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The impact of COVID-19 on the wellbeing of veterinarians

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The impact of COVID-19 on the wellbeing of veterinarians

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The Impact of COVID-19 on the Wellbeing of Veterinarians
by
Stephanie Neuvirth

Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education

August 2022

© Copyright by Stephanie Neuvirth 2022
All Rights Reserved

The Committee for Stephanie Neuvirth certifies the approval of this Dissertation

Kimberly Hirabayashi
Steven Marshall
Bryant Adibe, Committee Chair

Rossier School of Education
University of Southern California
2022
iv
Abstract
Veterinarian wellbeing has been an industry concern for many years, with documented high rates
of psychological distress, suicide ideation, and burnout. The COVID-19 pandemic created high
levels of occupational stress within organizations leading to a negative impact on employee
wellbeing. Veterinarians throughout the pandemic were faced with a responsibility to care for
sick and injured pets, meet increased client demands, address zoonotic disease, and meet
employers’ expectations while having a responsibility to safeguard their own health and the
health of their family and community. The research identifies the strong relationship burnout,
emotional exhaustion, fatigue, and engagement have on veterinarian effectiveness and wellbeing
throughout the pandemic. In addition, this study identifies the specific strategies organizations
and leaders implemented that effectively supported the wellbeing of veterinarians during the
COVID-19 pandemic. The study utilized the bioecological model described by Bronfenbrenner.
The findings of the study showed that wellbeing declined while effectiveness stayed the same or
improved. The study also revealed that changes in process and workflow impacted veterinarian
effectiveness, and direct supervisors had a significant impact on wellbeing. Based on the findings
and conceptual framework, the study includes five recommendations for practice.

v
Acknowledgments
Thank you to the veterinarians whose passion and purpose driven-work have inspired me.
Health and wellbeing is my passion. I believe in the health of people, pets, and planet and am
committed to spending time identifying and implementing ways to improve the lives of those
who have dedicated their lives to the health of animals. Whether it be through physical, mental,
community, financial, or career health, I want to help create environments where all individuals
can thrive and be at their best.
Thank you to my current and former colleagues who have been on this journey with me,
together we have and will continue to transform the pet industry and improve the lives of pet
professionals and their families. I am grateful for your collaboration and know all things are
possible when aligned teams execute synergistically together.
Special thanks to my parents who have encouraged me to think about what could be
possible and have instilled in me the drive, courage, and work ethic to continuously learn and see
change as opportunity.
I dedicate this dissertation to my two daughters and my husband. Tom, thank you for
your unconditional love and encouragement to persevere. You have been my biggest supporter,
and consistently there to encourage me to keep going, especially when times were challenging.
Your patience, understanding, love, and support made this educational experience possible. You
live life to the fullest and are my greatest adventure! Jackie and Maddie, thank you for your
never-ending love and patience in supporting this journey. Believe in possibilities, create
networks, pursue your dreams, and fail often in pursuit of learning, you are both destined for
greatness.
vi
I am grateful for my dissertation committee, Dr. Adibe, Dr. Hirabayashi, and Dr.
Marshall, whose patience and knowledge guided me through this dissertation process.
To the Rossier School of Education, Cohort16, Saturday Breakfast Club members, you
inspire and amaze me! We have experienced a global pandemic, social unrest, geo-political
conflict, sickness, passing of family members, birth of babies, job changes, and domestic and
international relocations together. I am grateful to have taken this journey with you. You have
taught me resilience, courage, patience, kindness, and resourcefulness. Your generosity of spirit
and support will never be forgotten. You will forever be a part of my family and together we
have achieved this academic milestone. I know each of you will leave an amazing legacy and
together we can change the world. Fight on!

vii
Table of Contents
Abstract .......................................................................................................................................... iv
Acknowledgments............................................................................................................................v
List of Tables ................................................................................................................................. ix
List of Figures ..................................................................................................................................x
Chapter One: Introduction to the Study ...........................................................................................1
Background AND Context of the Problem ..........................................................................2
Purpose of the Project and Research Questions ...................................................................6
Importance of the Study .......................................................................................................7
Overview of Theoretical Framework and Methodology .....................................................8
Definitions............................................................................................................................9
Organization of the Dissertation ........................................................................................11
Chapter Two: Literature Review ...................................................................................................13
Wellbeing in the Workplace ..............................................................................................13
Antecedents and Interventions Associated With Wellbeing at Work ................................18
Wellbeing in Veterinary Medicine.....................................................................................33
The Impact of COVID-19 on Veterinarians ......................................................................38
Organization and Leadership Responses to COVID-19 ....................................................45
Conceptual Framework ......................................................................................................53
Summary of Review ..........................................................................................................57
Chapter Three: Methodology .........................................................................................................58
Research Questions ............................................................................................................58
Methodology Approach and Rationale ..............................................................................58
Population and Sample ......................................................................................................59
The Researcher...................................................................................................................61
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Survey ................................................................................................................................62
Data Collection Procedures ................................................................................................63
Data Analysis .................................................................................................................................65
Validity and Reliability ......................................................................................................66
Ethics..................................................................................................................................66
Chapter Four: Results ....................................................................................................................68
Participant Demographics ..................................................................................................68
Research Question One (RQ1): How Have Emotional Exhaustion, Burnout, and
Fatigue impacted Veterinarian Effectiveness Throughout the COVID-19 Pandemic? .....70
Research Question Two (RQ2): What Specific Strategies Have Organizations and
Leaders Implemented That Support the Wellbeing of Veterinarians During the
COVID-19 Pandemic? .......................................................................................................92
Summary of Results and Findings ...................................................................................103
Chapter Five: Discussion .............................................................................................................104
Discussion of the Findings and Results ...........................................................................104
Recommendations for Practice ........................................................................................114
Limitations and Delimitations ..........................................................................................127
Recommendations for Future Research ...........................................................................130
Conclusion .......................................................................................................................132
References ....................................................................................................................................134
Appendix A: Industry Association Director Email ......................................................................162
Appendix B: Survey Instrument ..................................................................................................163
Appendix C: Participant Recruitment Email ...............................................................................169
Appendix D: Supplemental Tables ..............................................................................................170

ix
List of Tables
Table 1: Hertzberg Two-Factor Theory of Motivation 26
Table 2: Frequency Table for Nominal Variables 69
Table 3: Summary Statistics for Burnout, Emotional Exhaustion, Fatigue, Engagement, and
Employee Effectiveness 72
Table 4: Frequencies and Percentages for Employee Effectiveness Survey Items 79
Table 5: Pearson Correlations Between Variables of Interest 82
Table 6: Variance Inflation Factors for Variables of Interest 86
Table 7: Results for Multiple Linear Regression with Burnout, Emotional Exhaustion,
Fatigue, and Engagement Predicting Employee Effectiveness 87
Table 8: Summary Statistics for Variables of Interest by Gender 89
Table 9: Frequency Table for Employee Wellbeing Regarding Strategies Implemented by
Direct Supervisor 98
Table 10: Summary Table of Open-ended Questions 15 and 17, Findings (Themes) 102

x
List of Figures
Figure 1: Histogram for Burnout Scores 73
Figure 2: Histogram for Emotional Exhaustion Scores 74
Figure 3: Histogram for Fatigue Scores 76
Figure 4: Histogram for Engagement Scores 77
Figure 5: Histogram for Employee Effectiveness Scores 80
Figure 6: Normal P-P Scatterplot With Regression Model Predicting Employee Effectiveness 84
Figure 7: Residuals Scatterplot With Regression Model Predicting Employee Effectiveness 85

1

Chapter One: Introduction to the Study
The health and wellbeing of veterinarians have been an ongoing industry concern for the
profession. Veterinarians play a critical role in delivering care to sick and injured pets and
protecting humans from zoonotic disease. Veterinarians indicate that stress, emotional
exhaustion, burnout, and compassion fatigue are the most critical wellness issues affecting the
veterinary community and impacting the quality of care to animals (Lovell & Lee, 2013).
Occupational stress and psychological distress contribute to the growing suicide rates of
veterinarians in the United States and the ongoing industry concerns about mental health (Nett et
al., 2015).
In December 2019, scientists in China identified the coronavirus disease 2019 (COVID-
19), suspected of being zoonotic in origin, which spread globally in a matter of weeks resulting
in tens of thousands of cases and almost 2,000 deaths (Garfin et al., 2020). On March 13, 2020,
COVID-19 was declared a U.S. public health emergency, which changed the way we worked
and lived and created uncertainty for the U.S. public (Says, 2021). The rapid spread of the virus
initiated social distancing, self-isolating, and mandated lockdowns to contain the virus from
spreading (Galea et al., 2020). Exposure to an abundance of news coverage from health officials
and journalists sharing transmissibility, death rates, and precautionary measures was conflicting
and constantly changing, causing psychological distress, anxiety, mistrust, and fear of a virus
with no cure or vaccination (Garfin et al., 2020). The U.S. government responded by closing
borders, implementing quarantine-in-place guidelines, and closure of non-essential businesses.
Veterinarians categorized as essential workers during the pandemic were challenged with
determining what was essential care, providing for sick and injured pets, interacting with the
public at the risk of their own and their family’s health, and complying with changing
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government-imposed restrictions (Quain et al., 2021). The COVID-19 pandemic has created high
levels of occupational stress within organizations, leading to a further negative impact on
employee wellbeing. This study examined the literature and contributes to the ongoing
conversation on veterinary wellbeing by exploring organizational and leadership practices
implemented during the COVID-19 pandemic that positively impacted veterinarians’ wellbeing.
Background AND Context of the Problem
COVID-19 has been identified as one of the greatest medical and public health
challenges presented in decades, with the greatest impact on individuals living with underlying
health conditions such as cardiovascular disease, diabetes, and chronic lung disease (Centers for
Disease Control and Prevention [CDC], 2021). The severe acute respiratory syndrome
coronavirus 2 (SARS-coV-2) is an infectious disease that is transmitted from an infected
person’s mouth or nose in small liquid particles when they cough, sneeze, speak, or breathe to
another individual (World Health Organization [WHO], 2021). The WHO identified the
coronavirus disease 2019 (COVID-19) as a novel infectious disease caused by a newly
discovered SARS-CoV-2 that emerged in late 2019 in Wuhan, China, and declared the outbreak
a global pandemic on March 11, 2020 (WHO, 2021). On March 13, 2020, the United States
declared COVID-19 a public health emergency creating fear for many people as governments
abruptly implemented stay-at-home orders impacting all organizations, businesses, and schools
to limit the spread of the virus, generating feelings of stress and uncertainty (Says, 2021).
COVID-19 and its countermeasures caused a worldwide crisis due to the medical and public
health impact, socio-economic consequences, and social isolation (Menculini et al., 2021).
Most employers lacked business continuity plans to address this type of crisis and were
thrust into an unprecedented period with little clarity and understanding of the overall impact or
3

length of time needed to control the spread of the virus. COVID-19 presented new occupational
and family stressors, physical and mental health consequences, and leadership challenges that
employers and employees had not previously experienced or anticipated. More than 55 million
workers were in jobs considered essential to maintaining critical infrastructure (Minihan et al.,
2020), and while some workers in essential industries were able to work remotely, the majority
were unable to work from home, placing them in close proximity to others for potentially being
exposed to the virus, increasing their risk of illness and death (Yaqub, 2020). The subset of
essential workers who were unable to work from home was termed frontline workers (Blau et al.,
2020). Workers who interacted with customers were five times more likely to test positive for
COVID-19 and reported significantly higher rates of anxiety and depression, suggesting that
frontline workers were at risk for experiencing significant mental health issues related to the
stress associated with working throughout COVID-19 (Gaitens et al., 2021). Employers of
essential businesses reacted quickly to develop and communicate new safety and health policies,
procedures, and new measures for interacting with other employees and the public to keep their
workers safe.
Veterinarians were deemed essential frontline workers caring for sick and injured pets
and protecting humans from zoonotic disease. During the COVID-19 pandemic, veterinary
professionals put themselves, their families, and communities, at risk of personal infection from
contact with sick pets and interaction with the public. It was initially unclear if veterinarians
could contract COVID-19 from pets, resulting in additional anxiety from veterinarians. In a
survey conducted by the British Veterinary Association in 2020, 50% of small animal practicing
doctors were concerned about contracting COVID at work (Association, 2020). The American
Animal Hospital Association has reported that 356 pets have been diagnosed with SARS-CoV-2
4

since the beginning of the pandemic, 208 companion animals and 148 captive animals
(McReynolds, 2022).
Pre-pandemic, Merck (2019) conducted a health and wellbeing study, surveying more
than 11,000 practicing U.S. veterinarians, where it identified occupational stress, psychological
distress, and student debt as top reasons for burnout, compassion fatigue, anxiety, emotional
exhaustion, and an overall lack of wellbeing among veterinarians (Volk et al., 2018). Pre-
pandemic, industry studies have shown that veterinarians must cope with occupational stressors
regarding frequent communications of death and dying, work conditions, business practices,
angry and emotional clients, euthanasia, and long hours (Emmett et al., 2019). Occupational
stress and psychological distress among veterinarians in the U.S. have resulted in suicide rates
higher than any other healthcare profession (Tomasi et al., 2015). Veterinarians in the United
States are four times more likely than the public to die by suicide, according to the Centers for
Disease Control and Prevention (Nett et al., 2015). A survey conducted by Veterinary
Information Network in 2014 of 11,627 practicing veterinarians identified that 1 in 11
veterinarians had serious psychological distress and 1 in 6 experienced suicide ideation since
leaving veterinary school. Implementing measures to help veterinarians cope with practice-
related stressors and reducing barriers to mental health treatment might reduce suicide among
veterinarians (Nett et al., 2015). The gender distribution in the veterinary profession is currently
more than 60% female and will continue to shift as the current student population in veterinary
school is more than 80% female (Tomasi et al., 2019). Studies show that female veterinarians
represent a vulnerable group for stress and stress-related illnesses (Emmett et al., 2019).
The COVID-19 pandemic exacerbated the traditional causes of burnout for veterinary
professionals through rapid and dramatic changes in government operating mandates, operational
5

protocols, and process changes (shifting to telehealth, curbside drop-off, and virtual check-ins
and check-outs), determining what counted as a valid veterinary client-patient relationship,
adjusting to staffing shortages due to sick and quarantining staff, and increased workload due to
the number of pets adopted during COVID-19 (Neill et al., 2022). Veterinary teams traditionally
work closely together in confined spaces, which also makes it difficult to practice physical
distancing in the workplace and interact with clients in small patient exam rooms, preventing the
inability to social distance. In addition, due to the surge of COVID-19 patients in human
healthcare, overloading hospital systems, veterinary teams were asked to donate or forfeit
personal protective equipment and medical equipment, such as ventilators, for human healthcare
and limit the range and types of procedures offered in veterinary care to truly essential services
(Ridley et al., 2020). Veterinarians were faced with the ethical tension of balancing animal
welfare and the health of the public, their colleagues, and their families (Quain, 2021).
According to the 2021 American Veterinary Medical Association’s (AVMA) Report on
Economic State of the Veterinary Profession (Bain et al., 2021), 40% of veterinarians are
considering leaving the profession due to lack of work-life balance followed by mental health
challenges such as stress, anxiety, or depression. COVID-19 introduce new ethically challenging
situations adding to the existing health and wellbeing concerns for veterinarians and their
obligation to animals, clients, employers, and their community. While there has been an ongoing
focus on individual wellbeing, resilience, and self-care to combat veterinary burnout, a focus on
organizational interventions, workplace environment, team culture, and quality of leadership are
important areas of focus in support of veterinarian wellbeing (Neill et al., 2022).

6

Stakeholder Groups for the Study
In alignment with the problem of practice, this study identifies four main stakeholders:
employers, direct supervisors of veterinarians, academia, and industry groups supporting the
advancement of the profession. Employers have the ability to increase staffing resources to
satisfy demand requirements; design roles, responsibilities, and organization structures; and
implement policies, practices, benefits, and training programs to impact veterinarian wellbeing.
Direct supervisors of veterinarians have a direct ability to provide support to the veterinarian in
personalized and impactful ways. Academia has the ability to shape the thinking and
expectations of veterinarians as it relates to their professional responsibility and contributes to
the fundamental operational knowledge and communication skills needed to support the
wellbeing of veterinarians. Veterinary industry groups have a desire to protect the health, safety,
and welfare of veterinarians as a professional body and to ensure the perpetuation of the
profession, while advocating for the needs of pet professionals.
Purpose of the Project and Research Questions
This study aimed to examine organizational and leadership practices implemented during
the COVID-19 pandemic that positively impacted veterinarians’ wellbeing. The following
research questions guided this study:
1. How has burnout, emotional exhaustion, and fatigue impacted veterinarian effectiveness
throughout the COVID-19 pandemic?
2. What specific strategies have organizations and leaders implemented that support the
wellbeing of veterinarians during the COVID-19 pandemic?

7

Importance of the Study
Veterinarians’ health is critical to the delivery of veterinary medicine. Doctors are
necessary to research virus transmission through pets, protect humans from zoonotic disease, and
care for sick and injured pets. According to the American Pet Products Association (COVID-19
Pulse Study, 2021), American households adopted 12.6 million additional pets during the
pandemic, generating increased demands for veterinary services and adding to the already high
workload for veterinarians and the pressures of clinical talent shortages. Veterinarians were
already struggling to meet pre-pandemic demand, with veterinary schools unable to increase the
number of veterinary doctors.
To sustain through the pandemic, organizations implemented a variety of wellbeing
practices to support healthcare workers. Leaders played a critical role in managing the working
climate, developing operating practices to support safety, and supplying resources and strategies
needed for healthcare workers’ wellbeing. This study’s axiology places value on the health and
wellbeing of frontline veterinarians and recognizes the responsibility of employers during
COVID-19 to keep veterinarians healthy and persisting in the profession and the influence direct
supervisors and organizations have on the individual wellbeing of veterinarians. The importance
of this research serves the interest of employers of veterinarians, direct supervisors of
veterinarians, academia, and veterinary professional industry organizations and will assess the
level of occupational stress, burnout, emotional exhaustion, fatigue, and engagement impacting
employee effectiveness and wellbeing amongst veterinarians following two years of a global
pandemic. This study will also clarify which organizational strategies were effective in
supporting the wellbeing of veterinarians and should be continued post-pandemic. This study
also aims to learn whether the impact of any of these strategies varied by gender.
8

Overview of Theoretical Framework and Methodology
Bronfenbrenner’s (1979) ecological systems theory will guide this quantitative study and
will focus on the first level, the microsystem, and the second level, the mesosystem. This
theoretical framework will provide the basis to address the problem of practice and support the
examination of how veterinarians persisted throughout the COVID-19 pandemic. The theory
suggests that what makes an individual is a nested arrangement of five interconnected layers: the
microsystem (the individual’s immediate environment); the mesosystem (the interactions
between the individual’s microsystems); the exosystem (the individual’s formal and informal
social structures); the macrosystem (the cultural elements); the chronosystem (all the
environmental changes that occur over a lifetime). Bronfenbrenner defines the microsystem as
the individual’s immediate environment, which includes individuals who have a high level of
influence in shaping the individual person, such as their immediate family, friends, and school.
The next level is the mesosystem which are the interactions between the microsystems, such as
the individuals’ parents’ relationship with the school, in addition to the institutions,
organizations, and groups that most immediately and directly impact an individual’s
environment. The five interrelated layers of each system influence the individual’s life and are
related to the others (Salazar & Beanton, 2000).
Bronfenbrenner’s (1979) ecological framework helps identify the impact of the
COVID-19 pandemic on the role of veterinarians. Bronfenbrenner’s first level of the ecological
model (microsystems) is the individual veterinarian. The direct interactions between the
veterinarian and their immediate environment have an impact on their wellbeing and are bi-
directional. The microsystem is the veterinarian’s immediate surrounding environment, including
family members, personal friends, and peer employees. The organization and direct supervisor
9

represent Bronfenbrenner’s second level of the ecological model, the mesosystem, providing the
structure that further influences the individual veterinarian. COVID-19 led to the mandate of
government emergency policies, resulting in the macrosystem of social, legal, government, and
educational structures to be impacted. These system changes triggered elements in the
exosystem: a focus on the risk associated with being an essential frontline worker interacting
with the public, during a time of mandatory quarantine, and increased need for veterinary care
services due to the acquisition of pets triggering increased need for pet care. Veterinarians were
influenced by their lived experiences, direct influences, educational background, and beliefs.
Definitions
There are no universal definitions for wellbeing, burnout, fatigue, and emotional
exhaustion. For this research, the key concepts in this study are defined as follows.
Burnout: a state of emotional, physical, and mental exhaustion caused by excessive and
prolonged stress that occurs when an individual feels overwhelmed, emotionally drained, and
unable to meet constant demands (Volk et al., 2018). The WHO (2019) defined burnout as a
“syndrome conceptualized as resulting from chronic workplace stress that has not been
successfully managed.”
Compassion fatigue: stress from exposure to a secondary traumatized individual and
cumulative burnout, resulting in a state of physical and mental exhaustion caused by an inability
to cope with one’s routine environment (Cocker & Joss, 2016).
COVID-19: Defined by the CDC as a respiratory disease caused by SARS-CoV-2, a new
coronavirus discovered in 2019. The virus is spread from person to person through respiratory
droplets produced when an infected person coughs, sneezes, or talks (Coronavirus Disease 2019
(COVID-19) | Disease or Condition of the Week | CDC, 2020).
10

Emotional exhaustion is a sign of burnout and is the state of feeling emotionally worn-out
and drained as a result of accumulated stress from your personal or work life. People
experiencing emotional exhaustion lack energy, have decreased motivation, are frequently
overwhelmed and are experiencing poor sleep (Glicken & Robinson, 2013).
Essential workers considered vital for maintaining the health, safety, and wellbeing of the
community in times of an emergency and therefore must continue to work and provide services
during the pandemic (COVID-19: Essential Workers in the States, 2021).
Fatigue involves extreme tiredness and reduced functional capacity and can manifest
physically, mentally, and emotionally. Fatigue can be exacerbated by any or all of the following:
lack of sleep, disruptive work, lack of rest cycles, neurological conditions, excess mental or
physical workload, exposure to extreme conditions, emotional stress, use of drugs or alcohol or
illness (CDC, 2021).
Occupational Stress: a chronic condition associated with the workplace and is linked to
seven of ten leading causes of death globally as defined by the National Institutes of Health
(Quick & Henderson, 2016, pg 458). There are three parts to be considered when analyzing
occupational stress: 1) the causes and risk factors, 2) the stress response, and 3) medical,
psychological, and behavioral consequences of distress (Quick & Henderson, 2016).
Pandemic: defined by the WHO (Kelly, 2011), is an epidemic occurring worldwide,
crossing international boundaries, and usually affecting many people. COVID-19 was declared a
pandemic in March 2020 by the WHO (Cucinotta & Vanelli, 2020).
A veterinarian is defined by the Bureau of Labor Statistics as a clinically trained licensed
professional who cares for the health of animals and works to protect public health. Veterinarians
11

must have earned a Doctor of Veterinary Medicine (DVM) degree from an accredited veterinary
college and a state license (BLS, 2021).
Wellbeing: according to the Centers for Disease Prevention (CDC), wellbeing integrates
an individual’s mental health and physical health, resulting in more holistic approaches to
disease prevention and health promotion (CDC, 2021). Wellbeing includes the presence of
positive emotions and moods and the absence of negative emotions and includes a variety of
different aspects that include physical, economic, social, development, emotional, and
psychological components.
Organization of the Dissertation
Chapter One begins with the statement of the problem of practice, the importance of
the study, industry context, research questions, the theoretical framework, the target
population being studied, proposed methodologies, and conceptual definitions. Chapter Two
is a review of current literature on wellbeing in the workplace, work health promotion, and
wellbeing in healthcare and veterinary care. The chapter will focus on workplace strategies
that prevent or mitigate occupational stress, burnout, emotional exhaustion, and fatigue, while
increasing engagement and effectiveness for veterinarians. Chapter Two will also include key
employer organization and leadership strategies deployed during the COVID-19 pandemic.
Chapter Three describes the research design methodologies used in the quantitative study as
well as the specific attributes of the participant sample, data sources, instrumentation, and data
collection procedures. Chapter Four contains the results of the structured survey and includes
data analysis and key findings. Chapter Five delivers conclusions from the research analysis
against the existing literature and theoretical foundation on the problem of practice, as well as
12

outlines implications, recommendations, and opportunities for further research. This section
also includes design limitations as well as researcher conclusions

13

Chapter Two: Literature Review
This literature review aims to examine what organizational and leadership practices
implemented during COVID-19 have positively impacted veterinarians’ wellbeing? Due to the
recency of the pandemic, there are few empirical research documents available regarding
veterinarian wellbeing and effectiveness during COVID-19. The following chapter evaluates the
current state of knowledge in the field of wellbeing in human and veterinary healthcare. It
examines selected peer-reviewed literature on topics connected to the problem of practice in
veterinary care. In addition, professional sources considered reliable and relevant are consulted,
such as research from industry groups, governmental agencies, and non-governmental
organizations. The five main topics emerging from this literature review are as follows: (a) what
wellbeing is and how it evolved in the workplace, (b) workplace antecedents, (c) the employer
lens on workplace health promotion and the business case, (d) wellbeing in veterinary medicine,
and (e) the global pandemic and its impact on wellbeing in human and veterinary health care.
Wellbeing in the Workplace
Workplace health as a foundational concept date to the 1600s when Italian physician
Bernardini Ramazzini wrote about the effects of occupational disease and preventative measures
(Rucker, 2016). The Industrial Revolution focused on occupational injuries, which led to
initiatives to improve occupational safety and health and established the foundation for labor
unions. During the 19th and 20th centuries, employers recognized that various chemical,
physical, and biological agents could harm workers’ health, which resulted in a focus on
eliminating work-related hazards (Litchfield et al., 2016). Government regulation emerged over
this time, and workers and their families began to sue employers over unsafe and unhealthy
working conditions. Initially, the courts ruled in favor of the employer and then shifted to the
14

employee when the evidence was clearly in their favor, which resulted in settlements, liability
insurance, death insurance, and increased medical expenses (Danna & Griffin, 1999). In the
1970s, the Occupational Safety and Health Act guaranteed Americans a workplace free from
recognizable hazards. Employers focused on workplace conditions, equipment standards, and
safe working processes to minimize workers’ exposure to harm and injury. By the 1980s,
employers focused on physical health programs addressing absenteeism and expenses associated
with employee injury, illness, liability, and medical benefits (Rucker, 2016).
Defining Wellbeing in the Workplace
The topic of workplace wellbeing is broad and diverse. While researchers have made
increased efforts to define wellbeing, there is no clear definition or agreed standard for
evaluating employee wellbeing. The topic is complex from many business perspectives and
varies globally according to country, language, and culture. The terminology varies from health
and safety, wellness, and occupational health to wellbeing at work (WBW), referring to similar
employment factors. The definition of WBW has evolved from basic standards for working
conditions focused on occupational safety to the role of the workplace in enabling employees to
thrive as individuals. Efforts to increase WBW intend to improve the health of the employee and
their families while mitigating employer-related costs and liability. Traditionally, the focus of
WBW has been individual or organizational concern from the physical, emotional, mental, or
social perspective (Danna & Griffin, 1999).
King (2007) expanded the definition of wellbeing from individual wellbeing to collective
wellbeing, comprising community, ethnic and cultural groupings, and other groups of shared
interest and/or characteristics. King suggested that relationships, industry, professional,
neighborhood, and community networks, government resources and policies, and transportation
15

infrastructures influence collective wellbeing. Employers are further shifting to a multifaceted,
holistic approach and recognize the interdependencies of physical health and financial, mental,
career, and community health (Clifton & Harter, 2021). Research has found that the work
environment can positively or negatively impact employee engagement, physical wellbeing,
mental health, and stress levels and questions whether symptoms such as burnout are about the
workplace and not the people (Moss, 2019). The literature on wellbeing at work continues to
evolve, and researchers have defined wellbeing in a variety of ways.
Six Dimensions of Wellness Model
Hettler (1976) viewed wellness as an active process through which people become aware
of, and make choices toward, a more successful, positive, and affirming existence. Hettler
developed the Dimensions of Wellness Model (SDW) as president of the National Wellness
Institute, an organization established to promote and support wellness. Through the application
of the SDW, individuals become aware of the interconnectedness of the six dimensions and their
contributions to healthy living. The model is a pathway to optimal living. In the SDW model, all
six wellness dimensions (social, physical, occupational, emotional, spiritual, and intellectual)
must be present for an individual to have overall wellness (Hettler, 2008). Occupational wellness
means balancing leisure time and work time by addressing work-related stress. The model
identifies that when individuals contribute their skills meaningfully at work, they achieve
satisfaction. Employees also achieve satisfaction by choosing a career path matched with their
passion, motivation, and ambition (Hettler, 2008).
The SDW identifies six broad categories that link organization dimensions to causes of
stress and apply to healthcare workers. Physical wellness recognizes the need for daily physical
activity and encourages an individual to care for their physical body through proper diet and
16

nutrition, physical activities, and good mental condition. Social wellness recognizes the need for
individuals to be aware of their existence and to be contributing members of society. Intellectual
wellness emphasizes the need to explore new ideas, expand knowledge, and stretch our minds
through exercising creativity and intellectual curiosity. Spiritual wellness emphasizes the
meaning in life and purpose in human existence and includes optimism, love, compassion, joy,
and happiness. Spiritual dimensions also can include pessimism, intolerance, despair, fear, doubt,
and disappointment. Spiritual wellness also includes ethics and moral decision making.
Emotional wellness contains aspects of self-confidence, trust, self-acceptance, self-awareness,
and self-control. It also involves the ability for individuals to be aware of and address worry,
attitude, and flexibility. Occupational wellness centers around personal satisfaction and
enrichment in one’s life through work. It involves the premise that occupational development is
related to an individual’s attitude about their work and connection to personal values, interests,
and beliefs (Hettler, 1976, p. 1-2).
While an employer can influence many aspects of WBW, an employee’s skills and
capabilities, behaviors, and personal life also influence wellbeing. Employers appreciate the
many interdependencies and immense challenges of balancing home, family, pets, and work to
achieve employee wellbeing and satisfaction.
The Concept of Wellbeing Has Changed
While there continue to be hazards in the modern workplace, workers expect employers
to provide a workplace free from physical harm (Litchfield et al., 2016). Health and safety
hazards create dangerous work settings, which, in turn, harm workers’ health and wellbeing and
result in negative physical, psychological, and behavioral consequences. Organizational
consequences of poor wellbeing are lost productivity, inconsistent quality of care, client
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dissatisfaction, increased medical costs, absenteeism, and employee turnover (Danna & Griffin,
1999). Over the past 20 years, workplace wellness programs have evolved and moved from
injury prevention and medical cost containment to a holistic appreciation of employee wellbeing
and the desire for associates to thrive while delivering business objectives. Employers prevent
on-the-job injuries and promote healthy lifestyles (Torrington, 2008). Wellness research further
demonstrates that employers have shifted to proactive measures focused on the absence of illness
and health mitigation strategies, including hedonic wellbeing strategies to improve happiness and
pleasure and eudemonic wellbeing to improve energy (Ryan & Deci, 2001).
Defining Wellbeing Through Work Experience
A European study identified common themes in the definition of wellbeing, highlighting
the work, experience, and description of experience (Anttonen et al., 2019). WBW means safe,
healthy, and productive work in a well-led organization with competent workers and
communities who see their jobs as meaningful and rewarding and see work as a factor that
supports their life management. The worker’s experience is influenced by how safe, healthy, and
organized work is and how meaningful and rewarding a person finds it, accounting for the
factors of leadership, competence, and productivity. WBW describes the workers’ experience
with the safety and healthiness of work, good leadership, competent change management, the
organization of work, the support of the work community for the individual, and how meaningful
and rewarding the person finds work (Anttonen et al., 2019).
Gallup’s Definition: Wellbeing at Work
The Gallup Organization surveyed over 2.6 million workers and conducted the Q12
employee engagement survey to understand the effects of the organizational, team, and
environment on workers’ quality of life and performance (Gallup, 2022). Gallup defines engaged
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employees as involved in, enthusiastic about, and committed to their work and workplace.
Clifton and Harter (2021) studied stress and health, focusing on the theory of person-
environment fit and the behavioral, cognitive, and health benefits of positive feelings. Gallup
research demonstrates the relationships among employees, workplace, and business unit
outcomes. It prescribes that positive workplace perceptions are associated with higher
engagement, better financial results, greater productivity, and lower turnover. Clifton described
wellbeing as five types: physical, social, career, community, and financial, suggesting that
different combinations of the five focus areas of wellbeing emerge uniquely for each individual
and are different in various life stages (Clifton & Harter, 2021). Gallup’s initial work on
employee engagement identified cognitive and emotional antecedents in the workplace that
generate positive correlations to employee retention, innovation, and business outcomes (Harter
et al., 2003).
Antecedents and Interventions Associated With Wellbeing at Work
Many employers, organizations, and countries have implemented interventions to
improve their workers’ wellbeing, demonstrating the positive impact employers can have on
wellbeing by addressing antecedents and lessening occupational stressors while improving
individuals’ coping mechanisms (Danna & Griffin, 1999). Today, more workplace injuries are
psychological and related to the way work is organized than caused by physical hazards of the
job (Litchfield et al., 2016). Mental health disorders have become the most important cause of
disability in all WHO regions, accounting for around one-third of years lost to disability among
all individuals 15 years and older (WHO, 2004).
The Health and Safety Executive (2009) published the primary sources of stress affecting
psychological health as management standards for organizations: Demands are issues such as
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workload, work patterns, and the work environment. Control refers to how much say the person
has in the way they do their work. Support is the encouragement, sponsorship, and resources
provided by the organization, line management, and colleagues. Relationships refer to promoting
positive working interactions, avoiding conflict, and addressing unacceptable behavior. Role
refers to whether people understand their role within the organization and whether the
organization ensures that they do not have conflicting roles. Change is how organizational
change (large or small) is managed and communicated in the organization (Spreitzer, 2017)
Cooper and Marshall (1978) developed a comprehensive model that conceptualizes the
sources of occupational stress in six categories with relevance to healthcare workers: (a) factors
intrinsic to the job include work overload, or underload, high work variability, shift patterns,
length of shifts, risk and danger, new technology, and the quality of the working environment;
(b) role in the organization due to ambiguity, conflicting duties, redundant roles, and the degree
of responsibility for others pain and suffering are also major sources of potential stress and
emotional exhaustion; (c) interpersonal relationships at work: superiors, peers, and subordinates
have also been identified as potential stressors; (d) career development: job insecurity,
downsizing, lack of career progression, lack of development; (e) organizational structure,
leadership, and culture to include poor financial performance, poor communications, and
organizational politics; (f) home / work interface: the need to balance work and life which can
create the need for flexibility in scheduling, especially with dual career families (Cooper &
Marshall, 1976, pp. 11–28).
Evidence suggests that overwork (high demand, low support) can be related to marital
conflict, and the spillover of occupational stress is multidimensional (Danna & Griffin, 1999).
Findings from Fletcher (1988) support the link between work stress and its effect on
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psychological health, physical health, life expectancy, and marital satisfaction. Identifying work
setting and occupational antecedents to stress helps employers understand organization drivers
that influence WBW, and it is also important to identify the psychological needs required to
achieve positive WBW.
Psychological Needs and Motivation
Maslow’s (1943) hierarchy of needs provides a roadmap for employers that can frame
WBW based on the concept of psychological needs that drive behavior. Maslow’s research is
one of the most popular and often-cited theories of human motivation (Huitt, 2007). The
hierarchy identifies five levels of needs: physiological (biological needs), safety (physical and
psychological), belonging (relationships), esteem (feeling valued, confident, and respected), and
self-actualization (fulfilling one’s potential; Arnold & Randall, 2010; Maslow, 1943, 1971). The
foundational level refers to physical health. The next level is psychological, manifesting in the
work environment, safety, and security. The third level is social wellbeing, supported by
relationships, communities, and human interaction and engagement. The fourth is about self,
recognition, and esteem, and the fifth level is about self-actualization, such as ambition and goal
achievement. Maslow’s hierarchy of human needs is often represented as a triangle or pyramid.
Only when the lower-order needs of physical and emotional wellbeing are satisfied are people
concerned with the higher-order needs of influence and personal development and growth.
Conversely, if the lower-order needs are not satisfied, individuals are no longer concerned about
maintaining their higher-order needs. The lower four layers contain what Maslow (1971) called
deficiency or deprivation needs. If these needs are not met, the individual’s wellbeing is
compromised. Humans require security, food, shelter, personal safety, air and water, and
emotional needs for connectedness (Huitt, 2007).
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Otala and Ahonen (2003) added one additional layer to Maslow’s work focused on values
and motivation. The layer on motivation has the most impact on productivity (Azadeh & Zarrin,
2016). Motivation is traditionally explained in direction/choice, intensity/effort, and
persistence/duration and is related to why individuals continue to pursue an objective. This work
on motivation and basic needs is relevant to the problem of practice as infectious disease
research conducted during severe acute respiratory syndrome, H1N1, and Ebola outbreaks
identified that frontline healthcare workers were at risk for higher psychological issues, including
chronic stress, anxiety, depression, and posttraumatic stress syndrome (Denning et al., 2021).
The COVID-19 pandemic placed unprecedented pressure on healthcare systems and workers in
the form of high patient volumes, long work hours, and workplace demands and created
questions for healthcare workers about their own safety and the safety and wellbeing of their
families. Maslow’s hierarchy helps to establish the framework of foundational needs for
healthcare workers to persist in their profession. COVID-19 has accelerated an exodus of
healthcare workers by 20% to 30% as individuals consider retirement or alternative professions
due to mental health concerns (Denning et al., 2021).
Workplace Productivity
Traditionally, goods or services produced quantified employees’ workplace productivity.
Various studies have found that healthy and motivated employees are more productive than those
less well. Wellbeing is a holistic concept that characterizes an employee’s life quality and
includes occupational safety and health aspects. Organizations correlate productivity at the
individual, enterprise, and social levels, connecting workforce wellbeing, productivity, and
population wellbeing (Schulte & Vainio, 2010). Work environment, competence, motivation,
leadership, atmosphere, and organizational culture drive performance and productivity (Aura et
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al., 2010). Research has moved from a focus on worker absenteeism to presenteeism, focused on
worker satisfaction and how to gain the most productivity from an employee at work through
both use of time and effectiveness (Stepanek, 2019). Aura et al. (2010) highlighted that good
employee productivity is related to company economic performance and WBW.
Organizational Wellbeing Models
The literature review identified multiple models that apply to the problem of practice and
provide healthcare employers insights into improving organizational wellbeing and workplace
productivity. These models highlight job design, resourcing, the role of leadership, and
individual motivation.
Job Characteristics Model
Hackman and Oldham (1976) developed the job characteristics model to examine the
critical elements of job design in determining the satisfaction and psychological reaction
employees have to their work. The model identifies five core characteristics: Skill variety is
defined as making use of an appropriate variety of skills and talents for a given individual worker
– neither too many as to be overwhelming nor too few leading to boredom. Task identity is the
ability to identify a recognizable outcome from the task undertaken, either as an individual or
part of a group, so that the worker can feel a sense of achievement and pride. Task significance is
characterized as seeing that the task has a beneficial impact on others, over and above the worker
himself or herself, either within or outside the organization. Autonomy speaks to the degree of
freedom, independence, and discretion in the way work is scheduled and the process by which it
is carried out. Feedback is defined as providing information on how effective the worker has
been in converting effort into performance (so that mistakes can be learned from) and connecting
the worker emotionally with the end-user of his output (Hackman &Oldham, 1976. P. 250-279).
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The job characteristics model has helped improve organizational performance, quality of care,
motivation, and satisfaction. This model is appropriate for veterinary healthcare workers who
experience limited autonomy, flexibility in scheduling, high demand for general practice, dental,
and emergency services, and perform a wide variety of tasks to support animals of all types.
Job Demands-Resources Model
The Job Demands-Resources Model (JDRM), developed by Bakker and Dermouti
(2006), was developed as an alternative to existing models of wellbeing. The model identifies
that job demands and job resources cause job strain. The JDRM establishes a correlation between
high and low job demands and high and low job resources. Employers identify and address job
demands and identify resources and job positives to mitigate burnout and increase engagement.
In a study of 203 independent samples across various industries, the JDRM research identified
that health impairment and motivation were related to high work pressure, emotional demands,
and role ambiguity (Bakker & Demerouti, 2007). Job demands such as hazardous work,
complaining customers, workplace overload, or complexity impair employees’ health and relate
to burnout (Nahrgang et al., 2011).
Job resources related to proper staffing, gaining knowledge, autonomy, and a supportive
environment corresponded with positive employee engagement. In addition, job resources such
as social support, performance feedback and autonomy, and job-related learning are job positives
linked to organizational commitment and high work engagement (Halbesleben & Buckley,
2004). Job resources exist at the organizational level (pay, security, job opportunities), the
interpersonal level (supervisor, coworkers), in the organization of work (role clarity, decision-
making authority), or at the task level (feedback, variety, task identity, significance, autonomy),
(Bakker & Demerouti, 2007). Strong supervisor relationships and social support are the most
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common variables to address job demands and resources. Organizations can mitigate stress and
burnout by ensuring the right people are assigned the right roles based on skills and individual
strengths. Other solutions identified through the JDRM are related to clear work processes that
eliminate bottlenecks and redundant and inefficient workflow. This model is relevant to
veterinary care as most practices were originally small community clinics with sole clinician
practitioners performing multiple functions.
Job Demand Control Support Model
The Job Demand Control Support Model (JDCS), developed by Karasek (1979), is one of
the most widely studied models of occupational stress (Kain & Jex, 2010). The key finding
behind the JDCS is that control counters the impact of job demands and can help enhance
employees’ job satisfaction with the opportunity to engage in challenging tasks and learn new
skills. The research behind JDCS identified that job strain is brought about by a combination of
high job demands (work overload and time pressures) and low job control (inability to control
tasks throughout the day), generating stress and burnout. Job demands are the physical or
emotional stressors related to a demanding workload, stressful working environment, role
ambiguity, emotional labor, and poor relationships. Job resources are the physical, social, or
organizational factors that help individuals achieve goals and reduce stress, including strong
relationships, development, mentorship, and coaching (Bakker & Demerouti, 2007).
The JDCS model can help employees with a high workload identify why they experience
stress (Flynn & James, 2009). The model encourages managers to use the framework to converse
with employees to personalize strategies to improve job demands and highlights how supervisors
can influence the employees’ job satisfaction. Peers also play a key role in the model and are
critical to teamwork, the social interaction needed for critical and immediate support, and
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companionship. Key relevant research insights include (a) the need for autonomy, (b) decision-
making control, (c) strong relationships with supervisors or colleagues for social support, (d) a
focus on physical and psychological health, and (e) trusting and supportive relationships
(Karasek,1979).
Herzberg Two-Factor Theory
Herzberg’s (1966) two-factor theory focuses on using internal job factors to motivate
employees. Hertzberg’s theory reviews hygiene factors and motivators leading to job satisfaction
and dissatisfaction. Hygiene factors if absent create job dissatisfaction and are items such as
company policies, supervision, relationships, working conditions, salary, security. Motivators
include job components such as responsibility, decision making, autonomy, and challenging
work to generate more positive satisfaction amongst employees. Hertzberg’s research
demonstrated that the ability to meet higher-level hygiene needs leads to increased individual
satisfaction in the workplace and greater motivation (Comella et al., 2021). According to
Herzberg, hygiene factors can cause dissatisfaction among employees in the workplace and are
foundational to employee satisfaction. Hertzberg also found that managers need to recognize
both motivation and hygiene factors as they are independent of each other and both equally
important (Moss, 2019). Some of the most important ways to improve satisfaction are higher
wages, job stability, and a positive culture in the workplace. The model also addresses increased
satisfaction by improving employee motivation through recognition, growth, and acquiring new
skills. There are many opportunities to improve hygiene factors in veterinarian care as the
veterinary industry identified many contributors to stress, such as pay, benefits, procedures, and
relationships with coworkers and supervisors (Volk et al., 2018)
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The two-factor model (Herzberg, 1966) identifies four possible outcomes: high hygiene
and high motivation (highly engaged and satisfied), high hygiene and low motivation (few
complaints but not motivated), low hygiene and high motivation (employees are motivated, but
work conditions are not satisfactory), and low hygiene and low motivation (disengaged and
dissatisfied).

Table 1
Hertzberg Two-Factor Theory of Motivation
Leading to dissatisfaction Leading to satisfaction
Company policy Achievement
Relationship with supervisor Work itself
Salary Growth
Relationship with coworkers Recognition
Working conditions Responsibility
Supervision Advancement

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Workplace Health Promotion
The literature found that the employee has primary responsibility for managing their
health in the workplace; however, employees have growing expectations that employers will
support their wellbeing as the work environment is one of the primary sources of stress risk
(Prada-Ospina, 2019). Additionally, there is a growing sentiment on the role of the employer to
support employee wellbeing now that WHO has officially recognized burnout in its International
Classification of Diseases (ICD-11; Moss, 2019) as an occupation phenomenon. Many
employees expect employers to offer workplace wellness programs (Wieneke et al., 2019).
Extensive research indicates that wellbeing is the shared responsibility of employees,
supervisors, and organizations (CIPD, 2021; Danna & Griffin, 1999; Litchfield et al., 2016).
Large employers have moved from a focus on changing individual behaviors: offering wellness
courses, individualized coaching, self-monitoring tools, midweek wellness courses, and financial
incentives to organizational behaviors (Wieneke et al., 2019). Organizations are also focused on
the shared responsibility of the individual employee and addressing obstacles that create the
conditions for employees to be unwell (Wieneke et al., 2019). This shared responsibility has
highlighted the role of the line manager and leadership in fostering a culture of wellbeing in
organizations, enhancing the workplace environment. It creates greater engagement,
productivity, and organizational commitment in the workplace (Deloitte, 2021).
Employers’ Role in Workplace Health Promotion
Organizations are transparent that promoting health and wellbeing benefits employee
engagement, retention, quality, financial performance, and business objectives. The WHO
identified the workplace as an optimal setting for promoting health and wellbeing, including
fostering a safe and healthy physical and psychosocial work environment. The Centers for
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Disease Control and Prevention (CDC) noted the workplace is an important setting to educate
employees on the concepts of health protection, health promotion, and disease prevention due to
the time employees spend at work (CDC, 2021). In 2000, the U.S. Department of Health and
Human Services published a program, “Healthy People 2000 – Healthy People 2010,” which
aimed for 75% of worksites with more than 50 people to have comprehensive work health
promotion plans. The program focuses on five key elements: health education, supportive social
and physical work environment, integration of the program into the administrative structure,
related assistance programs for workers, and screening programs (Hughes et al., 2011).
Workplace health promotion identifies activities of employers, employees, and society to
improve people’s health and wellbeing while working. The objective of workplace health
promotion is to promote messages and programming that educates and influences individuals to
change their behavior while reducing work-related stress that negatively influences their long-
term health. Employees, their families, and communities’ benefit from the promotion of
wellbeing (Andersen et al., 2015). Workplace health promotion spans a wide range of topics,
such as work-life balance, mental health and work stress, aging, nutrition, health, lifestyles,
culture, employee development, wellness, and corporate social responsibility (ENWHP, 2017).
According to the European Agency for Safety and Health at Work in 2010, workplace
health promotion includes improving the way work is organized, improving the work
environment, encouraging employees to get involved in healthy activities, and encouraging
personal development (EU-OSHA, 2010). Government legislation has further advanced the push
for employers, employees, and communities to recognize the need for health promotion,
primarily in labor standards regarding family welfare, wage and hour laws, time away, and
required health benefits. Effective workplace programs support the reduction of health risks,
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improve health status, and improve the quality of life for employees while enabling employers to
reduce direct costs associated with injury, illness, and absenteeism and create healthier societies
(CDC, 2021).
Occupational Stress
Stress is an individual’s adverse reaction and causes a wide variety of complex personal,
emotional, and behavioral problems (Bunk & Magley, 2013). Two-thirds of all employees
encountered difficulties focusing on their jobs due to stress (Karatepe et al., 2009). Four
considerations substantiate the importance of wellbeing in the workplace for healthcare workers:
moral case, business case, regulatory case, and tragic case (Ripp & Shanafelt, 2020). The moral
case highlights the employer’s desire to demonstrate compassionate and empathic care to
individual employee instances of physical or mental health, challenging personal relationships,
self-harm, and substance abuse. The business case links wellbeing to increased engagement,
retention, and achievement of financial performance, client satisfaction, and the impact on
patient outcomes. The regulatory case links to the desire to comply with industry standards for
hospital accreditation. The fourth consideration is related to tragic consequences and the high
rates of clinician suicide (Ripp & Shanafelt, 2020).
According to the Mayo Clinic, the cost of physician burnout to the U.S. health system is
estimated at $3.4 billion annually and is contributing to the shortage of physicians (Davis, 2020).
Industry professional groups and academia are working to destigmatize mental health and
cultivate greater knowledge of mental health and wellbeing as part of medical school curricula,
clinical licensing, and accreditation (Davis, 2020). Mental health concerns are the most common
cause of absence for employees in developed countries, accounting for up to 40% of time lost,
with presenteeism adding at least 1.5 times the cost of absenteeism (Cooper & Dewe, 2008). The
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cost of burnout due to turnover and reduced working hours in veterinary care is estimated to be
approximately $997 million in lost revenue, and the industry level cost attributable to burnout is
$1.075 billion due to the cost of reduced clinical hours (Neill et al., 2022).
Higher psychosocial work demands in veterinary care are associated with decreased
occupational, physical, and mental wellbeing (McKee et al., 2021). The Copenhagen
Psychosocial Questionnaire (COPSOQ-III) has been used in veterinary care and is an
internationally validated and reliable instrument used to measure psychosocial workplace factors
across employee populations and workplaces. The COPSOQ-III examines wellbeing on the
individual and institutional level to assess workplace psychosocial dimensions and six domains:
demands at work, work organization and job contents, interpersonal relations, and leadership,
work individual interface, social capital, and health and wellbeing (Burr et al., 2019).
Burnout, Compassion Fatigue, and Emotional Exhaustion
Burnout, compassion fatigue, and work-life imbalance are sources of mental health
challenges in the workplace and are primary sources of stress and exhaustion. Burnout is a work-
related issue that leads to the emotional exhaustion and cynicism seen in service occupations or
roles focused on assisting other people (Bakker et al., 2008). It is a syndrome that develops in
response to work-related stress and consists of three distinct components: emotional exhaustion,
depersonalization, and diminished personal accomplishment (Maslach & Jackson, 1981;
Shanafelt et al., 2015). The Maslach Burnout Inventory (MBI) is commonly used to measure
burnout in human-services workers. It assesses burnout to better understand the personal, social,
and institutional variables that promote or reduce burnout (Maslach & Jackson, 1981). Burnout
impacts organizations in many ways, including clinical outcomes, patient satisfaction, and health
systems’ financial standing (Davis, 2020). The persistence of chronic workplace stress in
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healthcare organizations results in burnout, leading to poor quality of care, patient
dissatisfaction, increased medical errors, turnover, absenteeism, low morale, loss of empathy,
and quitting (Vahey et al., 2004; West et al., 2012). Burnout is also correlated with personal
distress, physical exhaustion, insomnia, increased alcohol and drugs, and marital and family
problems (Maslach & Jackson, 1981).
Christina Maslach, professor emerita of psychology at the University of California,
Berkeley, said in a recent Harvard Business Review article on burnout, “Categorizing burnout as
a disease was an attempt by the WHO to provide definitions for what is wrong with people
versus what is wrong with companies,” (Moss, 2019). In the same article, Maslach cites a Gallup
survey of 7500 full-time employees who identify the top five reasons for burnout are (a) unfair
treatment at work, (b) unmanageable workload, (c) lack of role clarity, (d) lack of
communication and support from their manager, and (e) unreasonable time pressure, further
identifying root causes in burnout (Moss, 2019).
Emotional exhaustion has been identified as the first stage in burnout syndrome (Cordes
& Dougherty, 1993) and is chronic fatigue or a lack of energy due to the depletion of one’s
emotional resources and excessive psychological demands (Gaines & Jermier, 1983; Maslach et
al., 2018). A veterinarian’s diminished emotional resources can damage their level of service to
clients. Cynical attitudes and negative feelings toward clients develop (Maslach et al., 2018).
Cynicism is defined as callous, distanced, negative attitudes toward an organization, work, or
coworkers and results from emotional exhaustion (Bakker et al., 2008). Individuals experiencing
burnout syndrome evaluate themselves negatively regarding their work and clients, feeling
unhappy and dissatisfied with their accomplishments on the job (Maslach, 1993). Employees
suffering from burnout demonstrate lower job effectiveness and performance due to a reduction
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in energy and effort to perform well, becoming trapped in a negative cycle where one is not
motivated to change their situation (Bakker et al., 2008). There are three types of energy
accounts: physical, emotional, and spiritual. Burnout occurs when energy accounts are depleted
more than filled (Drummond, 2016). Proper rest, healthy relationships at home and work,
community service, and achieving a personal sense of purpose can add to energy accounts.
Research has found that self-efficacy is an effective protective coping strategy to address fatigue
and posttraumatic stress symptoms (Carmassi et al., 2020).
Fatigue is a common characteristic of chronic job stress and burnout and is defined as “an
experience of tiredness, dislike of present activity, and unwillingness to continue” (Bartley,
1970), or “as a disinclination to continue to perform the task at hand and a progressive
withdrawal of attention from environmental demands” (Brown, 1994). Fatigue has been
traditionally seen as unidimensional in working populations and is more recently being seen as a
multidimensional construct having five components: general fatigue, physical fatigue, reduction
in activity, reduction in motivation, and mental fatigue (De Vries et al., 2003). The Fatigue
Assessment Scale (FAS) has been identified as the most promising fatigue measurement tool
(DeVries et al., 2003). Fatigue scales were originally developed for patient populations, and the
Energy and Fatigue Scale of the WHO, Quality of Life Assessment Instrument (WHOQOL-100)
is an example of a measurement tool being used to evaluate patient and healthy community
populations.
The term “compassion fatigue” describes stress resulting from exposure to traumatized
patients rather than from exposure to the trauma itself, which is very common among healthcare,
community service, and emergency workers (Cocker & Joss, 2016; Deering, 1996). Compassion
fatigue is the convergence of secondary traumatic stress and cumulative burnout, a state of
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physical and mental exhaustion caused by an inability to cope with one’s routine environment
(Cocker & Joss, 2016). As a part of the demands of the healthcare worker, symptoms can
materialize in the form of inability to empathize, hopelessness, anxiety, depression, poor
concentration, and cognitive issues (Davis, 2020). Compassion fatigue can create higher
absenteeism, decrease engagement and productivity, and increase turnover (Heeter et al., 2017).
Another common behavior of individuals suffering from burnout is a reduction in self-
confidence in their ability to solve work-related problems, which, over time, results in
detachment in the workplace (Maslach & Jackson, 1981). Extensive burnout, depression, and
suicidal thoughts can lead to alcohol abuse, drug abuse, and self-harm, which are growing
industry concerns in veterinary medicine.
Wellbeing in Veterinary Medicine
The lack of veterinarian wellbeing and mental health concerns are well-researched and
documented (Armitage-Chan, 2020). The veterinary profession in the United States has some of
the highest levels of occupational stress, burnout, compassion fatigue, and rates of suicide among
healthcare professionals (Nett et al., 2015). In a 2014 study of more than 11,000 small animal
veterinarians and practice owners, approximately 1 in 11 had severe psychological distress, and 1
in 6 experienced suicidal ideation since leaving veterinary school (Nett et al., 2016). Female
veterinarians make up more than 60% of the practicing small animal doctors and more than 80%
of the veterinary student population (Tomasi et al., 2019). In a study from 1979 to 2015, female
veterinarians in clinical and non-clinical roles were 3.4 to 5.0 times more likely to die by suicide
than the general population due to long hours, work overload, occupational stress, practice
responsibilities, client expectations, euthanasia, and poor work-life balance (Bartram & Baldwin,
2010; Nett et al., 2015; Tomasi et al., 2019). Veterinary surgeons have a proportional mortality
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ratio for suicide approximately four times that of the general population and around twice that of
other healthcare professions (Bartram & Baldwin, 2010). Research conducted on 130 veterinary
students found a positive relationship between experience with euthanasia and fearlessness about
death, resulting in 39% of all veterinary suicides through pharmaceutical poisoning (Witte et al.,
2013).
Psychological morbidity in veterinarians was found to be linked to psychosocial work to
the higher risk of suicide observed in veterinarians in the UK (Bertram & Baldwin, 2010) can be
defined as interactions between work environment (social interactions), job content,
organizational conditions (culture), and an employee’s capacity to manage these occupational
factors which can impact health, job performance and workplace satisfaction (Fraser, 1984).
Occupational stressors such as relationships with clients, euthanasia, working hours, and
excessive workload have been ongoing topics of discussion in veterinary academia and the
veterinary industry (McKee et al., 2021). Recent research examined why veterinarians do not
persist in the profession and focused on motivation and operational practices to improve health
and wellbeing. Three topic areas emerged from this review: occupational stress (Ashton-James &
McNeilage, 2022), financial stressors (Bain & Dicks, 2016), and attitude toward and engagement
in euthanasia practices on a routine basis, leading to psychological distress (Moir & Van den
Brink, 2020). Although the literature highlights multiple concerns, this review will focus on the
literature’s application to the problem of practice contributing to the lack of wellbeing.
Occupational Stress
Veterinary professionals care deeply for pets and understand the relationship between the
health of people and their pets. Severe and increasing occupational stress rates are prevalent in
veterinarians, leading to high anxiety, compassion fatigue, and burnout, which can create stress
35

and cause self-doubt and concerns about competence (Wu, Buckle et al., 2020). Individuals
entering the veterinary profession commonly share that a motivation to care for animals drew
them to their job. However, the reality and complexity of their daily work can quickly create
intrinsic tension (Moir & Van den Brink, 2020). This stress begins in veterinary school and
continues throughout the veterinarian’s career based on demanding client expectations,
emotional client interactions, the management of teams of employees, and the need to ensure
quality medical outcomes (Root, 2017). Veterinarians have an obligation and professional
responsibility to the pet, client, employer, and society. They face ethical challenges on a
reoccurring basis due to the demands of convenience euthanasia, financial limitations of pet
owners, clinical uncertainty in choosing and recommending the most appropriate treatment, and
conflicts between patient and client interests (Richards et al., 2020). In a 2017 study of former
and practicing North American veterinarians, 73% of respondents said not being able to do the
right thing for a patient caused their staff moderate to severe stress, and 78% responded that it
caused them moderate to severe distress ( Moses et al., 2018). Veterinarians identify that they are
not appropriately trained in conflict management or addressing ethical challenges, and more
formal training in university and the use of real-life ethical cases would be helpful (Richards et
al., 2020). Seventy-one percent of veterinarians said they received no conflict resolution training
on how to resolve differences of opinion, and 79% said they received no training on self-care (
Moses et al., 2018).
The Merck Animal Health Veterinary Wellbeing Study (Volk et al., 2018) was
commissioned in partnership with industry advocates to examine growing concerns about
veterinarian mental distress, suicide, compassion fatigue, burnout, and other forms of job stress.
The Merck study identified occupational stress levels as veterinarians’ leading wellbeing
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concern, as reported by 92% of those surveyed. Common amongst veterinarians is compassion
fatigue, the depletion of internal emotional resources that materializes from listening, relating,
and engaging empathetically with clients experiencing emotional pain (Deering, 1996). Burnout
is related to the loss of desire to perform work-related tasks (Hides et al., 2019). Occupational
stressors, including burnout, psychological distress, and depression, are known risk factors for
suicide. Stress for veterinarians is caused by long working hours, communicating bad news,
unexpected outcomes, and poor work-life balance as well as cyberbullying, professional
isolation, euthanasia procedures, and high student debt in combination with low pay (Tomasi et
al., 2019). Empathizing with clients can be very challenging, as clients are often upset about the
impending loss of a pet or stressed about the financial or logistical aspects of caring for an ill pet,
given that few clients have insurance to defray the costs of care (Armitage-Chan, 2020).
A shortage of talented clinical professionals and increasing demand for veterinarian
services compounds stress caused by ethically challenging client demands (Neill et al., 2022). A
KPMG LLP study between 1997 and 2015 revealed a substantial increase in demand for
veterinarians and predicted the veterinarian shortage (Brown & Silverman, 1999). Resolving the
continuing problems of veterinarian labor shortages is a central challenge for the veterinary
profession (Prince et al., 2006).
Financial Stressors
Student debt is a crucial contributor to psychological distress, as identified by 67% of
3,600 veterinarians surveyed by the Chesapeake Institute Review Board (Volk et al., 2018). The
findings linked student debt to worry about financial wellbeing and severe mental health issues
and identified it as one of the most critical issues impacting the veterinary profession (Volk et al.,
2018). According to the AVMA, 89% of senior veterinary students at 28 U.S. colleges of
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veterinary medicine had debt at the time of graduation, with a mean debt of $184,299 (Bain &
Dicks, 2016). The mean starting salary of new veterinarians in private practice in 2018 was
$82,894 (Bain et al., 2019). Financial stress and poor mental wellbeing contribute to suicidal
ideation and further raise questions about whether the desire to care for animals is worth the
compensation and challenges involved. These concerns, compounded with access to lethal
pharmaceuticals and the knowledge and acceptance of performing euthanasia as a viable option
for ending life, contribute to mental health challenges among practicing veterinarians and their
employers (Tran et al.,2014).
Moral Stress Due to Euthanasia
Veterinarians perform euthanasia as an acceptable and routine part of the job and a
peaceful way to mitigate animals’ pain, suffering, and quality of life. Pet loss by dissolution can
be traumatic, lead to mourning, and create grief (Fragoso et al., 2016). Euthanasia is seen as a
viable option to address an owner’s inability to pay for care or needed treatment, causing moral
stress, which produces intense emotional demands on the administering veterinarian and is the
predominant cause of compassion fatigue (Kahler, 2015). Additionally, in a study of 889 North
American veterinarians, 71% reported having little to no training on mitigating ethical conflict or
moral stress caused by clients requesting euthanasia for pets who could otherwise be treated or
rehabilitated (Moses et al., 2018). Euthanasia frequency has a positive correlation with depressed
mood and forces the veterinarian to experience the impact of death repeatedly (Tran et al., 2014).
Veterinarians receive extensive training on the pharmacokinetics and pharmacodynamics of
lethal pharmaceuticals and access injectable barbiturates, narcotics, sedatives, and tranquilizers
(Witte et al., 2013).

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The Impact of COVID-19 on Veterinarians
During the pandemic, employers and veterinarians addressed many challenges by
responding to government guidelines and operational changes required to protect veterinarians,
hospital teams, and clients while serving sick and injured pets. Throughout COVID-19, research
examined whether the virus could be transmitted from pets to people and from people to pets.
This ambiguity created occupational stress for veterinarians and their families. Veterinarians
adapted to social distancing restrictions, interpreted government-mandated restrictions of non-
essential services, navigated through pressure to consider what counts as a valid veterinary
patient-client relationship, in addition to limiting the range and volume of services provided,
limited personal protective equipment availability, and using masks and ventilators needed in
human healthcare, as well as restrictions impacting ancillary services such as diagnostic
laboratories (Mair & Lockett, 2020).
According to the AVMA, veterinarians play a critical role in protecting animal and public
health, safeguarding our food supply, monitoring for zoonotic pathogens, and supporting
biomedical research and medical countermeasures, such as the development of COVID-19
diagnostics, treatments, and vaccinations (COVID-19, 2022). Veterinarians played a role in
providing patient care to sick pets and in contributing to the research and knowledge of ways
COVID-19 could be contracted. They also played a role in helping the public understand there
was a low level of contracting COVID-19 from their pets and that the pet owner should
quarantine and mitigate contact with their pets when sick as the majority of transitions for
COVID is known to be from infected people to pets. Through the work of the Center for Disease
Control (CDC) and the Organization of OIE, the animal health sector has contributed to a one
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health common response to COVID-19. This collaboration with human health allowed for a
rapid response to coordinate research findings (CDC 2022).
Essential Worker
As essential frontline workers, veterinarians experienced conflict between personal
wellbeing and their professional role. Conflict between the wellbeing of family or household
members was particularly challenging if the veterinarian had underlying health conditions or had
high-risk family members who were more susceptible to health impacts associated with the virus.
The impact of this infectious disease was underscored by the biosecurity concerns expressed by
veterinarians who were torn with the decision to worry about the risk to their family and their
community and stop work but leave their colleagues and patients. This commitment to provide
services to patients, and to not let down their team members or employer, often led to sickness
presenteeism, where team members come to work, even though they are not healthy (Quain et
al., 2021).
Job Duties and Ethically Challenging Situations
Ethically challenging situations (ECS) are common in veterinary health and have been a
common source of occupational stress for veterinarians. Traditionally, discussions on ECS are
related to client financial limitations restricting treatment options, euthanasia, continuing
treatment despite the animal’s poor health, or animal abuse (Quain et al., 2021). In an online
mixed methods survey of 540 veterinary team members from 22 countries, conducted in March
2020, researchers sought to determine the frequency, stressfulness, and types of ECS
encountered by veterinarians, animal health technicians, and veterinary nurses since the
beginning of the pandemic. The study showed themes related to biosecurity, client financial
limitations, animal welfare, working conditions, and client relations, in addition to themes about
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the moral dilemma to prioritize human health over animal health as it relates to the use of needed
personal protective equipment, such as personal protective equipment and ventilators.
The most common ECS encountered was (at least several times a week) challenging
decisions about how to proceed when clients have limited finances, conflicts between personal
wellbeing and professional role, and conflicts between the interest of clients and the interests of
their animals. These were followed by decisions regarding what counts as an essential veterinary
service, conflicts between wellbeing of family and professional role, and challenges about
whether to perform non-contact veterinary visits (Quain et al., 2021). Veterinarians assessed
concerns like dental disease, which is not immediately life-threatening but could create life-
altering issues if not treated or preventative measures against diseases such as rabies or
tuberculosis suppressed during lockdown (Gortázar & de la Fuente, 2020). Veterinarians also
made challenging decisions about whether to perform non-contact veterinary visits. While some
respondents surveyed enjoyed non-contact consultations, many struggled with non-contact
euthanasia, communications, or animal handling issues in the absence of the owner. The inability
to communicate with the owner increased the risk of miscommunication or misunderstanding
(Quain et al., 2021).
Based on survey findings, veterinarians experience a high degree of autonomy in making
ethical decisions (Quain et al., 2021). Autonomy and job control allow for motivation,
engagement, and increased performance, which is an organizational-level approach to improving
employees’ wellbeing (Bartram & Baldwin, 2010). During COVID-19, veterinarians were faced
with new personal ethical decisions not previously encountered, which led to additional
occupational stress and the dilemma of prioritizing the risk of exposure to zoonoses and personal
safety, and risk to family members over their professional role. Another survey of 484
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veterinarians in the U.S. found that only 51% of veterinarians reported having any ethics training
during their veterinary degree (Kipperman et al., 2018). In the same survey, 83.9% of
respondents overall agreed there is a need for veterinary school curricula to include training in
ethical theories and tools for coping with ECS (Kipperman et al., 2018).
Workplace Demands
Increased workplace pace and work demands during COVID-19 have been linked to the
worldwide increase in pet ownership, which resulted in an increased demand for veterinary
services. 18% of North American practices added additional appointments to their standard
schedules, and 77% have needed to introduce new curbside appointments to mitigate social
distancing policies (Muzzatti & Grieve, 2022). According to a study conducted by McKee, 2021,
increased work demands and work pace, combined with the impact of school closures, may have
contributed to females and caregivers experiencing worse wellbeing, which is supported by
current COVID-19 research citing higher levels of psychological distress in mothers of
elementary school children since the pandemic began (Zamarro & Prados, 2021). The pandemic
brought a significant increase in work hours and weekend appointments, unpredictable
schedules, and longer workdays to accommodate increased pet services (CM Research, 2021).
The workload of veterinarians based on surveys of 24-hour small animal emergency veterinary
hospitals, based on the findings of an online survey, found that 10% to 44% of hospitals reported
at least a 25% increase in caseload during the pandemic (Wayne & Rozanski, 2020).
In Merck’s third wellbeing study, administered in September and October 2021, focused
on the wellbeing and mental health of veterinarians, 90% of respondents reported that the
shortage of qualified veterinary staff had been one of the biggest concerns throughout COVID-
19, of which 67% of veterinarians faced challenges with staffing due to employees spending time
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away for illness or family care. 68% of participants cited the challenge of providing veterinary
services under evolving pandemic and industry conditions. In the same study, 30.5% of
veterinarians reported high levels of burnout. 92% of veterinary and veterinary staff respondents
rated increased stress as one of their top mental health challenges, and 88% of veterinarians cited
stressors due to student debt and concerns related to the risk of suicide (Veterinary Wellbeing
Study, 2022).
The impact of the increased workload created additional stress and fatigue due to staffing
shortages, including those necessitated due to COVID-related absences or potential exposure to
COVID. Sickness presenteeism results in veterinary staff working even though they are not
healthy, based on a sense of obligation to care for sick and injured pets, obligation to colleagues,
and economic reasons such as a lack of sick leave. COVID-19 highlighted the negative
consequences of sickness presenteeism, including many practices not offering sick leave and
employer exposure to liability for failing to prevent exposure to other employees. Employers
lacked contingency plans for staff absences due to illness and needed to develop contingency
plans for staff taking leave and need to develop plans with locum agencies, trained casual
temporary staff on standby, and cross-trained employees (Petervary et al., 2020).
Social Capital
The COPSOQ-III study conducted on 157 respondents from the Ontario Veterinary
College, completed from November 2020 to January 2021, identified respondents with
dependents at home had three times greater odds of reporting significantly worsened health and
wellbeing compared to those without dependents at home (McKee et al., 2021). In this same
study, common themes identified by respondents as stressful aspects of working during COVID-
19 were childcare -finding childcare and balancing caregiver and work demands; fear of COVID
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exposure in clinics due to proximity to staff, inability to control others' private exposures,
reduced trust in coworkers and staff; increased workload, lack of work-life balance, perceived
lack of support and communication from leadership (McKee et al., 2021). Trust between
colleagues and supervisors throughout COVID-19 was felt through concerns about whether
colleagues were abiding by social distancing protocols and health measures leading to
interprofessional trust. With increased absences during COVID, feelings of unfairness could be
associated with workload distribution on employees continuing to work during the COVID-19
restrictions leading to a lack of social cohesion and interpersonal trust, mediating factors in
emotional exhaustion and burnout (McKee et al., 2021, Welp & Manser, 2016).
Health and Wellbeing
The impact on mental health and wellbeing for veterinarians had been profound and
universal, challenging the health and sustainability of the profession. Themes from a study of
157 respondents who were faculty, staff, residents, and interns at the Ontario Veterinary College,
in Ontario, Canada, during COVID-19, using the Copenhagen Psychosocial Questionnaire
(COPSOQ-III) and open text questions on perceived needs for wellbeing found quantitative
demands, recognition, sense of community, burnout, stress, and depressive symptoms were
significantly worse and emotional demands, health and wellbeing (including depressive
symptoms, stress, cognitive stress, somatic stress, and burnout), and work-life conflict were
reported to have worsened since the start of the pandemic. The study also found females having
decreased health and wellbeing compared to males (McKee et al., 2021).
Four main themes on the topic of mental health emerged from the Royal College of
Veterinary Surgeons from a 2021 international roundtable focused on the impact of COVID-19
on mental health in the veterinary team: (a) the impact of the pandemic on burnout, anxiety and
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fatigue was not all negative as veterinarians used it as the opportunity to reassess their work and
how they practiced their work, (b) regulators played an important role in messaging that they
were not out to punish practitioners for modifying professionally acceptable standards of
operation during the pandemic, and were told to do the best they could with the established
guidelines; (c) while tolerant at the beginning of the pandemic, clients were complaining about
having to wait outside the hospital and wear masks, reigniting challenges with client
communication, conflict, and problem resolution; and (d) the important emphasis on
relationships and communication for those struggling from mental health issues (A Report of an
International Online Roundtable, 2021). The ability for veterinarians to recognize that others
outside the profession also suffered from mental health issues gave veterinarians the opportunity
to share their anxieties and experiences with colleagues who were going through similar
circumstances. Pastoral care and WhatsApp groups had been helpful for those working in
isolation (Quain et al., 2021; RCVS, 2021).
Financial Impact
Initially, veterinary practices experienced financial worries as while they were considered
an essential service and open to see sick and injured pets, yet clients were quarantined and held
from bringing their pets to the vet hospitals. Clinical veterinary practices initially faced revenue
declines associated with forced cancellations of appointments due to lockdowns and quarantine-
in-place guidelines (ReliefWeb, 2021). This changed over time as the pandemic guidelines
opened across the country, bringing increased financial income to some practices due to an
increase in pet ownership resulting in increased demand for veterinary services. Along with
increased veterinary visits, there was also increased turnover and increased workload, stress, and
burnout as a result (RCVS, 2021). For some practices, operating in a COVID safe way took
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longer and was more expensive, meaning that working hours could be longer, curfews made
scheduling difficult, and increased patient volume meant needing increased staff.
Organization and Leadership Responses to COVID-19
COVID-19 presented new government business mandates, physical and mental health
consequences, and family and leadership challenges that healthcare employers had not
previously faced. During the COVID-19 pandemic, human and veterinary healthcare employers
implemented a number of organizational and leadership strategies to comply with government
guidelines, ensure the safety and health of employees, and continue to operate essential services.
Reoccurring themes for human healthcare workers throughout the pandemic have been
(a) moral distress, resource allocation, and absolute scarcity; (b) personal safety; (c) economic
insecurity; (d) social and family disruption; (e) stigmatization of health care workers; and (f)
sense of being powerless. (Adibe et al., 2021, p. 12). Caring for patients diagnosed with COVID-
19 provoked worry, fear, anxiety, and isolation for workers and their families (Wu, Buckle et al.,
2020). Learnings from SARS were that up to 57% of healthcare workers had acute psychological
distress, burnout, and posttraumatic stress while caring for patients (Wong et al., 2005).
The Harris Poll conducted a COVID study in April 2020 on behalf of the American
Psychological Association with more than 3,000 U.S. adult participants. The survey identified
that stress levels during COVID were considerably higher for parents of children and teens under
age 18. More than 7 in 10 parents reported that distance/online learning for their children was a
significant source of stress. Parents identified stress related to their children’s education, basic
needs, access to healthcare services, the lack of daycare and after-school programs, and missing
out on major milestones. The Harris Poll survey findings identified that women had an elevated
level of stress over men and were concerned about their workload, work-life balance, and the
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overall impact of COVID on society. In the same study, men worried about their career and their
jobs. McKinsey & Company (2021) revealed that the pandemic’s impact on women’s
employment has 1 in 4 women considering leaving the workforce or downshifting careers. Three
groups experienced the largest impact of COVID: working mothers, women in leadership, and
Black women (McKinsey & Company, 2021). Throughout the pandemic, women have felt less
supported by their management and leadership and expressed their need for flexible hours,
recalibrated performance goals, mental health care services, clear communications, and
empathetic leadership as important sources of support (American Psychological Association,
2020).
Basic Health
Working with a changing environment, suboptimal conditions, adapting processes, and
foundational worries about personal protective equipment can throw individuals off balance
(Wu, Buckle et al., 2020). New employee operating procedures around gathering information
about daily employee health status and required personal protective equipment became
commonplace. The employer’s role was to keep employees physically protected during the crisis
and do its part to mitigate the spread of the virus, which resulted in strategies such as keeping
shifts of workers together and isolating workers from their high-risk family members. Employers
required workers who had been exposed to the virus to quarantine. The mental stress of isolation
and precautionary physical challenges while juggling increased homeschooling and childcare
responsibilities and worry for elderly and high-risk friends and family members created
additional stress for healthcare professionals (Koss, 2020).
Based on state mandates, employers in most states were mandated to implement daily
basic health questionnaires and temperature checks to ensure workers who came to work were
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healthy. Employers discouraged sickness presenteeism to minimize risk to colleagues, clients,
and their families. According to an article published by the Harvard Business Review, 25% of
U.S. workers have no sick pay benefit and no protections to affordable healthcare, remote work
accommodations, paid time off, and high health care out-of-pocket deductibles, resulting in the
financial risk of becoming sick or exposed to the virus creating anxiety and low job security
(Neely, 2020). Many states mandated paid sick leave for COVID-related absences, and
employers implemented additional sick pay and quarantine pay to encourage sickness
absenteeism and paid pandemic leave for those self-isolating or undergoing COVID testing
(Quain et al., 2021).
Support for Employees
As the pandemic continued, support and recognition for essential healthcare employees
came with time, as communities and organizations demonstrated their gratitude for healthcare
workers and other essential workers as heroes. Billboards, car parades, and daily horns were
present throughout communities. This recognition boosted confidence and developed a shared
sense of purpose and comradery among essential workers, including security officers, shuttle
drivers, and frontline healthcare workers (Gaitens et al., 2021). Respondents from a study at the
Ontario Veterinary College found that increased workload support, community building,
recognition of employees’ capacities and personal needs, flexible work schedules, and consistent
communication were strategies that increased wellbeing during COVID-19 (McKee et al., 2021).
Employers shared mental health resources, toolkits, peer-to-peer support models, and training
programs to aid in creating awareness, education, and motivation of employees on the need for
self-care (RCVS, 2021).
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Organizations also established employee assistance programs, spiritual care, and peer
support groups to encourage employees to talk about their concerns in the appropriate forums.
Some organizations established sharing circles for working parents with school-aged children to
discuss homeschooling and the lack of daycare. Resilience in Stressful Events is an example of a
program offering psychological first aid and emotional support to staff at Johns Hopkins
University. The program is based on the foundational concept that if workers feel they are
supported in a disaster, they will be more resilient; therefore, support is a central part of the
university’s strategy alongside infection control and supply chain management (Wu Buckle et
al., 2020). Research and learnings after the 2003 SARS outbreak in Hong Kong were that
increasing social connectedness offset the negative mental health impacts of the pandemic (Koss,
2020). Social connection can help mitigate isolation and provide a feeling of support.
Employer support also addressed other employee basic needs by offering discounted on-
site childcare, subsidizing costs for commuting or using mass transit, enabling food shopping
where food in stores was scarce or shopping hours were limited, opening in-hospital food stores,
or having personal packages delivered to the place of employment (Wu, Buckle et al., 2020).
Boosting energy, motivation, and engagement resulted in some employers using this period to
accelerate learning through upskilling employees and cross-skilling teams (Koss, 2020).
Organizations found new ways to align employees to their mission and focus on building
resiliency skills. They produced toolkits and educational resources to raise awareness of the need
for energy management and focus on improving individual and team energy (Deloitte, 2021).
Employees were empowered to take ownership of how their work would get done and of their
wellbeing. Employers continued to invest in health and wellbeing incentives to positively
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motivate employees to take steps toward improving their health, improving organizational
productivity, and building engagement.
Employers focused on strategies to support healthcare workers through COVID-19,
which included meeting employee foundational needs, open communication, promoting
wellbeing, and providing mental and emotional support (Wu, Connors et al., 2020; Wu, Roemer
et al., 2021). Protecting employees with essential personal protective equipment, such as gloves,
masks, face shields, protective eyewear, and gowns, helps to reduce employees’ risk of infection
and anxiety. Ensuring employees were not harmed from their work was a foundational
occupational health expectation of employees throughout COVID-19 (Wu, Buckle et al., 2020).
Veterinary employers also took steps to increase staffing levels, focus on limiting working hours,
and teambuilding and random acts of kindness (RCVS, 2021).
System-Level Interventions
Leadership has a strong role to play in crisis situations. Sharing information, even if
limited or incomplete, has been known to reduce employees’ anxiety. The COVID-19 pandemic
presented the opportunity for leaders to communicate authentically and transparently, sharing
plans to relay calm and set the tone for a culture of support during a crisis (Wu, Connors et al.,
2020). Effective crisis management can convey a clear, optimistic vision and a realistic plan,
facilitates taking decisive action, and facilitates open, honest, and frequent communication.
Leaders’ efforts to express gratitude for the burden imposed on employees and their families
were influential in creating positive employee sentiment. Many organizations increased
employee communication channels so that leaders could hear concerns directly from employees,
offer support, and answer questions; organizations also structured crisis communication teams to
empower managers and employees to raise and solve problems quickly (Wu, Connors et al.,
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2020). Moreover, line managers played a critical part in addressing COVID-19 by cascading
information, offering support and empathy, and encouraging participation, delegation, and
constructive feedback. In addition, line managers recognized mental health symptoms and
referred employees to occupational health services (Munir et al., 2019).
The National Academy of Medicine and other professional societies encouraged system-
level interventions to support the need for clinician wellbeing (Adams, 2019; Ripp & Shanafelt,
2020). Employers invested in creating positions such as the chief wellness officer (CWO) and
wellness champions to understand the concerns of the healthcare workforce, assist with
diagnosing needs, determine individual and organizational strategies, and facilitate the successful
execution and implementation of culture and programs that supported wellbeing during COVID-
19 (Brower et al., 2021). In some companies, CWOs are responsible for individual-level
interventions; however, the CWO’s primary role in health care is to focus on improving an
organization’s work environment and culture, optimizing workflow, addressing staffing issues,
and improving support and resources for clinicians.
The goal is to improve what is wrong with the work environment, not to equip
individuals to tolerate dysfunctional organizational structures and systems better, as
burnout is caused by characteristics in the work environment, not by individual lack of
resilience. (Ripp & Shanafelt, 2020, p.1354–1358).
Rush Medical Center created a model for providing mental health support to frontline
staff during the pandemic by designing a proactive organizational approach that addresses basic
physiologic needs, physical and emotional safety, and the basic needs of immediate family
members (Adibe et al., 2020). Wellness task forces included representation from the CWO,
social workers, chaplains, psychiatry, and behavioral sciences to conduct four critical strategies
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designed to reinforce staff wellness throughout the crisis: wellness rounds, a wellness consult
service, an advanced health intervention program, and a central wellness hub (Adibe et al.,
2020). Multi-disciplinary collaboration and the visibility of system-wide support embed and
encourage the importance of a culture of wellbeing. Most healthcare workers do not take
advantage of treatment options or resources due to lack of time, concerns regarding
confidentiality, stigma, or self-esteem (Garman et al., 2002).
Through qualitative research during COVID-19, nine CWOs shared the use of two
models to determine their employees’ stress levels. The Stress Continuum Model was initially
developed for the U.S. Navy and Marine Corps (Hatch et al.,2011). This model determines
different categories of stress response with increasing severity to determine the level of support
needed, recognizing that people react to trauma differently (Nash et al., 2011). A second model
used by CWOs, the SAMHSA model, evaluates stages of emotional response to trauma or
disasters. This model looks at the stages of crisis containment, pre-disaster, impact, heroic,
honeymoon, disillusionment, and rebuilding/recovery stage and the psychological impact on
employees (Brower et al., 2021). It suggests that an individual’s wellbeing shifts during the
various stages of a crisis. During the pre-surge phase of COVID-19, employees were
experiencing job stress, burnout, and fear of contagion for coworkers, clients, self, and family;
they also experienced isolation, redeployment of staff to cover for quarantine, and a change in
operating procedures (Brower et al., 2021). The initial designation of being an essential worker
versus a non-essential worker created feelings of guilt, heightened fear, and the risk of going to
work when others were working remotely or not working (Brower et al., 2021).
Greater workplace flexibility emerged in the healthcare industry during the COVID-19
pandemic as the needs of essential workers changed. To keep employees from quitting or
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reducing their hours, new employee scheduling and staffing models emerged. Employers such as
the NHS created guidelines that normalized and permitted flexibility for all clinical and non-
clinical roles practical on day one of employment (NHS website, 2021). The literature identified
three standard dimensions of flexibility that capture the range of alternative work arrangements:
flexibility in the employment relationship, flexibility in the scheduling of work, and flexibility in
the location where work is accomplished (Spreitzer et al., 2017). When workers have the
flexibility to address their needs, their experience is more favorable (Spreitzer et al., 2017).
Healthcare employers accommodated employees’ needs throughout COVID-19 by adopting
hybrid, split shifts, reduced schedules, or self-rostering to meet the workforce’s needs (NHS,
2021). In addition, the NHS People Plan for 2020/21 identified flexibility as a strategy to
mitigate the number of people leaving healthcare due to poor work-life balance. The NHS action
plan includes defining a clear vision of what flexibility means, designing flexible roles, and
developing a flexible culture.
Deloitte Consulting (2021) reported that as we have evolved through the pandemic,
leaders have shifted their focus from surviving, protecting the workforce (health and safety), and
increasing workforce communication to associate wellbeing. As we move into the post-pandemic
phase, leadership will focus on thriving in the workplace. There will be the need to integrate
workers’ physical, mental, financial, and social health into the work design rather than
addressing wellbeing with adjacent programs (Deloitte, 2021). Embedding wellbeing into work
design helps workers experience wellbeing while doing their work, not just when they are away,
which will benefit organizations and workers (Deloitte, 2021). Revisiting the work environment
and work design to address wellbeing can enable employees to be at their best when on the job
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and prevent working parents and women from leaving the workforce (McKinsey & Company,
2021; NHS, 2021).
Conceptual Framework
I have selected Bronfenbrenner’s ecological systems framework (1979) to examine this
topic. The study will focus on the first two layers of the Bronfenbrenner model (microsystem and
mesosystem) and the impact from their direct supervisor and the organization on the
veterinarian’s wellbeing. Bronfenbrenner’s model is used to understand the bioecological theory
of a person’s development as a transactional bi-directional process in which a person’s
development is influenced by various and collective aspects of their surrounding environment
and their relationship to it. As the study centers the veterinarian (the individual), the ecological
systems framework (Bronfenbrenner, 1979) examines the role of the environment in shaping
veterinarian views (the participants’ microsystem and mesosystem) and the ability to persist in
the veterinary industry (the participants’ exosystem) and in their career throughout the global
pandemic (the participants’ macrosystem).
As defined by Tuck and Yang (2014), a theory of change (ToC) fills the gap between the
idea of how a situation can be changed and achieving that change. The ToC in this study will
contribute to the wellbeing conversation by filling a gap in the literature and exploring the role of
wellbeing during COVID-19.
Traditionally, the beliefs of the veterinarian and their ability to address, burnout,
emotional exhaustion, fatigue, effectiveness, and wellbeing have been an individual issue.
Veterinarians have not been traditionally trained in personal skills to address their own mental
and physical wellbeing or in the interpersonal and communication skills needed to address
conflict management and have historically had poor wellbeing practices. Additionally,
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supervisors and medical leadership have not been trained in leadership, as most medical leaders
were trained to be practitioners with no formal leadership training. Throughout COVID-19, the
veterinary industry was shifting with new guidelines being translated through leadership and
employer organizations that were adapting to meet the changing landscape and context of a
pandemic.
Ethically challenging situations are common in veterinary settings and contribute to high
levels of moral distress, where the right course of action is unclear or when obligations conflict
with the veterinarian’s own moral standards (Moses et al., 2018). The results of the Merck 2021
Veterinarian Wellbeing Study revealed that difficult client interactions, client financial
limitations, concern for the pets’ welfare, and euthanasia are of top concerns leading to burnout,
anxiety, and stress (Merck, 2022). The importance of veterinary professional ethics is reflected in
the oath veterinarians take as they enter the profession or register to practice. The oath refers to
the ethics, professional code of conduct, and standards of the profession that help to shape the
veterinarians’ beliefs. In the United States, veterinarians swear to adhere to the principles of
veterinary medical ethics developed by the AVMA. They have professional obligations to the
pet, pet owner, employer, other veterinary professionals, coworkers, and society (Moses et al.,
2018). Veterinarians face complex ethical and welfare issues, including consequences of their
actions with clients that may have legal, ethical, financial, and social implications, while
maintaining professional objectives to manage a business profitably or meet an employer’s
expectations.
A commonly encountered ethically challenging situation during COVID-19 resulted from
being considered an essential worker. The majority of veterinarians (64.3%) in a survey
conducted between May and June 2020 reported conflict with risking one’s own personal
55

wellbeing and performing their professional role. The respondents (46.3%) also felt conflicted
between the wellbeing of family and household members and their professional obligation
(Quain et al., 2021). The risk of exposure and the need to provide a service or support colleagues
may have led to sickness presenteeism (Quain et al., 2021). Participants in this study were
required to adapt to social distancing, restrictions on the types of service offered, restrictions on
non-essential services, and pressure as to what counts as a veterinary client-patient relationship
while balancing the pressures of being an essential worker. Veterinarians considered their
responsibility to preserve animal welfare and service pets while interacting with the public as a
risk to their own health, their family, and their broader community. In addition, the prioritization
of human health over pet health meant some veterinary teams donated or were required to forfeit
personal protective equipment and medical equipment, such as ventilators, to human healthcare
(Quain et al., 2021). Veterinarians were initially required to only perform essential services; thus,
they had to make difficult decisions to limit the range and volume of services provided due to the
lack of staff, limited access to PPE, or restrictions impacting ancillary services (Mair & Lockett,
2021). These various stressful challenges created by the COVID-19 pandemic added to the
ongoing moral dilemmas involving what is best for the pet and the interest of the client,
challenging decisions on how to proceed when the client has limited finances, there is animal
abuse or decisions regarding euthanasia must be made (Quain et al., 2021).
By examining the context between veterinarians’ effectiveness before and during the
COVID-19 pandemic, we can identify the interventions by the organization and leadership that
lead to employee wellbeing and persistence. Veterinarian strategies, decisions, and outcomes
during COVID-19 were influenced by the historical period and the era in which they developed
and matured and by the chronosystem related to the current context caused by the global
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pandemic (Bronfenbrenner, 1979). This study assumes that change occurred through
environmental, operational safety, and wellbeing interventions in the workplace in response to
COVID-19. Knowing what interventions were effective will enable hospitals to implement
appropriate programs to ensure veterinarians persist in the occupation. Improving the wellbeing
of veterinarians is nested at the industry level. However, the change that needs to happen is also
informed by veterinarian lived experiences.
To sustain through the pandemic, employers implemented various leadership and
organizational strategies to support the health and wellbeing of veterinarians and to ensure the
effectiveness of hospital workers. Employers also had to address the realities of the fundamental
beliefs of veterinarians that are developed through their educational training. Employers needed
to change hospital procedures and address the ways client and pet care were administered while
minimizing client interactions and non-essential services. Employers focused on individual,
team, and organizational wellbeing strategies through policies, benefits, and supervisory
approaches. The health of veterinarians to support the staffing of hospitals was critical for
hospitals to remain open as essential frontline workers. Leaders played a critical role in
managing the working climate, developing operating practices to support safety, and creating an
organizational culture valuing health and wellbeing. This study’s axiology places value on the
health and wellbeing of frontline veterinarians and recognizes the responsibility of employers
during COVID-19 to keep doctors healthy. The study recognizes that veterinarians suffered from
high occupational stress levels pre-COVID-19, and the need to address family and personal
health concerns throughout COVID-19 added to their condition.

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Summary of Review
This study aimed to understand the impact of burnout, fatigue, emotional exhaustion, and
engagement on veterinarian effectiveness during COVID-19 and the organization and leadership
practices that employers implemented that positively impacted veterinarians’ wellbeing during
the pandemic. The literature review included studies on employer health promotion, burnout,
compassion fatigue, and emotional exhaustion in healthcare and veterinary professionals before
and during the COVID-19 pandemic. Five main topics guided this study. The first is wellbeing in
the workplace, including the definition of wellbeing and the shifts that have been made in the
workplace to create a holistic definition. The second is workplace antecedents and interventions,
focusing on the work setting, psychological needs and motivation, work experience, and
workplace productivity models that demonstrate the interdependency among job demands and
job resources, behaviors, and work environment. The third is the employer lens, including why
workplace health promotion is important to employers, the business case for wellbeing, and a
review of burnout, compassion fatigue, and emotional exhaustion. The fourth is wellbeing in
veterinary care, highlighting the ongoing opportunities to improve the wellbeing of veterinarians
and identifying primary occupational drivers. The fifth is COVID-19’s impact on human
healthcare workers and the disproportionate impact on parents and women and includes
employer strategies for support through system-wide interventions, such as leadership and
flexibility.

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Chapter Three: Methodology
Veterinarians indicate that stress, emotional exhaustion, burnout, and compassion fatigue
have been the most critical wellness issues affecting the profession and impacting the quality of
care to animals (Lovell & Lee, 2013). The COVID-19 pandemic created high levels of
occupational stress in the United States, leading to a negative impact on employee wellbeing.
This chapter describes the research methodology and provides information concerning the
quantitative method used in undertaking this study, as well as a justification for using this
method. This chapter also describes the various stages of the research, including the recruitment
and selection of participants, data collection process, and data analysis. The chapter also
discusses the role of the researcher, validity, reliability, and ethical concerns related to this study.
Research Questions
The following research questions guided this study:
1. How has burnout, emotional exhaustion, and fatigue impacted employee effectiveness
throughout the COVID-19 pandemic?
2. What specific strategies have organizations and leaders implemented that support the
wellbeing of their employees during the COVID-19 pandemic?
Methodology Approach and Rationale
I collected quantitative data using an online survey instrument over a 30-business day
period and subsequently evaluated and interpreted the results. This quantitative approach helped
to understand the participants' perceptions regarding the organizational strategies and
leadership's influence in creating a culture of wellbeing and the dependent variables.
Following the IRB approval for research studies at the University of California, I
administered an open- and closed-ended questionnaire addressing the following two research
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questions to obtain data on current practices and perceptions on organizational and leadership
practices that positively impacted veterinarians’ wellbeing throughout the pandemic. Qualtrics
was used to distribute the survey instrument to potential participants quickly via link or QR code
and provided easy administration for industry partners to help distribute the survey. The use of
professional industry organizations to promote survey administration ensured participant reach
and confidentiality. The Qualtrics survey platform was selected due to its low-cost ability to
collect information from a large population and protects participants’ privacy while providing
them flexibility in completing the survey at a place and time that is convenient for them. The
demographic, employment, and geographic data collected from respondents at the end of the
questionnaire allowed for additional insights into practice and preferences on the future of
wellbeing programs in veterinary medicine.
Population and Sample
There were 506 participants who responded to the survey, and following the cleaning of
the data, 38 participants were removed for not responding to a majority of the survey questions;
therefore, the researcher was able to use data from 468 practicing veterinarians. Very small
samples undermine the internal and external validity of a study (Faber & Fonseca, 2014). There
are currently 116,091 practicing veterinarians in the United States, of whom 59.8% (69,422) are
employed in companion animal practice (Bain et al., 2020). This study aimed to survey 390
practicing veterinarians, as a sample of U.S. practicing small animal veterinarians, based on
achieving a confidence level of 95% and a margin of error that the real value is within plus or
minus 5% of the measured value. The minimum sample size of participants was selected based
on using Calculator.net’s sample size modeler, which identified 385 participants to achieve a
95% confidence level and a 5% margin of error (Calculator.net, 2021). A second sample size
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modeler was used that resulted in 383 participants (Research-advisors.com, 2021) and helped to
provide reassurance that the study size of 390 is credible. Power Analysis Findings – G*Power
was also used to determine the minimum sample size target based on a multiple linear regression
with four predictors. The minimum target was 85 participants, which was achieved.
This survey invited members of five professional veterinarian associations to promote the
survey to its membership: AVMA, AAHA, Latinx Veterinary Medical Association (LMVA),
Black DVM Network (BDVMN), and Multicultural Veterinary Medical Association (MCVMA).
The AVMA has a membership of 97,000 veterinarians and provides resources, continuing
education opportunities, publications, professional products, programs, and services. The AVMA
promotes animal-friendly legislation within a framework that supports the use of animals for
human purposes (e.g., food, fiber, research, companionship) and publishes the Journal of the
American Veterinary Medical Association and the American Journal of Veterinary Research.
AAHA has a focus on enhancing the abilities of veterinarians to provide quality medical care to
companion animals. LMVA formed in 2020 as a community of Latinx professionals in
veterinary medicine with a goal is to elevate, make visible, and celebrate Latinx veterinary
professionals and veterinary students. BDVMN, with a membership of 100 veterinarians and
veterinary students, has a mission to foster diversity as an integral part of the veterinary medicine
agenda and build a strong network of Black veterinarians and students. MCVMA exists to lead
veterinary medicine towards racial and ethnic diversity, equity, and inclusivity that the veterinary
profession needs to serve a multicultural society and has a membership of 2900 veterinarians.
The online survey was made available to professionally licensed and practicing veterinarians in
the United States through the membership of the five veterinary industry associations, through
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the DVM Moms Facebook Group, and through my professional network. The survey had 506
respondents, of whom 468 provided useable information.
The Researcher
I acknowledge my position as a chief human resources officer for a global pet care
company and former chief human resources officer for a corporately owned veterinary health
organization. My goal was to add to the literature, through the veterinarian's perspective, on the
perceived value of leadership and organizational strategies and their impact on veterinarian
wellbeing and effectiveness implemented by employers throughout COVID-19. My motivation
is to understand what employers can do to create an organizational culture where veterinarians
can be well and thrive. I am an Asian American working mother and am sensitive to the
challenges, demands, and resilience required to balance family, work, and personal health
throughout the pandemic. As the leader of a human resources function throughout COVID-19, I
played an active role in my organization to sponsor wellbeing strategies and policies. Having
been an executive sponsor of health and wellbeing and inclusion and diversity initiatives, I
acknowledge that my perceptions may differ from the lived experience of veterinarians who
participated in the programs or were the intended recipients of the wellbeing and inclusion
strategies. As the topic of wellbeing has been an ongoing topic of research for the veterinary
community, in my former role as chief human resources officer for a corporate-owned veterinary
practice, I have participated in industry wellbeing conversations with various veterinary
professional organizations in the United States, specifically the AVMA and AAHA.
Additionally, I am cognizant that some veterinarians did not wish to participate in the research,
potentially due to stigma regarding wellbeing and mental health that could result in personal and
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professional reputational harm, loss of licensure, and distress for their colleagues and family
members.
My intent was to adopt a self-reflective practice through journaling in conjunction with
seeking feedback from the thematic group and the dissertation committee to ensure the research
findings accurately reflect the data. While this acknowledgment does not eliminate bias, it adds
transparency to the research.
Survey
This study used an online anonymous survey instrument as the primary source of data.
The survey contained 33 questions consisting of 17 closed-ended Likert response questions, two
open-ended questions (Robinson & Leonard, 2017), and 14 demographic questions. The survey
instrument contained nine Likert questions and one open-ended question related to RQ1. Two
questions address the topics of burnout and emotional exhaustion, four address fatigue, and four
address employee effectiveness. One open-ended question addresses effectiveness before the
pandemic and during it. There are five questions related to RQ2, of which four Likert questions
address overall wellbeing, and one open-ended question relates to organization and leadership
strategies supporting RQ2. The survey questions related to organizational wellbeing strategies
measured both the participants' perceptions of the role of their direct supervisor in influencing
wellbeing and the role of the organization. The open-ended questions sought specific strategies
that the participant believed positively impacted their wellbeing during the pandemic.
Questions were adopted from a number of existing recognized survey tools for their
research outcomes in identifying burnout, fatigue, and employee effectiveness. The questions
regarding burnout were adopted from the MBI – Human Service Survey (West et al., 2012).
Questions regarding emotional exhaustion and fatigue were adopted from the FAS survey
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(Michielsen et al., 2003), and questions regarding employee effectiveness were adopted from the
Gallup Q12 Survey (Gallup.com, 2022), and the Perceived Stress in Probability Sample of the
United States (Cohen, 1988). Two of the questions from the Perceived Stress in Probability
Sample were adapted for clarity by adding the word “work” (Questions 2 and 4), and one
question was adopted (Question 10).
The survey concluded with 14 questions to gather demographic information (e.g., gender,
race/ethnicity, age group, and familial obligations) and contextual information about the
veterinarian’s practice environment. The survey questions related to veterinary professional
experience provided participant information on years of experience in the industry, type of
practitioner, type of clinical environment worked in throughout COVID-19, and employment
status. Data collected from all questions relevant to demographics and years of professional
veterinary experience allowed for drawing further insights.
For the survey questions relating to demographic identity, I adopted the Respectful
Collection of Demographic Data (Rosenberg, 2018). Rosenberg suggested that the questionnaire
should be designed to allow the participant to make flexible choices to self-identify their gender
in terms of pronouns they prefer. According to Rosenberg, the questionnaire should offer multi-
select checkboxes in place of a single-select radio button to provide users the option to select
multiple boxes with example descriptions, choose not to answer, or write their description
(Rosenberg, 2018).
Data Collection Procedures
Below are the data collection procedures used to gather the research findings from this
study:
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1. One week after I received approval from the institutional review board (IRB), I
approached the leadership of five veterinary professional organizations, using a
recruitment letter sent via email, to obtain permission to distribute an online survey to
its professional U.S.-based members, regardless of gender pronouns. The participants
were recruited through five professional veterinary associations: AVMA, AAHA,
LMVA, BDVMN, and MCVMA. These associations were selected based on the
demographics of their membership and extensive membership database. To solicit
participants, I sent an introductory overview and recruitment email to the
organization's president and director of membership to introduce the study and obtain
permission to distribute the survey to their membership (Appendix A).
2. Upon obtaining permission, I asked the organizations to share a mass distribution
email (Appendix B) to their membership soliciting participation in the study, with a
link to the anonymous Qualtrics survey. The survey was available to the five
organizations’ memberships from February 26, 2022 to March 30, 2022.
3. At the beginning of the online survey questionnaire, participants were provided with a
brief overview of the study and were asked for voluntary consent to participate in the
study(Appendix C). After electronically providing consent, the participant was able to
access the survey questions and complete the survey.
4. I monitored and analyzed the survey results to track the number of participants and
survey completion versus my goal of 390 participants. Additional participants were
invited to participate through my personal external network via survey link and
followed a similar consent process as used with industry association groups.

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Data Analysis
Following the 30-day survey period, I cleaned the data to identify incomplete surveys,
analyzed quantitative data through coding, clustered the codes into broad themes, and integrated
my experiences to interpret the results (Creswell & Creswell, 2018). The cleaned data served as
the primary resource for calculating the Likert-scale interval question responses, inclusive of
counts and their percentages, mean, mode, and median. SPSS software was used to conduct
statistical significance testing on the survey data. Frequencies and percentages were used to
examine the trends of the nominal-level variables. Means and standard deviations were used to
examine the trends of the continuous-level variables. Pearson correlations were used to examine
the two-way associations between the variables of interest. A multiple linear regression was used
to examine the predictive relationship between burnout, emotional exhaustion, fatigue,
engagement, and employee effectiveness. Several tests were applied to analyze RQ2: Chi-
squared, t-tests, and ANOVA were used for significance. Statistical significance will be
evaluated at the generally accepted level, α = .05.Also, dispersion statistics encompassing
standard deviation, variance, range, and standard error mean, as appropriate, were reviewed.
I coded the data to generate a description of the participants and categories or themes for
analysis (Creswell & Creswell, 2018; Merriam & Tisdell, 2016). The data analysis served as the
source for identifying findings and inductive themes. I then compared the data to the theoretical
framework, motivational models, and the literature to identify findings, recommendations, and
conclusions based on relevance to the two research questions. I used an iterative yet progressive
process to reflect on the codes which were independently analyzed and further examined to
generate inductive themes emerging from the data. Deductive analysis using a priori codes
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created from theoretical constructs emerging from the literature review followed the coding
process.
Validity and Reliability
Internal validity is how we can infer a relationship between two variables, whereas
external validity is the extent to which the causal relationship applies across different people,
settings, and times (Creswell & Creswell, 2018). The demographic survey questions identified
the relationship between veterinarians (independent variables) and the participants' perceptions
of leadership influence (dependent variables) on wellbeing and organizational culture. The
survey was distributed to four different professional veterinary industry associations to reach
more participants and increase internal validity and external validity.
Reliability refers to the assurance that study protocols were followed consistently and as
described (Merriam & Tisdell, 2016). Internal reliability is the extent to which researchers
collect, analyze, and interpret data consistently within a project, whereas external reliability is
how other researchers can reproduce a study and its results (Creswell & Creswell, 2018). To
increase internal reliability, the survey was anonymously administered to the members of five
professional veterinary associations. To further increase reliability, the survey consists of
previously published questions from other reliable and validated surveys: the MBI (Maslach et
al., 2018), Perceived Stress Scale (Cohen et al., 1983), FAS (Michelsen et al., 2003), and
Gallup’s Q12 (Gallup, 2022). The intended survey time of three weeks minimizes threats to
validity via history, selection, and maturation factors.
Ethics
The University of Southern California (2021) is committed to exhibiting respect for the
rights and dignity of all persons. I complied with the University’s code of ethics, and the IRB
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process began only after completing a proposal defense to gain approval from my committee
chair for submission to IRB (D. Grant, personal communication, February 6, 2021). There are
three levels of IRB review: (a) exempt, which poses less than minimal risk to participants, (b)
expedited, which poses no greater than minimal risk to the participants; and (c) full board
review, which poses more than minimal risk to the participants. Creswell and Creswell (2018)
identified additional best practices:
1. Confidentiality of participants: Records are to be de-identified to ensure participants’
anonymity. Confidentiality was supported by ensuring the removal of names or
identifying information, and all files were password-protected.
2. IRB process: Researchers participate in IRB training, receive IRB guidelines, and
receive guidance from the committee chair.
3. Compensation/incentives: There was no compensation to participants. All
participation was voluntary.
4. Power dynamics: Explain the researcher’s positionality and provide assurances that
the purpose of the study is to support veterinarian wellbeing.

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Chapter Four: Results
COVID-19 has created high levels of occupational stress within organizations, leading to
a further negative impact on veterinarian wellbeing. The purpose of this study was to explore the
impact of burnout, emotional exhaustion, fatigue, and engagement, on employee effectiveness
throughout the pandemic. The study also explored the organizational and leadership strategies
implemented during the pandemic that positively impacted veterinarians’ wellbeing. This
research study utilized an online survey instrument that adopted and adapted survey questions
from existing survey instruments and included novel questions. The instrument included Likert-
style items, demographic questions, and open-ended questions. Statistical analysis was
conducted using descriptive and inferential statistics, and coding and thematic analysis were
conducted for the open-ended questions. Two research questions guided this study:
1. How has burnout, emotional exhaustion, and fatigue impacted veterinarian
effectiveness throughout the COVID-19 pandemic?
2. What specific strategies have organizations and leaders implemented that support the
wellbeing of veterinarians during the COVID-19 pandemic?
The overall findings for each research question follow. The chapter concludes with a
summary of the overall research study findings.
Participant Demographics
The initial sample consisted of 506 veterinarians. Thirty-eight participants were removed
for not responding to a majority of the survey. The final sample consisted of 468 U.S. practicing
veterinarians, with the largest number practicing in California. Respondents work in small
animal general practice hospitals, emergency, and specialty hospitals, shelters, government
agencies, and academia. There was a wide distribution of age profiles, which were grouped into
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three age categories for simplification. Participants also spanned a wide range of years of service
in the industry, from less than 12 months to 23.1% having more than 16 years in the profession.
The mean was 10.3 years in the industry. The majority of participants (82%) have been with their
employer longer than 3 years, which signifies experience with their employer and not being a
new employee. The majority of respondents were married (66%), and 59% had no dependent
children living at home throughout the pandemic. Table 2 presents frequencies and percentages.

Table 2
Frequency Table for Nominal Variables
Demographic n %
Gender
Male 66 14.1
Female 343 73.3
Other 22 4.7
No response 37 7.9
Ethnicity
White 300 64.1
Hispanic, Latino, or Spanish origin 28 6.0
Black 14 3.0
Asian 32 6.8
Multiracial 20 4.3
Other 36 7.7
No response 38 8.1
Age
25–34 years 136 29.1
35–44 years 181 38.7
45+ years 105 22.4
Prefer not to answer 43 9.8
How many years have you been
practicing in the veterinary
profession?

< 12 months 16 3.4
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Demographic n %
1-2 years 29 6.2
3–5 years 75 16.0
6–10 years 128 27.4
11–15 years 74 15.8
16-20 years 45 9.6
21+ 63 13.5
No response 38 8.1
How many years have you been
employed with your current
employer?

< 12 months 31 6.6
1–2 years 55 11.8
3–5 years 117 25.0
6–10 years 131 28.0
11–15 years 52 11.1
16–20 years 21 4.5
21+ 23 4.9
No response 38 8.1

a
Participants had the option to select all categories that applied.

Research Question One (RQ1): How Have Emotional Exhaustion, Burnout, and Fatigue
impacted Veterinarian Effectiveness Throughout the COVID-19 Pandemic?
This study examined whether the beliefs about veterinarian effectiveness are related to
burnout, emotional exhaustion, fatigue, and engagement. Two different measures of
effectiveness were used to determine the effectiveness of veterinarians through creation of a
composite variable. The second measure for effectiveness was achieved by asking veterinarians
to compare their effectiveness before COVID-19 to present. This section provides descriptive
statistics using questions adopted or adapted from existing survey tools, then will report the
statistical results that measure effectiveness as a dependent variable. Reliability analysis will be
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presented for the independent variables of burnout, exhaustion, fatigue, and engagement and the
dependent variable for effectiveness. Correlational analysis will also be evaluated, including
differences between specific demographic groups of veterinarians.
Burnout
Burnout is a significant concern for veterinarians and results in callousness. Almost half
of the veterinary population surveyed (46%) feel burned out from their work a few times per
month or more, with 13% feeling burned out every day. Forty percent of veterinarians also report
they have become more callous toward people since taking this job with 11% feeling more
callous every day. These results demonstrate that veterinarians’ increased callousness is due to
their work, likely as a result of sustained fatigue and exhaustion. Callousness can result in
depersonalization, negative, and cynical interpersonal interactions and can be caused by
continued experiences of fatigue, and exhaustion (Admin, 2021).
Burnout consisted of two survey items adopted from the Maslach Burnout Inventory
(Maslach et al., 2018). These two survey questions have been demonstrated to correlate with
burnout in physicians (Li-Sauerwine et al., 2020). Participants (20%) said “I feel burned out
from my work” a few times per week. The single-item response to the “feeling burned out from
my work” question represents almost half of the participants suffering from regular mental and
physical health challenges, as this question has been shown to effectively measure emotional
exhaustion (West et al., 2012).
A composite score was developed for burnout by developing a mean composite variable
of the two respective survey items. Burnout scores ranged from 1.00 to 7.00, with M = 4.18 and
SD = 1.58. This mean is shifted toward more frequent burnout. The Cronbach alpha coefficient
for burnout was .73, indicating acceptable internal consistency. The summary statistics for
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burnout, emotional exhaustion, fatigue, engagement, and effectiveness are presented in Table 3.
Figure 1 presents the histogram for burnout scores.

Table 3
Summary Statistics for Burnout, Emotional Exhaustion, Fatigue, Engagement, and Employee
Effectiveness
Variable n Min Max M SD Items Cronbach’s α
Burnout 468 1.00 7.00 4.18 1.58 2 .73
Emotional exhaustion 468 1.00 5.00 3.04 0.87 2 .57
Fatigue 468 1.00 5.00 2.99 0.80 3 .69
Engagement 468 1.00 5.00 3.83 0.80 2 .59
Employee effectiveness 468 1.00 5.00 3.05 0.68 4 .72

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Figure 1
Histogram for Burnout Scores

Emotional Exhaustion
Participants reported feeling exhausted on a regular basis with moderate abilities to
control the important things in their life. Emotional exhaustion was examined using two survey
items from existing survey instruments. The number of participants who responded to the
question “Mentally, I feel exhausted” as regularly or often was 46.1%, and always 14.3%.
Participants said they were never or almost never able to control the important things in their life
29.3% of the time, which is likely due to extensive exhaustion impacted by mental and physical
fatigue.
A composite score was developed for emotional exhaustion through an average of the
two respective survey items. Emotional exhaustion scores ranged from 1.00 to 5.00, with M =
3.04 and SD = 0.87. The Cronbach alpha coefficient for burnout was .57, indicating questionable
74

internal consistency, which could be due to the small number of survey variables being used. The
summary statistics for emotional exhaustion are presented in Table 3. Figure 2 presents the
histogram for emotional exhaustion scores.

Figure 2
Histogram for Emotional Exhaustion Scores

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Fatigue
This study found that veterinarians are routinely fatigued, however, despite being
fatigued, have the energy needed, and are able to concentrate at work. Participants responded to
the question, “Physically, I feel exhausted,” as follows: always (12.4%), and regularly (45.2%).
Most participants (95%) expressed having enough energy for everyday life with only 5% feeling
they never have enough energy for everyday life. Veterinarians rated emotional exhaustion and
physical exhaustion similarly, with slightly over one-third of the population surveyed feeling
often or always mentally or physically exhausted. Most responded to the question “When I am
doing something, I can concentrate quite well” as regularly, often, or always (76.71%), and only
1.3% responded to the question on concentration as never. This data suggests that even though
veterinarians are exhausted, they can still concentrate. A composite score was developed for
fatigue through an average of the three respective survey items. Fatigue scores ranged from 1.00
to 5.00, with M = 2.99 and SD = 0.80. The Cronbach alpha coefficient for fatigue was .7,
indicating internal consistency. The summary statistics for fatigue are presented in Table 3.
Figure 33 presents the histogram for fatigue scores.

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Figure 3
Histogram for Fatigue Scores

Engagement
Engagement was assessed using two survey items taken from the Gallup Q-12 survey
instrument ( Gallup 2022) to help understand workplace resources and organizational and
leadership support perceived by veterinarians. Two questions were used from the Gallup survey,
“Do you have the materials and equipment to do your job right?” and “Does your supervisor or
someone care about me as a person?” The findings show that the vast majority of veterinarians
felt care was demonstrated by their supervisor or colleagues and materials and supplies were an
issue throughout the pandemic. Just slightly less than half of the veterinarians (47.2%) felt they
had the materials and equipment to do their job right which identifies that slightly more than half
of the veterinarians felt they did not have the resources and equipment needed throughout the
pandemic. Notably, 18.59% of participants disagree or strongly disagree with the question
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relating to materials and equipment. A future study could examine whether this negative
response was specifically COVID-19 related or whether sufficient materials and equipment is an
ongoing issue in veterinary hospitals. The vast majority of survey participants (85%) agreed that
their supervisor or someone at work seems to care about them as a person. The theme of caring
was a consistent theme throughout the survey results and carried through to the direct supervisor
effectiveness strategies supporting the wellbeing of veterinarians, which is connected to RQ2. A
composite score was developed for engagement through an average of the respective two survey
items. Engagement scores ranged from 1.00 to 5.00, with M = 3.83 and SD = 0.80. The
Cronbach alpha coefficient for engagement was .59, indicating questionable internal consistency.
The summary statistics for engagement are presented in Table 3. Figure 4 presents the histogram
for engagement scores.

Figure 4
Histogram for Engagement Scores

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Perceptions of Employee Effectiveness
Employee effectiveness was measured through four survey items. Employee
effectiveness remained the same or improved for 60% of respondents despite the fact that the
majority said their wellbeing decreased. Participants were asked a direct question to compare
their wellbeing before and during COVID-19; the majority (67%) responded they had less
wellbeing, with 10.8% saying improved or significantly improved wellbeing. The majority of
respondents (71.2%) said they were fairly often and very often feeling confident about their
ability to handle problems at work. In response to the question about how often in the last month
they felt difficulties at work were piling up so high that they could not overcome them, more
than 70% responded sometimes or almost never implying that the majority of veterinarians are
able to manage the workload and address difficulties at work despite being mentally and
physically fatigued. Frequencies and percentages of the survey responses are presented in Table
4.

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Table 4
Frequencies and Percentages for Employee Effectiveness Survey Items
Survey item n %
Q8: In the last month, how often have you felt
confident about your ability to handle your
problems at work?

Never 3 0.64
Almost never 21 4.49
Sometimes 111 23.72
Fairly often 231 49.36
Very often 102 21.79
Q9: In the last month, how often have you felt
difficulties at work were piling up so high that
you could not overcome them?

Very often 20 4.27
Fairly often 74 15.81
Sometimes 169 36.11
Almost never 161 34.40
Never 44 9.40
Q12: How do you compare your current
effectiveness in your work relative to before the
pandemic?

Significantly less effective 35 7.48
Somewhat less effective 154 32.91
Same 162 34.62
More effective 102 21.79
Significantly more effective 15 3.21
Q13: How do you compare your current wellbeing
relative to before the pandemic?

Significantly less wellbeing 105 22.44
Somewhat less wellbeing 209 44.66
Same wellbeing 105 22.44
Improved wellbeing 44 9.40
Significantly improved wellbeing 5 1.07

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A composite score was developed for employee effectiveness through an average of the
four respective survey items. Employee effectiveness scores ranged from 1.00 to 5.00, with M =
3.83 and SD = 0.80, with 5.0 being more effective, the mean of 3.83 gives an indicator that more
than half felt more effective throughout the pandemic. The Cronbach alpha coefficient for
employee effectiveness was .72, indicating acceptable internal consistency. The summary
statistics for employee effectiveness are presented in Table 3. Figure 5 presents the histogram for
employee effectiveness scores.

Figure 5
Histogram for Employee Effectiveness Scores

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Correlation Analyses: Bivariate Associations
A series of Pearson correlations were proposed to analyze the two-way relationships
between the variables of interest: burnout, emotional exhaustion, fatigue, employee
effectiveness, and engagement. A Pearson correlation is appropriate when testing the two-way
association between continuous-level variables (Pallant, 2020). Prior to analysis, the assumption
of normality was tested with a series of Shapiro-Wilk tests. The findings of the Shapiro-Wilk
tests were statistically significant (all p < .001), indicating that the normality was not supported
by the variables. Howell (2013) indicated that violations of normality are not problematic when
the sample size for the research exceeds 50 cases. Therefore, the Pearson correlations were
reported, and non-parametric Spearman correlations were conducted as an alternative. Spearman
correlations are appropriate when testing the two-way relationship between ordinal variables or
two continuous-level variables that do not follow a bell-shaped distribution (Tabachnick &
Fidell, 2019).
Burnout and emotional exhaustion were positively related to fatigue and negatively
related to engagement and employee effectiveness. Upon examination of the Pearson
correlations, burnout was significantly, positively related to emotional exhaustion (r = .65, p <
.001) and fatigue (r = .59, p < .001). Burnout was significantly, inversely related to engagement
(r = -.40, p < .001) and employee effectiveness (r = -.60, p < .001).
Emotional exhaustion was significantly, positively related to fatigue (r = .70, p < .001).
Emotional exhaustion was significantly, negatively related to engagement (r = -.42, p < .001)
and employee effectiveness (r = -.62, p < .001).
Fatigue was significantly, inversely related to engagement (r = -.46, p < .001) and
employee effectiveness (r = -.63, p < .001).
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Engagement was significantly positively related to employee effectiveness (r =.51, p <
.001). The findings of the Pearson correlations are presented in Table 5.

Table 5
Pearson Correlations Between Variables of Interest
Variable 1 2 3 4
r r r r
1. Burnout
2. Emotional exhaustion .65*
3. Fatigue .59* .70*
4. Engagement -.40* -.42* -.46*
5. Employee effectiveness -.60* -.62* -.63* .51*

*Correlation was significant at .05 level.

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Additionally, upon examination of the non-parametric Spearman correlations, the
significance and directionality of the associations mirrored the same findings of the Pearson
correlations. Burnout was significantly, positively related to emotional exhaustion (rs = .65, p <
.001) and fatigue (rs = .58, p < .001). Burnout was significantly, inversely related to engagement
(rs = -.39, p < .001) and employee effectiveness (rs = -.59, p < .001).
Emotional exhaustion was significantly, positively related to fatigue (rs = .69, p < .001).
Emotional exhaustion was significantly, inversely related to engagement (rs = -.41, p < .001) and
employee effectiveness (rs = -.60, p < .001). Fatigue was significantly, inversely related to
engagement (rs = -.47, p < .001) and employee effectiveness (rs = -.61, p < .001). Engagement
was significantly positively related to employee effectiveness (rs =.51, p < .001).
Linear Regression Analysis
A multiple linear regression was conducted to examine the predictive relationship
between burnout, emotional exhaustion, fatigue, engagement, and employee effectiveness. A
linear regression is appropriate when testing the predictive relationship between a series of
independent variables on a continuous criterion variable (Pallant, 2020). The predictor variables
corresponded to burnout, emotional exhaustion, fatigue, and engagement. The continuous
dependent variable corresponded to employee effectiveness.
Prior to analysis, the assumptions of a multiple linear regression were tested: normality,
homoscedasticity, and absence of multicollinearity. Normality was assessed with a P-P
scatterplot. The data in the scatterplot closely followed the normality trend line indicating that
the residuals in the regression model approximately followed a normal distribution (Figure 6).

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Figure 6
Normal P-P Scatterplot With Regression Model Predicting Employee Effectiveness

Homoscedasticity was tested with a residuals scatterplot. The findings (Figure 7) showed
random spread and did not indicate a clear trend, providing evidence that the assumption of
homoscedasticity was supported.

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Figure 7
Residuals Scatterplot With Regression Model Predicting Employee Effectiveness

Variance Inflation Factors (VIFs) were calculated to identify the presence of
multicollinearity between predictors. All the VIFs were lower than 10, indicating that the
predictor variables were independent of each other, and the assumption for the absence of
multicollinearity was supported. Table 6 presents the VIF for each predictor in the model.

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Table 6
Variance Inflation Factors for Variables of Interest
Variable VIF
Burnout 1.88
Emotional exhaustion 2.36
Fatigue 2.19
Engagement 1.32

The results of the collective regression model were significant, F(4, 463) = 130.24, p <
.001, R
2
= .53, indicating a significant relationship between burnout, emotional exhaustion,
fatigue, and engagement in terms of employee effectiveness scores. The coefficient of
determination, R
2
, indicates that approximately 52.95% of the variance in employee effectiveness
can be explained by the predictor variables. Due to the significance of the collective model, the
individual predictors were examined further.
Burnout (B = -0.10, t = -5.40, p < .001) was a significant predictor of employee
effectiveness, indicating that with every one-unit increase in burnout, employee effectiveness
decreased by approximately 0.10 units. Emotional exhaustion (B = -0.15, t = -3.97, p < .001)
was a significant predictor of employee effectiveness, indicating that with every one-unit
increase in emotional exhaustion, employee effectiveness decreased by approximately 0.15 units.
Fatigue (B = -0.22, t = -5.46, p < .001) was a significant predictor of employee effectiveness,
indicating that with every one-unit increase in fatigue, employee effectiveness decreased by
approximately 0.22 units. Engagement (B = 0.18, t = 5.74, p < .001) was a significant predictor
of employee effectiveness, indicating that with every one-unit increase in engagement, employee
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effectiveness increased by approximately 0.18 units. Table 7 summarizes the results of the
regression model.

Table 7
Results for Multiple Linear Regression with Burnout, Emotional Exhaustion, Fatigue, and
Engagement Predicting Employee Effectiveness
Variable b SE β t p
Burnout -0.10 0.02 -.24 -5.40 < .001
Emotional exhaustion -0.15 0.04 -.19 -3.97 < .001
Fatigue -0.22 0.04 -.26 -5.46 < .001
Engagement 0.18 0.03 .21 5.74 < .001

Note. Overall model fit: F(4, 463) = 130.24, p < .001, R
2
= .529.

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Examination of Variables of Interest by Demographic Characteristics
Several tests were applied: Chi-squared, t-tests, and ANOVA were used for significance.
Testing was done at the 95% confidence level. The summary statistics for the variables of
interest by gender are presented in Table 8. Women experienced higher levels of burnout,
emotional exhaustion, and fatigue than men. In terms of feeling burned out, 42.2% of women
reported feeling burned out every day, a few times a week, or once a week, versus men who
reported this 28% of the time. There is a significant difference between men reporting never
feeling burned out or feeling burned out only a few times a year or less: 30.3% of men and 12%
of women.

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Table 8
Summary Statistics for Variables of Interest by Gender
Variable n Min Max M SD
Burnout
Male 66 1.00 7.00 3.38 1.64
Female 343 1.00 7.00 4.33 1.52
Other 22 1.50 7.00 4.36 1.71
Emotional exhaustion
Male 66 1.00 5.00 2.75 0.88
Female 343 1.00 5.00 3.09 0.87
Other 22 2.00 5.00 3.45 0.83
Fatigue
Male 66 1.00 4.33 2.64 0.81
Female 343 1.00 5.00 3.05 0.79
Other 22 1.33 4.33 3.17 0.85
Engagement
Male 66 2.00 5.00 3.92 0.78
Female 343 1.50 5.00 3.84 0.76
Other 22 1.00 5.00 3.30 1.14
Employee effectiveness
Male 66 1.50 5.00 3.22 0.70
Female 343 1.00 4.75 3.02 0.67
Other 22 1.75 4.50 2.88 0.74

Women are experiencing greater rates of burnout, emotional exhaustion, and fatigue than
men, along with underrepresented minorities and the newest veterinarians. Women are
significantly more likely to report being callous to others every day, or weekly (40%), while men
reported significantly less callousness to others (16.6%). Women reported feeling a higher level
of frequency than men to the following questions: feeling mentally exhausted (35.8% versus
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19.7%), feeling physically exhausted (34.3% versus 18.2%), not having enough energy for
everyday life (54.3% versus 39.4%), and not able to concentrate quite well as 24.5% versus
13.6%. Men had slightly higher engagement than women throughout COVID-19 (3.92 versus
3.84), even though there were no differences between men and women in terms of perceived
effectiveness in their work relative to before the pandemic. In terms of overall wellbeing, there
were no significant differences between men and women; 62.1% of men said they had less
wellbeing during COVID-19 versus 68.6% of women.
The youngest veterinarians (25-34 years) and the newest to the profession, with 4.0 mean
years practicing in veterinary medicine, were most negatively impacted by burnout frequency.
The youngest veterinarians reported frequent burnout (78%). The youngest also reported three
times more callousness to others than older veterinarians, with 15.4% reporting callousness
“everyday” versus older veterinarians reporting 4.8%. The youngest also reported lower levels of
confidence in handling problems at work (29%), and the highest levels of concern for difficulties
at work piling up so they were hard to overcome for three out of 10 youngest veterinarians.
The data showed that veterinarians with children under 18 at home are more likely to
report burnout a few times a month (32.7%) versus those without children under 18 living at
home (23.4%). Almost four out of 10 (36.9%) without children reported burnout every day or a
few times a week, whereas those with children at home only reported this at 23.2%. The data
indicate that veterinarians with children cope somewhat better than those without children, which
could be related to isolation and social distancing caused by the pandemic where non-essential
businesses were closed along with community and neighborhood venues. There were significant
differences between the segments in the number and ages of dependent children at home and
their ability to cope throughout the pandemic. Amongst the youngest population of 25 to 34 year-
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old veterinarians, 16% had children at home, of which 77% had children under age 5 at home.
This finding could be one of the contributing factors to the finding that 78% of this age group
(25-34 years) reported frequent burnout. The summary statistics for the variables of interest by
having dependents are presented in Table D2.
The summary statistics for the variables of interest by ethnicity are presented in Table D1
(see Appendix D), and while all underrepresented groups are small populations and some are not
statistically significant, there are opportunities to further examine Black, Latino, and Asian
veterinarians’ responses to understand the variations in burnout, emotional exhaustion, fatigue,
and engagement. Latino veterinarians reported higher rates of burnout with 52% saying they
faced burnout daily, followed by Asian veterinarians (37%) reporting daily burnout. Black
veterinarians (44%) reported burnout a few times a month.
Overall Pattern of Effectiveness by Demographics
As demonstrated through the previous findings and tables, veterinarians with different
demographic characteristics experienced effectiveness differently throughout COVID-19,
resulting in different levels of burnout, emotional exhaustion, fatigue, wellbeing, and
effectiveness.
• Ineffectiveness was greater in women than men.
• Ineffectiveness was greater among underrepresented minorities than White
veterinarians.
• Ineffectiveness was greater in the 25–44 age group.
• Ineffectiveness was greater in the newest to the profession, with the least tenure.
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Research Question Two (RQ2): What Specific Strategies Have Organizations and Leaders
Implemented That Support the Wellbeing of Veterinarians During the COVID-19
Pandemic?
This study examined specific strategies implemented by organizations or leaders to
identify which positively supported the wellbeing of veterinarians throughout the COVID-19
pandemic. Four questions were asked, and respondents were to rate each strategy using a Likert
response ranging from one to five. An open-ended text box was provided for each of the four
questions. The four questions were as follows:
• What policies, if any, did your organization implement to support your wellbeing
during the pandemic?
• Which of the organizational programs or practices, if any, did your organization
implement to support your wellbeing during the pandemic?
• What benefits or training, if any, did your organization implement to support your
wellbeing during the pandemic?
• What supervisor practices, if any, did your direct supervisor implement to support
your wellbeing at work during the pandemic?
Responses from participants demonstrate that veterinarian organizations implemented
more than two dozen policies and practices and added or enhanced employee benefits supervisor
strategies during COVID-19.
Company Policies: Employee Wellbeing
Participants rated each policy using a Likert scale based on effectiveness. Veterinarians
identified policies that protected their health and the health and caring of their families as most
effective. A series of survey items regarded the respondents’ company implementing policies
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and how they contributed to wellbeing. Table D3 presents the frequencies for these responses.
There were few differences by age group in the perceived effectiveness of the policies tested in
the research. In the case of policies, mandated personal protective equipment was the highest-
rated benefit, with 67.5% of participants rating this policy as effective or highly effective, and
women rated it as more effective than men did (73.9% versus 56.1%) along with the oldest
veterinarians, who felt this was a more important strategy than the youngest veterinarians. A
policy that was seen as not effective by 77.1% of veterinarians was the reporting of daily health
symptoms. Based on an open-ended comment, the perceived accuracy of individuals reporting
their own health status during COVID was largely on the honor system and, due to the staffing
shortages in veterinary hospitals, likely created even larger staffing challenges for veterinarians
to be sent home should they self-identify COVID-related symptoms.
Respondents saw additional sick time as one of the most effective policies, with 54.9% of
those offered additional sick time rating this policy as effective or highly effective. This finding
is likely supported by the need to quarantine when having been exposed to COVID or if the
veterinarian contracted COVID, the need to be out of the hospital for an established period of
time to recover. While 28.9% of participants were not offered time off to care for family
members, of those who were offered this policy, 42.5% felt it was effective to highly effective,
which correlates to the finding that 39% of veterinarians surveyed had dependent children at
home. This policy was rated highest by those aged 35 to 44 years, of whom 59.7% had children
under 18 at home.
Quarantine guidelines for exposure to others with COVID were also seen as an effective
policy by 54.27% of the participants, with the oldest veterinarians surveyed (age 45 years plus)
rating this as highly effective or effective (64%). This recognizes that the COVID-19 health
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impact was more detrimental to older individuals and reaffirms the veterinarian’s desire to
remain healthy and to keep hospital teams healthy to service pets. Remote working was not
offered to 71.37% of the participants, which corresponds to the type of services performed by
veterinarians. Men rated flexible scheduling (57.6%) as more effective than women (40.8%), and
men rated remote working (27.3%) as more effective than women (15.5%). Fixed team
schedules, defined as being scheduled with the same team members each shift, were not offered
to 59.19%; however, of those who were offered fixed team schedules, only 11.75% rated this
strategy as effective or highly effective. This suggests that while fixed schedules allow teams to
work in consistent groups; and can be appropriate for the containment of COVID from spreading
from one team to another they might not have been practical based on the small size of hospital
teams and the reported staffing shortages.
Company Practices: Employee Wellbeing
Veterinarians were asked to use a Likert scale to rate a series of survey items regarding
company implemented practices and how they contributed to wellbeing. Table D4 presents the
frequencies for these responses. There were no significant differences in how women and men
rated company practices. Respondents rated items consistent with company policies – items that
supported the veterinarian’s personal health were seen as effective. The company providing
personal protective equipment was seen as highly effective or effective by 72.65% of
respondents.
Additionally, workflow or process changes to protect veterinarians from exposure to
clients and ensure social distancing were seen as effective. Curbside drop-off was seen as a
highly effective or effective policy by 56.21% of respondents. Independent veterinarians rating
curbside drop-off as 74.4% effective versus 58.3% of the corporate veterinarians. Contactless
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payments were also seen as highly effective or effective by 59.83% of veterinarians. Telehealth
was seen as effective or highly effective by 30% of veterinarians. Telehealth is a newer modality
in veterinary medicine and was not offered to 13.9% of the veterinarians. Black veterinarians,
although the number of respondents is small (4%), saw Telehealth as a very effective strategy.
Consistent with the company policies, the practice of maintaining consistent or fixed personnel
teams assigned together on shifts was not offered to 45% of veterinarians surveyed and was not
seen as an effective strategy, likely due to the staffing shortages in hospitals due to the increased
caseload and staff being out due to COVID. The practice of daily health questionnaires was seen
as not offered, highly ineffective, or ineffective by 52.78% of respondents, consistent with a
similar response to company policies.
Benefits or Training: Employee Wellbeing
Veterinarians valued COVID and wellbeing benefits when they were offered. Benefits
was the area of the survey where we saw the greatest number of programs not offered to all
veterinarians, which is likely related to the size of the different hospital practices. Benefits
effectiveness was determined by a series of survey items, where the respondent was asked to rate
the company benefit or training based on its effectiveness. Table D5 presents the frequencies for
these responses. There were few differences between women and men in rating the effectiveness
of benefits. While 38.3% of respondents were not offered an increased number of sick days as a
benefit, an increased number of sick days was seen as highly effective or effective by 40.4% of
all participants. Mental health benefits were seen by 36.5% of participants as highly effective or
effective, but these were not offered to 14.6% of participants. An employee assistance program
was not offered to 38.03% of participants, and social work programs were not offered to 56.84%
of participants. Interestingly, social worker programs were rated higher in effectiveness for men
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than women (27.3%), and the employee assistance program benefit was highly rated by 45.5% of
Latino DVM’s. These programs provide direct support related to mental and physical health
associated with burnout, emotional exhaustion, and fatigue. The data suggests there is an
opportunity to provide more mental health support to all veterinarians.
Almost half of the DVM’s surveyed (47.4 %) were not offered childcare benefits.
Childcare benefits were reported significantly more often for men than women (27.3% versus
14.1%). Wellbeing or resilience training was not offered to 31.62% of respondents; however, of
those who were offered wellbeing or resilience training, 19% felt like the training was effective,
suggesting there is an opportunity to strengthen the skills of veterinarians on wellbeing and
resilience.
Direct Supervisor Strategies: Employee Wellbeing
Consistently throughout the research, veterinarians rated programs and actions that
demonstrated care as important. A series of survey items addressed 12 strategies that direct
supervisors implemented and how they contributed to veterinarian wellbeing. Strategies that
supported emotional care by supervisors to veterinarians were rated most effective: demonstrated
empathy and care, shared company communications, listening to veterinarian needs, and
recognition of employee efforts received effective or highly effective ratings from 50% or more
of the veterinarians. Direct supervisors who demonstrated empathy and care were the highest
rated of the 12 strategies surveyed, with 62% of the respondents rating this strategy as effective
or highly effective. Table 9 presents the frequencies for these responses. The age segments
ranked the effectiveness of supervisor strategies in a similar order. People of color responded
even more positively to demonstrated empathy and care, with 75% or more considering this
strategy effective, as did DVMs with children under age 10 at home (84.4%). Black veterinarians
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responded to all four supervisor strategies demonstrating care, listening, sharing communication,
and recognizing efforts with the highest responses for effectiveness.
Respondents also rated supervisors who shared communications in a timely manner as
58.98% highly effective or effective and supervisors who listened to employee needs as 56.65%
highly effective or effective. It is also important to highlight that while 58.9 % of veterinarians
rate the timely communication of information as an effective strategy, there are other
communication methods or opportunities to share information that were not offered. For
example, 27.8% did not have routine check-in conversations with their supervisors, and 19.7%
did not have team meetings.
Direct supervisors who accommodated flexibility in scheduling were perceived by
49.36% of participants as highly effective or effective, while 23.08% were not offered flexibility
in scheduling. Additionally, 45.5% of veterinarians were not offered accommodation or a change
in duties which is understandable considering veterinarians serve a unique role in veterinary
hospitals and speaks to the limited coverage options to accommodate the needs of veterinarians.
However, there were likely veterinarians who were high risk and may have needed
accommodation throughout COVID who were not able to be accommodated. During this time,
supervisors who encouraged personal development or training were seen by 43.38% of
participants as highly effective or effective; however, 57.0% were not permitted time off to
attend wellbeing training, which is likely related to the increased caseload and staffing shortages
in hospitals.

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Table 9
Frequency Table for Employee Wellbeing Regarding Strategies Implemented by Direct
Supervisor
If your direct supervisor implemented the below strategies,
how effective were they to your wellbeing?
n %
Routine individual check-in conversations
Not offered 130 27.8
Highly ineffective 7 1.5
Ineffective 32 6.8
Neither effective nor ineffective 61 13.0
Effective 156 33.3
Highly effective 45 9.6
No response 37 7.9
Regular team meetings
Not offered 92 19.7
Highly ineffective 21 4.5
Ineffective 30 6.4
Neither effective nor ineffective 77 16.5
Effective 175 37.4
Highly effective 36 7.7
No response 37 7.9
Accommodated flexibility in scheduling
Not offered 108 23.1
Highly ineffective 8 1.7
Ineffective 16 3.4
Neither effective nor ineffective 68 14.5
Effective 164 35.0
Highly effective 67 14.3
No response 37 7.9
Accommodated a change in duties
Not offered 213 45.5
Highly ineffective 4 0.9
Ineffective 17 3.6
Neither effective nor ineffective 56 12.0
Effective 98 20.9
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If your direct supervisor implemented the below strategies,
how effective were they to your wellbeing?
n %
Highly effective 43 9.2
No response 37 7.9
Demonstrated empathy and care
Not offered 30 6.4
Highly ineffective 11 2.4
Ineffective 30 6.4
Neither effective nor ineffective 66 14.1
Effective 193 41.2
Highly effective 101 21.6
No response 37 7.9
Listened to employee needs
Not offered 42 9.0
Highly ineffective 21 4.5
Ineffective 37 7.9
Neither effective nor ineffective 65 13.9
Effective 190 40.6
Highly effective 76 16.2
No response 37 7.9
Permitted time off to attend wellbeing training
Not offered 267 57.1
Highly ineffective 4 0.9
Ineffective 12 2.6
Neither effective nor ineffective 61 13.0
Effective 52 11.1
Highly effective 35 7.5
No response 37 7.9
Referred employees to benefit/wellbeing programs
Not offered 126 26.9
Highly ineffective 15 3.2
Ineffective 30 6.4
Neither effective nor ineffective 105 22.4
Effective 115 24.6
Highly effective 40 8.6
No response 37 7.9
Role modeled wellbeing
Not offered 125 26.7
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If your direct supervisor implemented the below strategies,
how effective were they to your wellbeing?
n %
Highly ineffective 16 3.4
Ineffective 34 7.3
Neither effective nor ineffective 113 24.2
Effective 103 22.0
Highly effective 40 8.6
No response 37 7.91
Recognized employee efforts
Not offered 52 11.1
Highly ineffective 18 3.9
Ineffective 35 7.5
Neither effective nor ineffective 68 14.5
Effective 172 36.8
Highly effective 86 18.4
No response 37 7.9
Shared company communications in a timely manner
Not offered 45 9.6
Highly ineffective 20 4.3
Ineffective 26 5.6
Neither effective nor ineffective 64 13.7
Effective 211 45.1
Highly effective 65 13.9
No response 37 8.0
Encouraged job training or development programs
Not offered 114 24.4
Highly ineffective 9 1.9
Ineffective 19 4.1
Neither effective nor ineffective 86 18.4
Effective 144 30.8
Highly effective 59 12.6
No response 37 7.9

Four questions (Q14, Q15, Q16, and Q17) permitted an option for an open-ended
response. These questions asked about organizational policies, programs, benefits, and leadership
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strategies that participants believed were effective throughout COVID-19. Twenty-eight
participants wrote in responses, representing 5.9% of the participants. The themes of the
responses can be found below in Table 10 and mirror the analysis provided in each of the four
sections on policies, practices, benefits, and supervisory strategies. The only new significant
theme related to effectiveness and wellbeing identified through the open-ended questions was
related to an underlying concern regarding the staffing shortages of veterinarians by 15
individuals. The comments also identify the issue of increased workload for veterinarians
throughout COVID-19. Some direct quotes related to staffing were
• “Staffing shortages are our biggest wellbeing issue, requiring doctors to work longer
hours due to increased pets and support multiple hospitals to cover when other
doctors are out sick due to COVID.”
• “There is a talent supply shortage of veterinarians, we are not staffed to cover the
increased workload of pets, especially throughout COVID when individuals are out
sick.”
• “We need more doctor staffing to improve wellbeing, there is a talent shortage of
veterinarians.”
• “Veterinarians work when sick because there is not adequate backup coverage, and
then there is no one to see the pets.”
• “Productivity goals and unrealistic staffing coverage is impacting veterinarian
wellbeing.”

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Table 10
Summary Table of Open-ended Questions 15 and 17, Findings (Themes)
Open-ended question Themes
Q. 15 Which of the organizational policies or programs
listed in question 14 were the most effective?
1. Staffing (n=15)
2. COVID sick pay and PPE (n =9)
3. Limiting client contact (n =7)
Q. 17 Which of the supervisor items listed in question 16
you thought were the most effective?
1. Flexibility and empathy (n=6)
2. Communications (n=5)
3. Teamwork (n=3)

Summary of Findings for Research Question Two
This study intended to understand the organizational and leadership practices that
supported the wellbeing of veterinarians throughout COVID-19. The most effective policies,
practices, benefits, and strategies are listed below:
• Provided and mandated personal protective equipment
• Quarantine guidelines for exposure to others with COVID
• Additional paid sick time
• Time off to care for family members
• Implementing contactless payment
• Implementing curbside drop-off and pickup
• Supervisors who demonstrated empathy and care
• Supervisors who shared timely communications
• Supervisors who listened to employee needs
• Supervisors who recognized employee efforts
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Summary of Results and Findings
The first research question aimed at understanding how burnout, emotional exhaustion,
and fatigue impacted employee effectiveness throughout the COVID-19 pandemic. The
following are five key findings for this question: (a) burnout, emotional exhaustion, fatigue, and
engagement are strongly correlated to wellbeing; (b) effectiveness improved for a significant
number of veterinarians (25.2%) throughout COVID-19 and remained the same for 60%; (c)
wellbeing declined for the majority of survey participants during COVID-19; (d) women
experienced greater levels of burnout, physical, and mental fatigue than men (e) the youngest and
newest veterinarians to the profession had greater wellbeing and effectiveness challenges than
experienced veterinarians and (f) underrepresented minorities experienced greater wellbeing
challenges than white veterinarians.
The second research question focused on what specific strategies organizations and
leaders implemented during the pandemic to support the veterinarians’ wellbeing. There are
three key findings for this question: (a) COVID-19 quarantine policies and foundational benefits
such as sick leave, quarantine policies, and mandating and providing personal protective
equipment were effective; (b) processes limiting client interaction were perceived to be effective
or highly effective, such as curbside drop-off, contactless payment, telehealth; and (c) there were
many benefits and programs not offered to veterinarians, such as accommodation in a change of
duties, time off to attend wellbeing training, flexibility in scheduling, employee assistance
program, access to a social worker, childcare benefits, resilience training, access to increased
sick days or time away benefits, and (d) direct supervisors who demonstrated care and empathy,
strong listening skills, and recognized employees efforts were perceived as positively supporting
veterinarian wellbeing.
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Chapter Five: Discussion
This chapter will first provide further analysis of the findings presented in Chapter Four
and discuss how the results connect to scholarly literature in the healthcare and veterinary field,
and Bronfenbrenner’s (1979) ecological systems theory that guides this study. Next, the chapter
turns to recommendations for practice based on the study’s findings to be used by employers,
direct supervisors, academia, and industry association groups, followed by a discussion of
limitations and delimitations. Finally, the chapter provides recommendations for future research
and concluding reflections.
Discussion of the Findings and Results
The major findings from the research study identified a strong relationship between
burnout, fatigue, emotional exhaustion, and engagement in relation to effectiveness since the
pandemic. These results align with Bronfenbrenner’s (1979) first level of the ecological model
(microsystems), which demonstrates the influence of its immediate environment, including
family, close friends, and peers. The veterinarian's direct interactions with their immediate
environment negatively impacted their wellbeing. The organization and direct supervisor,
representing Bronfenbrenner’s second level of the ecological model (mesosystem), provide the
structure that further influences the relationships between the individual microsystems. While
veterinarian wellbeing has been an ongoing industry concern, rooted in belief systems,
education, professional influences, and social context, 67% of veterinarians surveyed saw a
decrease in their wellbeing throughout COVID-19. In addition, 44% of participants report feeling
burned out at work at least once a week, 48% regularly feel mentally exhausted, and more than
57% of participants physically feel regularly exhausted.
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This study found a significant difference in demographic groups for some variables. The
most significant difference was in the perceived wellbeing between women and men. Both men
and women equally revealed having less wellbeing during the pandemic than prior to the
pandemic. Additionally, the youngest veterinarians experienced the most burnout.
Discussion of Findings and Results Related to Work Effectiveness, Burnout, Emotional
Exhaustion, and Fatigue and Measures of Organizational Support
The pandemic impacted veterinarians’ effectiveness in different ways. While four out of
10 (40.4%) said they have become less effective (most saying they are somewhat less effective),
60% of veterinarians said their effectiveness stayed the same, with 25.2% saying they have been
more effective throughout COVID-19. Additionally, 30% of men said their effectiveness
improved. Work effectiveness through this research study was measured in multiple ways. One
method was a composite variable using multiple questions from the Perceived Stress Scale (S.
Cohen et al., 1983) adapted to represent the level of effectiveness veterinarians felt at work. This
composite variable demonstrated high reliability. The second method used to measure work
effectiveness was based on asking the survey participant to compare their current effectiveness
prior to the pandemic. The two measures were correlated to each other, with lower wellbeing
showing a stronger correlation to emotional exhaustion, fatigue, and burnout than the single-item
measure about the perceived effectiveness throughout the pandemic. Caution from an internal
reliability perspective should be used in interpreting the single items measured as the results to
the single item measures cannot be retested based on the survey design selected by the researcher
(Hudson et al., 2016).
Despite caseload and staffing shortages identified in the literature review, findings, and
open-ended responses, veterinarians surveyed identified that their effectiveness remained the
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same or improved throughout COVID-19 due to workflow and process changes reducing the
interaction with clients identified through curbside drop-off, contactless payment, and the
introduction of telehealth. Veterinarians are influenced by a series of guidelines and procedures
that are ingrained in their education system, professional organizations, legislature, and
enforceable non-written practices that are observed in their professional lives (Kimera &
Mlangwa, 2015). These beliefs are deeply rooted in the education systems and industry norms
and shape their actions. A veterinary oath to care for pets reinforces the veterinarians’
commitment to their purpose, belief systems, the professional standards for care and influences
their delivery of care. These fundamentals were challenged throughout COVID-19 based on the
seriousness of the virus, external context, and government regulations (Bronfenbrenner, 1979)
and could be seen through the slow adoption of telehealth. There were no significant differences
related to perceptions of effectiveness reported between women and men.
This study examined burnout using a two-item construct with one question focused on
emotional exhaustion, and the other question focused on depersonalization. In this study, the
Cronbach alpha was .73, which demonstrates internal consistency. Overall, 43.8% of respondents
feel burned out at least weekly, another 25% said that they are burned out a few times a month,
and 30.8% said they are burned out once a month or less, a few times per year, or never. There is
a significant difference between men reporting never feeling burned out or feeling burned out
only a few times a year or less: 30.3% of men and 12% of women. In terms of feeling burned
out, 42.2% of women reported feeling burned out every day, a few times a week, or once a week,
versus men who reported this 28% of the time.
Consistent with the literature, women were more likely to feel pressured through
deterioration of work-life balance due to the lack of childcare (McKinsey & Company, 2021) or
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depressive symptoms (Platts et a., 2022). Women are significantly more likely to report being
callous to others every day, a few times a week, or once a week (40%), while men reported
significantly less callousness to others (16.6%). The youngest veterinarians reported greater
callousness than older veterinarians, along with lower confidence levels. Women reported higher
levels of mental exhaustion (35.8% versus 19.7%) and physical exhaustion (34.3% versus
18.2%). Work-related perceptions related to control also showed gender differences. When asked
how often they felt they were unable to control the important things in their lives over the
previous month, 9.1% of women and 1.5% of men selected very often. The feeling of confidence
also emerged through the question, “In the last month, how often have you felt confident about
your ability to handle your problems at work?” Eight of 10 men (86.4%) said very often, and
70.1% of women felt very confident. The majority of women (58.4%) feel they were the same or
more effective during COVID, and 68.2% of the men feel they are as effective or more so. These
findings identify that while work effectiveness improved, wellbeing declined, and there are
opportunities to further examine the support needed for women veterinarians to build resilience
through behavioral skill building, resources, and emotional support to address callousness,
emotional exhaustion, and physical and mental fatigue.
Another difference the survey identified was between the youngest veterinarians (ages
25–34 years) and newest to the profession (average of less than 4 years) and the oldest (45 years
plus) and those with longer industry tenure (average of 18 years). For instance, burnout was
reported as the highest amongst the youngest population (ages 25–34), with 77.9% reporting
frequent burnout of once a month or more frequency. Of this population, 26.5% say they
experienced burnout a few times a week, which was significantly higher than the older
veterinarians surveyed. The youngest veterinarians also reported the lowest energy levels,
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confidence in handling problems at work, and ability to address difficulties piling up. The
majority of the youngest DVMs were in a corporate practice (96%) and had practiced less than
12 months.
The Maslach and Jackson model of burnout suggests that emotional exhaustion leads to
depersonalization, which decreases professional efficacy or sense of accomplishment (Mashlach
& Jackson, 1981). These findings suggest that the younger, less experienced veterinarians are not
coping well and need additional time, attention, and support to manage the caseload and the
complexity brought in the hospital environment throughout COVID-19. One possibility for these
findings is that these new graduates had less experience and less confidence in their skills,
ability, and emotional maturity as they were early in their careers. Starting a career during
COVID-19 likely also presented challenges for new graduates with traditional onboarding
programs or mentoring programs being impacted by hospital context, consistent with the
literature identifying staffing shortages, hospital staff being out due to COVID exposure, the
need to socially distance, and the increase in patient caseloads for hospitals (McKee et al., 2021).
Women and younger veterinarians suffered more than men and older veterinarians with
increased levels of burnout, fatigue, and emotional exhaustion, which was consistent in the
literature (McKee et al., 2021).
Another notable factor is related to dependent children at home. Surprisingly, DVMs with
no children at home are more likely to report being burned out every day or a few times a week
(37%). This could be related to the feelings of isolation when not at work created by social
distancing and non-essential businesses and services being closed. Among the youngest
veterinarians, 25- to 34-year-olds, over half (54.5%) had children under 12 months at home, and
77% had children 1–5 years at home, adding to the responsibilities of the youngest veterinarians.
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One-third of DVMs with children at home reported being burned out a few times a month. The
findings related to the youngest veterinarians align with the literature review and identify that
work-life balance challenges, such as caring for young children throughout the pandemic, added
to parents' stress levels (McKinsey and Company, 2021).
As a level of organizational support, supervisors who demonstrated care about the
individual were identified as an effective strategy by 82% of the veterinarians and correlated
with burnout to a moderate degree and with emotional exhaustion, fatigue, and low effectiveness
to a lesser degree. The importance of a caring supervisor to the wellbeing of veterinarians in
demonstrating care, support, encouragement, recognition, and listening was seen as an important
and common strategy in supporting veterinarian wellbeing throughout COVID-19.
While the number of underrepresented minorities is a small percentage of the surveyed
population, higher rates of burnout were seen for Latino DVMs, with 52% reporting every day or
a few times per week, followed by Asian DVMs reporting 37% and 44% of Black DVMs (while
only 16 participants and significance testing is not reliable) reporting a few times per month.
People of color responded even more positively to supervisors who demonstrated care, with 75%
or more considering this an effective strategy. Black DVMs, as compared to White, Asian, and
Latino DVMs, considered the demonstration of supervisors who care an even more important
strategy from an effectiveness standpoint. In addition, Black DVMs also rated the other two
emotional care strategies of listened to employee needs and recognized employee efforts higher
than other ethnicities. Due to the small number so underrepresented minority populations who
responded to this study, further investigation is recommended on the diversity of this study’s
findings.
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The second measure of perceived organizational support was having the materials and
equipment necessary to do their work. The majority of veterinarians (61%) believed they had the
materials and equipment necessary to do their work right. The correlation was not significant
between this variable and burnout, emotional exhaustion, fatigue, and effectiveness. There was
no difference in the rating of this area of organizational support between women and men or any
major demographic group.
Discussion of Findings and Results Related to Policies, Practices, and Strategies that
Positively Influenced Wellbeing
Participants in this study identified organizational and leadership strategies in the form of
policies, practices, processes, benefits, and training programs implemented by the organization
or their direct supervisor that they found effective in supporting their wellbeing throughout
COVID-19. These policies, practices, and strategies are a part of the work environment that
influence the veterinarian’s behavior and beliefs.
Specifically, participants identified supervisory care strategies as effective to highly
effective strategies that positively contributed to veterinarians’ wellbeing during COVID-19.
Veterinarians identified three leadership strategies they felt supported their effectiveness:
demonstrated empathy and care (62.8%), listened to employee needs (56.7%), recognized
employee efforts (55.2%). Participants also rated shared company communication in a timely
manner as a top strategy seen as effective (58%). The majority (72%) of the oldest veterinarians,
aged 45 years and older, identified supervisors demonstrating empathy and care as an effective
strategy. These strategies demonstrate the importance of direct supervisors who demonstrate care
for the wellbeing of veterinarians. An individual’s direct supervisor plays a role in improving
wellbeing, preventing burnout, and increasing effectiveness. The research shows that supervisors
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played a key role in sharing information, interpreting workplace and government policies,
prioritizing their employees' health, and ensuring staffing coverage to keep the hospital running.
Leaders can improve workflow, offload non-essential tasks, and improve work practices while
increasing autonomy to decrease veterinary burnout.
The supervisor strategies that were not offered or seen as the least effective were
supervisors role modeling wellbeing (61.5%), supervisors referring employees to
benefit/wellbeing programs (59.0%), and encouraging job training or development programs
(49%). These findings can be attributed to the fact that supervisors were also trying to adapt to
the changing environment. In addition, due to the increased caseload throughout COVID-19,
wellness programs and development courses were canceled or moved to an online format due to
social distancing, which could have created feasibility challenges in a hospital environment.
The youngest veterinarians (ages 25–34) felt that their supervisors were less likely to feel
their supervisors communicated in a timely manner and listened to their needs. As seen in other
research, the youngest generation is accustomed to instant communication and a variety of
information channels which could account for why they were less likely to feel their supervisors
communicated with them in a timely manner. Training opportunities exist to supplement clinical
skills learned in medical school around leadership, situational and change management skills,
and other topics, such as (a) keeping individuals informed, (b) encouraging reports to suggest
ideas for improvement, (c) providing feedback and coaching, and (d) recognizing quality job
performance (Shanafelt, Gorringe, et al., 2015).
Teams of veterinary clinicians and staff members perform veterinary care. Leaders play a
role in fostering community and can support relationship building and establishing a high
performance and supportive team culture. The literature clarifies the importance of team
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members' support, care, and social interaction as critical to mental health and self-care
throughout COVID-19. Creating an inclusive and connected work environment was mutually
beneficial for people with mental health conditions and the organization (Wu et al., 2021).
Consistent with the literature, supervisors who demonstrate empathy, care, encouragement, and
support through check-ins, advocacy, and recognition of team and individual efforts and
performance see higher engagement (Gallup, 2022).
Process and workflow interventions were also seen as highly effective. Respondents saw
organizational workflow changes, contactless payment (59.8%), and curbside drop-off (56.4%)
as effective. There were very few variations in the perceived effectiveness of policies and
practices. While telehealth was not common in veterinary medicine pre-COVID and all practices
did not offer telehealth visits, 30% of veterinarians surveyed rated the strategy as effective.
These findings could be attributed to the desire to minimize client contact due to social
distancing requirements and, in most cases, reduced client interaction, allowing the veterinarian
to have more focused time with pets.
Additional organization interventions were seen through policy and benefits initiatives to
provide support throughout COVID-19. While 28.9% of participants were not offered time off to
care for family members, 42.5% rated such time off as effective or highly effective. Additional
sick time was not offered to 20.09% of participants, although 54.3% rated this benefit as
effective or highly effective. Consistent with the literature, veterinarians had a difficult time
prioritizing their personal safety and wellbeing over their professional role, and the veterinary
industry has a culture of sickness presenteeism (Pasfield et al., 2022). Due to staffing shortages,
veterinarians have tended to work even when sick to not let down the rest of the team, pets, or
clients. The survey identified that 38.3% of participants were not offered increased paid sick
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days or other time away, and 40.4% of participants said an increased number of sick days and
other time away benefits were effective or highly effective throughout COVID-19. Flexible
scheduling was seen as an effective benefit by 41.5% of respondents. The veterinarians aged 35–
44, 60% of whom had young children at home, rated flexible scheduling and additional paid time
as more effective than the youngest and oldest veterinarians.
According to the Merck Veterinarian Wellbeing study, 40% of veterinarians are
considering leaving the profession; the top reasons for doing so are a lack of work-life balance
and mental health concerns (Merck Animal Health, 2022). Increased workload has been
described throughout the pandemic and is a primary predictor of burnout, emotional exhaustion,
and fatigue. Supervisors can support wellbeing relative to work-life balance relative to areas that
influence burnout: workload, control, reward, community, fairness, and values (Leiter &
Maslach, 2004).
While there were fewer differences in the effectiveness of benefits between women and
men, 42.75% of the participants saw offering mental health benefits as effective or highly
effective. In addition, 44.13% of those offered an employee assistance program rated the benefit
as effective or highly effective. Most veterinarians surveyed (56.83%) were not offered access to
a social worker or social worker programming, and 47.44% were not offered childcare benefits.
It is also important to note that some of the most effective strategies rated by participants
are related to COVID-19-related policies and protocols related to individual-oriented approaches
to ensure safety and health. Veterinarians rated mandated PPE as an effective strategy at 67.5%,
with women rating this policy higher than men at 73.9% versus men at 56.1%. Quarantine
guidelines for those exposed to COVID were also seen as an effective policy by 54.3% of the
participants. The vast majority of veterinarians surveyed (71.4%) were not offered the
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opportunity to work from home, which is expected in a hospital service environment.
Veterinarians valued these policy interventions needed to ensure their health and the health of
their coworkers and family members were maintained.
Recommendations for Practice
Based on the key findings of this study, this section presents recommendations for
employers, academia, and industry associations to address the high levels of occupational stress
and decreased wellbeing throughout COVID-19. These recommendations are based on findings
that wellbeing decreased for all veterinarians while effectiveness remained the same or improved
for the majority of veterinarians. The recommendations focus on collective influences and
interventions. The recommendations are also based on the findings that burnout, emotional
exhaustion, and fatigue are correlated with wellbeing and effectiveness. Increased workplace
demands and decreased wellbeing negatively impact individuals and decrease job engagement,
increased turnover, and intent to leave the profession (McKee et al., 2021). The four
recommendations focus on organization, direct supervisor, and individual strategies that can be
implemented to positively influence veterinarian wellbeing.
Recommendation 1: Implement Leadership and Direct Supervisor Training With a Focus
on Empathy and Care, Communications, and Change Management
Organizations should implement mandatory human-centric leadership training for all
people leaders. This is an organizational intervention to improve the work environment for
veterinarians, as many individuals in veterinary supervisory roles are former
veterinarians/owners/operators with no formal leadership training. As demonstrated in the
research, direct supervisors play a critical role in employees’ wellbeing and can help to prevent
burnout, emotional exhaustion, and fatigue. Leaders actively influence the workplace and work
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culture through their own actions, such as demonstrating care and empathy, recognizing
individual efforts, and referring employees to health and wellbeing resources and training.
People leaders should be taught how to support employees through burnout, emotional
exhaustion, and fatigue. Direct supervisors should be educated on how their role as a leader
impacts team members and how organizational decisions, such as in process workflow, impact
wellbeing. In addition, teaching leaders how to solve problems in the moment to meet their
hospital staff’s needs is critical. The competency of managing ambiguity and being agile are
situational leadership skills that can be taught and developed. As demonstrated in the research as
effective strategies, employers should invest in teaching managers leadership skills, focused on
leading with compassion, empathy, asking questions, and listening to support veterinarian
wellbeing. Improving timely communications skills to support transparency throughout a crisis is
another area of focus for leaders, as demonstrated by the survey findings.
Ensuring all people leaders in veterinary medicine are trained and equipped with basic
people management skills will ensure the development of leadership programs relevant to the
context of the changing environment. Leaders should also be further trained in change
management, motivation, and creating strong relationships with their hospital staff to ensure
psychological safety and trust in the workplace. Additional focus areas could dive deeper into
leading and managing wellbeing in the workplace with a specific focus on mental health issues
and resiliency as line managers provide first-level support to their employees.
The veterinarian oath should receive special consideration when designing the training
program alongside the foundational beliefs that veterinarians bring to their role, which are deeply
embedded in their purpose. Understanding the goals of leadership training and how the training
will be measured will influence the design of the training program and ensure the training goals
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are achieved. The New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2015) identifies
ways to design a training program to ensure it facilitates the transfer of learning to behaviors,
delivers organizational results, and determines the training program's value. The model also
provides a format to evaluate training effectiveness based on four levels: reaction, learning of
knowledge, behavior, and results (Kirkpatrick & Kirkpatrick, 2016). The model can help to
ensure the biannual training meets the participants’ needs. Understanding the intended outcomes
and desired results is the first step in building a program that aligns with veterinary leaders’
needs.
Additionally, organizations can implement the following leadership practices that may
facilitate more supportive supervisory relationships.
● Create a culture of wellbeing and onboard leaders into the company’s culture; share
expectations that the leader's role is to provide empathy and care for veterinarians.
● Train direct supervisors on organizational resources available to support wellbeing,
such as health benefits, time away resources, and other wellbeing programs.
● Introduce a buddy scheme for new people leaders/supervisors. The buddy can help
provide information, assist with introductions and identifying resources, and can
explain the organization's culture.
As consistent with the literature, providing employees with a direct supervisor who is
well trained and demonstrates empathy, care, and other supportive behaviors along with
motivation and knowledge will enable veterinarians to perform at their best. Even when the
organizational culture feels chaotic, the climate created by co‐workers and managers can make a
difference and facilitate effectiveness and wellbeing (Peters et al., 2022; Moses et al., 2018).
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Recommendation 2: Re-Examine and Streamline Process Workflows, and Identify
Alternative Resources, such as Social Workers to Support Clients
This recommendation is an organizational strategy to improve the workflow for the
veterinarian by producing greater control and by improving the work environment. The shortage
of veterinarians identified in the research is increasingly a challenge and contributes to the
effectiveness of doctors, burnout, fatigue, and emotional exhaustion.
Re-Examine Workflows for Veterinarian Effectiveness
Re-examining workflows and work processes would identify ways to create greater
control, be more efficient while supporting the wellbeing and effectiveness of veterinarians. The
research findings identified that curbside drop-off and pick-up, contactless payment, and
telehealth created greater effectiveness for veterinarians. These workflow changes minimized
face-to-face client interactions with the veterinarian and created greater efficiency for the
veterinarian, as the veterinarian was able to focus on the services needed and call the client back
when it was time to pick up the pet versus the client waiting for the pet to be serviced.
Organizing the work of the veterinarian in a more focused way could contribute to greater
wellbeing and effectiveness. Hospitals should consider examining their portfolio of services
offered and understand if clustering services by day or scheduling patients to correspond with the
clinical talent on staff would create less randomness in daily routines and allow the veterinarians’
to better plan for the day. An example could be performing all dental exams on one day or
scheduling specialists on a pre-determined day of the week.
Consistent with the literature, eliminating variation throughout the day and providing
greater clarity of services performed would allow veterinarians to have the right support staff at
the right time, greater focus, higher levels of quality of patient care, and command over their
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work to reduce ambiguity (McKee et al., 2021). The shortage of veterinarian support requires
employers to ensure process workflows are efficient so veterinarians can see the most critical
pets and perform the services needed (McKee et al., 2021).
Explore Alternative Clinical Resources, such as Social Workers to Support Workflows
Social workers were not offered to 56.8% of the population but were seen as effective or
highly effective by 37% of those who had access to them. Employers should consider what work
is permitted to be shifted from a veterinarian to other hospital staff to enable veterinarians to
work at the top of their license and be as effective as possible. Clinics could consider adding
other roles like human health, such as Client Patient Services representatives for client intake,
further segregating duties and removing responsibilities from the veterinarian to others within the
hospital. Clinically trained social workers could help to support clients through the grieving
process and could also support the hospital staff during emotional client interactions or negative
pet outcomes.
Telehealth was seen as an effective strategy by veterinarians throughout COVID-19.
Employers should consider adding telehealth capabilities and nutritionists. Also, medical
virtualists are veterinarians who can address client concerns on the phone or over the internet and
determine if a pet's circumstances require an in-office visit. Telehealth and medical virtualists are
trends in human healthcare; patient care teams perform telehealth visits, conduct remote patient
monitoring, and integrate various data streams about the patient’s health using technology (Gans,
2020).
While some of the strategies mentioned can be implemented in the short term, as
identified in the open-ended responses by participants, increasing the supply of veterinarians
over the longer term requires the attention and collaboration of academia, industry professionals,
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and employers. Employers should ensure job demands are reasonable for the resources available,
consider shifting work to others who are clinically trained, and ensure efficient workflows to
maintain a manageable workload and work schedule.
Recommendation 3: Establish Mentoring Programs to Support Newly Practicing
Veterinarians
This recommendation is focused on the individual veterinarian and identifies mentors as
one of the collective influences who can play a role in supporting veterinarian effectiveness and
wellbeing. The findings identify that the youngest and newest veterinarians need additional
support to achieve greater effectiveness and wellbeing. Employers, academia, and industry
professionals should initiate and amplify formal mentoring programs using experienced
veterinarians to support newly practicing veterinarians. The survey findings identified that the
newest veterinarians experienced higher burnout than those who had been practicing for 2 or
more years.
Mentoring Can Help to Support Health and Wellbeing
A mentoring program for early career veterinarians can be achieved by assigning the
new graduate to a sympathetic experienced veterinarian. The mentor can provide information,
introduce the new veterinarian to their work surroundings, make introductions to other
colleagues essential to their role, and help them understand the organization's culture as they
settle into the hospital practice and establish themselves. Mentors can help by creating a sense of
belonging and assist in quickly building community with industry introductions and support the
establishment of a professional network of practicing veterinarians. Establishing strong ties to a
mentor early on in a new graduate’s veterinarian career will increase the likelihood of retention
because they will feel a stronger connection to other members of their hospital team and the
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organization. Additionally, they will establish a trusted relationship where they can seek support
for both professional and personal reasons and can assist with interventions to keep an employee
engaged and retained. Mentoring has a positive impact on the health and wellbeing of both
mentors and mentees by reducing isolation and anxiety by ensuring a trusted resource is
available for connection and understanding what the veterinarian is experiencing.
Mentors Can Offer Assistance and Support Stronger Performance On the job
A structured mentorship program will ensure the right learning happens at the right
time for newly practicing veterinarians, which will improve the likelihood of stronger
performance on the job and will support confidence building. Specific hands-on learning offers
the organization an opportunity to build the veterinarian’s knowledge base, while course
correcting on any clinical areas needing improvement early in the new graduate’s tenure, which
will boost performance as well as the quality of patient care. Mentoring also can help build
confidence in both technical areas as well as emotional and behavioral areas. Mentors can
provide an environment free from judgement and support achievable goals for personal growth
in the profession. Research conducted in 2005 on mentoring in the veterinary profession suggests
that most practicing veterinarians had mentors and that the most frequent and effective mentors
were initial employers, followed by teachers and advisors (Niehoff et al., 2005).
A mentor would also be able to support questions related to ethically challenging
situations and would allow for veterinarians to discuss openly with their mentor situations with
which they struggle while gaining advice, guidance, and professional assurance. New
veterinarians can benefit from shadowing their mentor on ethics rounds, which can improve
moral reasoning, ethical awareness, and ethical sensitivity (Quain et al., 2022).

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Mentor and New Graduate Cohorts bring great Learning and Insights
Where possible, developing a new graduate cohort of practicing veterinarians along with
mentors would allow for an even greater community and a sense of belonging as new graduate
veterinarians learn from each other with the support of a mentor. The shared learning from other
newly practicing veterinarians in a peer assist format helps to build long-term relationships with
those experiencing similar questions and learnings through the lens of induction into the
industry.
New graduate peer and mentor cohorts could be established demographically and could be
virtual or in-person connections. Additionally, cohorts could be arranged by specialty area or
focused on a practice-specific topic with a focus on peer learning. New graduate peer mentor
cohorts could also be facilitated by universities or by industry associations. Topics for new
graduate discussions could be developed using the Burke Litwin Casual Model (1992), which
provides a process to identify a gap analysis or the difference between actual performance and
expected performance, based on the greatest needs from newly graduating veterinarians. A peer
mentor discussion topic, for example, could be focused on providing practical guidance on
ethical situations likely to be encountered and on conflict resolution with clients. Throughout
COVID-19, veterinarians faced concerns about ethically challenging situations and their
responsibility to pets, clients, family members, and their employers. Mentors can play a valuable
role in helping guide new graduates through these situations.
The literature highlights the value and importance of peers and the dependence on peers
for support, advice, and comparative benchmarking of experiences over ethical intuition
(Richards et al., 2020). Traditionally, universities place little emphasis on how to address
challenging interactions with clients (animal owners) and professional colleagues (Kimera &
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Mlangwa, 2015). According to a 2018 study by the AVMA Council of Education, 18 of 30
schools offer formal training and education in veterinary ethics (Shivley et al., 2018). In a recent
survey of 889 general and emergency veterinarians, 71% said they received no training on
conflict resolution or resolving differences of opinions on what care is best for patients, and 79%
said they received no training in self-care (Moses et al., 2018).
Recommendation 4: Develop and Implement Diversity Resource Groups That Support
Women and Intersectional Identities
This recommendation is intended to support veterinarian women and underrepresented
minorities as a part of the work environment. Due to the research findings that women and
underrepresented minorities experienced greater signs of burnout, fatigue, and emotional
exhaustion, employers, universities, and industry associations can develop DRGs that serve the
intersectional identities of these vulnerable veterinarians. Veterinarian practices, universities, and
industry groups can form support groups through the formation of DRGs to offer personalized
resources, care, and peer support, enabling women veterinarians to feel valued and supported.
Companies are increasingly establishing programs and resources to address the needs and
concerns of America’s minority population (Ernst Kossek et al., 2010). The following section
identifies steps to support the creation of DRGs to support women and underrepresented
minorities in veterinary medicine:
Step 1: Identify Executive Support to Gain DRG Sponsorship
Although employees typically initiate DRGs, it is critical to make the business case for
DRGs prior to their implementation (Welbourne et al., 2017). Within a company, the support of
the human resources function and executive leadership is essential to the success of a DRG, in
addition to identifying an executive sponsor. A DRG is typically a group of internal volunteer
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employees with an aligned purpose. From the inception of the DRG, a charter should be created
to ensure the DRG is aligned to the business needs and there is clarity on the purpose and
mission for the DRG. Executive sponsors are traditionally identified by
1. The DRG chooses the executive sponsor.
2. Companies can assign executive sponsors to DRGs and rotate them through term limits,
for example, every two years, which can help to ensure the energy and exposure of the
sponsor remain intact.
3. Companies frequently make a point to designate an executive sponsor who is not a
member of that interest group to demonstrate the concept of allyship (support from
individuals traditionally not of the membership, who advocate and actively work for the
inclusion of marginalized individuals).
Step 2: Develop a Leadership Team and Connect With Existing DRGs
New DRGs should create an organization operating structure and identify a leadership
team to support the development and implementation of the new organization. They should
connect with existing internal diversity groups (Kozlowski, 2018) to share learnings, operational
procedures, and organizational structure best practices. The name and identification of the DRG
should reflect the group's mission and values and should be decided upon collaboratively.
Step 3: Determine DRG Charter, Mission, and Goals
The DRGs charter, mission, and goals should be established in collaboration with all
DRG members and the executive sponsor. The DRG should be linked to specific business goals,
such as recruiting and retaining women and underrepresented groups (Glen, 2006). The charter
should clarify the purpose and mission for why the group was established, with clear goals,
timelines, measures, and initiatives.
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Step 4: Establish Budget and Secure Funding
Following the creation and alignment of goals for the DRG, prepare a budget (Levin et
al., 2017) that appropriately supports the mission of the DRG and submit it to the Executive
Sponsor. Executive leaders are in the best position to help advocate for funding the DRG and can
support the process steps involved in establishing the resources needed for success.
Step 5: Design a Meeting Structure, Schedule, and Ways of Working
The DRG membership should determine the organizational structure (Kozlowski, 2018)
and meeting schedule with the support of the executive sponsor. The DRG should also clarify its
meeting protocols and ways of working to ensure clarity on how decisions will be made and
maintain accountability for actions and outcomes.
Step 6: Recruit Members and Increase Awareness
Gaining membership is critical to the success of DRGs, and DRG leaders should establish
marketing and communications plans for outreach to generate interest in joining the group. It is
important to identify what purpose the DRG will serve and highlight how the DRG links to the
business objectives for the organization and the benefits of participation.
Step 7: Identify DRG priorities and initiatives
Identifying business priorities and measuring impact will help the DRG create and
maintain energy and momentum. For example, a women’s DRG could establish a mentorship
program for new graduate veterinarians to help guide and onboard new veterinarians to the
company culture while providing peer guidance on career or work-life balance issues. Another
idea is to highlight career stories of female and underrepresented role models to share stories that
will help shape the beliefs of women and underrepresented minorities in leadership.
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Advancing awareness or education is also a common goal of DRGs internal and external
to organizations. It is common for DRGs to celebrate awareness of their focus area and to use the
celebration as a way to educate the organization on its mission and priorities. Serving on Boards
or participating in community events, conferences, or industry events also promotes widespread
recognition of the issues while engaging the membership (Green, 2018).
Step 8: Sustaining Momentum and Celebrating Success
Ongoing company and member support while recruiting more members is vital to
success. Advancing the DRG’s work while sharing out its organizational outcomes with the
sponsor and the organization is critical for visibility and sustainability. Ownership for
maintaining DRG momentum (Green, 2018) resides with the entire group, including the
executive sponsor. Working collaboratively with other DRGs internally or externally is a
common way of gaining a larger impact. Many organizations have DRGs focused on roles,
ethnicity, disability, or sexual orientation.
The DRG should establish goals and success criteria as an initial part of establishing the
DRG. These goals will clarify the measures of success for the group’s performance. Basic forms
of DRG evaluation are the growth of membership, number of programs, how it functions,
number of new hires, and the wellbeing of the participants (Posavac, 2010).
Recommendation 5: Develop a Culture of Listening to Support Wellbeing and
Effectiveness
This recommendation is intended to be an organizational strategy to support the
collective influences that shape veterinarian beliefs and contribute to their wellbeing. Survey
participants identified that supervisors who listened to veterinarians’ needs had a positive impact
on the majority of veterinarians. COVID-19 presented many new challenges for veterinarians
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and employers, creating a time of uncertainty and an opportunity to seek to understand
challenges, test ideas, and learn.
A Culture of Learning Can Support Wellbeing and Higher Engagement
A two-way culture of communication with a focus on listening and learning brings the
benefit of a sense of belonging and community. Ensuring that employees’ voices are heard can
be part of a larger focus on ensuring equality, belonging, and inclusiveness in the workplace.
When employees feel heard and feel they have the psychological safety to have input into an
organization’s processes and policies, they are more likely to be positively engaged and more
likely to stay with the organization (Nadkarni, 2021), and are also more likely to refer others to
work for the company. A culture of listening can provide early information about a changing
environment or context when an organization regularly receives feedback through active
listening. A culture of listening can also support a culture of greater authenticity and
transparency (Nadkarni et al., 2021).
Various Listening Vehicles Meet Different Needs
Conventional listening approaches include individual conversations between a supervisor
and the employee, skip-level meetings (i.e., meeting an employee meeting with supervisors a
level above their direct supervisor), face-to-face group meetings, pulse surveys, and employee
resource groups. The results showed that 27.8% of veterinarians did not have routine individual
check-in conversations with their supervisor, and 19.7% did not have regular team meetings.
These statistics demonstrate additional opportunities for leaders to increase their communication
and listening opportunities with veterinarians. Pulse surveys are important tools between
comprehensive annual surveys and are intended to be short and quick, providing leadership with
information in the moment on how individuals feel on a topic.
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Focus groups are qualitative discussions that offer a veterinarian the opportunity to share
their perspective and provide the company with the ability to dive beyond the data from a
quantitative survey. Focus groups allow employers to understand the nonverbal communication
from employees and provide the opportunity to jointly build solutions with their employees.
When designed appropriately, focus groups can and should serve as motivating moments for
employees. Organizations can conduct stay interviews to understand how satisfied individuals
are with their employer or in the industry. Identifying employees to seek out what is going well,
what they would like to see, and what could be improved allows for well-rounded feedback.
Other possible ways to gather feedback are through daily huddles, annual employee surveys,
hotlines, suggestion boxes, and graffiti walls. Emoji buttons (happy and sad face symbols) by
elevators, staircases, and exits are a simple way to gain instant feedback in the moment.
Organizations and leaders should encourage veterinarians to share information and provide their
opinions. Some other common ways to encourage a listening culture are through leadership
listening tours, onboarding programs, and seeking insights from DRGs.
Limitations and Delimitations
While quantitative research was the right choice for this study, quantitative research tools
like surveys do not capture depth of participants’ nuanced experiences. This study would have
more credibility if paired with qualitative research. For example, interviews designed to provide
qualitative findings may offer more evidence to strengthen the data discovered using quantitative
research tools (McKim, 2017).
The reliability of the study was impacted by using existing survey questions adapted for
this study and with constructs of one or two survey items such as Gallup’s Q-12 or MBI. Using
three or more questions from a survey would have potentially strengthened the reliability of the
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correlations as a number fell short from a Cronbach alpha perspective with an alpha coefficient
less than .7. One item measures also are likely to have lower reliability, which can result in
measurement error (Creswell & Creswell, 2018).
Because the survey instrument was adopted from multiple existing instruments along
with a few adaptations for work, its reliability was not known prior to the start of the survey
(Creswell & Creswell, 2018). The Likert-style questions rating scale was reversed for multiple
questions, which may have led to confusion for the participant, and results could have been
impacted by the order of the questions (Robinson & Leonard, 2017).
The use of an anonymous survey distributed through associations could lead to a non-
representative sample, generalizable findings (Creswell & Creswell, 2018), and the small sample
size of underrepresented minorities could also have generated non-representative data. There
may have been self-selection bias by participants in this study, with people who remained
employed throughout COVID-19, and there are valuable insights to learn from those who left the
industry or their employer. Insights can be gained by involving both employees who stayed and
those who left a work environment (William Lee et al., 2014). There may have also been self-
selection bias in that those with poorer mental wellbeing may have been more likely to complete
the survey. Secondly, the participants were asked to self-report their effectiveness and wellbeing
throughout the pandemic, potentially introducing reporting bias.
From an external validity perspective, it is also important to note that this survey was
conducted more than two years into COVID-19, and many of the initial challenges and barriers
faced by practicing veterinarians due to social distancing, school closures, and quarantines have
been lifted, along with vaccinations and booster programs that have been implemented. While
the study was ultimately about the impact of burnout, emotional exhaustion, fatigue, and
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engagement on veterinarian effectiveness and the organizational and supervisory strategies that
positively impacted wellbeing, it is clear COVID-19 presented obstacles for veterinarians beyond
the workplace, such as with caring for dependent children during the initial phases of COVID.
This study considered the limitations of online surveys due to data collection beyond the
researcher's control (Merriam & Tisdell, 2016). A standardized survey also assumes that the
respondents can comprehend, retrieve, and judge to be able to respond to the survey questions;
and that the respondent can interpret operational definitions (Robinson & Leonard, 2017). One of
the limitations of surveys is that the researcher has no control over the respondents' accuracy and
honesty. Another limitation of a quantitative approach is that there is little or no ability to clarify
or confirm the information captured. Though some survey questions aimed to measure behavior,
they could not directly measure it (Salkind & Frey, 2020). Finally, an online survey did not allow
for capturing the respondents’ nonverbal cues (e.g., facial expressions or body language).
Delimitations refer to the boundaries of the study based on the researcher's decision on
what to include and exclude to make the study more manageable and relevant to the problem of
practice (Creswell & Creswell, 2018). Due to time limitations and restricted access to
veterinarians, the online survey distribution may not have reached the full membership of the
five professional organizations that agreed to help promote the survey. In addition, due to the
small number of men, underrepresented minorities, and veterinarians from independent practices,
the significance of the results may warrant additional studies. Delimitations also include the
decision to use a quantitative survey approach, anonymous survey instrument, questions from
existing surveys, a Likert scale, and the research framework.
There are a few important delimitations to identify. The first is that the research questions
were one-directional and focused on the organizational and supervisor interventions environment
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and not on the individual’s behaviors. Thus, the questions were not designed to focus on various
interlocking layers of the Bronfenbrenner (1979) model. The questions were focused on the
strategies, policies, practices, benefits, and supervisory actions that positively supported the
wellbeing of veterinarians versus how veterinarians influenced their wellbeing and effectiveness.
The survey instrument did not ask which strategies, policies, practices, benefits, or supervisory
actions negatively impacted wellbeing and effectiveness or which strategies veterinarians
implemented on their own, nor ask veterinarians to rank the various strategies by most to least
effective. Also, while the study was designed to provide an opportunity for additional
information through open-ended questions, it is possible that participants, after 2 years of the
pandemic, were not able to recall what their supervisors or organization had done.
My positionality and identities (former chief human resources officer of a corporate-
owned veterinary practice, Asian American female professional in a leadership role, and mother
with a dependent child during COVID-19) influenced the data interpretation. Employing
constant reflective practices throughout the research raised my awareness of this influence on
interpreting participants' lived experiences (Merriam & Tisdell, 2016). The findings of the
current study were interpreted considering its limitations.
Recommendations for Future Research
The findings of this study, its limitations, and delimitations identify additional areas to
consider for further research. The ability to triangulate the findings through qualitative
interviews could provide additional meaning (Creswell & Creswell, 2018). The study could be
repeated with an opportunity for follow-up interviews allowing for qualitative insights to explore
the veterinarians’ effectiveness and wellbeing in greater depth. The survey identifies women as
experiencing greater burnout than men. A qualitative research study could investigate female
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veterinarians' lived experiences, which would provide additional insights and an opportunity for
understanding individual and gender wellbeing and effectiveness in greater depth.
The survey instrument raised a number of newer strategies, such as telehealth or social
workers, that many veterinarians identified as “not offered” yet were rated as effective or highly
effective for those in practices that offered the strategy. Additional quantitative or qualitative
studies could explore new and emerging veterinary models of care, such as telehealth and mobile
services, in addition to exploring newer roles, such as social workers, further.
A future quantitative study on wellbeing and effectiveness throughout COVID-19 could
compare the perspectives of veterinarians with those of veterinary technicians, practice
managers, and customer service representatives to understand experiences by role under similar
COVID-19 conditions.
Although this study found interesting patterns and themes regarding wellbeing and
effectiveness among underrepresented minorities, caution must be taken when interpreting the
results due to the low number of these participants. Further research could identify ways to
support female and underrepresented minority veterinarians with career development, building
greater confidence and resilience, and sustainability in the industry. Additional studies could
focus on new graduate veterinarians, identifying ways to help them be better prepared for the
practice environment. While this study was open to all veterinarians, the participants were
largely from corporate-owned, small companion animal practices, which allows for additional
studies to be extended to other types of practices, such as those with production or large animals,
in academia, at shelters, and in other geographical regions.
The current study provides a unique perspective during a specific period in history by
addressing the impacts of COVID-19 and the associated impacts on veterinarian effectiveness. It
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identified organizational and leadership practices that positively impacted veterinarians’
wellbeing. More studies need to be conducted to understand the impact of the organizational
culture, employment practices, and the underlying organizational, team, and leadership drivers
impacting veterinarians’ wellbeing in the United States. In addition, future studies should be
conducted as COVID continues into recovery to understand the longer-term impact of the
pandemic and associated process, policy, and benefit changes supporting veterinarian wellbeing
with a specific emphasis on mental health.
People and organizational experts and veterinary practice leadership can take this study
as a basis to examine employment policies, practices, and benefits that positively impacted
wellbeing and effectiveness of essential frontline workers throughout COVID-19. Business
leaders can quantify the impact of benefit changes made throughout COVID-19 on the financial
performance and productivity associated with plans implemented, seeking a specific
understanding of these plans’ educational awareness, access, and utilization. Leaders can also
learn from this study about better supporting new graduates and specific demographic groups,
advocating for supervisory skills development, and directly and indirectly influencing
veterinarian wellbeing and practice effectiveness.
Conclusion
COVID-19 created an unprecedented time for veterinarians, with new workplace
occupational hazards that were not previously considered. The findings identified that there is a
strong relationship between burnout, emotional exhaustion, fatigue, and engagement which
negatively impacted veterinarian wellbeing. The survey findings also identified that while
wellbeing declined for most participants, effectiveness improved or stayed the same for a
majority of veterinarians due to workflow changes minimizing interaction with clients due to
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social distancing guidelines, curbside drop-off, contactless payment, and telehealth. The results
also identified that women and underrepresented minorities suffered more frequent impacts of
burnout, emotional exhaustion, and fatigue, and the youngest veterinarians experienced greater
burnout and less wellbeing than those with more tenure. The findings identified that veterinarians
valued the policies and practices that helped them to remain healthy and care for their families.
Ultimately supervisors that demonstrated empathy and care, listening skills, provided timely
communication, and recognition were seen as positively supporting veterinarian wellbeing and
effectiveness.
Four recommendations for practice were proposed based on findings and successful
practices in other organizations, allowing for broad adoption by veterinarian organizations and
leaders. The ownership for veterinarian wellbeing has historically been placed on the individual;
however, the employer, direct supervisors, academia, and industry associations have a role to
play in equipping veterinarians with the agility needed to sustain in a changing context.
According to the Report on Economic State of the Veterinary Profession (AVMA, 2021), 40% of
veterinarians are considering leaving the industry due to work-life balance concerns, followed by
mental health challenges. Keeping veterinarians healthy, well, and in the profession is paramount
to all stakeholders involved and is a shared responsibility. As COVID-19 continues to challenge
the health of all, organizations and leaders can play an active role in helping veterinarians thrive
and be well.
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162

Appendix A: Industry Association Director Email

To: Industry Association Director
My name is Stephanie Neuvirth, and I am a doctoral candidate in the Rossier School of
Education at the University of Southern California, conducting a research study as part of my
dissertation.

The COVID-19 pandemic created high levels of occupational stress in the United States, leading
to a negative impact on employee wellbeing. I am looking to examine the wellbeing of
veterinarians throughout COVID and the leadership practices that positively impacted
veterinarian wellbeing.

It is my intent to conduct research on the following two questions from practicing U.S.
veterinarians:

1. How has burnout, emotional exhaustion, and fatigue impacted employee effectiveness
throughout the COVID-19 pandemic?
2. What specific strategies have organizations and leaders implemented that support the
wellbeing of their employees during the COVID-19 pandemic?

This research has been approved by the institutional review board (IRB).

I would appreciate your help by inviting your membership of U.S. practicing veterinarians to
participate in an anonymous online survey of 33 questions anticipated to take about 10 minutes
to complete.

Participation in this study is entirely voluntary. The participants identity will remain
confidential at all times during and after the study.

If you have any questions, please feel free to contact me at neuvirth@usc.edu or 971.254.7584.

Thank you in advance for your support in advancing the wellbeing of veterinarians.

Stephanie Neuvirth
Doctoral Candidate - Rossier School of Education
University of Southern California

163

Appendix B: Survey Instrument
The COVID -19 pandemic has created high levels of occupational stress within organizations leading to a
negative impact on veterinarian wellbeing. The purpose of this survey is to examine the organizational
and leadership practices implemented during the COVID-19 pandemic that impacted the wellbeing of
veterinarians. You are asked to provide your opinion on the following 33 questions which is anticipated to
take approximately 10 minutes. If you have any questions regarding the survey items, please feel free to
contact the researcher at: neuvirth@usc.edu. Thank you!

Research Questions:

RQ1. How has burnout, emotional exhaustion, and fatigue impacted veterinarian
effectiveness throughout the COVID-19 pandemic?
RQ2. What specific strategies have organizations and leaders implemented that support the
wellbeing of veterinarians during the COVID-19 pandemic?

The study will also examine the impact of intersectional identities (i.e., gender, race/ethnicity,
employment and family status, and practice environment) on veterinarian wellbeing.

Wellbeing is defined by how you evaluate your life, including career, physical, social,
community, and financial elements. It also includes positive emotion, engagement, positive
relationships, accomplishment, satisfaction and meaning.

Your participation in this research is entirely voluntary. If you have any questions
regarding the survey items, please feel free to contact the researcher, Stephanie Neuvirth @
neuvirth@usc.edu.

By beginning the survey, you acknowledge that your participation in this study is
voluntary, you are 21 years of age or older, you are a practicing U.S. veterinarian, and you are
aware that you may choose to terminate your participation at any time and for any reason.

Instructions for Questions 1-10: Please mark one answer for each question to indicate how
strongly you agree or disagree with each survey item (at your present working environment).
1. I feel burned out from my work.
a. Never
b. A few times a year or less
c. Once a month or less
d. A few times a month
e. Once a week
f. A few times a week
g. Everyday
2. I have become more callous toward people since I took this job.
a. Never
b. A few times a year or less
c. Once a month or less
d. A few times a month
164

e. Once a week
f. A few times a week
g. Every day
3. Mentally, I feel exhausted.
a. Never
b. Sometimes
c. Regularly
d. Often
e. Always
4. Physically, I feel exhausted.
a. Never
b. Sometimes
c. Regularly
d. Often
e. Always
5. I have enough energy for everyday life.
a. Never
b. Sometimes
c. Regularly
d. Often
e. Always
6. When I am doing something, I can concentrate quite well.
a. Never
b. Sometimes
c. Regularly
d. Often
e. Always
7. In the last month, how often have you felt that you were unable to control the important things in
your life?
a. Never
b. Almost never
c. Sometimes
d. Fairly often
e. Very often
8. In the last month, how often have you felt confident about your ability to handle your problems at
work?
a. Never
b. Almost never
c. Sometimes
d. Fairly often
e. Very often
9. In the last month, how often have you felt difficulties at work, were piling up so high that you could
not overcome them?
a. Never
165

b. Almost never
c. Sometimes
d. Fairly often
e. Very often

10. I have the materials and equipment I need to do my work right.
a. Strongly Disagree
b. Disagree
c. Neither agree nor disagree
d. Agree
e. Strongly Agree
11. My supervisor or someone at work seems to care about me as a person.
a. Strongly Disagree
b. Disagree
c. Neither agree nor disagree
d. Agree
e. Strongly Agree
12. How do you compare your current effectiveness in your work relative to before the pandemic?
a. Significantly less effective
b. Somewhat less effective
c. Same
d. More effective
e. Significantly more effective
13. How do you compare your current wellbeing relative to before the pandemic?
a. Significantly less wellbeing
b. Somewhat less wellbeing
c. Same
d. More wellbeing
e. Significantly more wellbeing
14. What policies or practices, if any, did your organization implement to support your wellbeing
during the pandemic? (Check as many boxes as apply)
a. Time off to care for family members
b. Remote working
c. Flexible scheduling
d. Consistent team scheduling
e. Mandated personal protective equipment
f. Implemented workplace social distancing guidelines
g. Additional paid sick time for COVID positive employees
h. Reporting daily health symptoms / health questionnaire
i. Quarantine guidelines for exposure to others with COVID
j. List any other employee policies that supported your wellbeing throughout COVID-19
15. Which of the organizational policies or programs listed in question 14 were the most effective?
a. Maintained consistent personnel on shifts
b. Provide personal protective equipment
c. Daily health questionnaire on health symptoms or temperature checking
166

d. Offered telehealth appointments
e. Implemented curbside drop-off and pickup
f. Implemented contactless payment
g. List any other employer practices that positively supported your wellbeing throughout
COVID-19
16. If your company offered the below benefits or training, how effective were they to your wellbeing?
a. Offered an Employee Assistance Program
b. Offered mental health benefits
c. Added social worker(s) or social worker programming
d. Offered child care benefits
e. Offered wellbeing or resilience training
f. Increased paid number of sick days and other time away benefits
g. List any other benefits that positively supported your wellbeing throughout COVID-19
17. What supervisor practices, if any, did your direct supervisor implement to support your wellbeing at
work during the pandemic?
a. Routine 1:1 check in’s
b. Routine team meetings
c. Accommodated flexibility in scheduling
d. Accommodated change in duties
e. Demonstrated empathy and care
f. Listened to employee needs
g. Permitted time off to attend wellbeing training
h. Recognized employees efforts
i. Referenced company benefit programs
j. Referenced training on wellbeing
k. Role modeled wellbeing
l. List any other benefits that positively supported your wellbeing throughout COVID-19
Instructions for Questions 18-33: These questions will only be used for analytical purposes. They
will not be used to identify any individual.
18. What gender do you identify with?
a. Female
b. Male
c. Non-binary
d. Prefer to self-describe______ (Short Answer Space)
Prefer not to answer
19.What is your age? (Select age from drop down)
20.What is your marital status?
a. Single (never married)
b. Married, or in a domestic partnership
c. Widowed
d. Divorced
e. Separated
f. Prefer not to answer
167

21.Do you have dependent children under the age of 18 years?
a. Yes
b. No
c. Prefer not to answer
22.How old are your children under the age of 18, living with you? (Select age with drop down)
a) Dependent one
b) Dependent two
c) Dependent three
d) Dependent four
e) Dependent five
f) Dependent six
23. How many children under the age of 18 live with you?
24. Identify my ethnicity as:(Select all that apply)
a. White (For example, German, Irish, English, Italian, Polish, French)
b. Hispanic, Latino, or Spanish origin (For example, Mexican or Mexican American, Puerto
Rican, Cuban, Salvadoran, Dominican, Columbian)
c. Black or African American (For example, African American, Jamaican, Haitian, Nigerian,
Ethiopian, Somalian)
d. Asian (For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese)
e. Middle Eastern or North African (For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan,
Algerian)
f. American Indian or Alaska Native (For example, Navajo Nation, Blackfeet Tribe, Mayan,
Aztec, Nome Eskimo Community)
g. Native Hawaiian or Other Pacific Islander (For example, Native Hawaiian, Samoan, Chamorro,
Tongan, Fijian, Marshallese)
h. Prefer not to answer
i. Other (i.e. sub-ethnic or multiple ethnic identities)__________
25. How long have you been practicing in the veterinary profession? (Select years from drop down)
26. How long have you been employed with your current employer? (Select years from drop down)
27. Which best describes your employment status?
a. Practice Owner
b. Full-time employed
c. Part-time employed
d. Locum
e. Retired
f. Prefer not to answer

28. Has your employment status changed since the beginning of COVID-19, March 2020?
29. Describe what factors influenced your change in employment status?
30.Which best describes the hospital or clinic you are practicing in?
a. Corporate-owned general practice hospital or clinic
b. Corporate-owned emergency hospital
c. Corporate-owned specialty hospital
168

a. Independently owned general practice hospital or clinic
b. Independently owned ER hospital
c. Independently owned specialty hospital
d. Academic or university clinic
e. Government
f. Other _____________________
g. Prefer not to answer
31. How many employees work in your hospital?
a) 0–5 employees
b) 6–10 employees
c) 11–25 employees
d) 26–50 employees
e) 51–75 employees
f) 76-100 employees
g) More then 100 employees
32. Do you practice in the U.S.
a. Yes
b. No
c. Prefer not to answer
33. What state do you practice in? (Select your state drop down)

169

Appendix C: Participant Recruitment Email
To Whom It May Concern:
My name is Stephanie Neuvirth, and I am a doctoral candidate in the Rossier School of
Education at the University of Southern California, conducting a research study as part of my
dissertation. I am examining the wellbeing of veterinarians throughout COVID and the
organizational and leadership practices that positively impacted the veterinarian’s wellbeing.
This research has been approved by the institutional review board (IRB).

You are cordially invited to participate in the study.

If you agree, you are invited to complete an anonymous online survey of 33 questions anticipated
to take about 10 minutes to complete.

Participation in this study is entirely voluntary. Your identity as a participant will remain
confidential at all times during and after the study.

If you would like to participate in the survey, please begin by using the survey link below.

If you have any questions, please feel free to contact me at neuvirth@usc.edu or 971.254.7584.

Thank you in advance for your participation.

Stephanie Neuvirth
Doctoral Candidate - Rossier School of Education
University of Southern California

170

Appendix D: Supplemental Tables
Table D1
Summary Statistics for Variables of Interest by Ethnicity
Variable n Min Max M SD
Burnout
White 300 1.00 7.00 4.20 1.57
Hispanic, Latino, or Spanish origin 28 1.50 6.50 4.54 1.48
Black 14 1.00 5.50 2.96 1.37
Asian 32 1.50 6.50 4.28 1.58
Multiracial 20 1.00 7.00 3.80 1.76
Other 36 1.50 7.00 4.42 1.59
Emotional exhaustion
White 300 1.00 5.00 3.05 0.88
Hispanic, Latino, or Spanish origin 28 1.50 5.00 3.00 0.93
Black 14 1.50 3.50 2.57 0.62
Asian 32 2.00 5.00 3.16 0.87
Multiracial 20 1.50 5.00 2.85 0.84
Other 36 1.00 5.00 3.33 0.94
Fatigue
White 300 1.00 5.00 2.98 0.82
Hispanic, Latino, or Spanish origin 28 1.33 4.00 2.99 0.72
Black 14 1.67 4.00 2.62 0.60
Asian 32 1.33 4.33 3.08 0.88
Multiracial 20 2.00 4.33 3.03 0.74
Other 36 1.00 4.00 3.12 0.78
Engagement
White 300 1.00 5.00 3.87 0.80
Hispanic, Latino, or Spanish origin 28 2.50 5.00 3.80 0.69
Black 14 3.00 5.00 4.11 0.59
Asian 32 2.00 5.00 3.62 0.70
Multiracial 20 2.50 5.00 3.80 0.75
Other 36 1.00 5.00 3.60 0.95
Employee effectiveness
White 300 1.00 4.75 3.06 0.68
171

Variable n Min Max M SD
Hispanic, Latino, or Spanish origin 28 1.75 4.50 3.03 0.68
Black 14 2.25 4.50 3.32 0.64
Asian 32 1.25 4.00 2.91 0.66
Multiracial 20 1.50 4.50 2.89 0.68
Other 36 1.50 5.00 3.05 0.74

172

Table D2
Summary Statistics for Variables of Interest by Having Dependents
Variable n Min Max M SD
Burnout
No, did not have dependents 252 1.00 7.00 4.31 1.65
Yes, had dependents 170 1.00 7.00 3.99 1.45
Emotional exhaustion
No, did not have dependents 252 1.50 5.00 3.09 0.89
Yes, had dependents 170 1.00 5.00 2.97 0.86
Fatigue
No, did not have dependents 252 1.00 5.00 3.02 0.81
Yes, had dependents 170 1.00 4.67 2.95 0.80
Engagement
No, did not have dependents 252 1.50 5.00 3.83 0.77
Yes, had dependents 170 1.00 5.00 3.85 0.83
Employee effectiveness
No, did not have dependents 252 1.25 4.75 3.03 0.66
Yes, had dependents 170 1.00 5.00 3.08 0.71

173

Table D3
Frequency Table for Employee Wellbeing Regarding Company Policies
If your company implemented any of the below policies,
how effective were they to your wellbeing?
n %
Time off to care for family members
Not offered 135 29.0
Highly ineffective 8 1.7
Ineffective 15 3.2
Neither effective nor ineffective 96 20.5
Effective 139 29.7
Highly effective 60 12.8
No response 15 3.2
Remote working
Not offered 334 71.4
Highly ineffective 8 1.7
Ineffective 12 2.6
Neither effective nor ineffective 22 4.7
Effective 30 6.4
Highly effective 47 10.0
No response 15 3.2
Flexible scheduling
Not offered 185 39.5
Highly ineffective 7 1.5
Ineffective 14 3.0
Neither effective nor ineffective 53 11.3
Effective 121 25.9
Highly effective 73 15.6
No response 15 3.2
Scheduled as “fixed” teams (not rotating members of team)
Not offered 277 59.2
Highly ineffective 16 3.4
Ineffective 28 6.0
Neither effective nor ineffective 77 16.5
Effective 38 8.1
Highly effective 17 3.6
174

If your company implemented any of the below policies,
how effective were they to your wellbeing?
n %
No response 15 3.2
Mandated personal protective equipment
Not offered 11 2.4
Highly ineffective 21 4.5
Ineffective 29 6.2
Neither effective nor ineffective 76 16.2
Effective 203 43.4
Highly effective 113 24.2
No response 15 3.2
Introduced workplace distancing guidelines
Not offered 58 12.4
Highly ineffective 70 15.0
Ineffective 77 16.5
Neither effective nor ineffective 87 18.6
Effective 108 23.1
Highly effective 53 11.3
No response 15 3.2
Additional paid sick time
Not offered 94 20.1
Highly ineffective 8 1.7
Ineffective 24 5.1
Neither effective nor ineffective 70 15.0
Effective 157 33.6
Highly effective 100 21.4
No response 15 3.2
Reporting daily health symptoms (i.e., temperature)
Not offered 65 13.9
Highly ineffective 83 17.7
Ineffective 97 20.7
Neither effective nor ineffective 116 24.8
Effective 68 14.5
Highly effective 24 5.1
No response 15 3.2
Quarantine guidelines for exposure to others with COVID
Not offered 12 2.6
175

If your company implemented any of the below policies,
how effective were they to your wellbeing?
n %
Highly ineffective 36 7.7
Ineffective 64 13.7
Neither effective nor ineffective 87 18.6
Effective 182 38.9
Highly effective 72 15.4
No response 15 3.2

176

Table D4
Frequency Table for Employee Wellbeing Regarding Company Practices
If your company implemented any of the below practices, how effective
were they to your wellbeing?
n %
Maintained consistent personnel on shifts
Not offered 213 45.5
Highly ineffective 18 3.9
Ineffective 35 7.5
Neither effective nor ineffective 62 13.5
Effective 87 18.6
Highly effective 29 6.2
No response 24 5.1
Provided personal protective equipment
Not offered 9 1.9
Highly ineffective 8 1.7
Ineffective 19 4.1
Neither effective nor ineffective 68 14.5
Effective 236 50.4
Highly effective 104 22.2
No response 24 5.1
Daily health questionnaire on health symptoms or temperature checking
Not offered 86 18.4
Highly ineffective 68 14.5
Ineffective 93 19.9
Neither effective nor ineffective 110 23.5
Effective 66 14.1
Highly effective 21 4.5
No response 24 5.1
Offered telehealth appointments
Not offered 65 13.9
Highly ineffective 54 11.5
Ineffective 69 14.7
Neither effective nor ineffective 107 22.9
Effective 112 23.9
Highly effective 37 7.9
177

If your company implemented any of the below practices, how effective
were they to your wellbeing?
n %
No response 24 5.1
Implemented curbside drop-off and pickup
Not offered 35 7.48
Highly ineffective 33 7.05
Ineffective 52 11.1
Neither effective nor ineffective 60 12.8
Effective 156 33.3
Highly effective 108 23.1
No response 24 5.1
Implemented contactless payment
Not offered 41 8.8
Highly ineffective 10 2.1
Ineffective 18 3.9
Neither effective nor ineffective 95 20.3
Effective 176 37.6
Highly effective 104 22.2
No response 24 5.1

178

Table D5
Frequency Table for Employee Wellbeing Regarding Company Benefits or Training Items
If your company offered the below benefits or training, how
effective were they to your wellbeing?
n %
Offered an employee assistance program
Not offered 178 38.0
Highly ineffective 5 1.1
Ineffective 14 3.0
Neither effective nor ineffective 114 24.4
Effective 100 21.4
Highly effective 28 6.0
No response 29 6.2
Offered mental health benefits
Not offered 68 14.5
Highly ineffective 16 3.4
Ineffective 30 6.4
Neither effective nor ineffective 154 32.9
Effective 110 23.5
Highly effective 61 13.0
No response 29 6.2
Added social worker or social worker programming
Not offered 266 56.8
Highly ineffective 10 2.1
Ineffective 10 2.1
Neither effective nor ineffective 89 19.0
Effective 48 10.3
Highly effective 16 3.4
No response 29 6.2
Offered childcare benefits
Not offered 222 47.4
Highly ineffective 14 3.0
Ineffective 20 4.3
Neither effective nor ineffective 113 24.2
Effective 45 9.6
Highly effective 25 5.3
179

If your company offered the below benefits or training, how
effective were they to your wellbeing?
n %
No response 29 6.2
Offered wellbeing or resilience training
Not offered 148 31.6
Highly ineffective 17 3.6
Ineffective 42 9.0
Neither effective nor ineffective 110 24.0
Effective 92 19.7
Highly effective 30 6.4
No response 29 6.2
Increased paid number of sick days and other time away benefits
Not offered 179 38.3
Highly ineffective 12 2.6
Ineffective 11 2.4
Neither effective nor ineffective 48 10.3
Effective 110 23.5
Highly effective 79 16.9
No response 29 6.2

Abstract (if available)

Abstract Veterinarian wellbeing has been an industry concern for many years, with documented high rates of psychological distress, suicide ideation, and burnout. The COVID-19 pandemic created high levels of occupational stress within organizations leading to a negative impact on employee wellbeing. Veterinarians throughout the pandemic were faced with a responsibility to care for sick and injured pets, meet increased client demands, address zoonotic disease, and meet employers’ expectations while having a responsibility to safeguard their own health and the health of their family and community. The research identifies the strong relationship burnout, emotional exhaustion, fatigue, and engagement have on veterinarian effectiveness and wellbeing throughout the pandemic. In addition, this study identifies the specific strategies organizations and leaders implemented that effectively supported the wellbeing of veterinarians during the COVID-19 pandemic. The study utilized the bioecological model described by Bronfenbrenner. The findings of the study showed that wellbeing declined while effectiveness stayed the same or improved. The study also revealed that changes in process and workflow impacted veterinarian effectiveness, and direct supervisors had a significant impact on wellbeing. Based on the findings and conceptual framework, the study includes five recommendations for practice.

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Asset Metadata

Creator Neuvirth, Stephanie (author)

Core Title The impact of COVID-19 on the wellbeing of veterinarians

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2022-08

Publication Date 08/05/2022

Defense Date 07/07/2022

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Burnout,COVID-19,emotional exhaustion,fatigue,Mental Health,OAI-PMH Harvest,veterinarian,veterinary profession,wellbeing

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Adibe, Bryant (committee chair), Hirabayashi, Kimberly (committee member), Marshall, Steven (committee member)

Creator Email neuvirth@usc.edu,sneuvirth@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC111376211

Unique identifier UC111376211

Legacy Identifier etd-NeuvirthSt-11111

Document Type Dissertation

Format application/pdf (imt)

Rights Neuvirth, Stephanie

Type texts

Source 20220806-usctheses-batch-971 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

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Repository Name University of Southern California Digital Library

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