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KEY POINTS

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  • Fifty percent (50%) of physicians and nurse caregivers working in intensive care units (ICUs) are reported to experience burnout. Physician burnout is attributable to the number of working hours (number of night shifts, and vacation time and frequency), whereas burnout among ICU nurses is mainly related to ICU organization and end-of-life care policy.

  • ICU conflicts are independent predictors of burnout for both physicians and nurses. Recent studies identify potentially effective preventive measures. Despite identification of associations and triggers, no prospective study addresses the issues of impact on quality of care or caregiver outcome, or effective management strategies once burnout occurs.

  • Standardized communication strategies appear key to ensure safety, effective functioning, and harmonious end-of-life decision making and care; physicians may not be natural leaders in establishing interprofessional intensive care communication strategies. Communication should be considered a safety feature on par with infection control, and requires organization and buy-in from all stakeholders.

  • The specific context of pandemics and natural disasters impose a greater burden on critical care staff and require planning and postevent debriefing and caregiver follow-up.

  • The stress experienced by trainees exposed to critical care is essential to learning. Reflexive learning and the use of the narrative are useful in contexts where emotion and morality are part of the critical caregiver's experience.

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INTRODUCTION

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Caring for the sick can strain critical care caregivers. Long working hours and sleep deprivation can exhaust even the most energetic physicians. Death is a constant companion to all critical care nurses, trainees, and doctors. Treatments are proffered, and decisions made that alter whether patients live or die. Families accompany patients, bringing with them their sorrow, anxieties, and conflicts. Teamwork, which is at the center of caring for the critically ill, can be disturbed by individuals, local culture, and demands exceeding the physical or organizational capacities of its members.

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Although the stress experienced by critical care nurses has been explored in the nursing literature for decades, the first publication addressing stress lived by intensive care unit (ICU) physicians only appeared in 1986.1 Burnout, a negative consequence of stress, and of the individual's response to it, is now understood to affect ICU physicians2 and nurses3 frequently. Its incidence among physicians is roughly 50% and correlates with overall burnout rates among all (critical care and noncritical care) physicians. This correlation suggests that despite stressors inherent to critical illness and its technology-focused environment, the balance between effort and reward4 may be no different than in other environments.

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The correlation between stressors, burnout, and job dissatisfaction, and the personnel shortages in critical care should make stress and burnout a policy-driving issue, in addition to a caregiver's health issue. Calls for recognition by professional societies, better organization, and proactive resolution of stressors within individual intensive care units5 have not affected the daily challenges faced by caregivers. No prospective studies have validated the effectiveness of interventions that ...

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