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
Accepted on November 16, 2006
Burnout Syndrome in Critical Care Nursing Staff
Marie Cecile Poncet1, Philippe Toullic1, Laurent Papazian2, Nancy Kentish-Barnes1, Jean-Francois Timsit3, Frederic Pochard4, Sylvie Chevret5, Benoit Schlemmer1, and Elie Azoulay1*
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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