Background: Staffing shortages across the healthcare sector pose a threat to the continuity of the Canadian healthcare system in the post-COVID-19 pandemic era. We sought to understand factors associated with turnover intention as well as Canadian healthcare providers’ (HCPs) perspectives and experiences with turnover intention as related to both organizational and professional turnover. Method: A convergent questionnaire mixed-methods design was employed. Descriptive statistics and ordinal logistic regressions were used to analyze quantitative data and ascertain factors associated with turnover intention. Thematic analysis was used to analyze qualitative open-field textbox data and understand HCPs’ perspectives and experiences with turnover intention. Results: Quantitative analyses revealed that 78.6% of HCPs surveyed (N = 398) reported at least a 25% turnover likelihood regarding their organization, with 67.5% reporting at least a 25% turnover likelihood regarding their profession. Whereas regression models revealed the significant impact of years worked, burnout, and organizational support on turnover likelihood for organizations, age, sex, burnout, and organizational support contributed to the likelihood of leaving a profession. Patterns of meaning drawn from participants’ qualitative responses were organized according to the following four themes: (1) Content to stay, (2) Drowning and no one cares, (3) Moral stressors, and (4) Wrestling with the costs and benefits. Conclusions: Many HCPs described weighing the costs and benefits of leaving their organization or profession during the COVID-19 pandemic. Although challenging working conditions, moral stressors, and burnout may play a significant role in HCPs’ experiences of turnover intention, there is ample room to intervene with organizational support.

Healthcare providers (HCPs) have described the onset of shame- and trust-violation-related moral injuries (MI) throughout the COVID-19 pandemic. Previous research suggests that HCPs may turn to various coping methods and supports, such as spirituality/religiosity, substance use, friends/family or organizational support, to manage workplace stress. It remains unknown, however, if similar coping methods and supports are associated with MI among this population. We explored associations between MI (including the shame and trust-violation presentations individually) and coping methods and supports. Canadian HCPs completed an online survey about their mental health and experiences during the COVID-19 pandemic, including demographic indices (e.g., sex, age, mental health history) and measures of MI, organizational support, social support, spiritual well-being, self-compassion, alcohol use, cannabis use and childhood adversity. Three hierarchical multiple linear regressions were conducted to assess the associations between coping methods/supports and (i) MI, (ii) shame-related MI and (iii) trust-violation-related MI, when controlling for age, mental health history and childhood adversity. One hundred and seventy-six (N = 176) HCPs were included in the data analysis. Spiritual well-being and organizational support were each significantly associated with reduced total MI (p’s < 0.001), shame-related MI (p = 0.03 and p = 0.02, respectively) and trust-violation-related MI (p’s < 0.001). Notably, comparison of the standardized beta coefficients suggests that the association between trust-violation-related MI and both spiritual well-being and organizational support was more than twice as great as the associations between these variables and shame-related MI, emphasizing the importance of these supports and the trust-violation outcomes particularly. Mental health history (p = 0.02) and self-compassion (p = 0.01) were additionally related to shame-related MI only. Our findings indicate that heightened levels of spiritual well-being and organizational support were associated with reduced MI among HCPs during the COVID-19 pandemic. Rather than placing sole responsibility for mental health outcomes on HCPs individually, organizations can instead play a significant role in mitigating MI among staff by implementing evidence-informed organizational policies and interventions and by considering how supports for spiritual well-being may be implemented into existing models of care where relevant for employees.

Minority stress refers to the chronic stressors (i.e., discrimination, victimization, internalized stigma) that marginalized individuals experience, which increase the risk of psychopathology. Minority stress experiences are rarely considered during diagnostic assessment due to challenges in clinical application, as clinicians may not know what questions to ask or may hesitate to ask about identity-based experiences. To address this need, the Minority Stress Module (MSM) was developed for the Diagnostic Assessment Research Tool to facilitate minority stress assessment. An overview of its development and implications for diagnostic assessment are presented. The development of the MSM was led by a team with expertise in minority stress and diagnostic assessment. Item development was guided by: (a) Meyer's (2003) Minority Stress Model and associated research; (b) the team's experience providing care to equity-denied individuals; and (c) insights from consultation with members of equity-denied groups. The MSM is a brief semistructured interview consisting of 13 questions related to symptoms, experiences, and resilience factors associated with minority stress. The MSM aims to improve therapeutic rapport, case conceptualization, diagnostic decision making, and treatment planning when working with individuals from equity-denied groups. Integrating minority stress assessment into diagnostic assessment is critical for developing diagnostic impressions and tailored treatment recommendations that consider contextual information. The MSM can facilitate this process, and its inclusion in the Diagnostic Assessment Research Tool will improve clinicians' access to a standardized minority stress assessment tool for clinical practice. (PsycInfo Database Record (c) 2025 APA, all rights reserved).