Pressure-Cooker Work Schedules Lead to Burnout in the ICU

Key Point

Burnout is common among ICU physicians. Long hours, little time off, and problems with coworkers appear to be precipitating factors.

The high-stress environment of the critical care unit is taking a serious toll on medical and nursing staff, new studies show. In a recent survey on the sources of burnout among French intensivists, almost half of respondents (46.5%) were shown to have a high level of “burnout,” while one quarter had significant signs of depression. Lead author Nathalie Embriaco and colleagues found that heavy workloads with night-shift duty, as well as strained relationships with colleagues, contributed to the perception of burnout among the participating physicians.

The premise of this study was that given high burnout rates for physicians in general, physicians working with critically ill and dying patients might be subject to even greater stress. Investigators from Université de la Méditerranée in Marseille, France, distributed questionnaires to physicians in critical care units at 189 participating French public hospitals. They received 978 surveys (an 82% response rate)—62% from attending physicians and the remainder from residents, interns, and fellows. The multipart surveys solicited information on demographics, workload, and quality of working relationships with other ICU staff and included the Maslach Burnout Inventory and standard depression scale questionnaires.

In addition to depression and burnout, the study revealed high levels of depersonalization and emotional exhaustion (37% and 19% of respondents, respectively) among the ICU staff. Female sex and organizational factors (ie, conflicts with a physician colleague or a nurse, a recent night shift, greater number of night shifts in the previous month, and long intervals without time off) were independently associated with burnout.

These results were published in the April 1 issue of American Journal of Respiratory and Critical Care Medicine, along with the results of two studies on burnout among critical care nurses, one from France and one conducted in the United States. In the French study, one third of nurses were found to have high levels of burnout. In the US study, 24% had significant symptoms of depression and posttraumatic stress disorder (PTSD). In an accompanying editorial, J. Randall Curtis, MD, MPH, and Kathleen Puntillo, RN, DNSc, ask, “Is there an epidemic of burnout and posttraumatic stress” in critical care?

The Embriaco study did not find a correlation between severity of patients’ illness and physician burnout, except among physicians who had made a decision to withdraw or withhold care on the day of the survey. However, Dr. Curtis told Pulmonary Reviews that he is not surprised by this finding. “The severity of illness in the ICU in general is so high that this may represent a ‘ceiling effect’ in which there is not enough variation in severity of illness to see an effect on physician burnout.”

Dr. Curtis, Professor of Medicine at the University of Washington in Seattle and Director of the Harborview/University of Washington End-of-life Care Research Program, noted that an alarming finding of the study was that nearly 40% of critical care physicians (and over half of “burned out” physicians) said they wanted to leave their jobs.

“Burnout is an extremely important issue for critical care both in the US and internationally,” he said. “There are many critical care beds in the US and elsewhere that are closed because of lack of adequate staffing. With such a high prevalence of burnout, anxiety, depression, and PTSD among physicians and nurses, this is obviously an issue that will need to be addressed if we are going to be able to deliver critical care effectively.”            

—Katherine Wandersee

Reference
Curtis JR, Puntillo K. Is there an epidemic of burnout and post-traumatic stress in critical care medicine? Am J Respir Crit Care Med. 2007;175:634-636.
Embriaco N, Azoulay E, Barrau K, et al. High level of burnout in intensivists: prevalence and associated factors. Am J Respir Crit Care Med. 2007;175:686-692.
Mealer ML, Shelton A, Berg B, et al. Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. Am J Respir Crit Care Med. 2007;175:693-697.
Poncet MC, Toullic P, Papazian L, et al. Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med. 2007;175:698-704.

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