Burnout Syndrome among ICU Healthcare Professionals

Critical care health professionals are at high risk for burnout syndrome. This debilitating condition can cause physical and emotional exhaustion, cynicism, and feelings of detachment from work. Specialties that are experiencing the highest levels of burnout syndrome include emergency medicine, critical care physicians, and obstetrics and gynecology. Critical care physicians, nurses, and respiratory therapists can experience burnout syndrome at similar rates. The causes of burnout syndrome are many and varied, but some of the most common ones are long hours, emotional labor, and difficult working conditions. The consequences of burnout syndrome can be severe, leading to job dissatisfaction, decreased productivity, and even clinical errors.

Burnout syndrome was first described in 1974 by American psychologist Herbert Freudenberger. He defined it as "the extinction of motivation or incentive, especially where one's devotion to a cause or relationship fails to produce the desired results". The term has since been used more broadly to describe any type of physical or mental exhaustion that may be caused by prolonged stress.

As a physician, you know all too well the effect that stress can have on your body and mind. You also know that it's important to take some time for yourself every now and then to relax and rejuvenate. However, what happens when stressors in your life and at work become overwhelming and you can't seem to find a way to cope? You may be experiencing burnout syndrome.

  Burnout syndrome is a condition that can occur as a result of an imbalance of personal characteristics of the healthcare worker and work-related issues or other organizational factors. Symptoms include feelings of energy depletion or exhaustion, increased cynicism, apathy, and detachment, and a reduced sense of accomplishment. The symptoms of burnout syndrome can be divided into four main categories physical, emotional, mental, and behavioral.

  Physical symptoms may include fatigue, insomnia, gastrointestinal problems, headaches, or migraines. Emotional symptoms may include feeling overwhelmed or hopeless, feeling disconnected from your work, feeling like you're not making a difference, feeling incompetent or inadequate, or having a decrease in job satisfaction. Mental symptoms may include difficulty concentrating or focusing, problems with memory, decreased productivity, or making more medical errors. Lastly, behavioral symptoms may include absenteeism from work, increased alcohol or drug use, social withdrawal, or irritability or aggression. The most common symptoms reported were feelings of emotional exhaustion (78%), depersonalization or cynicism (50%), and a reduced sense of personal accomplishment (41%) [1].

A study published in the American Journal of Critical Care found that nearly 50% of critical care health professionals surveyed met the criteria for burnout. Of those who were burned out, nearly 60% said that they had considered leaving their current position due to job-related stress.

  The COVID-19 pandemic had a major impact on critical care physicians. In a single-center, cross-sectional, Italian study, over half (60%) met the criteria for burnout, with nearly the same percentages among nurses and physicians. Nurses reported significantly higher scores of anxiety and insomnia levels. Forty-five percent of participants reported symptoms of depression but most of the staff showed moderate to high levels (82.4%) of resilience [2]. Another study published in the Annals of Intensive Care reported symptoms of anxiety in 46.5%, depression in 30.2%, and severe burnout in 51% of intensivists part of the European Society of Intensive Care Medicine [3].

Burnout syndrome can be caused by work-related stressors such as long hours, demanding patients, high-pressure jobs, insufficient resources, or lack of autonomy. In a study published in Respiratory Care, the most common drivers reported were poor leadership (32%), high workload (31%), and staffing (29%) [4].
 

In a review study published in Behavioral Science, drivers included work factors, personal characteristics, and organizational factors. Work factors included low autonomy at work, decreased control over the work environment, inefficient use of time due to administrative requirements, and loss of support from colleagues. Personal characteristics included being self-critical, engaging in unhelpful coping strategies, sleep deprivation, over-commitment, perfectionism, idealism, work-life imbalance, and an inadequate family support system. Finally, organizational factors included negative leadership behaviors, workload expectations, insufficient rewards, limited interpersonal collaboration, and limited opportunities for advancement and social support [5].

The consequences of burnout syndrome can be significant, both for the individual and for the organization. At the individual level, burnout syndrome can lead to physical fatigue, mental exhaustion, and emotional detachment. This can in turn lead to errors in judgment, impaired decision-making, and reduced productivity. Physicians who are suffering from burnout syndrome are also more likely to suffer from depression, anxiety, substance abuse, and suicidal thoughts. In severe cases, burnout syndrome can even lead to death.

On the organizational level, burnout syndrome can lead to increased turnover rates, decreased patient satisfaction, decreased productivity, increased medical errors, unjustified absenteeism, and negative publicity. It can also put strain on relationships between physicians and other staff members. In severe cases, it can even lead to legal action being taken against the organization [6].

There is a paucity of evidence that addresses the prevention or treatment of burnout syndrome. Some general approaches have been reported to help improve resilience both at the individual and organizational levels. Individual strategies may include improving communication and collaboration within the organization, providing opportunities for professional development and setting realistic goals, offering flexible work arrangements, and promoting a healthy work-life. Organizational strategies may include a team-based care approach, participatory decision-making, the development of interpersonal relationships among health care providers, and training programs targeted at psychosocial well-being such as mindfulness training, cognitive behavioral therapy, and stress management training [6-7].

In a study published in BMC Health Services Research, interventions that were most effective in reducing symptoms of burnout included those that addressed job demands, job control, and social support. The study also found that interventions that addressed multiple drivers of burnout were more effective than those that addressed only one driver. Organizational interventions were more effective than individual interventions, but both approaches showed some benefits [8].

Burnout syndrome is a significant problem among ICU health professionals. The drivers of burnout syndrome include work-related stressors, personal characteristics, and organizational factors. The consequences of burnout syndrome can be significant for the individual and for the organization. There is a paucity of evidence that addresses the prevention or treatment of burnout syndrome. Some general approaches have been reported to help improve resilience both at the individual and organizational levels. More research is needed to identify effective interventions for preventing and treating burnout syndrome.