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：透析照护质量欠佳，部分原因可归咎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、人员高流动率以及培训缺乏统一性。本研究借助近期一项全国性调查收集的数据，首次全面描述了美国透析照护从业者的当前工作体验。
方法：本研究针对1240名在职美国透析诊所从业人员开展横断面调查，受访者涵盖医师、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术员，招募渠道为向学会会员名录发送电子邮件。调查内容涵盖多维度工作体验，包括工作满意度、职业成就感与职业倦怠（斯坦福职业成就感指数（Stanford Professional Fulfillment Index））、工作文化、敌意与暴力经历，以及自我报告的医疗差错情况。研究对整体应答数据进行了汇总分析，并按诊所岗位类别进行组间比较。
结果：本次调查覆盖美国全境50个州，受访者的人口学特征如下：年龄分布为35~49岁占58.3%、≥50岁占23.5%；女性占60.7%；白人占59.8%，黑人占23.1%，亚裔占10.0%；82.1%的受访者在当前岗位任职时长≥1年。多数参与调查的美国透析从业人员表示对自身工作总体满意（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标准，32.8%的受访者符合职业倦怠判定标准，该情况与工作耗竭维度得分偏高相关。透析照护从业者还普遍报告了诸多相关问题，包括高工作负荷、缺乏职业尊重（含暴力与敌意经历）、自主权不足，以及患者照护环境欠佳（涉及安全性与以患者为中心两方面），不过各类问题的发生率常因从业者岗位不同而存在差异。
结论：本研究结果显示，美国透析医护人力队伍正处于关键临界点。防范职业倦怠进一步恶化迫在眉睫——若任由其发展，将引发更为严重的人员短缺问题，且继续从事透析照护工作的从业者的工作环境也将进一步恶化，因此防范职业倦怠至关重要。