Burnout

BurnoutThe Critical Care Societies Collaborative (CCSC) has published a report on burnout syndrome (BOS) that gives critical care healthcare professionals guidance on mitigating the its development and calls for initiating research to examine ways to prevent and treat it.

The complete statement can be viewed in the official publication of each CCSC member journal: American Association of Critical-Care Nurses (AACN), the American College of Chest Physicians (CHEST), the American Thoracic Society (ATS), and Society of Critical Care Medicine (SCCM).

Join the conversation at #StopICUBurnout.

Burnout Syndrome Defined
Burnout syndrome (BOS) is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. 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 copublished 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 especially stressful environment in the ICU due to 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 number 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 president-elect of the American Thoracic Society. “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. Two potential strategies for dealing with burnout are interventions focused on enhancing the ICU environment and helping individuals cope with their environment.

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. A 2011 report in Nursing Standard identified problem-focused coping style, self-awareness, and lifestyle and coping strategies as ways to mitigate BOS. In 2013, the journal ESSAI reported that self-care and stress reduction measures can build resilience to help address and even prevent BOS.

“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 Curt Sessler, MD, senior author and immediate past president of the American College of Chest Physicians. “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.”

Next Steps

The CCSC is planning a National Summit on Prevention and Management of Burnout in the ICU, to be held in December 2017 in Chicago, Illinois, USA. The summit is being proposed in response to a national “Call for Action” that was published in the July 2016 issue of Critical Care Medicine to address BOS in ICU healthcare professionals.

The purposes of the summit are to: 1) identify steps needed to implement the call for action to focus on prevention and treatment of burnout in ICU healthcare professionals; 2) outline the preferred treatments related to individual and organizational factors influencing burnout; 3) describe key approaches for disseminating interventions and addressing barriers; and 4) define gaps in the field to outline a research agenda.

The one-day meeting would include brief morning presentations, followed by breakout panel-led discussions organized by theme, including: 1) key approaches for prevention, 2) individual focused interventions to address BOS, 3) organizational interventions to address BOS, and 3) identification of gaps in knowledge. Each breakout group will also be tasked with identifying priority areas for research. Theme breakout sessions will include focused questions and discussions, followed by consensus building and forming practice, education, and research recommendations. Information discussed, recommendations, and action items from each theme will be reported out at the end of the day.

The summit would have representation from the fields of medicine, psychology, sociology, occupational health, nursing, and allied health experts; professionals trained in meditation, time management, mindfulness, yoga, tai chi, and other behavioral and stress reduction measures; and educators, researchers, healthcare administrators, and students. It would also emphasize patient- and family- centered care by including ICU providers and former ICU patients.

Resources

  • Awa WL, Plaumann M, Walter U. Burnout prevention: a review of intervention programs. Patient Educ Couns. 2010 Feb;78(2):184-190.
  • Braunschneider H. Preventing and managing compassion fatigue and burnout in nursing. ESSAI. 2013 Spring;11:Article 11.
  • Epstein R, Krasner MS. Physician resilience: what it means, why it matters, and how to promote it. Acad Med. 2013 Mar;88(3):301-303.
  • Fearon C, Nicol M. Strategies to assist prevention of burnout in nursing staff. Nursing Standard. 2011 Dec;26(14):35-39.
  • Goitein L, O’Malley PG, Redberg RF. Physician work environment and well-being: a call for papers. JAMA Intern Med. 2017 Feb 1;177(2):164-165.
  • Linzer M, Levine R, Meltzer D, Poplau S, Warde C, West CP. 10 bold steps to prevent burnout in general internal medicine. J Gen Intern Med. 2014 Jan;29(1):18-20.
  • Moss M, Good VS, Gozal D, Kleinpell R, Sessler CN. An official Critical Care Societies Collaborative statement: burnout syndrome in critical care healthcare professionals: a call for action. Crit Care Med. 2016 Jul;44(7):1414-1421.
  • Panagioti M, Panagopoulou E, Bower P, et al. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Med. 2017 Feb 1;177(2):195-205.
  • Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017 Jan;92(1):129-146.
  • West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016 Nov 5;388(10057):2272-2281.