Damian McNamara

January 23, 2017

HONOLULU — High-stakes decisions, rapid-fire action, long hours, and "too much to do all at once" contribute to the perfect storm of burnout in the intensive care unit," said Curt Sessler, MD, a member of an expert panel looking at burnout here at the Society of Critical Care Medicine 46th Critical Care Congress. "Look to your left, look to your right — one of us is burned out."

The consequences of burnout reach beyond the individual to the organization and patients, Dr Sessler, who is from the Virginia Commonwealth University School of Medicine in Richmond, explained. Inefficiency, conflicts, absenteeism, and staff turnover are a few of the adverse outcomes for the healthcare system.

With excess stress, emotions are blunted and a person can feel detached, depressed, and unmotivated. It is common that a person experiencing burnout does not realize that many others are experiencing the same thing.

"They think it's an individual problem, not a group problem," said panel member Marc Moss, MD, from the University of Colorado in Denver. And it can affect even the best employees at a hospital. "We need to get away from the stigma," he said. "It's not due to an individual or an institution. The issue is with the kind of job we do."

"We're dedicated to our professions, but we need breaks, sleep, protect time, and a good work–life balance," said panelist Vicki Good, RN, MSN, immediate past president of the American Association of Critical Care Nurses.

Look to your left, look to your right — one of us is burned out.

Effective solutions to the burdens placed on healthcare professionals should improve work life, promote job satisfaction, ensure retention, and prevent burnout. "Individual interventions are important to work on, but if you don't address the work environment, it's all for naught," she added.

People usually come to these meetings to learn how to take better care of patients, but this session will "help us learn how to take better care of ourselves and our colleagues," said Dr Moss.

Best Practices to Beat Burnout

For an organization, it can be effective to shorten the length of rotations and change weekend call schedules, and stress management and self-care can help at the individual level, Dr Moss explained.

"We need to look at what interventions, personally, are best suited for us. Look at ways to address and prevent our stress — yoga, a hobby, family life, whatever works for you," said Society of Critical Care Medicine President Ruth Kleinpell, RN-CS, PhD, from the Rush University Medical Center in Chicago. She said she attended a short course on meditation practices for clinicians at her institution. "We have had more interest from clinicians in mindfulness in the past few years," she pointed out.

"Data show that if a physician takes care of 12 or more patients or a nurse takes care of more than 2.5 to 3 patients," the rate of burnout can increase, said session moderator Stephen Pastores, MD, from the Memorial Sloan Kettering Cancer Center in New York City.

An evidence-based leadership initiative geared at improving the working environment of nurses in an ICU reportedly decreased staff absenteeism by 49%, patient falls in the unit by 75%, and patient safety reports by 20% (Dimens Crit Care Nurs. 2013;32:166-173).

Components included appropriate staffing, true collaboration, and meaningful recognition. "Authentic leadership and organizational support was crucial to success," Good reported.

Although many people believe that funneling money and staff into ICU operations will prevent burnout, that's not necessarily the case. "We need to dispel belief that more staff can impact patient outcomes. It's really more about the work environment," Good said.

"Money doesn't solve everything," Dr Moss said. "It can delay people leaving from burnout, but it won't prevent it completely if you don't also fix the ICU environment and other factors," he added.

Work Environment

Adding more staff will not necessarily slash the risk for burnout in an ICU, Good explained. "Staffing is always an interesting dilemma. People think if only they could add five more nurses or three more intensivists, things will be great. But staffing is complex."

What does matter is relationships. In fact, the relationship between nurses and physicians is one of the most important factors associated with burnout in the ICU, Dr Moss said.

Skilled communication is also important, Good added. "We're all trained differently, thrown into the same ICU, and expected to communicate the same."

The institution of organizational change "is slow and steady, not a marathon," and needs to be tailored, Good explained. It can take up to 10 years to change a culture or work environment. "I wish we had a magic pill, but what is going to work in your environment is not necessarily going to work in mine."

"We are planning a national summit this year to address ways to mitigate burnout in the ICU," Dr Kleinpell reported.

"We want to bring together different disciplines and other fields, including experts on mindfulness," Dr Sessler pointed out. "Do we need to recreate the wheel or can we adopt strategies from others?"

The experts welcomed ideas and feedback not only from the audience, but also through an interactive #stopICUburnout twitter session.

The effort by different critical care societies to address burnout should be applauded, Dr Pastores told Medscape Medical News. "It can provide a strong push that this is a priority." He added that Sloan Kettering offers clinicians reflection time, tea breaks in the afternoon, and a conference room set aside for meditation.

Last year, a whitepaper on burnout was released by the Critical Care Societies Collaborative, which is a joint initiative of four critical care societies (Crit Care Med. 2016;44:1414-1421). It called for more research and attention to transform physician burnout from a subjective, sometimes stigma-heavy area of medicine to a realistic, objective, and accepted part of the practice of critical care.

Dr Sessler, Dr Moss, Dr Kleinpell, Ms Good, and Dr Pastores have disclosed no relevant financial relationships.

Society of Critical Care Medicine (SCCM) 46th Critical Care Congress. Presented January 22, 2017.


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