Burnout Syndrome in ICU Caregivers: Time to Extinguish!

Abstract

FOR RELATED ARTICLE SEE PAGE 17Critical care physicians and nurses are all too familiar with the chronic high levels of stress associated with working in the ICU that can lead to the development of burnout syndrome (BOS). Burnout, initially coined by Freudenberger in 19741Freudenberger H.J. Staff burnout.J Soc Issues. 1974; 30: 159-165Crossref Scopus (2546) Google Scholar and later defined as a psychological syndrome by Maslach in 19822Maslach C. Burnout: The cost of caring. Prentice Hall, Englewood Cliffs, NJ1982Google Scholar is characterized by high emotional exhaustion, feelings of depersonalization, and low levels of personal effectiveness or accomplishment. Among ICU physicians (intensivists), heavy patient workload, longer work hours, a large number of bureaucratic and computer-related tasks, an unsatisfactory work environment, and conflicts with fellow physicians or nurses are significant risk factors for BOS.3Embriaco N. Azoulay E. Barrau K. et al.High level of burnout in intensivists.Am J Respir Crit Care Med. 2007; 175: 686-692Crossref PubMed Scopus (498) Google Scholar, 4Verdon M. Merlani P. Perneger T. Ricou B. Burnout in a surgical ICU team.Intensive Care Med. 2008; 34: 152-156Crossref PubMed Scopus (78) Google Scholar, 5Merlani P. Verdon M. Businger A. et al.Burnout in ICU caregivers: a multicenter study of factors associated to centers.Am J Respir Crit Care Med. 2011; 184: 1140-1146Crossref PubMed Scopus (113) Google Scholar, 6Guntupalli K.K. Fromm Jr., R.E. Burnout in the internist-intensivist.Intensive Care Med. 1996; 22: 625-630Crossref PubMed Scopus (134) Google Scholar This year’s Medscape lifestyle report showed that critical care physicians were among the highest groups of practitioners expressing burnout, at 55%.7Peckham C. Medscape Lifestyle Report 2016: Bias and Burnout. January 13, 2016. http://www.medscape.com/features/slideshow/lifestyle/2016/public/overview. Accessed March 11, 2016.Google Scholar Similarly, among ICU nurses, contributory factors to BOS and psychological disorders (posttraumatic stress, depression) include high patient acuity and nurse to patient ratios, lack of ancillary support, the moral distress related to delivery of perceived inappropriate care (especially for patients at the end of life), and poor interdisciplinary communication and collaboration in the ICU.8Mallett K. Price J.H. Jurs S.G. Slenker S. Relationships among burnout, death anxiety, and social support in hospice and critical care nurses.Psychol Rep. 1991; 68: 1347-1359Crossref Scopus (74) Google Scholar, 9Poncet M.C. Toullic P. Papazian L. et al.Burnout syndrome in critical care nursing staff.Am J Respir Crit Care Med. 2007; 175: 698-704Crossref PubMed Scopus (493) Google Scholar, 10Mealer M.L. Shelton A. Berg B. Rothbaum B. Moss M. Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses.Am J Respir Crit Care Med. 2007; 175: 693-697Crossref PubMed Scopus (232) Google Scholar, 11Meltzer L.S. Huckabay L.M. Critical care nurses’ perceptions of futile care and its effect on burnout.Am J Crit Care. 2004; 13: 202-208Crossref PubMed Scopus (306) Google Scholar, 12Guntapalli K.K. Wachtel S. Mallampalli A. Surani S. Burnout in the intensive care unit professionals.Indian J Crit Care Med. 2014; 18: 139-143Crossref Scopus (38) Google Scholar, 13Chlan L.L. Burnout syndrome among critical care professionals: a cause for alarm.Critical Care Alert. 2013; 21: 65-68Google Scholar The consequences of BOS can be serious and affect not only the mental health and well-being of caregivers but also the institution with respect to staff turnover, poor job performance, lost productivity, increased numbers of medical errors and health care costs, decreased quality of care, and reduced patient satisfaction.5Merlani P. Verdon M. Businger A. et al.Burnout in ICU caregivers: a multicenter study of factors associated to centers.Am J Respir Crit Care Med. 2011; 184: 1140-1146Crossref PubMed Scopus (113) Google Scholar, 13Chlan L.L. Burnout syndrome among critical care professionals: a cause for alarm.Critical Care Alert. 2013; 21: 65-68Google Scholar FOR RELATED ARTICLE SEE PAGE 17 In this issue of CHEST, the importance of BOS among ICU practitioners is highlighted in a “call to action” report by a task force composed of representatives from key stakeholder societies (American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine, and American Association of Critical Care Nurses) that make up the Critical Care Societies Collaborative (CCSC).14Moss M. Good V.S. Gozal D. Kleinpell R. Sessler C.N. An official critical care societies collaborative statement—burnout syndrome in critical care health-care professionals: a call for action.Chest. 2016; 150: 17-26Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar Moss and colleagues14Moss M. Good V.S. Gozal D. Kleinpell R. Sessler C.N. An official critical care societies collaborative statement—burnout syndrome in critical care health-care professionals: a call for action.Chest. 2016; 150: 17-26Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar are to be commended for summarizing the available literature on the prevalence of and risk factors for BOS, raising awareness of BOS in the critical care community and among stakeholders, and outlining strategies at the ICU environmental culture and individual practitioner level to address and mitigate this problem. It is important to note that the studies examining the prevalence and risk factors for BOS in ICU caregivers are composed of surveys with significant methodologic issues.15Curtis J.R. Puntillo K. Is there an epidemic of burnout and post-traumatic stress in critical care clinicians?.Am J Respir Crit Care Med. 2007; 175: 634-636Crossref Scopus (21) Google Scholar These include modest response rates and potential for bias and limited generalizability because they were conducted among clinicians practicing in European ICUs3Embriaco N. Azoulay E. Barrau K. et al.High level of burnout in intensivists.Am J Respir Crit Care Med. 2007; 175: 686-692Crossref PubMed Scopus (498) Google Scholar, 4Verdon M. Merlani P. Perneger T. Ricou B. Burnout in a surgical ICU team.Intensive Care Med. 2008; 34: 152-156Crossref PubMed Scopus (78) Google Scholar, 5Merlani P. Verdon M. Businger A. et al.Burnout in ICU caregivers: a multicenter study of factors associated to centers.Am J Respir Crit Care Med. 2011; 184: 1140-1146Crossref PubMed Scopus (113) Google Scholar, 9Poncet M.C. Toullic P. Papazian L. et al.Burnout syndrome in critical care nursing staff.Am J Respir Crit Care Med. 2007; 175: 698-704Crossref PubMed Scopus (493) Google Scholar and in only two health care systems in the United States.10Mealer M.L. Shelton A. Berg B. Rothbaum B. Moss M. Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses.Am J Respir Crit Care Med. 2007; 175: 693-697Crossref PubMed Scopus (232) Google Scholar, 12Guntapalli K.K. Wachtel S. Mallampalli A. Surani S. Burnout in the intensive care unit professionals.Indian J Crit Care Med. 2014; 18: 139-143Crossref Scopus (38) Google Scholar Also, being cross-sectional studies makes it difficult to assign causality to the associations identified. Nevertheless, these contemporary studies3Embriaco N. Azoulay E. Barrau K. et al.High level of burnout in intensivists.Am J Respir Crit Care Med. 2007; 175: 686-692Crossref PubMed Scopus (498) Google Scholar, 4Verdon M. Merlani P. Perneger T. Ricou B. Burnout in a surgical ICU team.Intensive Care Med. 2008; 34: 152-156Crossref PubMed Scopus (78) Google Scholar, 5Merlani P. Verdon M. Businger A. et al.Burnout in ICU caregivers: a multicenter study of factors associated to centers.Am J Respir Crit Care Med. 2011; 184: 1140-1146Crossref PubMed Scopus (113) Google Scholar, 9Poncet M.C. Toullic P. Papazian L. et al.Burnout syndrome in critical care nursing staff.Am J Respir Crit Care Med. 2007; 175: 698-704Crossref PubMed Scopus (493) Google Scholar, 10Mealer M.L. Shelton A. Berg B. Rothbaum B. Moss M. Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses.Am J Respir Crit Care Med. 2007; 175: 693-697Crossref PubMed Scopus (232) Google Scholar, 11Meltzer L.S. Huckabay L.M. Critical care nurses’ perceptions of futile care and its effect on burnout.Am J Crit Care. 2004; 13: 202-208Crossref PubMed Scopus (306) Google Scholar, 12Guntapalli K.K. Wachtel S. Mallampalli A. Surani S. Burnout in the intensive care unit professionals.Indian J Crit Care Med. 2014; 18: 139-143Crossref Scopus (38) Google Scholar and earlier published reports6Guntupalli K.K. Fromm Jr., R.E. Burnout in the internist-intensivist.Intensive Care Med. 1996; 22: 625-630Crossref PubMed Scopus (134) Google Scholar, 8Mallett K. Price J.H. Jurs S.G. Slenker S. Relationships among burnout, death anxiety, and social support in hospice and critical care nurses.Psychol Rep. 1991; 68: 1347-1359Crossref Scopus (74) Google Scholar highlight the ongoing problem of BOS, the need for further study, and this call for action from the professional societies. A key element is for ICU practitioners not only to recognize the risk factors for BOS but also to know when to ask for help. Individual accountability and building resiliency through adequate self-care and enough rest, ensuring work-life balance, and using time management and stress reduction skills are emphasized by the task force. In our ICU, critical care physicians, nurses, fellows, and advanced practice providers hold regular staff debriefings on challenging end of life cases with ethics and palliative care consultants, social workers, and patient representatives. Team building is fostered with weekend sporting events, holiday parties, meditation sessions, and midafternoon “tea time” breaks. We should applaud the efforts by the CCSC to call attention to the significant issue of BOS among critical care health care professionals and the promotion of healthy work environments for which the AACN has established standards for slightly more than a decade.16American Association of Critical-Care NursesAACN standards for establishing and sustaining healthy work environments: a journey to excellence.Am J Crit Care. 2005; 14: 187-197Crossref PubMed Google Scholar Paying attention to our physical and mental well-being is crucial. Letting our hospital and ICU physician and nurse leaders understand and address how to improve the environmental culture and staffing issues will ensure that our ICU patients and their families obtain the best care from us and will keep our profession vibrant and attractive for future generations of critical care practitioners. Wellness programs and educational initiatives by medical universities, hospitals, professional societies, and patient advocacy groups that promote well-being and prevent BOS should be prioritized and strongly supported. Finally, the CCSC’s call for significant funding and research focused on BOS will help in further understanding the issues surrounding BOS and facilitate the implementation of innovative strategies to decrease the burden of this syndrome among ICU caregivers. After all, critical care health care professionals should not forget to take care of themselves, too! /cms/asset/6b091b66-7197-4553-8226-2a434ddd4e01/mmc1.mp3Loading ... Download .mp3 (36.14 MB) Help with .mp3 files Audio An Official Critical Care Societies Collaborative Statement—Burnout Syndrome in Critical Care Health-care Professionals: A Call for ActionCHESTVol. 150Issue 1PreviewBurnout syndrome (BOS) occurs in all types of health-care professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. Full-Text PDF