Multiple investigations document substantial concerns relative to emotional exhaustion, burnout, and job dissatisfaction in nurse and physician cohorts. Physician research has demonstrated considerable pervasiveness of emotional exhaustion, emotional hardening, burnout, depression, suicidal ideation, and fatigue. Emotional exhaustion, a risk for burnout, has also been found to be substantial in nurses in the United States. Surveys have indicated that 20-35% of hospital-based nurses have expressed the intent to leave their current job in the near future.

There is no single study that includes United States physicians and nurses and then provides subset analyses that compare physician to nurse burnout in the same healthcare environment. However; comparisons, although with limited conclusions, can be based on separate studies. The 33% burnout proportion in a nurse study is lower than the 40-55% proportion described in physician investigations; however, substantial in both. Data from a systematic review of intensive care unit professionals indicates that the emotional exhaustion proportion for nurses has a mean of 32% (5 studies) and for physicians is 25% (1 study). Physician emotional exhaustion scores (22-25) are similar to the 2 studies describing nurse emotional exhaustion scores (24). The proportions of depression for physicians have been reported to be similar to those for nurses. The job dissatisfaction proportion for physicians has been shown to be comparable to those for nurses. The investigators found 3 recent Middle Eastern studies demonstrating that physician and nurse burnout proportions and high emotional exhaustion proportions were similar when the physicians and nurses worked in the same healthcare environment.

In the past, the authors designed an 11-item nurse and physician survey, the St. Elizabeth Youngstown Hospital Wellbeing Inventory. The 4 positive affect items (restful sleep, energetic, alert, and enthusiastic) were each ranked as 1) very slightly or none at all, 2) a little, 3) moderately, 4) quite a bit, or 5) extremely. The positive affect score was the sum of the ratings for these 4 items. The 7 negative affect items (irritation, nervousness, overreaction, tension, feeling overwhelmed, feeling that people were too demanding, and feeling drained) were each ranked, using reversed coding, as 5) very slightly or none at all, 4) a little, 3) moderately, 2) quite a bit, or 1) extremely. The positive affect score was the sum of the ratings for the 4 positive affect items (range 4-20). The nonstress score was the sum of the reverse-scored ratings for the 7 negative affect items (range 7-35). The wellbeing score was the sum of the positive affect and nonstress scores (range 11-55). The Wellbeing Inventory has been demonstrated to be valid, according to psychometric properties, and can be considered to be most relevant to United States nurses and physicians working in a hospital-trauma center environment.

The content of Spiritual Flow: Pathways to Proficient Patient Care and Nurse \& Physician Wellbeing (available on Amazon.com) came directly from Authentic Sports: The 7 Pathways to Peak Performance, second edition, written by Bill Lefko and Daniel Baird. Authentic Sports is a guide for enhancing sports performance and increasing joy while playing sports. Guidance is provided using spiritual principles as they affect various sporting activities. Multiple sport vignettes are included throughout the guide to complement and illustrate the principles as they are being presented. The essence of each principle is virtually identical whether one is discussing sports activities; waitressing; machine shop working; or providing patient care. Accordingly, virtually all of the statements in Spiritual Flow are identical to that printed in Authentic Sports and written by Bill Lefko and Daniel Baird. C. Michael Dunham, MD changed a small percent of the language such that physicians and nurses reading the compendium would better relate to the content and better understand the principles that were presented in Authentic Sports. The sports vignettes were deleted to shorten the reading duration for time-limited physicians and nurses.

In chapter 9 of Spiritual Flow are guided meditations to assist nurses and physicians in enhancing mindfulness experiences during patient care activities. Mindfulness is an attitudinal expression of receptive awareness, wherein there is a distinction made between an experience occurring in the present moment and associated thoughts and interpretations about that experience. The thinking process itself is observed with all thoughts being treated as equal in value, without attraction or rejection. In two investigations that consisted of physicians and nurses, a high mindfulness score was associated with less stress, greater wellbeing, and a positive emotional tone among subjects. Mindfulness training has been associated with reductions in stress or burnout risk in literature reviews focusing on nurses or physicians and in studies that include nurses and physicians.