Peter J. Papadakos MD, FCCM, FCCP, FAARC, FNIV
The worldwide pandemic has developed many stressors on those in the Neuro ICU, such as taking care of critically ill non-Neuro Patients outside of normal comfort level, overworked staff, and working in areas we have not normally had too: such as caring for patients in overflow ICU’s such as recovery rooms. It has also brought into focus an already identified problem, that of ICU staff burnout. The literature defines burnout as “exhaustion of physical or emotional strength or motivation, usually the result of prolonged stress or frustration”. The last two years have greatly increased the stress as hospitals are overwhelmed with patients, ICU beds filled, and capacity at a breaking point along with a breakdown of normal care patterns. Lack of positive feedback and support from patients’ families and visitors have also contributed greatly as most hospitals have limited in person visits.
Higher-acuity specialties such as critical care medicine top the lists, with burnout rates of close to 48%. We are all familiar with the most horrible events of burnout such as severe depression, divorce, substance abuse and suicide, but perhaps more common and mostly unreported is the number of people who are just “getting by”. They have no crisis but yet are unhappy in their job, experiencing dissatisfaction, and may not be sure what to do, or know ways in which they can make a change. We have all experienced staff leaving the ICU to work in ambulatory clinics or less stressful controlled environments in health care or leaving the profession all together without forewarning.
The affect of the last two years has been staggering. 93% of healthcare workers polled by Mental Health America said that they experienced stress in the last three months, 86% reported anxiety, 77% reported frustration, 76% reported exhaustion and burnout and 75% said they are overwhelmed. Why such a massive decay of ICU staff mental health? One important variable is that the pandemic and the government’s response has removed many human safety valves that have helped provide a rest from stress and a reset of mental health. The decreased ability to socialize in restaurants, sporting events and concerts after a stressful day have disappeared. Life goals such as special vacations, family celebrations such as weddings, birthdays, graduations have been removed from our calendars. Even the daily thank you hugs and snacks from patients’ families have disappeared in light of regulations limiting visitors. Another often major stressor is the new role by ICU providers as the only in-person support individual for patients during end of life. This is definitely an emotional sinkhole for staff.
How can we as ICU providers help to decrease to toll on our colleagues during these times of stress and thus improve patient care of our patients? One of the first things to do is recognize that this is a universal problem that affects everyone. Start with self-awareness. Develop a unit-based plan with staff buy-in from all levels. Evaluate the real level of stress in real time, start a daily or weekly survey tool, do one-on-one check ins with all levels of staff. Have leadership rounds going from bedside to bedside to evaluate and address issues and symptoms of burnout. Actively intervene with colleagues in stress by giving support and aid. Allow staff to develop ideas to improve the workplace environments. Have herbal tea hours and snacks available during shifts. Develop a buddy system to give mutual aid during especially hectic periods.
Some Other Common Strategies:
- Offer opportunities for group support
- Redistribute tasks so staff can perform at the top of their professional license.
- Build in breaks in the work day “fresh air time” .
- Track burnout levels and key stressors.
- Rotate staff so the same person does not have the same complex patient each day.
- Create a workplace pipeline to reinforce ICU staff from areas that have decreased workloads such as outpatient clinics.
- Support and develop time off enjoyment such as staff camping trips, bike trips charity runs and volunteering.
- Celebrate life milestones of staff with catered meals
- Decrease electronic interactions with staff during off hours to cut the electronic chains of work during off hours.
- Post contact services that provide support in your facility or community for mental health.
The major take away is that working as an interactive team together to medicate stress and give mutual support helps greatly to decrease the risks of burnout.