From the President: Ah, Summer...A Good Season to Readdress Work-Life Balance
The relationships that physicians and nurses have with critically ill or injured patients, and, perhaps, more commonly with family members, can be highly stressful. Again, promoting understanding and healthy communication proactively can pay dividends in regards to stress mitigation. This ties in with the added challenges of end-of-life situations in which emotions often run high, and calm, thoughtful communication is of critical importance. Surveys indicate1,3 that end-of-life issues impact our ICU nursing colleagues even more significantly, perhaps in part because of their many hours of direct contact with patients and families at the bedside.
From a unit organizational perspective, studies indicate1,5 that an excessively heavy work schedule is an important risk factor for physicians. In particular, the number of night shifts per month, and the time since the last nonworking week, were independent risk factors for burnout in one study. In a prospective randomized trial,5 a continuous intensivist schedule of 14 consecutive days was associated with higher burnout, greater job distress, and more work-life imbalance than a schedule with weekend cross-coverage. Inclusion of nonclinical work, such as research, teaching, or administrative activities, or work in a different clinical setting, appears to be protective regarding burnout. Unit and practice leaders and administrators have an opportunity to influence scheduling and nonclinical activities to reduce burnout.
Individuals who seem to be higher risk for developing burnout tend to have perfectionist and controlling tendencies, pessimistic views, and an inability to express emotions or to delegate. Individuals with supportive relationships and those who are able to personally manage difficult situations effectively, ie, are “resilient,” tend to avoid burnout more effectively.
Strategies to manage burnout in the ICU focus on prevention, early identification of the individual with burnout, and mitigation of burnout (often employing the same techniques as for prevention). Preventive strategies include both individual and organizational approaches. Individual approaches include awareness and self-monitoring, willingness to accept help from others, lifestyle management, stress management, anger management, “mindfulness,” and development of resilience. Individual approaches are often promoted in an organization setting. Such programs are increasingly used for medical students and residents but must become more ingrained in clinical practice settings.
Organizational approaches include prospective identification and monitoring of worker well-being as a quality indicator, emphasis on teamwork, attention to high stress areas (such as the ICU), deliberate management of the work environment to address overwork, support for a healthy work environment in regards to respectful relationships and communication, and many others.
What can the American College of Chest Physicians do to help alleviate burnout and enhance work-life balance among our members? I’m pleased to report that CHEST is leading an important project conducted by members of the Critical Care Societies Collaborative (CCSC), that includes leaders and experts from the American Association of Critical-Care Nurses (AACN), the American Thoracic Society (ATS), the Society of Critical Care Medicine (SCCM), and CHEST. Key goals of this task force are to raise awareness and set the stage for interventions to reduce burnout in the ICU through publication of a review and call to action in multiple journals; sponsorship of educational sessions at our annual meetings; and development and posting of additional Web-based tools and resources. While critical care workers are certainly aware of the importance and prevalence of ICU burnout, an important aim is to raise awareness among other key groups, including policymakers, administrators, and funding agencies.
In conclusion, please take a moment during this month of August to pause and consider your own work-life balance and how, together, we can enhance not just the health of our patients but also the personal well-being and long productive career among those who care for the critically ill and injured.
References
1. Embriaco NE, Azoulay K, Barrau N et al. High level of burnout in intensivists: prevalence and associated factors. Am J Respir Crit Care Med. 2007;175[7]:686-692.
2. Merlani PM, Verdon A, Businger G, Domenighetti H, Parggerm H, Ricou B. Burnout in ICU caregivers: a multicenter study of factors associated to centers. Am J Respir Crit Care Med. 2011;184[10]:1140-1146.
3. Poncet MCP, Toullic L, Papazian N, et al. Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med. 2007;175[7]:698-704.
4. www.medscape.com/features/slideshow/lifestyle/2013/critical-care#7
5. Ali NA, Hammersley J, Hoffmann SP, et al. Continuity of care in intensive care units: a cluster-randomized trial of intensivist staffing. Am J Respir Crit Care Med. 2011;184[7]:803-808.
