Clinical Burnout in Critical Care

Clinical Burnout in Critical Care 

Pre-Quiz: Are Your Assumption About Clinical Burnout Correct?

Burnout in nurses has a negative influence on quality care of patients?

  • True
  • False

What physical symptoms that can result from burnout (click all that apply)

  • Insomnia
  • Gastrointestinal problems
  • Headaches
  • Muscle Tension

Clinical Burnout can lead to Post-Traumatic Stress Disorder (PTSD)

  • True
  • False

What specialty has the highest occurrence of clinical burnout?

  • Peadeatric
  • Nurology
  • Critical Care
  • Cardiology

What specialty has the lowest occurrence of clinical burnout?

  • Oncology
  • Nephrology
  • Endocrinolgy
  • Psychiatric and mental health

What is the current rate burnout syndrome in critical care?

  • <20%
  • 30%
  • 40%
  • >50%

What character types are at the greatest risk of developing clinical burnout?

  • Ambitious, perfectionistic and compassionate
  • Realistic, unmotivated and apathetic
  • Confident, Interested and committed

Name the three most common symptoms associated with clinical burnout?

  • Stress, Depression, Insomnia
  • Exhaustion, Depersonalization and Reduced personal accomplishment
  • Loss of Motivation, Isolation, Anxiety

What Is The Source?

Ambitious, perfectionistic and deeply compassionate?

You are at risk of clinical burnout

Work environment and working conditions expose the individual to numerous factors of stress. Explore this image to find out what people with clinical burnout are experiencing.

Studies indicate that critical care nurses have shown more burnout in comparison to other nurses due to regular exposure to traumatic stress as a result of unpredictable work conditions (Rong, Hong, Jianxin, Liyao, & Shangdong, 2017).

The Journey to Burnout

The following is a categorical view of the experiences and factors that influence the individual in becoming burnt out. 

Idealistic Enthusiasm

This concept derives from the motivations to begin a career path or choose a profession. For many Nurses, there is a desire to help people, being a change in their lives and even to be the one that saves lives. They seek to improve the world and themselves. There are also unconscious motives of increasing one's knowledge or to gain a form of power over another. Individuals expect immediate appreciation and improvement in their status (Gnerre, Rivetti, Rossi, Tesei, Montemurro, & Nardi, 2017).

Reality

For many that are highly ambitious, the work does not meet their expectations. The individual is left disappointed that induces closure to the work environment and their colleagues. One example in nursing when this happens is when their patient ends up dying even though they were doing everything they could to save them. Another is when they try to exercise their power but are undercut by someone in a higher position. They might be trying to move up the leadership structure but their efforts continue to go unnoticed. For others, their workload is just too great. They feel rushed, understaffed and under supported. The relentlessness of the nature of the work catches up with them. The individual has tried exceedingly hard but is now emotionally exhausted (Gnerre, Rivetti, Rossi, Tesei, Montemurro, & Nardi, 2017).

Frustration

Due to the lack of personal accomplishment, the individual feels a sense of worthlessness and lack of appreciation by patients and work colleagues. This can result at in anger at oneself and others (Gnerre, Rivetti, Rossi, Tesei, Montemurro, & Nardi, 2017).

Apathy

Where there was once empathy now exists apathy. The individual becomes depersonalised, distancing themselves from patients or their colleagues.

Literature suggests that burnout syndrome is actually caused by a discrepancy the expectation and ideals of the nurse and the actual experience of their position  (Moss, Good, Gozal, Klienpell, & Sessler, 2016).

General Symptoms

 (Gnerre, Rivetti, Rossi, Tesei, Montemurro, & Nardi, 2017)  (Moss, Good, Gozal, Klienpell, & Sessler, 2016) (Mcmillan, et al., 2016).

Physical Problems

  • Fatigue
  • Insomnia
  • Muscle Tension
  • Headache
  • Gastrointestinal problems
  • Drug abuse

 (Moss, Good, Gozal, Klienpell, & Sessler, 2016)

Case Study 1: Emotional Exhaustion

Jennie's Scenario

Jennie is a 35-year-old, emergency nurse. She has been working in the emergency department for the last 10 years and no longer finds any satisfaction in her job. She complains of being miserable and has started to miss work. She has taken all her holidays, used up all her sick days and is now taking unpaid leave. She claims, “She has given so much of herself to the job and claims she wants to spend time giving back to her self”.

Which of the following facts about Jennie do you think have contributed to these feelings?

  • Jennie has always tried to go above and beyond
  • Jennie always volunteers to do overtime and cover other people’s shifts
  • Jennie lacks a social life outside of work
  • Jennie is tired from working long shifts

Emotional exhaustion


Emotional exhaustion is characterized by the feeling of being drained of energy and lacking the emotional energy to provide the services required. Emotional Exhaustion can also be a manifestation of the emotional requirements needed to deals with multiple traumatic events. Emotional Exhaustion is a key element of burnout and usually a later expression of physical and mental fatigue (Epp, 2012). 

An ability to separate work life from social life has been proven to reduce the risk of burnout (Mcmillan, et al., 2016). Jennie’s inability to escape work life means that she is never obtaining adequate rest.

Case Study 2: Reduced Personal Accomplishment

Kate's Scenario

Kate is a 28-year-old ICU nurse, she joined the nursing profession at a very young age and was given the opportunity to work as an ICU nurse at a younger age than all her class mates. She always prided herself on her academic ability and wanted to go far in her nursing career. About a year ago she wanted to begin a postgraduate study to become a clinical nurse specialist for intensive care. There was an opportunity to do the study and receive a scholarship from the hospital to complete the studies and maintain regular pay. She missed out on the scholarship and it was given to a younger male nurse. Kate felt that this position was given to the other nurse because he had a better relationship with her unit manager.  A year on from this incident she found that could not tolerate working in ICU and was desperately searching for another career avenue.

Which factors do you think influenced Kate decision to leave ICU?

  • She wasn’t getting paid enough
  • Didn’t feel like she was being valued in her working environment
  • The differential in what she hoped to achieve in ICU and what she actually was achieving
  • She stopped caring for patients needs

Reduced Personal Accomplishment

Reduced personal accomplishment is a subjective evaluation made by the individual (Epp, 2012). It usually derives from a lack of fulfillment in one’s work. Within critical care nursing staff, this can occur due to the differential between the expectations and goals of the nurse and the actual experience of their position (Moss, Good, Gozal, Klienpell, & Sessler, 2016). This can be seen in the inevitability of sickness and death inability and in Kate’s case, not being appropriately commended on exceptional work. This can lead to feelings of being undervalued or lack of professional self-esteem (Moss, Good, Gozal, Klienpell, & Sessler, 2016).

Case Study 3: Depersonalisation

Dan's Scenario

Dan is a 45-year-old emergency nurse, he has been nursing for 20 years always in emergency. He used to love the energy of the emergency environment and always threw himself into challenging situations. About 2 years ago, a 6-year-old child, was brought into the emergency ward from a car accident. Initially, the child’s condition didn’t appear too severe, although the condition soon deteriorated as internal bleeding was discovered. Dan recognized the child as they lived on the same street and he had briefly met his parents on an occasion. Dan was determined to do everything in his power to make sure that this Child stayed alive. The child's heart stopped and the team commenced advanced life support. Dan was the team leader in this situation and instructed that they continue, even long past the time that they really should have. Dan was in disbelief in the events that had conspired. He decided to take the week of work and never talked to anyone about what had happened.

Two years down the track, Dan had become completely withdrawn from engaging with others on a social matter. People at work knew to only talk to him if it was work related. His friends felt like they didn’t know him anymore because he hardly ever saw them. He was having troubles with his wife and she felt like they never spoke anymore. His work colleagues noticed that he had developed the attitude of; 

“No matter what you do or how hard you try, you cannot make a difference”.

What factors do you think influenced Dan’s change in character?

  • Reduced personal accomplishment
  • Lack of social support
  • He wasn’t given the opportunity to debrief the situation.
  • Emotional exhaustion
  • Dan has been subjected to many morally distressing situations

Depersonalisation

Detachment can occur in critical care nursing staff after morally distressing situations. When a moral conflict is unable to be resolved a common response is to seek distance from the situation. This can lead to depersonalised behaviour of, lack of empathy for patients, inability to work within a team structure and poor work ethic. A cynical attitude is developed in response them feeling powerless (Epp, 2012).

In Dan’s situation, he has put the blame on himself and hasn’t been given the opportunity get past this experience. His perception of making an impact in health care has changed and he no longer wants to be associated with the profession.  

Management Strategies - What Can We Do About It?

Contributing Factors


To provide effective management strategies, an understanding of the main controllable contributing factors must be explored. We face a challenge in the management of Burnout syndrome due to the uncontrollable nature of the contributing factors.

1: Chronic Stress

2: Lack of Personal Recognition

3: Exposure to Morally Distressing Situations

Managements Role

Chronic stress is a major contributor to burnout as it wears the nursing staff down emotionally. Work stress must be understood as an organization-level problem, not the individual employees' problem (Epp, 2012). This is largely the responsibility of management, although individually we can take a responsibility in managing our own work stress and assist the people surrounding us. 

Effective management strategies that are largely out of our control include:

  • Increased communication platforms
  • Appropriate staffing
  • Establishing and sustaining a healthy work environment
  • Professional Recognition

Individual Management Strategies

As individuals, our goal is to build resilience so that we can be prepared when these types of situations arrive.

Moss, Good, Gozal, Klienpell, & Sessler (2016) suggest that as individuals we can build resilience through these self-care strategies.


Personal Resilience Building:

  • Adequate self-care
  • Adequate rest
  • Exercise
  • Meditation
  • Mindfulness
  • Hobbies outside work life

Professional Resilience Building:

  • Assertiveness building
  • Setting limits (overtime and days consecutively working)
  • Support groups
  • Meaningful recognition to fellow colleges
  • Debriefing.
  • Realistic goals

.

Kelly’s situation

Kelly is a part-time emergency nurse as well as a mother of 3 school-aged children. She finds that the shift work suits her family commitments but she is pushed right to the limit. She is a people pleaser and wants to give 100% to her career as well as well as being there for her family. The ward that she works on has lost a lot of staff lately and she is being pressed to work overtime as well as extra days. She is regularly missing time with her family but feels like she  “doesn’t want to let the team down at work”.

What individual management strategy is most relevant for Kelly’s situation?

  • Meditation
  • Assertiveness building
  • Appropriate staffing
  • Support groups

Darren’s situation

Darren was a cardiology nurse who has recently transferred to work in emergency. He is highly ambitious and was very excited to make the switch. He is struggling to find enjoyment within the emergency setting. He found that he no longer feels like he makes impacts in people lives during his time of care and feels as if he is just “another cog in the machine”. He feel’s like his whole character was summed up in whom he was as a nurse and no longer finds it fulfilling. He feels like he’s given his whole life to nursing and has neglected his own health and friendships to bolster his career.

What management strategy is most relevant for Darren’s situation?

  • Hobbies outside of work
  • Exercise
  • Realistic Goals
  • Setting Limits

Jill’s Situation

Jill is a new ICU nurse and has been working in the ICU for 6 months. She enjoys the challenge of the job but finds it emotionally draining. In the past months, she has had 3 patient’s die under her care. Her husband is an accountant and doesn’t like talking about death and dying. Most of her time at work she is alone with her patient and doesn’t get the opportunity to associate with her colleagues that often. She hasn’t been able to fit in well with the other staff and find that there is a pessimistic culture.

What management strategy is most relevant for Jill’s situation?

  • Support groups
  • Mindfulness
  • Adequate rest
  • Professional Recognition

Post Quiz: What did you learn?

What are the 3 main contributing factors to Burnout syndrome?

  • Morally Distressing Situations, Chronic Stress and Heavy Workloads
  • Chronic Stress, Lack of Professional Recognition and Exposure to Morally Distressing Situations
  • Chronic Stress, Morally Distressing Situations and Difficult Patients
  • Lack of Professional Recognition, Low Income and Difficult Employers

What is the final stage of the 'Journey to Burnout'

  • Frustration
  • Idealistic Enthusiasm
  • Apathy
  • Reality

Which of the following is not a physical symptom of Burnout?

  • Insomnia
  • Fatiugue
  • Gastrointesinal problems
  • Cardiac Arrest

Which factor is not associated with burnout?

  • Old age
  • Ambitiousness
  • Long work hours
  • Traumatic situations

Which management strategies are associated with building individual professional resilience?

  • Appropriate staffing
  • Exercise
  • Assertiveness building
  • Setting limits

What is not considered an expression of Clinical Burnout

  • Emotional Exhaustion
  • Depersonalization
  • Proffetional Ambition
  • Low Professional Self-Esteem

True or False. Less experienced nurses are at a greater risk of Burnout?

  • True
  • False

> 60% of critical care nursing staff are experiencing clinical burnout?

  • True
  • False

What general symptoms are associated with clinical burnout?

  • Anger
  • Difficulty concentrating
  • Post traumatic stress disorder
  • Suicidal ideation

Feedback for Evaluation

Has your understanding of the SYMPTOMS of burnout syndrome increased from your previous understanding before the commencement of this E-learning resource?

  • Yes
  • No

Has your understanding of the MANAGEMENT of burnout syndrome increased from your previous understanding before the commencement of this E-learning resource?

  • Yes
  • No

How likely will you transfer learnt management skills into your professional practice?

  • Not Likely At All
  • Unlikely
  • Not sure
  • Likely
  • Extremely Likely

How competent do you feel at managing burnout in your professional practice?

  • Not Competent At All
  • Somewhat Competent
  • Competent
  • Extremely Competent

Reference List

Epp, K. (2012). Burnout in Critical Care Nurses: A literature review. Dynamics, 23, 25-31.

Gnerre, P., Rivetti, C., Rossi, A., Tesei, L., Montemurro, D., & Nardi, R. (2017). Work Stress and Burnout among physicians and nurses in Internal and Emergency Department. Italian Journal of Medicine, 11, 151-158.

Mcmillan, K., Butow, P., Turner, J., Yates, P., White, K., Lambert, S., et al. (2016). Burnout and the provision of psychosocial care amongst Australian Cancer Nurses. European Journal Oncology Nursing, 22, 37-45.

Moss, M., Good, V., Gozal, D., Klienpell, R., & Sessler, C. (2016). An Official Critical Care Societies Collaborative Statement: Burnout syndrome in critical care health care professionals: A call for action. American Journal of Critical Care, 25, 368-376.

Poncet, M., Toullic, P., Papazian, L., Kentich-Barns, N., Timsit, J., Pochard, F., et al. (2007). Burnout Syndrome in Critical Care Nursing staff. American Journal of Respiratory and Critical Care Nursing, 168-704.

Rong, W., Hong, J., Jianxin, L., Liyao, Z., & Shangdong, C. (2017). Active Intervention Can Decrease Burnout In Ed Nurses. Journal of Emergency Nursing, 43, 145-148.