geyser country.

Montana is perfect for the outdoorsy adventurer. MedCare staffing has locum opportunities available with Indian Health Services at Blackfeet Reservation and Crow Reservation for nurses, nurse practitioners and physicians.

• Desert + Mountains + Beaches = California

California. It’s one of the most popular destinations in north America. The Goldengate bridge, Disneyland, and Hollywood are huge tourist attractions. However, California has a little bit of something for everyone.

Beautiful beaches, mountains and deserts are what make California a hot travel destination which never ceases to deliver. Music festivals in Coachella, Wine tasting in Sonoma, and surfing in Malibu are seasonal extras for the eclectic “Workationer.” Are your bags packed yet? Checkout MedCare staffing’s California locum assignments here.

• Georgia, the Peach State

Known as the largest state east of the Mississippi, Georgia is famous for more than just growing the sweetest ‘peaches.’ Georgia is home to the largest State Park in the nation, 350 bird species, Lookout Mountain, and the Okenfenokee Swamp.

Georgia is also home to the world’s largest aquarium, Botanic gardens and the beaches on Jekyll Island as well as historic sites and antebellum homes. You can also visit the romantic Savannah and stroll down the Historic District while sipping on a sweet tea.

If you’re a ‘foodie” Georgia has got some good eats. According to Lisa Love, Interim Deputy Commissioner at Georgia Tourism, she states that “One of the best ways to immerse yourself and truly experience Georgia is through our food.” She further goes on to say that “the history and culture of Georgia is woven into the many flavors, ingredients, dishes as well as traditions that create a dining experience that’s unforgettable.” For more information on Locum Tenem opportunities in Georgia through MedCare staffing click here.

Are you ready to embark on your ‘workation’ locum tenens adventure? Call a recruiter at MedCare staffing today and pack your bags. Click here to learn more.

#bestjobever

 It’s literally paid tourism. You can work in amazing places that offer historical and local attractions that will add to your work life balance.

Flexibility is key

The year 2020 was officially inaugurated “The Year of The Nurse.” The global COVID-19 pandemic showcased the nursing profession as a vital lifeline to safe patient care. And in 2021, the year of the nurse gets an extension!

The international theme for the 2021 “Year of The Nurse” is “A Voice to Lead-A Vision for the Future of Healthcare. “

Strength in numbers

Nursing is the largest healthcare profession in the United States. There are approximately 4 million nurses total. The average age of nurses is 47.9 years old. However, 77.3 percent of nurses are Caucasian and 9.6% are male.

According to the National State Board Of Nursing Statistics (2018), you can find most nurses working in the hospital setting 59.9 percent, 15.6 percent in ambulatory settings, 16.2 percent work in ‘other’ settings, and 16.6 percent have no direct patient contact.

Looking into the future of nursing

There’s no doubt in any nurses mind that healthcare in the United States needs an overhaul. The COVID-19 pandemic caused an already inflamed system to burst like a huge abscess. Frontline nurses working at the bedside suffered personal protective equipment shortages (PPE), burnout, and some even lost their lives.

It’s up to nurses to challenge hospital administrators and politicians regarding their healthcare policies and hospital standards in order to create a better future for safe and efficient patient care. Americans deserve a healthcare system that promises a better tomorrow that does not repeat the catastrophic pandemic crisis of 2020 and acknowledges the value of nurses.

The National Academy of Medicine Committee on the Future of Nursing 2020-2030 explores the roles of nurses, responsibilities and significant education changes to meet the demand for care created by healthcare reform which seeks to improve America’s complex healthcare system.

Trends in nursing on the horizon

Bachelors-in-Science to practice nursing (BSN)

New York in 2018 passed legislation that all nurses are required to earn a BSN with in 10 years of becoming licensed. Many states are planning to follow this trend.

Online education programs

The popularity of online nursing degree programs sprouted with COVID-19. Online nursing programs allow nurses to obtain higher degrees in nursing education while continuing to work as a nurse. An increase of online nurse practitioner programs, post masters and doctoral programs are predicted to flourish in 2021.

Shortages in Physicians

A physician shortage is predicted to continue. In 2018, the American Academy of Nurse Practitioners (AANP), reported that there were 248,000 licensed to practice in the United States. More and more hospitals are closing in rural areas. Family Nurse Practitioners are useful in rural areas where there is a growing population and lack of physicians.

Full practice authority for Nurse Practitioners

Both the national academy of medicine and the national council for state boards of nursing are urging states to allow nurse practitioners the authority to practice independently. Currently, 26 states allow nurse practitioners full practice authority.

Nurses leaving the profession

Several nurses are struggling with burnout which are causing them to leave the healthcare profession. Hospitals across the United States are suffering nursing shortages due to the COVID-19 pandemic. Many nurses are blaming lack of support from hospital management and administrators as well as a lack of focus on what nurses need in order to provide safe and efficient patient care.

Nurses creating innovative paths in nursing through Locum Tenens

Most hospitals lost about 30 percent of their nursing staff to travel nurse jobs due to the COVID-19 pandemic. As COVID-19 cases surged, so did travel nurse jobs with over 31, 000 openings. Many travel nurse agencies were offering nurses crisis pay of almost $10,000 per week. Staffing demands for travel nurses increased over 44 percent compared to the previous year.

Locum Tenens means ‘place holder’ in Latin. One fills an office for a certain amount of time. Locum tenen assignments as well as travel nursing assignments have the potential of turning into full time positions. Locums positions are great for nurses who want to travel or stay local and experience a variety of different neighborhoods and diverse socioeconomic patient populations in order to broaden their scope of practice.

There’s no doubt that travel nursing and locum tenems work offer nurses a better work life balance. Nurses, Advanced Nurse Practitioners, and Certified Nurse Anesthetists can plan their schedules and blocks of time off for higher education, travel, family planning and enjoy their life with ease.

Medcare staffing offers nurses and advanced nurse practitioners contract and temporary assignements with full coverage of medical malpractice insurance. Click here to learn more and speak with a recruiter today.

Approximately 1.8 million Americans are incarcerated in state and federal prisons. Based on the communal nature of the prison system, specific medical needs are created. Today, there is an increased demand for physicians, nurse practitioners and nurses specialized in correctional healthcare.

History of correctional healthcare

Correctional healthcare did not exist until 1770 and was invented in England by a wealthy philanthropic healthcare former by the name of John Howard and physician John Fothergill. Louise Rene-Villerme a physician and pioneering hygienist published a study titled Des Prisons in 1820, further overhauling the public health concerns in prisons.

According to the CDC the most common healthcare problems reported by prison inmates include:

Infectious disease

• Hepatitis
• HIV/ Aids
• MRSA
• Sexually Transmitted Diseases
• Tuberculosis

Chronic Diseases

• Arthritis
• Asthma
• Cancer
• Heart Disease

Learning disabilities and mental health

The most common impaired functioning that jail inmates report is a learning impairment such as dyslexia or attention deficit disorder. Many inmates also report having been enrolled in special education classes during their youth. Approximately 8 percent of inmates state they suffered from mental health condition that kept them from fully participating in school, work, or other activities.

Pregnancy in incarcerated women

Approximately 3 to 5 percent of incarcerated women are reported to be pregnant when they go into a correctional system. Pregnancies of incarcerated women are usually high risk due to poor nutrition, limited accesses to prenatal care, domestic violence, mental illness, drug and alcohol addiction.

Transgender healthcare

During incarceration, transgender people may face a multitude of problems that may endanger their health and wellbeing. Correctional healthcare professionals must pay special attention to evaluation, screening, referral, and management of mental healthcare needs. Particular attention must be given to hormonal treatments for gender dysphoria and should follow accepted guidelines developed by professionals with specialized in transgender health.

Special attention must be paid to transgender youth who enter into the corrections system. Mental health professionals experienced in working with transgender adolescents  must review the youths current clinical stability, mental health functioning , and possible need for added mental health therapy and intervention.

Overall decreased life expectancy

For every year a person spends in the correctional system, 2 years is taken off of their lives.  With 1.8 million people locked up, mass incarceration has lowered the life expectancy of a significant portion of the human population in the United States.

Healthcare staff within the correctional system:

Physicians: a physicians role in corrections is primary care that can reach highly intensive levels. Physicians medical practice roles include internal medicine, preventative care, urgent care, emergency care, routine patient care, basic orthopedics, dermatology, minor office procedures, chronic care and end of life care. Some patient may need to be transported off site for tests, medical procedures and consultations.

According to the American College of Correctional Physicians, a physician working in corrections must be aware of and balance interests of; good solid medical practice, medical supervision, implementation of process, medical board rules, the safety and security of the facility, the individuals in the facility, and the community. A few examples of medical-custody coordination are:

• Timely access to medical
• Timely treatments and
• Medical training and supervision

Nurse Practitioners: can provide care to adolescent patients to geriatric patients within the correctional healthcare system. Nurse practitioners practice within their scope and can perform physical exams, health screenings, medication management, sick calls and pregnancy and post-partum care. Correctional NP’s are positive advocates for patients and provide education to correctional administrators, judges, caseworkers and correctional staff.

Nurses: provide direct patient care to inmates in jails and prisons. Nurses treat patients in the correctional system for a variety of ailments including emergency medical conditions, acute illness, as well as chronic medical conditions.

Correctional healthcare staff may also be involved in hunger strikes, isolation, sexual abuse, transgender, elderly release pleas, compassionate release pleas and long term involuntary psychotropic medications. All incarcerated people within the correctional system must be treated with fairness and receive comprehensive healthcare. It is the responsibility of correctional healthcare team to advocate for the healthcare needs of these individuals.

Curious about a career in Corrections Health? Try out a Locum Tenens assignment with Medcare Staffing

Medcare staffing has a variety of locum tenen assignments in corrections for physicians, nurse practitioners and nurses in a variety of different states. Click here to find out more information and speak to a recruiter today.

Pain. That’s usually the first thought that pops into your mind when you think about going to see a Dentist. The second thing you might be thinking about is the shrill noise a drill makes right before it enters your mouth. And of course, the thought of needles comes next!

Dentists get a bad rap based on what typically happens during a normal dental checkup.

Unfortunately, a recent study conducted by New York University discovered that more than half of all the dentists surveyed stated they had experienced physical and or verbal abuse in their careers from patients. The study from the NYU college of Dentistry concluded that 55 percent of dentists were victims of verbal aggression from their patients in the last year. One in four of those dentists surveyed, experienced physical aggression from an irate patient.

“Workplace violence toward healthcare professionals is both widespread and widely overlooked,” said Kimberly Rhoades, a research scientist in the Family Translational Research Group at NYU College of Dentistry and the study’s lead author. “The purpose of this study was to provide an initial estimate of rates of patient aggression in dental practices in the United States.”

Rhoades and her colleagues surveyed 98 dentists practicing in the New York City metropolitan area; the dentists had been working an average of 17 years. Participants completed a confidential online survey assessing whether they had experienced any of 21 specific types of aggressive behaviors from their patients, including types of physical (e.g. being pushed or kicked), verbal (e.g. being insulted or sworn at), and reputational (e.g. threats of lawsuits or posting nasty comments on social media) aggression.

The study further discovered that the increased rates of aggression found in the study results did not differ by sex, race, ethnicity, specialty, age, years in practice or average number of patients seen and treated on a daily basis. Although, researchers did note that there was less aggression towards a trained dentist than towards dental students. Experienced professional received significantly less verbal abuse 55percent compared to 86 percent.

Violence in the healthcare workplace is a serious problem.

As a healthcare provider, you would never think your patient would want to harm you, but it happens. Workplace violence in healthcare is a growing problem. In 2018, workplace violence due to intentional injuries by other persons accounted for 2 percent of the 900,380 total nonfatal occupational injuries or illnesses in which required a leave of absence from their place of employment. The United States Bureau of Labor Statistics states that 73 percent of all nonfatal workplace injuries due to violence were experienced by healthcare workers in 2018.

Homicide is the most extreme form of healthcare workplace violence. It’s the third leading cause of an. Occupational injury that is fatal. In 2000, there were 11 percent of the total 5,915 fatal work injuries in the United States. The cause of these homicides is attributed to the environmental conditions experienced in these locations. 

The United States Occupational and Safety Administration (OSHA) has identified the following risk factors that increase a healthcare workers risk for assault as identified by the National Institute for Occupational Safety and Health (NIOSH) which include:

• Regular contact with the public
• Money exchange
• Delivery of goods and services
• Mobile workplace such as an ambulance
• Working alone or in small numbers
• Working late night
• Working with unstable or volatile patients
• Working in areas with a high crime rate
• Working in a community setting
• Guarding valuable possessions and or property

It’s true, people are afraid to go see a dentist

A recent survey found that 62% of adults stated that they were too scared to even walk into a dentist’s office. The survey also stated that millennials were more likely to come up with excuses to avoid going to see a dentist for a regular checkup than people over the age of 55.

Anxiety experienced by patients

Understanding that aggression can be experienced by dentists on a normal dental visit with a patient is the first step in developing interventions to prevent aggressive behavior in a dental practice.

5 tips to keep Dentists and Healthcare workers safe when dealing with anxious patients

1. Identify dental phobic patients: having the patient express to the dentist that they have anxiety is beneficial. The dentist should keep in mind both subjective and objective evaluations in order to work with the patient to establish a more relaxed mood. Having a calm and uninterrupted interview before any dental procedures could prove to be beneficial to both dentists and patient.

• Anxiety questionnaires: Based on these questionnaires, patients can be categorized as mildly anxious, moderately anxious, and extremely anxious or dental-phobic. This can help both the dentists and patient identify how to combat feelings of anxiety in order to have a less stressful experience as well as a positive outcome.

• Dental office environment: A patient can experience anxiety by just walking into a denial office. Receptionists, dental nurses, and dental hygienists are crucial personnel in creating an atmosphere in the dental office. Kind and courteous staff can decrease anxiety and provide a nurturing environment. Introducing pleasant ambient odors in the dental environment can reduce anxiety. Smells trigger emotions and can negatively condition a patient toward going to have a dental procedure done. Inhalation of pleasant scents like essential oils improves mood.

Shapiro et al adapted a “Snoezelen” dental environment for pediatric patients comprised of dimmed lighting, soothing music, and a special Velcro butterfly vest that hugs the child, providing a calming, deep-pressure sensation. Typical children and those with developmental disabilities have been shown to benefit by this SDE, as behavioral and psychophysiological measures of relaxation improved significantly in the SDE compared with a conventional dental environment.

• Behavioral contracts: Contractual agreements signed by the dentists and patient can set specific guidelines regarding how the patient will be treated or continue to receive treatment may help set up standards to protect both patient and dentist. Contracts should be specific in order to allow for action taken by the practice and staff to be sufficiently supported.

• Refusal or discontinuation of treatment: It’s ok to “fire” your patient and refuse to see them due to noncompliant, poor and aggressive behavior. If you have tried all of the above tips in order to ensure a safe environment for you, and your staff, and still your patient decides to behave badly, then it’s time to let them go.