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Efficacy of the Well-Being Index to identify distress and stratify well-being in nurse practitioners and physician assistants

Dyrbye, Liselotte N. MD, MHPE1; Johnson, Pamela O. MS, RN, NEA-BC2; Johnson, LeAnn M. MS, RN, NEA-BC3; Halasy, Michael P. PA-C, MS4; Gossard, Andrea A. APRN, CNP5; Satele, Daniel BA6; Shanafelt, Tait MD7

Journal of the American Association of Nurse Practitioners: July 2019 - Volume 31 - Issue 7 - p 403–412
doi: 10.1097/JXX.0000000000000179
Research - Quantitative
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Background and purpose: To evaluate the ability of the Well-Being Index (WBI) to stratify distress and well-being (high quality of life [QOL]) in nurse practitioners and physician assistants (NPs and PAs) and identify those whose degree of distress place them at an increased risk for medical error or turnover.

Methods: A national sample of NPs and PAs completed a survey that included the WBI and instruments to measure QOL, fatigue, burnout, recent suicidal ideation, medical error, and intent to leave the current job.

Conclusions: Overall, 1,576 of 4,106 (38.4%) NPs and PAs completed the survey. Those NPs and PAs with low mental QOL, extreme fatigue, recent suicidal ideation, or burnout had less favorable WBI scores (all p < .0001). Using a prevalence of low overall QOL among APPs of 14.4% as the pretest probability, the WBI score can reduce the posttest probability of low QOL to 2% or increase it to 64.7%. As the WBI score worsened, the posttest probability of high overall QOL decreased from 73% to 8.2%. Also, WBI score stratified the NPs and PAs likelihood of reporting recent medical errors and intent to leave his or her current job.

Implications for practice: The WBI is a useful screening tool to stratify distress and well-being in APPs across a variety of domains and identify those NPs and PAs whose degree of distress may increase the risk of medical error or turnover.

1Professor of Medicine and Medical Education, Co-Director of Mayo Clinic Program on Physician Well-Being, Mayo Clinic, Rochester, Minnesota

2Chief Nursing Officer, Mayo Clinic, Rochester, Minnesota

3Department of Nursing, Mayo Clinic, Rochester, Minnesota

4Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota

5Department of Medicine, Mayo Clinic, Rochester, Minnesota

6Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota

7Jeanie & Stewart Ritchie Professor of Medicine, Chief Wellness Officer Stanford Medicine, Associate Dean, Stanford School of Medicine, Stanford, California

Correspondence: Liselotte N. Dyrbye, MD, MHPE, 200 First Street SW, Rochester, MN 55905. Tel: 507.284.2511; Fax: 507.266.2297; E-mail: dyrbye.liselotte@mayo.edu

Funding: Funding for this study was provided by the Mayo Clinic Department of Medicine Program on Physician Well-Being.

Authors' contributions: Conceptualization: L. N. Dyrbye, P. O. Johnson, L. M. Johnson, M. P. Halasy, A. A. Gossard, T. Shanafelt. Formal analysis: L. N. Dyrbye, D. Satele. Funding acquisition: L. N. Dyrbye. Investigation: L. N. Dyrbye, P. O. Johnson, L. M. Johnson, T. Shanafelt. Methodology: L. N. Dyrbye, P. O. Johnson, M. P. Halasy, A. A. Gossard, D. Satele, T. Shanafelt. Project administration: L. N. Dyrbye, T. Shanafelt. Resources: L. N. Dyrbye, T. Shanafelt. Supervision: L. N. Dyrbye, T. Shanafelt. Writing - original draft: L. N. Dyrbye, T. Shanafelt. Writing - review and editing: L. N. Dyrbye, P. O. Johnson, L. M. Johnson, M. P. Halasy, A. A. Gossard, D. Satele, T. Shanafelt. Data curation: D. Satele, T. Shanafelt.

Competing interests: Dr. Shanafelt and Dr. Dyrbye are co-inventors of the Well-Being Index. Mayo Clinic holds the copyright for this instrument and has licensed it for use outside of the Mayo Clinic. Dr. Shanafelt and Dr. Dyrbye receive a portion of any royalties paid to the Mayo Clinic.

Received June 28, 2018

Accepted October 22, 2018

© 2019 American Association of Nurse Practitioners
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