Published ahead of print on November 16, 2006, doi:10.1164/rccm.200606-806OC Am. J. Respir. Crit. Care Med., Volume 175, Number 7, April 2007, 698-704 A more recent version of this article appeared on April 1, 2007
Submitted on June 15, 2006 Burnout Syndrome in Critical Care Nursing StaffMarie Cecile Poncet1,1 Medical ICU, Saint-Louis Hospital and Paris 7 University, Assistance Publique, Hopitaux de Paris, Paris, France, 2 Medical ICU, Sainte-Marguerite Hospital and Marseille University, Assistance Publique, Hopitaux de Marseille, Marseille, France, 3 Medical ICU, Department of Epidemiology Inserm U578, Hospital Michallon, Grenoble, Grenoble, France, 4 Psychiatry Department and Clinics for Adolescent Medicine, Cochin Hospital and Paris 5 University, Cochin, France, 5 Biostatistics Department, Saint-Louis Hospital and Paris 7 University, Assistance Publique, Hopitaux de Paris, Paris, France * To whom correspondence should be addressed. E-mail: elie.azoulay{at}sls.aphp.fr.
Rationale: Burnout syndrome (BOS) associated with stress has been documented in healthcare professionals in many specialities. The intensive care unit 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. Among 278 ICUs contacted for the study, 165 (59.4%) included 2525 nursing staff members, of whom 2392 sent questionnaires with complete Maslach Burnout Inventory (MBI) data. Measurements and Main Results: Of the 2392 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 (age, OR 1.03/y; CI [1.01-1.04]; P=0.0008)); (2) organisational factors (ability to choose days off (OR, 0.69; CI [0.52-0.91]; P=0.009), 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) 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) perceived conflict with patient (OR, 1.96; CI [1.16-1.30]; P=0.01), dying patient (OR, 1.39; CI [1.04-1.85]; P=0.02), and number of decisions to forgo 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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