High-Level Burnout in Physicians and Nurses Working in Adult Intensive Care Units

To estimate the prevalence of high-level burnout in physicians and nurses working in adult intensive care units (ICUs).Burnout among nurses has become a critical issue across health care systems globally, with major effects on both the well-being of health care professionals and the quality of patient care. Burnout is a psychological syndrome characterized by emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment. These experiences are often associated with feelings of cynicism, detachment from work, and a perception of being ineffective.1 Nurses are particularly vulnerable to this syndrome because of the demands of the nursing profession, including working long hours, caring for high-acuity patients, high-stress clinical decision-making, staffing challenges, and regularly witnessing human suffering, all of which can take a toll on nurses' well-being.1The prevalence of burnout among nurses has been studied for years, even before the COVID-19 pandemic, indicating that the syndrome has been an ongoing challenge.2 Throughout the pandemic and afterwards, burnout rates have continued to rise, highlighting a need for attention and action.3 Burnout can have personal and professional consequences. Studies have shown that employees who experience burnout may have an increased incidence of physical and mental health problems, greater turnover in roles, and decreased quality of job performance, all of which can affect the overall quality of patient care.4Although burnout among nurses and health care teams in the ICU has been the subject of considerable research, methods of measuring burnout and study design have varied widely. Thus, estimating the prevalence of burnout has been challenging. One tool, the internationally used Maslach Burnout Inventory (MBI), is a 22-item self-report questionnaire that has been shown to be valid and reliable in health care workers.1 This questionnaire asks respondents to indicate the frequency with which they experience certain feelings related to their job, resulting in high or low scores for each of the main subscales (emotional exhaustion, depersonalization, and professional accomplishment). The purpose of the systematic review conducted by Papazian et al5 was to evaluate studies that measured burnout using the MBI tool to estimate the prevalence of high-level burnout among physicians and nurses working in adult ICUs.The systematic review conducted by Papazian et al5 included 25 prevalence studies with a combined population of 20 723, including 8187 physicians and 12 536 nurses. The primary outcome of the review was the proportion of ICU physicians and nurses experiencing high-level burnout as measured with the MBI. Papazian et al5 independently assessed the risk of bias for each study, including selection, performance, detection, attrition, reporting, and publication biases. The JBI critical appraisal checklist for studies revealing prevalence data was used to assess the methodological quality.6 Any disagreements were resolved through joint review of the data and discussion. Proportions were calculated with 95% CIs.There was no statistically significant difference in the rates of high-level burnout between physicians and nurses included in these studies. When the subscales were evaluated, however, the proportion of high-level exhaustion was higher among the nurses. There were no differences in the other subscales.This systematic review showed that a large proportion of ICU team members experience high-level burnout, with rates for physicians and nurses of approximately 41% and 44%, respectively. Although previous studies have also shown that burnout is common among ICU team members, this systematic review provided additional data and highlights the need for continued evaluation of burnout using a standardized tool (eg, the MBI). This review illustrates the urgency of the problem of burnout and represents a call for action for interventions to help mitigate the negative impact of burnout on the health care system. These actions need to focus on both prevention and management.Several institutions are introducing interventions to help reduce or prevent burnout among staff members. One systematic review exploring interventions to reduce stress among ICU nurses showed that, compared with no change in current practice, cognitive-behavioral skills training and mindfulness-based interventions were more effective in reducing job-related stress.7 Another systematic review that explored specific interventions to reduce burnout in nurses found that mindfulness-based programs were the most frequently used; in addition, the authors noted that burnout is multifactorial, requiring a variety of approaches to manage and prevent.8 These approaches include nurse resiliency training and acknowledge the responsibility and accountability of the organization for factors such as adequate staffing, flexible scheduling, and leadership support. Reframing the health care field's approach to managing burnout from just an individual issue to an organizational priority will be critical in adequately addressing this ongoing challenge.Clinician burnout is an urgent issue for health care and will not go away without purposeful interventions that help prevent its occurrence and support those who are at risk. The evidence from this systematic review may increase awareness of the prevalence of burnout in the ICU setting and help leaders and clinicians start to develop interventions to support their teams. As nurses working in the critical care setting, we must regard advocating for the best evidence-based approaches as an important part of our role. We must always consider the best available evidence and understand the feasibility, appropriateness, meaningfulness, and effectiveness of any intervention to determine whether it is most appropriate to implement in our individual context.