Abstract & Commentary
Gender Composition of ICU Staff May Serve As a Buffer to Caregiver Burnout
By Linda L. Chlan, RN, PhD, School of Nursing, University of Minnesota, is Associate Editor for Critical Care Alert.
Dr. Chlan reports that she receives grant/research support from the National Institutes of Health.
Synopsis: The results from this multicenter Swiss survey on burnout and stress among ICU caregivers (nurses, physicians, nurse assistants) showed that an increased proportion of female nurses was associated with decreased risk for high burnout, but high stress was not consistently associated with high burnout in study participants.
Source: Merlani P, et al for the STRESI Group. Burnout in ICU caregivers: A multicenter study of factors associated to centers. Am J Respir Crit Care Med 2011;184:1140-1146.
The intensive care unit (ICU) can be immensely stressful for caregivers and can lead to burnout that results from chronic emotional and interpersonal stressors in the environment. This article reports on the findings of a nationwide survey involving all certified ICUs in Switzerland to determine if center-related characteristics of these ICUs are associated with burnout and job stress. Questionnaires were sent to all Swiss ICU centers inquiring about their ICUs' patient-related factors (mortality, length of stay) and staff composition (physicians, nurses, nurse assistants). Physicians, nurses, and nurse assistants completed a questionnaire that contained items on demographic characteristics as well as personal and professional characteristics. Respondents also completed the Maslach Burnout Inventory and a perceived evaluation of stress ("I feel stressed: never, sometimes, often, very often"). Odds ratios and logistic regression were the main analyses reporting results of individual characteristics and multiple characteristics that contributed to an increased or decreased risk for burnout and perceived stress.
The overall response rate by individual ICU center was a respectable 72%. A response rate of 69% was realized for physicians, 73% for nurses, and 46% for nurse assistants, for a total of 2996 respondents. Among those who responded, 29% showed a high degree of burnout, with 33% and 39% medium and low burnout, respectively. Presence of burnout was highest in the nurse assistants (41%), followed by physicians (31%) and nurses (28%). Overall, 37% of Swiss ICU professionals felt highly stressed. A higher proportion of female nurses and physicians decreased the risk of burnout. Increased risk of high stress was associated with working in university hospitals and pediatric ICUs, with the number of ICU beds, and with a higher proportion of female physicians. Not surprising was that both mortality rate and lengthy ICU stays increased risk of high burnout and high stress. Surprisingly, being male increased the risk of high burnout but decreased the risk of high stress. Nurse assistants had an increased risk of high burnout. The findings from the numerous analyses in this study suggest that a higher proportion of female ICU nurses decreased risk of high burnout among the entire ICU team.
Commentary
Stress and burnout are inherent in the work environment of the ICU and are worldwide phenomena. The finding that the presence of a higher proportion of female ICU staff nurses may decrease the risk for high burnout is interesting and also not surprising. Given that a majority of nurses worldwide are of the female gender, perhaps this group of ICU nurses has more years of experience and personal tools for dealing with stressful workplaces and the many factors that can contribute to burnout. That the presence of males in the nursing workforce has only begun to increase in the recent past suggests that men may not have gender-specific support systems in their places of employment if they are not represented in the staff in adequate numbers. Further, they may be lacking mentors or positive role models. Men may experience an increased risk for burnout because there are fewer of them in the nursing workforce.
As with any survey, the characteristics of the one-third of staff members who did not complete the survey are unknown. It is not known if these ICU professionals are at higher or lower risk for burnout and stress. One of the more interesting findings from this study is that high stress is not always associated with high burnout. This suggests that stress perception and risk for burnout may be associated more with personality styles and personal, effective coping patterns than the actual physical ICU environment.
Given the worldwide shortage of ICU professionals, stress and burnout are an important consideration as quality of care can suffer and contribute to professionals leaving the ICU work setting. This in turn only intensifies the chronic stress for those in the work setting and can contribute even more so to burnout. A respectful work environment for all professionals is an important factor in job satisfaction. The American Association of Critical-Care Nurses has several suggestions for creating and sustaining healthy work environments.1 Skilled ICU professionals are needed to provide care in this high-acuity setting where individuals need to take responsibility to self-monitor their own risk for stress and burnout.
Reference
- American Association of Critical-Care Nurses. AACN's Healthy Work Environments Initiative. http://www.aacn.org/wd/hwe/content/hwehome.pcms?menu=hwe. Accessed Feb. 8, 2012.
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