An Official Critical Care Societies Collaborative Statement—Burnout Syndrome in Critical Care Health-care Professionals

Comparing the stress response using heart rate variability during real and simulated crises: a pilot study

Medical personnel often experience stress when responding to a medical emergency. A known stress-response is a measurable reduction in heart rate variability. It is currently unknown if crisis simulation can elicit the same stress response as real clinical emergencies. We aim to compare heart rate variability changes amongst medical trainees during simulated and real medical emergencies. We performed a single center prospective observational study, enrolling 19 resident physicians. Heart rate variability was measured in real time, using a 2-lead heart rate monitor (Bodyguard 2, Firstbeat Technologies Ltd) worn during 24 h critical care call shifts. Data was collected at baseline, during crisis simulation and when responding to medical emergencies. 57 observations were made to compare participant's heart rate variability. Each heart rate variability metric changed as expected in response to stress. Statistically significant differences were observed between baseline and simulated medical emergencies in Standard Deviation of the N-N interval (SDNN), Root mean square standard deviation of the N-N interval (RMSSD), Percentage of successive R-R intervals that differ by more than 50 ms (PNN50), Low Frequency (LF) and Low Frequency: High Frequency ratios (LF:HF). No statistically significant differences between simulated and real medical emergencies were identified in any heart rate variability metrics. We have shown using objective results, that simulation can elicit the same psychophysiological response as actual medical emergencies. Therefore, simulation may represent a reasonable way to practice not only essential skills in a safe environment but has the additional benefit of creating a realistic, physiological response in medical trainees.

Hospital Unit Type and Professional Roles as a Predictor of Relational Coordination in an Army Medical Center

BACKGROUND AND OBJECTIVES

High-quality communication and relationships are associated with quality of care. Workflow differences across hospital units can impede communication and relationships among health care professionals. Relational coordination (RC) is a process of communication supported by shared goals, shared knowledge, and mutual respect and is associated with quality of care and better performance outcomes in civilian hospitals. However, RC has not been explored in military hospitals. The objective of our study was to determine whether RC differs between hospital units and professional roles. Specifically, we examined RC differences by unit type for nurses, resident physicians, and physicians working in an Army Medical Center.

METHODS

We conducted an exploratory analysis of a secondary question from a cross-sectional study using a convenience sample of active-duty and civilian licensed practical nurses (LPNs), registered nurses (RNs), physician residents, and physicians (n = 289). We received institutional review board approval from the study site. Data were collected from January 2020 to March 2020, and participants completed a 47-item survey regarding their experiences of RC in various hospital units. We used t tests and one-way analyses of variance to explore bivariate relationships between RC and other study variables, as well as multiple regression to explore whether RC varied by unit type. We controlled for education and experience by including them in the model because these variables may influence perceptions of nurse-physician RC and their interactions with each other.

RESULTS

Seventy percent of participants were civilian (n = 203), 75% RNs (n = 217), and 78% female (n = 216). The mean age of respondents was 40 years (SD = 11.7), and the mean experience level was 11.9 years (SD = 9.5). RC was not associated with unit type. Total RC and between-role RC were associated with professional role. Physicians reported higher RC (β = .45, P = .01), and LPNs reported lower RC (β = -.06, P = .01). Education and experience were associated with RC. Participants with less experience reported higher RC (β = -.01, P = .00), and participants with graduate degrees reported lower RC (β = -.62, P = .00).

CONCLUSIONS

We recommend hospital leaders consider interventions to build interprofessional relationships, including interdisciplinary meetings, huddles, and structured communication tools. Improving RC among health care professionals is a cost-effective and unique way to enhance communication and collaboration among health care professionals across hospital units.

Availability and use of institutional support programs for emergency department healthcare personnel during the COVID-19 pandemic

OBJECTIVES

The COVID-19 pandemic placed health care personnel (HCP) at risk for stress, anxiety, burnout, and post-traumatic stress disorder (PTSD). To address this, hospitals developed programs to mitigate risk. The objectives of the current study were to measure the availability and use of these programs in a cohort of academic emergency departments (EDs) in the United States early in the pandemic and identify factors associated with program use.

METHODS

Cross-sectional survey of ED HCP in 21 academic EDs in 15 states between June and September 2020. Site investigators provided data on the availability of 28 programs grouped into 9 categories. Individual support programs included: financial, workload mitigation, individual COVID-19 testing, emotional (e.g., mental health hotline), and instrumental (e.g., childcare) Clinical work support programs included: COVID-19 team communication (e.g., debriefing critical incident), patient-family communication facilitation, patient services (e.g., social work, ethics consultation), and system-level exposure reduction. Participants provided corresponding data on whether they used the programs. We used generalized linear mixed models clustered on site to measure the association between demographic and facility characteristics and program use.

RESULTS

We received 1,541 survey responses (96% response rate) from emergency physicians or advanced practice providers, nurses, and nonclinical staff. Program availability in each of the 9 categories was high (>95% of hospitals). Program use was variable, with clinical work support programs used more frequently (28-50% of eligible HCP across categories) than individual employee support programs (6-13% of eligible HCP across categories). Fifty-seven percent of respondents reported that the COVID-19 pandemic had affected their stress and anxiety, and 12% were at elevated risk for PTSD. Program use did not significantly differ for HCP who reported symptoms of anxiety and/or stress compared to those who did not.

CONCLUSIONS

Early in the pandemic, support programs were widely available to ED HCP, but program use was low. Future work will focus on identifying barriers and facilitators to use and specific programs most likely to be effective during periods of highest occupational stress.

Caring to care: Nurturing ICU healthcare professionals' wellbeing for enhanced patient safety

Healthcare professionals working in the Intensive Care Unit (ICU) care for patients suffering from a critical illness and their relatives. Working within a team of people with different personalities, competencies, and specialties, with constraints and demands might contribute to a working environment that is prone to conflicts and disagreements. This highlights that the ICU is a stressful place that can threaten healthcare professionals' wellbeing. This article aims to address the concept of wellbeing by describing how the stressful ICU work-environment threatens the wellbeing of health professionals and discussing how this situation jeopardizes patient safety. To promote wellbeing, it is imperative to explore actionable interventions such as improve communication skills, educational sessions on stress management, or mindfulness. Promoting ICU healthcare professionals' wellbeing through evidence-based strategies will not only increase their personal resilience but might contribute to a safer and more efficient patient care.

Nurses quality of life, sleep disturbance, and intention to leave critical care units: A cross-sectional moderated mediation analysis

OBJECTIVES

This study aims to explore the complex relationships between personal and demographic factors, intermediary factors such as quality of life (depression, anxiety, stress, burnout), and the mediating impact of sleep disturbance on nurses' intention to leave critical care units.

DESIGN

Cross-sectional quantitative survey.

SETTING

Data were collected from registered nurses at a major university hospital in southern Italy. Seven inpatient critical care units were sampled.

MAIN OUTCOME MEASURES

Intention to leave critical care units.

RESULTS

We included 160 participants recruited over five weeks in May and June 2023. The data showed that most were female, married, and possessed a bachelor's degree in nursing. The mean quality of life score was moderate, while stress, anxiety, and burnout were mild. A significant percentage of nurses reported poor sleep quality. Logistic regression indicates that service length did not significantly impact the intention to leave. The structural equation model showed that stress positively correlated with emotional exhaustion, whereas job quality was negatively associated with emotional exhaustion and the intention to leave. Sleep disturbance did not explain the relationship between stress and emotional fatigue; however, the results revealed that male gender moderated sleep mediation.

CONCLUSIONS

This study investigated factors influencing intention to leave among critical care unit nurses. The results suggest that the role of sleep disturbance should always be considered when assessing the issue. In this chain of causes, sleep disturbance explains the relationship between stress and emotional exhaustion. Furthermore, the strength of this mediation was influenced by gender, particularly by the male gender.

IMPLICATIONS FOR CLINICAL PRACTICE

Stress and emotional exhaustion significantly impact nurses' working quality of life, particularly when sleep quality is taken into account. This leads to a higher intention to leave critical care units. To reduce this tendency, healthcare managers could implement specific evidence-based interventions to promote a good climate of work, which would positively affect stress, emotional exhaustion and sleep disturbance. The likelihood of intention to leave decreased with achieving personal self-fulfilment among nurses.

Personality Traits, Burnout, and Psychopathology in Healthcare Professionals in Intensive Care Units-A Moderated Analysis

This study explored the associations between personality dimensions, burnout, and psychopathology in healthcare professionals in intensive care units (ICUs). This study further aimed to discern the differences in these relationships when considering the variables of critical care experience (less than 5 years, 5-10 years, and more than 10 years), profession (nurses versus intensivists), and the urban size of the city where the ICU is located (metropolitan cities versus smaller urban cities). This cross-sectional investigation's outcomes are based on data from 503 ICU personnel, including 155 intensivists and 348 nurses, in 31 ICU departments in Greece. Participants underwent a comprehensive assessment involving a sociodemographic questionnaire, the Eysenck Personality Questionnaire (EPQ), the Maslach Burnout Inventory (MBI), and the Symptom Checklist-90 (SCL-90). To analyze the interplay among critical care experience, burnout status, and psychopathology, a moderation analysis was conducted with personality dimensions (i.e., psychoticism, extraversion, and neuroticism) serving as the mediator variable. Profession and the urban size of the ICU location were considered as moderators influencing these relationships. Male healthcare professionals showed higher psychoticism levels than females, aligning with prior research. Experienced nurses reported lower personal achievement, hinting at potential motivation challenges for professional growth. Psychoticism predicted high depersonalization and low personal achievement. Neuroticism and psychoticism negatively impacted ICU personnel's mental well-being, reflected in elevated psychopathology scores and burnout status. Psychoticism appears to be the primary factor influencing burnout among the three personality dimensions, particularly affecting intensivists. In contrast, nurses are more influenced by their critical care experience on their mental health status.

The effect of a mindfulness intervention (MI) on sleep disturbance (SD) among nurses

Sleep disturbance (SD) makes it difficult for nurses in intensive care units (ICUs) to perform activities that require focused and continual concentration, which raises the risk of medical errors, health issues, loss of sleep, and patient care mistakes. The mindfulness intervention (MI) was created to give participants the capacity to approach their own emotions with non-judgmental awareness and to become more conscious of their thoughts and feelings, and it reduced psychological symptoms. This study examined the effect of MI on SD among nurses. A randomized control trail (RCT) was conducted and recruited 100 nurses from intensive care and medical-surgical units from three hospitals located at the northern and middle regions of Jordan. Bivariate analysis including independent T-test and multiple linear regressions were used to study the differences between the interventional group (MI) and the comparison group (watching mindfulness videos) in terms of the impact on the SD. Nurses reported significant and high levels of SD. MI significantly reduced the level of SD and improved sleep quality among nurses. MI should be integrated into nursing competences to combat the negative impacts of poor sleep quality on nurses and organizational-sensitive outcomes.

Perceived Quality of Life in Intensive Care Medicine Physicians: A French National Survey

Purpose: There is a growing interest in the quality of work life (QWL) of healthcare professionals and staff well-being. We decided to measure the perceived QWL of ICU physicians and the factors that could influence their perception. Methods: We performed a survey coordinated and executed by the French Trade Union of Intensive Care Physicians (SMR). QWL was assessed using the French version of the Work-Related Quality of Life (WRQoL) scale, perceived stress using the French version of 10 item-Perceived Stress Scale (PSS-10) and group functioning using the French version of the Reflexivity Scale, the Social Support at Work Questionnaire (QSSP-P). Results: 308 French-speaking ICU physicians participated. 40% perceived low WRQoL, mainly due to low general well-being, low satisfaction with working conditions and low possibility of managing the articulation between their private and professional lives. Decreased QWL was associated with being a woman (p = .002), having children (p = .022) and enduring many monthly shifts (p = .022). Conclusions: This work highlights the fact that ICU physicians feel a significant imbalance between the demands of their profession and the resources at their disposal. Communication and exchanges within a team and quality of social support appear to be positive elements to maintain and/or develop within our structures.

Development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review

BACKGROUND

Patients in intensive care units (ICUs) often require quality palliative care for relief from various types of suffering. To achieve quality palliative care, specific goals need to be identified, measured, and reported. The present study aimed to develop quality indicators (QIs) for palliative care in ICUs, based on a systematic review and modified Delphi method, and test their feasibility by reviewing electronic medical record (EMR) data.

METHODS

The current study was performed in two phases: the development of QIs using the modified Delphi method, and pilot-testing the quality of palliative care in ICUs based on EMR review. The pilot test included 262 patients admitted to the general or emergency ICU at a university hospital from January 1, 2019, to June 30, 2019.

RESULTS

A 28-item QI set for palliative care in ICUs was developed based on the consensus of 16 experts. The Delphi process resulted in low measurability ratings for two items: "Assessment of the patient's psychological distress" and "Assessment of the patient's spiritual and cultural practices." However, these items were determined to be important for quality care from the perspective of holistic assessment of distress and were adopted in the final version of the QI set. While the pilot test results indicated the feasibility of the developed QIs, they suggested that the frequency of care performance varied, and certain aspects of palliative care in ICUs needed to be improved, namely (1) regular pain assessment, (2) identification of the patient's advance directive and advance care planning for treatment, (3) conducting an interdisciplinary family conference on palliative care, and (4) assessment of psychological distress of family members.

CONCLUSIONS

The QI set, developed using the modified Delphi method and tested using EMR data, provided a tool for assessing the quality of palliative care in ICUs. In the two ICUs considered in this study, aspects of the palliative care process with a low performance frequency were identified, and further national surveys were recommended. It is necessary to conduct ongoing surveys at more facilities to improve the quality of palliative care in ICUs.

Becoming futile: the emotional pain of treating COVID-19 patients

Introduction

The COVID-19 pandemic has had a profoundly detrimental impact on the emotional wellbeing of health care workers. Numerous studies have shown that their rates of the various forms of work-related distress, which were already high before the pandemic, have worsened as the demands on health care workers intensified. Yet much less is known about the specific social processes that have generated these outcomes. This study adds to our collective knowledge by focusing on how one specific social process, the act of treating critically ill COVID-19 patients, contributed to emotional pain among health care workers.

Methods

This article draws from 40 interviews conducted with intensive care unit (ICU) staff in units that were overwhelmed with COVID-19 patients. The study participants were recruited from two suburban community hospitals in Massachusetts and the interviews were conducted between January and May 2021.

Results

The results show that the uncertainty over how to treat critically ill COVID-19 patients, given the absence of standard protocols combined with ineffective treatments that led to an unprecedented number of deaths caused significant emotional pain, characterized by a visceral, embodied experience that signaled moral distress, emotional exhaustion, depersonalization, and burnout. Furthermore, ICU workers' occupational identities were undermined as they confronted the limits of their own abilities and the limits of medicine more generally.

Discussion

The inability to save incurable COVID-19 patients while giving maximal care to such individuals caused health care workers in the ICU an immense amount of emotional pain, contributing to our understanding of the social processes that generated the well-documented increase in moral distress and related measures of work-related psychological distress. While recent studies of emotional socialization among health care workers have portrayed clinical empathy as a performed interactional strategy, the results here show empathy to be more than dramaturgical and, in this context, entailed considerable risk to workers' emotional wellbeing.

Building a Culture of Support at a Pediatric Surgery Center Through Multidisciplinary Peer Support

INTRODUCTION

Surgeons and perioperative staff experience high rates of burnout manifesting as exhaustion, depersonalization, and lack of achievement. Consequences include increases in errors and adverse patient events. Little data exist regarding the effectiveness of multidisciplinary peer support systems in combatting burnout. We sought to improve staff morale through establishment of a formally trained, multidisciplinary peer support team.

METHODS

Selfselected surgeons, anesthesiologists, and nurses were formally trained as Peer Responders as part of an institutional peer support program. All perioperative staff at our pediatric surgery center (n = 120) were surveyed before initiation of the program and then 1-mo and 12-mo after initiation. Primary outcomes were unit morale, unit support, and peer approachability. Kruskal-Wallis tests and Chi-squared tests were used for comparison of primary outcomes among surveys and by position with an alpha value of 0.05 set for significance. Institutional review board approval was waived.

RESULTS

The survey response rates were 57.5%, 32.5%, and 37.5% chronologically. After 1 year, there were statistically significant increases in unit support (P < 0.01) and peer approachability (P < 0.001), and a nonstatistically significant increase in unit morale (P = 0.22). On subgroup analysis by staff role, surgeons were least likely to utilize peer support.

CONCLUSIONS

A multidisciplinary peer support team is an effective and easily reproducible means of building a culture of support and improving morale among perioperative staff. Surgeons were least likely to seek interprofessional peer support. Consequently, surgeon-specific strategies may be necessary. Further investigations are ongoing regarding secondary effects on staff burnout rates, patient safety, and quality of care.

Critical care nursing workforce in crisis: A discussion paper examining contributing factors, the impact of the COVID-19 pandemic and potential solutions

AIMS AND OBJECTIVES

The critical care nursing workforce is in crisis, with one-third of critical care nurses worldwide intending to leave their roles. This paper aimed to examine the problem from a wellbeing perspective, offering implications for research, and potential solutions for organisations.

DESIGN

Discursive/Position paper.

METHOD

The discussion is based on the nursing and wellbeing literature. It is guided by the authors' collaborative expertise as both clinicians and researchers. Data were drawn from nursing and wellbeing peer-reviewed literature, such as reviews and empirical studies, national surveys and government and thinktank publications/reports.

RESULTS

Critical care nurses have been disproportionately affected by the COVID-19 pandemic with studies consistently showing critical care nurses to have the worst psychological outcomes on wellbeing measures, including depression, burnout and post-traumatic stress disorder (PTSD). These findings are not only concerning for the mental wellbeing of critical care nurses, they also raise significant issues for healthcare systems/organisations: poor wellbeing, increased burnout and PTSD are directly linked with critical care nurses intending to leave the profession. Thus, the wellbeing of critical care nurses must urgently be supported. Resilience has been identified as a protective mechanism against the development of PTSD and burnout, thus offering evidence-based interventions that address resilience and turnover have much to offer in tackling the workforce crisis. However, turnover data must be collected by studies evaluating resilience interventions, to further support their evidence base. Organisations cannot solely rely on the efficacy of these interventions to address their workforce crisis but must concomitantly engage in organisational change.

CONCLUSIONS

We conclude that critical care nurses are in urgent need of preventative, evidence-based wellbeing interventions, and make suggestions for research and practice.

Paws to Care: Implementation of a Novel Medical Dog Office Hours Program to Foster Pediatric Health Care Staff Resilience and Joy

Burnout and resiliency are significant challenges among health care workers. Animal-assisted therapy (AAT) has shown to improve patient-level outcomes; however, AAT research involving hospital staff is limited. Our novel Medical Dog ("MD") Office Hours Program aimed to provide support to pediatric hospital staff and explore the program's impact on burnout. Participant surveys described work role and years of experience, well-being, and emotional/physical descriptions and symptoms. Of 149 participants, 85% endorsed baseline distress/burnout; nearly half had at-risk Well-Being Index scores. Compared with baseline, postintervention participants endorsed significantly fewer negative (more positive) emotions; greater feelings of comfort and energy; and decreased tiredness and pain (P < .0001). Readiness to return to work scores were high (M = 78.1, SD = 18.4). Our Medical Dog ("MD") Office Hours Program resulted in improvements in emotional descriptions and physical symptoms among pediatric health care staff. Leveraging AAT among health care staff may help mitigate burnout and increase resiliency.

A relational coordination training intervention to improve job satisfaction and intent to stay in the intensive care unit: A pilot study

BACKGROUND

Relational coordination (RC) explores the coordination of work between and among professionals in a workgroup. RC is associated with higher job satisfaction and retention; however, researchers have not tested RC training interventions to improve job satisfaction and retention.

PURPOSE

To explore changes in job satisfaction and intent to stay among health care professionals following a virtual RC training intervention.

METHODS

We conducted a pilot, parallel group randomized controlled trial in four intensive care units. Data collection occurred via survey. Difference-in-difference regression models were used to analyze the job satisfaction and intent to stay outcomes.

DISCUSSION

The RC training intervention did not influence job satisfaction or intent to stay. Participants with baccalaureate degrees and African American/Black participants reported lower intent to stay.

CONCLUSION

The results from this pilot study are a critical first step in testing the efficacy of an RC training intervention to improve staff outcomes in a larger powered study.

Rates of Burnout in Female Orthopaedic Surgeons Correlate with Barriers to Gender Equity

BACKGROUND

The primary purpose of this study was to investigate the relationships between career burnout and the barriers to gender equity identified by Canadian female orthopaedic surgeons. A secondary purpose was to assess relationships between the demographic characteristics of the female surgeons and career burnout and job satisfaction.

METHODS

An electronic survey was distributed to 330 Canadian female orthopaedic surgeons. Demographic variables including age, stage and years in practice, practice setting, and marital status were collated. The survey included the Gender Bias Scale (GBS) questionnaire and 2 questions each about career burnout and job satisfaction. The Pearson r correlation coefficient evaluated the relationships among the higher- and lower-order factors of the GBS, burnout, and job satisfaction. Spearman rank correlation coefficient assessed relationships among burnout, job satisfaction, and demographic variables.

RESULTS

Survey responses were received from 218 (66.1%) of the 330 surgeons. A total of 110 surgeons (50.5%) agreed or strongly agreed that they felt career burnout (median score = 4). Burnout was positively correlated with the GBS higher-order factors of Male Privilege (r = 0.215, p < 0.01), Devaluation (r = 0.166, p < 0.05), and Disproportionate Constraints (r = 0.152, p < 0.05). Job satisfaction (median = 4) was reported by 168 surgeons (77.1%), and 66.1% were also satisfied or very satisfied with their role in the workplace (median = 4). Burnout was significantly negatively correlated with surgeon age and job satisfaction.

CONCLUSIONS

Half of the female orthopaedic surgeons reported symptoms of career burnout. Significant relationships were evident between burnout and barriers to gender equity. Identification of the relationships between gender-equity barriers and burnout presents an opportunity to modify organizational systems to dismantle barriers and reduce this occupational syndrome.

CLINICAL RELEVANCE

Given the relationships between gender inequity and career burnout in this study of female orthopaedic surgeons, actions to dismantle gender barriers and address systemic biases are necessary at all career stages to reduce burnout.

Long-term effects of a tailored mindfulness-based program for Chinese intensive care unit nurses: A randomized parallel-group trial

AIM

This study investigated the direct and long-term improvements that mindfulness-based interventions exert on intensive care unit nurses. We assessed an abbreviated four-week, twice-weekly mindfulness-based intervention program's effect on work-related mental health variables and examined whether the intervention impact was maintained at two- and six-month follow-up assessments. We also examined the training program's effects on work and life.

BACKGROUND

Previous research has shown that mindfulness interventions exert positive effects immediately after treatment. However, few studies have examined whether treatment effects are maintained over time or under different circumstances. Moreover, treatment effects among Chinese intensive care unit nurses have rarely been examined.

DESIGN

We conducted a randomized, non-blinded, parallel-group trial.

METHODS

Participants included 90 intensive care unit nurses, divided into two cohorts, who participated in the program in October 2016 and April 2017. They completed validated measures of mindfulness, burnout syndromes, anxiety and depressive symptoms and well-being at baseline (T₁), immediately after intervention (T₂), two months after (T₃) and six months after (T₄) the intervention.

RESULTS

We observed a significant group effect (1) immediately post-intervention and two months after intervention for mindfulness; (2) at two months after intervention for anxiety, depression and subjective well-being and (3) at post-intervention, two months after and six months after for emotional exhaustion.

CONCLUSIONS

These findings suggest that the tailored four-week mindfulness-based intervention program improved intensive care unit nurses' mental health, although further research is needed to verify its feasibility in a clinical working environment.

Complex interplay between moral distress and other risk factors of burnout in ICU professionals: findings from a cross-sectional survey study

BACKGROUND

Burnout threatens intensive care unit (ICU) professionals' capacity to provide high-quality care. Moral distress is previously considered a root cause of burnout, but there are other risk factors of burnout such as personality, work-life balance and culture. This study aimed to disentangle the associations of ICU professionals' moral distress and other risk factors with the components of burnout-emotional exhaustion, depersonalisation and personal accomplishment-suggesting informed burnout prevention strategies.

METHODS

Cross-sectional survey completed in 2019 of ICU professionals in two Dutch hospitals. The survey included validated measure for burnout (the Dutch Maslach Burnout Inventory), moral distress (Moral Distress Scale), personality (short Big Five Inventory), work-home balance (Survey Work-Home Interaction Nijmegen) and organisational culture (Culture of Care Barometer). Each of the three components of burnout was analysed as a separate outcome, and for each of the components, a separate regression analysis was carried out.

RESULTS

251 ICU professionals responded to the survey (response rate: 53.3%). Burnout prevalence was 22.7%. Findings showed that moral distress was associated with emotional exhaustion (β=0.18, 95% CI 0.9 to 0.26) and depersonalisation (β=0.19, 95% CI 0.10 to 0.28) and with increased emotional exhaustion mediated by negative work-to-home spillover (β=0.09, 95% CI 0.04 to 0.13). Support from direct supervisors mitigates the association between moral distress and emotional exhaustion (β=0.16, 95% CI 0.04 to 0.27).

CONCLUSIONS

Understanding moral distress as a root cause of burnout is too simplified. There is an important interplay between moral distress and work-home imbalance. Interventions that support individual coping with moral distress and a work-home imbalance, and the support of direct supervisors, are paramount to prevent burnout in physicians and nurses.

High-level burnout in physicians and nurses working in adult ICUs: a systematic review and meta-analysis

PURPOSE

The prevalence of burnout in intensive care unit (ICU) professionals is difficult to establish due to the variety of survey instruments used, the heterogeneity of the targeted population, the design of the studies, and the differences among countries regarding ICU organization.

METHODS

We performed a systematic review and meta-analysis examining the prevalence of high-level burnout in physicians and nurses working in adult ICUs, including only studies that use the Maslach Burnout Inventory (MBI) as a tool to evaluate burnout and involving at least 3 different ICUs.

RESULTS

Twenty-five studies with a combined population of 20,723 healthcare workers from adult ICUs satisfied the inclusion criteria. Combining 18 studies including 8187 ICU physicians, 3660 of them reported a high level of burnout (prevalence 0.41, range 0.15-0.71, 95% CI [0.33; 0.5], I2 97.6%, 95% CI [96.9%; 98.1%]). The heterogeneity can be at least in part explained by the definition of burnout used and the response rate as confirmed by the multivariable metaregression done. In contrast, there was no significant difference regarding other factors such as the study period (before or during the coronavirus disease 2019 (COVID-19) pandemic), the income of the countries, or the Healthcare Access and Quality (HAQ) index. Combining 20 studies including 12,536 ICU nurses, 6232 of nurses were reporting burnout (prevalence 0.44, range 0.14-0.74, [95% CI 0.34; 0.55], I2 98.6% 95% CI [98.4%; 98.9%]). The prevalence of high-level burnout in ICU nurses for studies performed during the COVID-19 pandemic was higher than that reported for studies performed before the COVID-19 pandemic (0.61 [95% CI, 0.46; 0.75] and 0.37 [95% CI, 0.26; 0.49] respectively, p = 0.003). As for physicians, the heterogeneity is at least in part explained by the definition used for burnout using the MBI but not by the number of participants. When compared, the prevalence of high-level burnout was not different between ICU physicians and ICU nurses. However, the proportion of ICU nurses with a high level of emotional exhaustion was higher than for ICU physicians (0.42 [95% CI, 0.37; 0.48] and 0.28 [0.2; 0.39], respectively, p = 0.022).

CONCLUSION

According to this meta-analysis, the prevalence of high-level burnout is higher than 40% in all ICU professionals. However, there is a great heterogeneity in the results. To evaluate and to compare preventive and therapeutic strategies, there is the need to use a consensual definition of burnout when using the MBI instrument.

Occupational Burnout in Healthcare Workers, Stress and Other Symptoms of Work Overload during the COVID-19 Pandemic in Poland

This study explored the level and selected determinants of burnout among five groups of healthcare workers (physicians, nurses, paramedics, other medical and nonmedical staff) working during the COVID-19 pandemic in Poland. This cross-sectional study was conducted from February to April 2022, with the use of a self-administered mostly online survey. The BAT-12 scale was used to measure burnout, and the PSS-4 scale was used to measure stress. The sample was limited to 2196 individuals who worked with patients during the COVID-19 pandemic. A series of multivariate logistic regression models with three to nine predictors was estimated. The prevalence of burnout ranged from 27.7% in other nonmedical staff to 36.5% in nurses. Adjusting for age and gender, both physicians (p = 0.011) and nurses (p < 0.001) were at higher risk of burnout. In the final model, elevated stress most likely increased the risk of burnout (OR = 3.88; 95%CI <3.13-3.81>; p < 0,001). Other significant predictors of burnout included traumatic work-related experience (OR =1.91, p < 0.001), mobbing (OR = 1.83, p < 0.001) and higher workload than before the pandemic (OR = 1.41, p = 0.002). Only 7% of the respondents decided to use various forms of psychological support during the pandemic. The presented research can contribute to the effective planning and implementation of measures in the face of crisis when the workload continues to increase.

Burnout in Trauma Surgeons During the COVID-19 Pandemic: a Long-standing Problem Worsens

Purpose of Review

Physician burnout is well-described in the literature. We analyze the effects of the COVID-19 pandemic on burnout in trauma and acute care surgeons (TACS).

Recent Findings

Along with other healthcare workers and trainees, TACS faced unprecedented clinical, personal, and professional challenges in treating a novel pathogen and were uniquely affected due to their skillset as surgeons, intensivists, and leaders. The pandemic and its consequences have increased burnout and are suspected to have worsened PTSD and moral injury among TACS. The healthcare system is just beginning to grapple with these problems.

Summary

COVID-19 significantly added to the pre-existing burden of burnout among TACS. We offer prevention and mitigation strategies. Furthermore, to build upon the work done by individuals and organizations, we urge that national institutions address burnout from a regulatory standpoint.

TILES-2019: A longitudinal physiologic and behavioral data set of medical residents in an intensive care unit

The TILES-2019 data set consists of behavioral and physiological data gathered from 57 medical residents (i.e., trainees) working in an intensive care unit (ICU) in the United States. The data set allows for the exploration of longitudinal changes in well-being, teamwork, and job performance in a demanding environment, as residents worked in the ICU for three weeks. Residents wore a Fitbit, a Bluetooth-based proximity sensor, and an audio-feature recorder. They completed daily surveys and interviews at the beginning and end of their rotation. In addition, we collected data from environmental sensors (i.e., Internet-of-Things Bluetooth data hubs) and obtained hospital records (e.g., patient census) and residents’ job evaluations. This data set may be may be of interest to researchers interested in workplace stress, group dynamics, social support, the physical and psychological effects of witnessing patient deaths, predicting survey data from sensors, and privacy-aware and privacy-preserving machine learning. Notably, a small subset of the data was collected during the first wave of the COVID-19 pandemic.

Measurement(s)	Stress • Burnout • Affect • Depression • Sleep • Physical Activity Measurement • Alcohol Use History • Frequency Any Tobacco Use • Personality • Social Support • Intragroup Conflict • Challenge and Hindrance Stressors • Demographics • Context and Atypical Events • Daily Stressors • Most Stressful Event • Work Context • Job Performance • Job Satisfaction • Stressors at Work • Charting at Home • Coworker Trust • Social Networks at Work • Socialization Outside of Work • Use of Wellness Resources • Heart Rate • Step Count • Acoustic Features • Team Interactions • Proximity to Key Objects • Cell Phone Use • Hospital Contextual Data • Coping with Stress • Productivity at Work • Pride at Work • Teamwork • Support System
Technology Type(s)	Perceived Stress Scale - 14 Questionnaire • Survey • Patient Health Questionnaire - 9 Item • Pittsburgh Sleep Quality Index • FitBit • International Physical Activity Questionnaire (August 2002) Short Last 7 Days Self-Administered Format • Unihertz Atom Phone • Minew E8- TILES Interaction Sensors • Minew E8- Eddystone Beach • Rescuetime • Evaluations • Patient Census • Interview
Sample Characteristic - Organism	Homo sapiens
Sample Characteristic - Location	Los Angeles County and University of Southern California Medical Center

Supporting Professionals in Critical Care Medicine: Burnout, Resiliency, and System-Level Change

Burnout is occurring in epidemic proportions among intensive care unit physicians and other health-care professionals-accelerated by pandemic-driven stress. The impact of burnout is far-reaching, threatening the health of individual workers, the safety and quality of care our patients receive, and eroding the infrastructure of health care in general. Drivers of burnout include excessive quantity of work (nights, weekends, and acuity surges); excessive menial tasks; incivility, poor communication, and challenges to team success; and frequent moral distress and end-of-life issues. This article provides system-based practice and individual strategies to address these drivers and improve the well-being of our team and our patients.

A qualitative descriptive study of the COVID-19 pandemic: Impacts on nursing care delivery in the critical care work system

The COVID-19 pandemic drastically changed the delivery of nursing care in U.S. critical care settings. The purpose of this study was to describe nurses' perceptions of the critical care work system during the COVID-19 pandemic in the U.S. We conducted interviews with experienced critical care nurses who worked during the pandemic and analyzed these data using deductive content analysis framed by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model. Concepts include the critical care work system structures, nursing care processes, outcomes, and adaptations during the pandemic. Our findings revealed a description of the critical care work system framed by the SEIPS 2.0 model. We suggest how human factors engineers can utilize a human factors and engineering approach to maximize the adaptations critical care nurses made to their work system during the pandemic.

Psychological needs of critical care staff and barriers to accessing support: A qualitative study

Worldwide, critical care staff are vulnerable to mental health difficulties. Support is varied and uptake is minimal.Therefore, barriers need to be understood in order to be addressed; doing so may improve staff's mental health, resulting in positive consequences. This qualitative research took place between September 2020–November 2020 at a National Health Service critical care unit in England. Participants were critical care staff (n = 9). Data were collected through semistructured interviews and analyzed using thematic analysis. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) was used to report the findings, with analysis resulting in six themes: support is the team together in the moment, keeping work‐related difficulties from the forefront of the mind, it's just part of the job, stigma makes it hard to speak up about psychological difficulties, normalizing psychological support, and desire for psychological support within critical care. Psychologist presence in critical care, as well as further options for support, may help to reduce barriers and improve staff mental health. Further research is needed to evaluate staff outcomes across multiple sites to refine understanding and interventional approach.

Drivers of Burnout Among Critical Care Providers: A Multicenter Mixed-Methods Study

BACKGROUND

Critical care practitioners have some of the highest levels of burnout in health care.

RESEARCH QUESTION

What are key drivers of burnout across the multidisciplinary ICU team?

STUDY DESIGN AND METHODS

We conducted a multicenter mixed-methods cohort study in ICUs at three diverse hospitals. We recruited physicians, nurses, respiratory therapists, and other staff members who worked primarily in an ICU. Participants completed the Maslach Burnout Inventory for Human Services Survey for Medical Personnel (MBI) and a qualitative focus group or interview using a phenomenologic approach. MBI subscales for emotional exhaustion, depersonalization, and lack of personal accomplishment were calculated. Emergent shared themes contributing to burnout were identified from qualitative interviews.

RESULTS

Fifty-eight providers (26 physicians, 22 nurses, six respiratory therapists, three pharmacists, and one case manager) participated. Ten participants (17.9%) described their burnout as moderate to high. However, participants scored moderate or high levels across the three MBI subscales (emotional exhaustion, 71.4%; depersonalization, 53.6%; and lack of personal achievement, 53.6%). Drivers of burnout aligned with three core themes: patient factors, team dynamics, and hospital culture. Individual drivers included medically futile cases, difficult families, contagiousness of burnout, lack of respect between team members, the increasing burden of administrative or regulatory requirements at the cost of time with patients, lack of recognition from hospital leadership, and technology. All were highly interconnected across the three larger domains. Despite differences in MBI scores, most provider types described very similar drivers of burnout.

INTERPRETATION

High levels of burnout were identified through the MBI, but participants did not self-report high levels of burnout, suggesting a lack of awareness. Drivers of burnout were highly interconnected, but factors related to team dynamics and hospital culture were most prominent and shared across provider types. The shared drivers of burnout across multiple provider types highlights the need for interventions focused on team- and system-level drivers.

Association between work-related psychological empowerment and quality of nursing care among critical care nurses

AIM

This study aimed to examine the association between work-related psychological empowerment and quality of nursing care in Jordanian critical care nurses.

BACKGROUND

Nurses' work-related empowerment is the essential element to enhance nurses' quality of care. There are few studies about this area among critical care nurses.

METHODS

A cross-sectional design was used, and data were collected from critical care registered nurses (N = 480) from different health sectors.

RESULTS

The mean scores of work-related psychological empowerment and quality of nursing care were 5.22 (SD = 0.92) and 3.75 (SD = 0.62), respectively. The nurses had agreement level of psychological empowerment and very good level of quality of nursing care. There was a positive relationship between quality of nursing care and psychological empowerment.

CONCLUSION

The need to enhance work psychological empowerment is necessary to improve quality of nursing care.

IMPLICATION FOR NURSING MANAGEMENT

The results reflect the need for policy-makers and nursing managers to develop and implement strategies to promote psychological empowerment to provide high quality of nursing care among critical care nurses.

Veterinary house officer perceptions of dimensions of well-being during postgraduate training

OBJECTIVE

To describe veterinary house officers’ perceptions of dimensions of well-being during postgraduate training and to identify potential areas for targeted intervention.

SAMPLE

303 house officers.

PROCEDURES

A 62-item questionnaire was generated by use of an online platform and sent to house officers at participating institutions in October 2020. Responses were analyzed for trends and associations between selected variables.

RESULTS

239 residents, 45 rotating interns, and 19 specialty interns responded to the survey. The majority of house officers felt that their training program negatively interfered with their exercise habits, diet, and social engagement. House officers reported engaging in exercise significantly less during times of clinical responsibility, averaging 1.6 exercise sessions/wk (SD ± 0.8) on clinical duty and 2.4 exercise sessions/wk (SD ± 0.9) when not on clinical duty (P < 0.001). Ninety-four percent of respondents reported experiencing some degree of anxiety regarding their physical health, and 95% of house officers reported feeling some degree of anxiety regarding their current financial situation. Overall, 47% reported that their work-life balance was unsustainable for > 1 year; there was no association between specialty and sustainability of work-life balance. Most house officers were satisfied with their current training program, level of clinical responsibility, and mentorship.

CLINICAL RELEVANCE

Veterinary house officers demonstrated a poor balance between the demands of postgraduate training and maintenance of personal health. Thoughtful interventions are needed to support the well-being of veterinary house officers.

Implementation and evaluation of clinical supervision for support workers in a paediatric palliative care setting

Support workers represent a large proportion of the NHS workforce and yet their supervisory needs are often overlooked. This study focused specifically on a cohort of support workers in a community paediatric palliative care setting. Peer supervision was implemented for this group, initially face to face and then virtually. The experiences of clinical supervision for this group were investigated through responses to an online survey (n = 25) and two focus groups (n = 7). Survey data were analysed concurrently with a thematic analysis. The following themes and sub-themes were developed from transcribed focus groups: (1) Barriers to engagement (2) Being Listened to (3) What Worked Well: Logistics. Overall, delivery of supervision was effective to a mixed degree - though support workers appreciated a space to be listened to, their distrust of colleagues and other barriers impeded the capacity of supervision to achieve more than support and catharsis for this group. Future projects should focus on introducing more preliminary interventions to promote reflection and peer support for these groups as well as continue to consider the supervisory needs of support workers.

Outcomes Associated with ICU Telemedicine and Other Risk Factors in a Multi-Hospital Critical Care System: A Retrospective, Cohort Study for 30-Day In-Hospital Mortality

Introduction: Intensive care unit telemedicine (ICU-TM) is expanding due to increasing demands for critical care, but impact on outcomes remains controversial. This study evaluated the association of ICU-TM and other clinical factors with 30-day, in-hospital mortality. Methods: This retrospective, cohort study included 151,780 consecutive ICU patients admitted to nine hospitals in the Cleveland Clinic Health System from 2010 to 2020. Patients were identified from an institutional datamart and Acute Physiology and Chronic Health Evaluation IV (APACHE IV) registry. Primary outcome was 30-day in-hospital mortality. Analyses included multivariate logistic regression modeling, and survival analysis. Results: Overall, unadjusted 30-day, in-hospital mortality incidence was significantly different with (5.6%) or without ICU-TM (7.2%), and risk ratio was 0.78 (95% confidence interval [CI] 0.75-0.81) (p < 0.0001). Mortality rate for ICU-TM and no ICU-TM was 2.4/1,000 versus 3.2/1,000 patient days, respectively (p < 0.0001). Multivariate logistic regression showed that ICU-TM was associated with reduced 30-day mortality (odds ratio 0.78, 95% CI 0.72-0.83). Increased risk was seen with cardiac arrest admissions, males, acute stroke, weekend admission, emergency admission, race (non-white), sepsis, APACHE IV score, ICU length of stay (LOS), and the interaction term, emergency surgical admissions. Reduced risk was associated with hospital LOS, surgical admission, and the interaction terms (weekend admissions with ICU-TM and after-hour admissions with ICU-TM). The model c-statistic was 0.77. Median ICU and hospital lengths of stay were significantly reduced with ICU-TM, with no difference in 48-h mortality or 48-h mortality rate. Conclusion: ICU telemedicine exposure appears to be one of several operational and clinical factors associated with reduced 30-day, in-hospital mortality.

Critical Care Nurses' Experiences During the COVID-19 Pandemic: A US National Survey

BACKGROUND

Given critical care nurses' high prepandemic levels of moral distress and burnout, the COVID-19 pandemic will most likely have a tremendous influence on intensive care unit (ICU) nurses' mental health and continuation in the ICU workforce.

OBJECTIVE

To describe the experiences of ICU nurses during the COVID-19 pandemic in the United States.

METHODS

Nurses who worked in ICUs in the United States during the COVID-19 pandemic were recruited to complete a survey from October 2020 through early January 2021 through social media and the American Association of Critical-Care Nurses. Three open-ended questions focused on the experiences of ICU nurses during the pandemic.

RESULTS

Of 498 nurses who completed the survey, 285 answered the open-ended questions. Nurses reported stress related to a lack of evidence-based treatment, poor patient prognosis, and lack of family presence in the ICU. Nurses perceived inadequate leadership support and inequity within the health care team. Lack of consistent community support to slow the spread of COVID-19 or recognition that COVID-19 was real increased nurses' feelings of isolation. Nurses reported physical and emotional symptoms including exhaustion, anxiety, sleeplessness, and moral distress. Fear of contracting COVID-19 or of infecting family and friends was also prevalent.

CONCLUSIONS

Intensive care unit nurses in the United States experienced unprecedented and immense burden during the COVID-19 pandemic. Understanding these experiences provides insights into areas that must be addressed to build and sustain an ICU nurse workforce. Studies are needed to further describe nurses' experiences during the COVID-19 pandemic and identify effective resources that support ICU nurse well-being.

Burnout and Well-Being Among Medical Professionals in China: A National Cross-Sectional Study

Objective

To determine the profile of Chinese medical professionals with burnout symptoms at the national level and identify the association between capability well-being and burnout.

Design and Setting

A cross-sectional study in a nonrandom national sample of medical staff from 6 provinces across western, central and eastern China.

Participants

Physicians, medical laboratory scientists, nurses, and general practitioners aged 18 years or above who submitted a completed online questionnaire from June 2019 to January 2020 successfully (N = 25,120).

Main Outcome Measures

The prevalence of burnout symptoms was assessed by the 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS), which consists of three domains: emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). The overall high burnout was defined as EE score ≥27 or DP score ≥10. The capability well-being was measured by the Investigating Choice Experiments Capability Measure for Adults (ICECAP-A) and the overall ICECAP-A score was calculated using the UK value set, ranging from a score of 0–1. Multivariable logistic regression analysis was used to identify the association between well-being and the overall high burnout.

Results

Among the 25,120 participants, 60.8% of the participants reported at least one symptom of burnout, whereas 11.2% reported all three symptoms of burnout. In the adjusted model, ICECAP-A score was independently associated with high burnout (AOR = 0.018, 95% CI = 0.015–0.022). Medical staff who were males, with shorter working years, working in tertiary hospitals, and those with the specialties of psychiatry, intensive care, emergency medicine, internal medicine, oncology, and pediatrics were at higher risk of reporting burnout symptoms.

Conclusion

The burnout symptoms were relatively common among Chinese medical staff and they were found to be independently associated with capability well-being in health professionals. Interventions should be enhanced on vulnerable groups to reduce burnout and promote well-being in future studies.

Association Among Work Characteristics, Role Transition, and Job Burnout in Nurse Practitioners in Taiwan

Workplace burnout is common among nurse practitioners (NPs) and often occurs during role transition from a registered nurse to an NP. This study aimed to explore the predictors of job burnout in nurse practitioners (NPs). A quantitative cross-sectional design was conducted on 361 convenience sample of NPs from four hospitals in central Taiwan. Data on the demographic and working characteristics (hospital grade, years of experience as an RN and NP, practice setting, working shifts, working hours, average number of patients take care, salary, and performance bonus), Chinese version of the Nurse Practitioner Role Transition Scale, and Occupational Burnout Inventory were used. The enrolled NPs showed medium-level role transition scores (mean = 65.73, SD = 9.59), and the prevalence of personal burnout, client-related burnout, and over-commitment was 51.2%, 19.4%, and 49.9%, respectively. Role transition, hospital grade, practice setting, working hours, and number of patients take care were significant predictors of personal burnout, client-related burnout, and over-commitment after adjusting for cofounding variables, possibly explaining 52.8%, 42.1%, and 36.3% of variance, respectively. Hospital administrators should provide necessary assistance to help NPs transition to new role and ensure a positive work environment and reasonable workload so as to prevent the impact of job burnout on NPs.

Critical Care Nurse Burnout, Moral Distress, and Mental Health During the COVID-19 Pandemic: A United States Survey

BACKGROUND

The COVID-19 pandemic has and will continue to have a tremendous influence on intensive care unit (ICU) nurses' mental health.

OBJECTIVES

The purpose of this study was to describe the impact of COVID-19 on nurse moral distress, burnout, and mental health.

METHODS

Between October 2020 and January 2021 this descriptive study recruited a national sample of nurses who worked in the ICU during the COVID-19 pandemic through American Association of Critical Care Nurses newsletters and social media.

RESULTS

A total of 488 survey responses were received from critical care nurses working in the U.S. during the COVID pandemic. Over two thirds of respondents experienced a shortage of personal protective equipment (PPE). Nurse respondents reported moderate/high levels of moral distress and burnout. Symptoms of moderate to severe depression and anxiety were reported by 44.6% and 31.1% of respondents, respectively. Forty-seven percent of respondents were at risk for having posttraumatic stress disorder (PTSD). Lack of perceived support from administration and shortage of PPE were associated with higher levels of burnout, moral distress, and PTSD symptoms.

CONCLUSIONS

Respondents had higher anxiety and depression than the general population and higher risk for having PTSD than recent veterans or patients after traumatic injury. High levels of reported burnout and moral distress increase the risk of nurses leaving ICU practice or the profession. This study offers important insights about the mental health of nurses during a global pandemic that can guide the development of customized interventions for ICU nurses related to this health care crisis.

Influence of Mutual Support on Burnout among Intensive Care Unit Healthcare Professionals

Introduction

Burnout among healthcare professionals in intensive care units (ICUs) is a serious issue that leads to early retirement and medication errors. Their gender, lower years of experience, and lower education have been reported as risk factors. Simultaneously, mutual support—commonly referred to as “back-up behavior,” in which staff members support each other—is critical for team performance. However, little is known about the influence of mutual support among ICU healthcare professionals on burnout. The U.S. Agency for Healthcare Research and Quality refers to mutual support as the involvement of team members in: assisting one another, providing and receiving feedback, and exerting assertive and advocacy behaviors when patient safety is threatened.

Objective

This study aimed to verify the hypothesis that lower mutual support among ICU healthcare professionals is associated with increased probability of burnout.

Methods

A web-based survey was conducted from March 4 to 20, 2021. All ICU healthcare professionals in Japan were included. An invitation was sent via the mailing list of the Japanese Society of Intensive Care Medicine and asked to mail to local communities and social network services. We measured burnout severity using the Maslach Burnout-Human Services Survey and mutual support using the TeamSTEPPS Teamwork Perceptions Questionnaire, as well as occupational background. The cutoff value for burnout was predefined and conducted logistic regression.

Results

We received 335 responses, all of which were analyzed. The majority of respondents were nurses (58.5%), followed by physicians (18.5%) and clinical engineers (10.1%). The burnout group scored significantly lower on mutual support than the non-burnout group. After adjusting for covariates in a logistic regression, low mutual support was an independent factor predicting a high probability of burnout.

Conclusions

This study suggests that it is important to focus on mutual support among ICU healthcare professionals to reduce the frequency of burnout.

The Science of Health Care Worker Burnout: Assessing and Improving Health Care Worker Well-Being

CONTEXT.—

Problems with health care worker (HCW) well-being have become a leading concern in medicine given their severity and robust links to outcomes like medical error, mortality, and turnover.

OBJECTIVE.—

To describe the state of the science regarding HCW well-being, including how it is measured, what outcomes it predicts, and what institutional and individual interventions appear to reduce it.

DATA SOURCES.—

Peer review articles as well as multiple large data sets collected within our own research team are used to describe the nature of burnout, associations with institutional resources, and individual tools to improve well-being.

CONCLUSIONS.—

Rates of HCW burnout are alarmingly high, placing the health and safety of patients and HCWs at risk. To help address the urgent need to help HCWs, we summarize some of the most promising early interventions, and point toward future research that uses standardized metrics to evaluate interventions (with a focus on low-cost institutional and personal interventions).

Dimensions of the Burnout Measure: Relationships with shame- and guilt-proneness in neonatal intensive care unit nurses

BACKGROUND

Burnout in neonatal intensive care unit (NICU) nurses has been correlated with personality proneness to shame. However, the structural validities of the one-factor Burnout Measure (BM) and the two-factor Personal Feelings Questionnaire-2 (PFQ-2) used to assess burnout and shame-proneness, respectively, in these nurses were not evaluated.

OBJECTIVES

The aim of the study was (i) to perform factor analyses of the BM and the PFQ-2 and (ii) to determine the relationships of burnout dimensions retrieved by factor analysis with similarly validated dimensions of shame- and guilt-proneness in NICU nurses.

METHODS

This is a multicentre cross-sectional cohort study that involved 142 (24%) of 585 NICU nurses who were currently providing direct newborn care in six level 3-4 NICUs in New South Wales, Australia.

RESULTS

The BM was a multidimensional measure of burnout composed of three latent factors: Demoralisation, exhaustion, and loss of motive. Based on burnout dimension mean scores of 4 or more, worryingly high levels of Demoralisation, Exhaustion, and Loss of Motive were reported by 21%, 84%, and 24% of nurses, respectively. Shame and Guilt together explained 41%, 9%, and 15% of the variance in Demoralisation, Exhaustion, and Loss of Motive, respectively. Shame controlled for guilt made respective large and moderate contributions to the variance in Demoralisation (β = .62, p < .001) and Loss of Motive (β = .33, p < .001). Guilt moderated the effect of Shame on Loss of Motive (ΔR² = .031, p = .027).

CONCLUSIONS

Factor analysis of the BM showed burnout in NICU nurses was a multidimensional syndrome comprising exhaustion, Demoralisation, and loss of motive. Worryingly high levels of exhaustion, Demoralisation, and loss of motive were not uncommon. The Demoralisation dimension had a strong correlation with shame-proneness. Understanding the nature of Demoralisation and the phenomenology of shame and guilt should be psychoeducational components of the holistic management of burnout in NICU nurses.

Workforce, Workload, and Burnout in Critical Care Organizations: Survey Results and Research Agenda

OBJECTIVES

This report provides analyses and perspective of a survey of critical care workforce, workload, and burnout among the intensivists and advanced practice providers of established U.S. and Canadian critical care organizations and provides a research agenda.

DESIGN

A 97-item electronic survey questionnaire was distributed to the leaders of 27 qualifying organizations.

SETTING

United States and Canada.

PARTICIPANTS

Leaders of critical care organizations in the United States and Canada.

INTERVENTIONS

None.

DATA SYNTHESIS AND MAIN RESULTS

We received 23 responses (85%). The critical care organization survey recorded substantial variability of most organizational aspects that were not restricted by the critical care organization definition or regulatory mandates. The most common physician staffing model was a combination of full-time and part-time intensivists. Approximately 80% of critical care organizations had dedicated advanced practice providers that staffed some or all their ICUs. Full-time intensivists worked a median of 168 days (range 42-192 d) in the ICU (168 shifts = 24 7-d wk). The median shift duration was 12 hours (range, 7-14 hr), and the median number of consecutive shifts allowed was 7 hours (range 7-14 hr). More than half of critical care organizations reported having burnout prevention programs targeted to ICU physicians, advanced practice providers, and nurses.

CONCLUSIONS

The variability of current approaches suggests that systematic comparative analyses could identify best organizational practices. The research agenda for the study of critical care organizations should include studies that provide insights regarding the effects of the integrative structure of critical care organizations on outcomes at the levels of our patients, our workforce, our work practices, and sustainability.

Drivers of Moral Distress in Surgical Intensive Care Providers: A Mixed Methods Study

BACKGROUND

Moral distress is common among healthcare providers, leading to staff burnout and attrition. This study aimed to identify root causes of and potential solutions to moral distress experienced by surgical intensive care unit (SICU) providers.

MATERIALS AND METHODS

This is a mixed methods study of physicians and nurses from a single, academic SICU. We obtained quantitative data from the Measures of Moral Distress for Healthcare Professionals (MMD-HP) survey and qualitative data from semi-structured interviews. The MMD-HP is a 27 question, validated survey on triggers of moral distress. Survey and interview data were analyzed to identify drivers of moral distress using a convergent design.

RESULTS

21 nurses and 25 physicians were surveyed and 17 providers interviewed. MMD-HP data demonstrated high levels of moral distress for nurses (mean total MMD-HP 132 ± 63.5) and physicians (121.7 ± 64.7), P = 0.68. The most frequent root cause of moral distress for all providers was participating in the delivery of aggressive care perceived to be futile. Nurses also reported caring for patients with unclear goals of care as a key driver of moral distress. Interview data supported these findings. Providers recommended improving access to palliative care to increase early communication on patient goals of care and end-of-life as a solution. Culture in the SICU often promotes supporting aggressive care however, acting as a potential barrier to increasing palliative resources.

CONCLUSIONS

Providing aggressive care that is perceived as futile was the primary driver of moral distress in the SICU. Interventions to improve early communication and access to end-of-life care should be prioritized to decrease moral distress in staff.

Internationally trained nurses and host nurses' perceptions of safety culture, work-life-balance, burnout, and job demand during workplace integration: a cross-sectional study

BACKGROUND

The shortage of qualified nurses is a problem of growing concern in many countries. Recruitment of internationally trained nurses has been used to address this shortage, but successful integration in the workplace is complex and resource intensive. For effective recruitment and retention, it is important to identify why nurses migrate and if their expectations are met to ensure their successful integration and promote a satisfying work climate for the entire nursing team. The aim of this study was to examine the perceptions of safety culture, work-life-balance, burnout and job demand of internationally trained nurses and associated host nurses in German hospitals.

METHODS

A multicentric, cross-sectional study was conducted with internationally trained nurses (n = 64) and host nurses (n = 103) employed at two university hospitals in the state of Baden-Wuerttemberg, Germany. An anonymous paper-based survey was conducted between August 2019 and April 2020. The questionnaire included sociodemographic questions, questions regarding factors related to migration, and the German version of the Assessment of your work setting Safety, Communication, Operational Reliability, and Engagement (SCORE) questionnaire. SCORE is divided into three sections: Safety Culture Domains (six subscales), Work-Life-Balance (one subscale), and Engagement Assessment Tool (four subscales).

RESULTS

Nurses who migrated to Germany were primarily seeking better working conditions, a higher standard of living, and professional development opportunities. Internationally trained nurses reported lower work-related burnout climate (Mean 55.4 (SD 22.5)) than host nurses (Mean 66.4 (SD 23.5)) but still at a moderately high degree (Safety Culture Domains). Host nurses indicated a higher workload (Mean 4.06 (SD 0.65)) (Engagement Assessment Tool) and a lower Work-Life-Balance (Mean 2.31 (SD 0.66)) (Work-Life-Balance) compared to nurses who trained abroad (Mean 3.67 (SD 0.81) and Mean 2.02 (SD 0.86), respectively). No differences were detected for the other subscales. The Safety Culture Domains and Engagement Assessment Tool showed room for improvement in both groups.

CONCLUSION

The study suggest that the expectations migrant nurses had prior to migration may not be met and that in turn could have a negative impact on the integration process and their retention. With increasing recruitment of internationally trained nurses from within Europe but also overseas, it is crucial to identify factors that retain migrant nurses and assist integration.

TRIAL REGISTRATION

The study has been prospectively registered (27 June 2019) at the German Clinical Trial Register ( DRKS00017465 ).

Moral Distress, Mattering, and Secondary Traumatic Stress in Provider Burnout: A Call for Moral Community

Burnout incurs significant costs to health care organizations and professionals. Mattering, moral distress, and secondary traumatic stress are personal experiences linked to burnout and are byproducts of the organizations in which we work. This article conceptualizes health care organizations as moral communities-groups of people united by a common moral purpose to promote the well-being of others. We argue that health care organizations have a fundamental obligation to mitigate and prevent the costs of caring (eg, moral distress, secondary traumatic stress) and to foster a sense of mattering. Well-functioning moral communities have strong support systems, inclusivity, fairness, open communication, and collaboration and are able to protect their members. In this article, we address mattering, moral distress, and secondary traumatic stress as they relate to burnout. We conclude that leaders of moral communities are responsible for implementing systemic changes that foster mattering among its members and attend to the problems that cause moral distress and burnout.