While clinicians working in the ICU experienced burnout symptoms during COVID-19, several were associated with “moral distress,” such as scarcity of resources and not working with qualified colleagues, a researcher said.
Moral distress from scarcity of time, personnel, and resources, as well as from unsafe colleagues, were significantly associated with burnout symptoms in ICU clinicians, such as emotional exhaustion, depersonalization, and reduced feeling of personal accomplishment, reported Niek Kok, MSc, a PhD candidate at Radboud Institute for Health Sciences in Nijmegen, the Netherlands, at the Society of Critical Care Medicine (SCCM) virtual Critical Care Congress. The findings were simultaneously published in Critical Care Medicine.
While odds for nurses to have burnout symptoms were more than 2.5 times greater than for physicians, incidence of burnout among physicians rose significantly during the COVID-19 pandemic.
Kok noted while several studies measured prevalence of burnout among healthcare workers during COVID-19, none had a baseline measurement, allowing a “before/after” picture of clinician symptoms.
“Simple prevalence estimates don’t tell us anything about how burnout symptoms develop in ICU professionals over time,” he said. “We cannot predict a disruptive event like the COVID-19 pandemic, so it’s hard to time a baseline measurement like this.”
Fortunately, Kok’s group had a baseline measurement, as they surveyed ICU professionals about burnout in December 2019, just before the pandemic hit. They then followed up with a survey in May-June 2020 of the same ICU professionals to see how “burnout symptoms develop over time,” Kok said.
Overall, 252 ICU professionals in a university medical center and a large teaching hospital in the Netherlands responded to the survey in December, and 233 in June, for a response rate above 50% each time, with 153 overlapping. Of these, 21% were physicians and 79% were nurses. In June, 56% of respondents said they worked overtime, and 88% said they worked in a COVID unit.
Not surprisingly, 36% of respondents said they experienced burnout symptoms in June 2020 versus 23% in December 2019. Interestingly, the prevalence of burnout symptoms increased, with the percentage more than doubling among physicians from December to June (13.2% vs 28.6%, respectively).
Incidence of burnout also increased dramatically with 26.6% of physicians who did not report burnout symptoms in December reporting them in June. This incidence was higher than in nurses (21.7%).
The authors also measured “moral distress,” which Kok defined as “where professionals know the right thing to do, but are prevented from doing so.”
Among those surveyed, scarcity of time, personnel, and resources was the most morally distressing situation in June. When compared with December, there were significant increases among those who thought a colleague was perceived as not skilled enough and a colleague believed to act unsafe.
“We believe this has to do with recruitment of personnel from outside ICU wards because of the shortage of ICU nurses,” Kok said.
Kok said moral distress clearly plays a role in the development of burnout symptoms, so it is “highly important” to address it through peer supports and ethics committees, though more research is needed to assess this issue as the pandemic continues to progress, he noted.
The study was supported by ZonMw.
Kok disclosed no relevant relationships with industry. Coo-authors disclosed support from the Netherlands Organization for Health Research and Development/National Health Care Institute and the Dutch Cancer Society.