BurnoutNational Summit on Prevention and Management of Burnout in the ICU

The Critical Care Societies Collaborative (CCSC) held a National Summit on Prevention and Management of Burnout in the ICU in December 2017 in Naperville, Illinois, USA, bringing together experts from a variety of fields to address burnout. The CCSC consists of the Society of Critical Care Medicine (SCCM), American Association of Critical-Care Nurses (AACN), American Thoracic Society (ATS), and American College of Chest Physicians (CHEST).

Summit attendees aimed to:

  • Identify steps to implement the call to action to focus on prevention and treatment of burnout in healthcare professionals working in the intensive care unit (ICU)
  • Outline the preferred treatments related to individual and organizational factors influencing burnout
  • Describe key approaches for disseminating interventions and addressing barriers
  • Define gaps in the field to outline a research agenda

The CCSC will publish the proceedings from the summit, including implications for a research and implementation agenda.

Learn more about the issues addressed by the faculty and guests at the summit with these videos:

The Awakening: Tackling Burnout Syndrome in Critical Care Professionals
Meredith Mealer, PhD RN, CCRN

Using a Moral Conflict Assessment to Move from Moral Distress to Moral Action in Intensive Care Units
Peter Dodek MD

Video Interviews with Burnout Summit faculty:

  • Vicki Good, DNP RN, past president of AACN
  • Marc Moss MD, 2017 president of ATS
  • Ruth Kleinpell CCRN, PhD, FCCM, 2017 president of SCCM

These faculty reflections are audio only:
Dorrie Fontaine, PhD, RN, FAAN
Phil Hagen MD
Aviad Harmati PhD

Official Critical Care Societies Collaborative Call to Action

During the summer of 2016, the CCSC released an official statement on burnout, published in each CCSC member journal: AACN’s Journal of Critical Care, CHEST’s Chest Journal, ATS’s American Journal of Respiratory and Critical Care Medicine, and SCCM’s Critical Care Medicine.

The call to action notes that burnout syndrome (BOS) is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress in the workplace. This exhaustion is typically work-related and is triggered by discrepancies between the expectations and the actual requirements of the job. BOS has become a common worldwide phenomenon, especially among members of high-stress professions such as firefighters, police officers, teachers, and all types of healthcare professionals. Critical care healthcare professionals have one of the highest rates of BOS, with nearly half of the workforce exhibiting symptoms.

The co-published document reports these findings:

  • Up to 45% of critical care physicians reported symptoms of severe BOS, while 71% of those specializing in pediatric critical care reported symptoms.
  • Approximately 25% to 33% of critical care nurses manifest symptoms of severe BOS, and up to 86% have at least one of the three classic symptoms.
  • The high BOS rate in critical care professionals can be attributed to the stressful environment in the ICU caused by high patient morbidity and mortality, challenging daily work routines, and regular encounters with traumatic and ethical issues.
  • BOS in critical care healthcare professionals may result in posttraumatic stress disorder, alcohol abuse, and even suicidal thoughts.
  • In nurses, burnout is associated with reduced quality of care, lower patient satisfaction, increased numbers of medical errors, higher rates of healthcare-associated infections, and higher 30-day patient mortality rates.

Exploring Solutions and Research

“Everyone has a part to play in decreasing burnout syndrome. A full collaborative effort is required among researchers, educators, professional societies, patient advocacy groups, funding agencies, policy makers, and ourselves as critical care healthcare professionals,” says Marc Moss, MD, coauthor, vice-chair of clinical research for the Department of Medicine at the University of Colorado School of Medicine, and the 2017 president of ATS. “We can’t take care of patients if we don’t take care of each other. An increased commitment to research on burnout syndrome is a necessary first step.”

The CCSC call for action advises key stakeholder groups to help mitigate the development of BOS. Key stakeholders include critical care clinicians, friends and family, ICU unit-based leaders, hospital administrators, funding agencies, professional societies, academic institutions, patient advocacy groups, and policy makers. Potential strategies for dealing with burnout are interventions focused on enhancing the ICU environment and helping individuals cope with their environment.

It has been demonstrated that a number of organizational and individual interventions lessen the symptoms of burnout. Organizational interventions include appropriate staffing, meaningful recognition, team building, or altering work schedules; individual interventions include stress reduction training, relaxation techniques, exercise, meditation, healthy eating, and sleep hygiene measures. However, additional research is needed to focus specifically on ICU clinicians.

The CCSC is looking into ways to combat BOS in the ICU, including analyzing current research on related topics. A study in Academic Medicine noted that mindfulness training in healthcare professionals has demonstrated beneficial effects, including improved attentiveness and responsiveness to patients’ concerns and development of adaptive reserve. Two recent meta-analyses found that a number of interventions have been shown to reduce burnout symptoms, including self-care workshops, stress reduction measures, mindfulness interventions, workload or schedule changes, exercise, and meditation. Both studies conclude that there is organizational accountability as well as individual accountability to effectively mitigate BOS (West CP, et al. Lancet. 2016;388:2272-2281; Panagioti M, et al. JAMA Intern Med. 20167;177:195-205). It becomes clear as we witness the accrued interest in BOS across the workplace in general, and more particularly in healthcare fields that, although we are not the only ones to recognize BOS as a major challenge, we are also particularly vulnerable due to the unique characteristics of our work in the critical care units.

“With more than 10,000 critical care physicians and 500,000 critical care nurses practicing in the United States, the effects of burnout syndrome in the ICU cannot be ignored,” says Curtis N. Sessler, MD, senior author and past president of CHEST. “We believe that protecting the mental and physical health of healthcare professionals who are at risk for burnout syndrome is vitally important for not only the professionals but for all stakeholders, including our patients.”

Vicki S. Good, DNP, RN, coauthor and past president of AACN, highlights that “a main issue that we see with burnout syndrome is the fact that leadership has to be engaged and has to understand the impact of work culture. Having a healthy work environment that clinicians can practice in so they can have feelings of satisfaction, joy, and meaning in their work environment is important.”

“Targeting measures to address the stressful environment of the ICU is a key component in mitigating burnout in ICU clinicians,” relates Ruth M. Kleinpell, CCRN, PhD, FCCM, coauthor and 2017 president of SCCM. “There is greater awareness that we need to build resilience and recognize that individuals have to take care of themselves in order to care for patients and family members.”

Collectively, CCSC will continue to examine best strategies for raising awareness and mitigating and addressing burnout in ICU clinicians. Join the conversation at #StopICUBurnout.