Supplementary Material for: Work Experiences of the Interdisciplinary Dialysis Workforce in the United States: A Cross-Sectional Survey

Introduction: Suboptimal dialysis care may be in part due to staff issues such as job dissatisfaction, burnout, work overload, high staff turnover, and inconsistent training. Here, we leveraged data collected in a recent national survey to provide an initial, comprehensive description of current work experiences of U.S. dialysis care providers. Methods: We conducted a cross-sectional survey of 1240 active U.S. dialysis clinic staff members (physicians, advanced practice providers, nurse managers/clinic coordinators, nurses, social workers, dietitians, and patient care technicians), who were recruited via emails to society membership lists. Respondents were asked about a wide variety of work experiences, including job satisfaction, professional fulfillment and burnout (Stanford Professional Fulfillment Index), work culture, experiences of hostility and violence, and self-reported medical errors. Responses were summarized overall and compared by clinic role. Results: Most of the survey respondents, representing all 50 U.S. states, were aged 35-49 (58.3%) or ≥50 (23.5%), female (60.7%), and white (59.8%; 23.1% Black and 10.0% Asian); 82.1% had been in their current role for at least 1 year. Most U.S. dialysis staff responding to our survey reported being generally satisfied with their jobs (mean rating of 7.9 on 0-10 scale), but only 54.4% met criteria for professional fulfillment, and 32.8% met criteria for burnout, driven by high scores in the work exhaustion domain. Related issues, including high workloads, lack of respect (including experiences of violence and hostility), lack of autonomy, and suboptimal patient environments (in terms of both safety and patient-centeredness), were commonly reported among dialysis care providers, although their prevalence often differed by provider type. Conclusion: Our results suggest that the dialysis workforce may be at a critical point. Preventing further staff burn out, which could lead to even greater staffing shortages and worse working conditions among those who continue to provide dialysis care, is essential.

引言：透析护理质量欠佳的部分诱因源于医护人员相关问题，例如工作满意度低下、职业倦怠、工作负荷过载、人员高流失率以及培训不统一。本研究借助近期一项全国性调查所收集的数据，首次全面阐述美国透析护理从业者的当前工作体验现状。方法：本研究针对1240名在职美国透析诊所医护人员开展横断面调查，调研对象涵盖医师、高级执业医护人员、护士长/诊所协调员、护士、社会工作者、营养师及患者护理技师，招募渠道为向各学会会员名录发送邀请邮件。调研对象需回答一系列与工作体验相关的问题，涵盖工作满意度、职业成就感与职业倦怠（采用斯坦福职业成就感量表Stanford Professional Fulfillment Index）、工作文化、遭受敌意与暴力的经历，以及自我报告的医疗差错情况。研究对所有问卷回复进行了汇总分析，并按诊所岗位类别进行分组比较。结果：本次调查的受访者覆盖美国全部50个州，其中年龄分布为35~49岁者占58.3%、50岁及以上者占23.5%；性别方面女性占60.7%，种族方面白人占59.8%（黑人23.1%、亚裔10.0%）；82.1%的受访者在当前岗位任职已满1年及以上。多数参与调研的美国透析医护人员表示对自身工作整体较为满意（0~10分量表的平均评分为7.9），但仅54.4%的受访者达到职业成就感达标标准，32.8%符合职业倦怠判定标准，这一结果与工作耗竭维度的高分表现密切相关。透析护理从业者普遍报告存在一系列相关问题，包括高工作负荷、缺乏尊重（含遭受暴力与敌意的经历）、自主权不足，以及患者照护环境欠佳（涵盖安全性与以患者为中心程度两方面），不过各类问题的发生率在不同岗位类型的从业者中存在显著差异。结论：本研究结果表明，美国透析医护队伍正处于关键转折点。预防医护人员进一步出现职业倦怠至关重要，否则将引发更为严重的人员短缺问题，并加剧在职透析医护人员的工作环境恶化。