Published ahead of print on November 16, 2006, doi:10.1164/rccm.200606-806OC
© 2007 American Thoracic Society doi: 10.1164/rccm.200606-806OC
Burnout Syndrome in Critical Care Nursing Staff1 Medical ICU, and 5 Biostatistics Department, Saint-Louis Hospital and Paris 7 University, Assistance Publique, Hôpitaux de Paris, Paris, France; 2 Medical ICU, Sainte-Marguerite Hospital and Marseille University, Assistance Publique, Hôpitaux de Marseille, Marseille, France; 3 Medical ICU, Hospital Michallon, Grenoble, and Department of Epidemiology Inserm U578, Grenoble, France; and 4 Psychiatry Department and Clinics for Adolescent Medicine, Cochin Hospital and Paris 5 University, Cochin, France Correspondence and requests for reprints should be addressed to Élie Azoulay, M.D., Ph.D., Service de Réanimation Médicale, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France. E-mail: elie.azoulay{at}sls-ap-hop-paris.fr Rationale: Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The intensive care unit (ICU) is a highly stressful environment. Little is known about BOS in critical care nursing staff. Objectives: To identify determinants of BOS in critical care nurses. Methods: We conducted a questionnaire survey in France. Among 278 ICUs contacted for the study, 165 (59.4%) included 2,525 nursing staff members, of whom 2,392 returned questionnaires with complete Maslach Burnout Inventory data. Measurements and Main Results: Of the 2,392 respondents (82% female), 80% were nurses, 15% nursing assistants, and 5% head nurses. Severe BOS-related symptoms were identified in 790 (33%) respondents. By multivariate analysis, four domains were associated with severe BOS: (1) personal characteristics, such as age (odds ratio [OR], 0.97/yr; confidence interval [CI], 0.96–0.99; p = 0.0008); (2) organizational factors, such as ability to choose days off (OR, 0.69; CI, 0.52–0.91; p = 0.009) or participation in an ICU research group (OR, 0.74; CI, 0.56–0.97; p = 0.03); (3) quality of working relations (1–10 scale), such as conflicts with patients (OR, 1.96; CI, 1.16–1.30; p = 0.01), relationship with head nurse (OR, 0.92/point; CI, 0.86–0.98; p = 0.02) or physicians (OR, 0.81; CI, 0.74–0.87; p = 0.0001); and (4) end-of-life related factors, such as caring for a dying patient (OR, 1.39; CI, 1.04–1.85; p = 0.02), and number of decisions to forego life-sustaining treatments in the last week (OR, 1.14; CI, 1.01–1.29; p = 0.04). Conclusion: One-third of ICU nursing staff had severe BOS. Areas for improvement identified in our study include conflict prevention, participation in ICU research groups, and better management of end-of-life care. Interventional studies are needed to investigate these potentially preventive strategies.
Key Words: end of life • conflicts • ethics • communication • organization
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