Addressing Burnout and Stress among Critical Care Nurses: Strategies for Prevention and Intervention

Stress and burnout have become pervasive, especially for healthcare professionals, including critical care nurses. Working in critical care units involves complex workloads, difficult daily routines, high patient morbidity and mortality, and challenging ethical decision-making experiences. Common undesirable situations in critical care often represent a stressful burden that increases nurses’ risk for burnout and stress. In their study, Bogue and Bogue (2020) showed that between 25 and 33% of critical care nurses experience severe burnout syndrome. The study further reveals that 86% of critical care nurses reported at least one symptom of burnout, some even more than once, across all the studies reviewing burnout in critical care nurses. The prevalence of these cases in critical care settings requires the implementation of effective prevention and intervention strategies to address the issues.

Causes of Burnout and Stress

Individual, organizational, and systemic factors can contribute to burnout and stress among critical care nurses. Individual factors include personal characteristics, such as self-criticism, unhealthy coping styles, inadequate physical and psychological self-care, lack of work and relationship management skills, and a work-life imbalance (Bogue & Bogue, 2020). On the organizational and systemic levels, contributors to burnout and stress include challenging workloads, low personal control over the work environment, and less favorable rewards (Moss et al., 2016). Further, end-of-life issues and exposure to stressful or high-conflict relationships with co-workers can worsen the problem (Jun & Costa, 2020). Therefore, the complexity of these individual and contextual factors can contribute to the emergence of this growing problem. Respectively, an integrated approach will be required to intervene at individual, organizational, and system levels to prevent and alleviate the development of burnout and stress. The approach can assist in minimizing the harmful consequences for the provision and receipt of patient care and costs to the healthcare system.

Impact of Burnout and Stress

The implications of burnout and stress amongst critical care nurses on patient care, healthcare organizations, and the healthcare system cannot be underestimated. Burnout on the individual level can manifest serious issues, including reduced job satisfaction, increased turnover, and a higher incidence of mental health diagnoses, including depression, anxiety, and post-traumatic stress disorder (PTSD) (Moss et al., 2016). Specifically, critical care nurses who have experienced burnout have reported a sense of emotional exhaustion, depersonalization, and a decline in their sense of personal accomplishment. Burnout carries significant implications for health and well-being.

The emotional exhaustion component is of great concern among the three dimensions of burnout. At this stage, nurses often feel exhausted and are unlikely to cope with the demands of their work. Emotional exhaustion presents as fatigue, impatience, and lack of motivation. It was found that critical care nurses would provide patients with lower-quality care when emotionally exhausted (Bogue & Bogue, 2020). Depersonalization, a component of burnout, would assume negative, callous, and cynical behaviors among nurses, which, when manifested, would negatively influence patients’ perception of the nurses’ relationships in mutual interactions.

Burnout and stress’s effect on patient care quality is a primary concern for healthcare organizations and systems. Nurses experiencing burnout are more likely to make mistakes and provide subpar care. Conversely, healthcare organizations will likely experience increasing medical errors, healthcare-associated infections, and decreased overall patient safety (Moss et al., 2016). Beyond medical care, emotional exhaustion can also affect patient satisfaction with nursing care. Patients might perceive nurse communication negatively and be less likely to recommend the hospital for care (Bogue & Bogue, 2020). The negative referral can have serious financial implications as patient satisfaction scores are increasingly linked with reimbursements and financial incentives for healthcare organizations.

Alongside the financial cost, this loss of experienced critical care nurses through burnout and stress can also lead to reduced quality of care. Critical care nurses have highly specific knowledge and skills. They care for complex patient care needs, often communicating across healthcare teams. As staff with long-term experience leave the workforce, there is a need for more institutional knowledge and educated staff (Jun & Costa, 2020). The quality of care can be reduced, and there is potential for an increase in adverse patient outcomes.

The high turnover rates associated with burnout and stress among critical care nurses translate to healthcare organizations and the system. The cost of replacing a single critical care nurse is estimated at more than $65,000, consisting of expenses related to recruitment, training, and onboarding (Bogue & Bogue, 2020). High turnover rates can also result in reduced productivity, decreased staff morale, and reduced quality of care. This outcome is likely to result from experienced nurses leaving their profession, only to be replaced by less experienced staff, creating a difficult-to-adverse cycle that eventually can lead to these nurses leaving their jobs, including exerting workload and stress on the remaining staff.

Strategies for Prevention and Intervention

Prevention of and respite from burnout and stress among critical care nurses should be composed of multilevel strategies addressing individual-level, organizational-level, and systemic-level interventions. Self-care, encompassing both physical and psychological domains, is an imperative component of burnout prevention and recovery for individual critical care nurses (Bogue & Bogue, 2020). Wellness maintenance includes engaging in physical activities, having a healthy diet, hydration, and adequate sleep. Mentally, individuals can speak positively to themselves, practice meditation and some relaxing activities, and explore self-interests to promote their work-life balance.

At the individual level, preventing and recovering from burnout can be facilitated by self-care, calibrating expectations, and standardizing perception of results. The Expectations-Results Gap Model, proposed by Bogue and Bogue (2020), emphasizes the importance of expectation and perceived result calibration to minimize the gap that brings about burnout. Critical care nurses could gather information on their job performance and keep their standardized perception of results in sync with reality to maintain a realistic view of their contribution to patient care (Bogue & Bogue, 2020). This practice might prevent the emergence of the perception of inefficacy and uncontrollability, which are two core features of burnout.

At the organizational level, efforts should be made to create a work environment that is protective against burnout and detrimental stress. Organizations should invest in developing healthy work environments for critical care nurses and foster an environment of connectedness and trust among all healthcare providers to promote collaboration, communication, and teamwork (Friganović & Selič, 2021). Shared governance models of workers’ participation in decision-making and having an active voice in organizational processes can help, including ensuring that critically ill patients are provided with safe and appropriate levels of nursing care by providing adequate staffing levels and adequate time for decision-making.

Significant recognition and rewards are the other ways to build a supportive working environment. Healthcare managers can consider widely adaptable nursing recognition programs to recognize critical care nurses’ contributions and achievements and support potential advancement and continued learning. For example, organizations could consider securing honorary titles like head nurse or chief nurse or implementing formal recognition with awards and promotions. Informal recognition could also be encouraged, such as positive verbal feedback from managers and peers who report on admirable work performed, awards, and celebration events for critical care nurses to honor their achievements (Friganović  Selič, 2021). Offering competitive compensation and benefits packages can avoid turning away nurses with better opportunities or keep them from burnout.

In turn, interventions at the organizational level should foster a work-life balance and reduce the effect of high workload on critical care nurses, such as through flexible work scheduling. Examples of such interventions include self-scheduling or job sharing, which would allow nurses to assume control of their working hours and satisfy personal and familial duties (Jun & Costa, 2020). Investment in developing support programs, such as employee assistance programs or peer support groups, can provide critical care nurses with the tools and training to prevent acute stress and burnout (Jun & Costa, 2020).

Systemically, it is essential to change policies, shift funding priorities, expand research, and improve nurses’ understanding of models of burnout and how to treat it. Professional societies like the American Association of Critical Care Nurses have issued calls to action. They suggest standardizing the way burnout is measured and linking reduced burnout scores to reward the fiscal status of health organizations (Moss et al., 2016). This way, clear guidelines and benchmarks for addressing burnout and stress can hold organizations accountable for creating supportive and healthy places for their workforce to provide patients with astute, ongoing care.

Funding for research in developing and evaluating EBPs to prevent and treat burnout and stress in critical care nurses is also crucial. Alkhawaldeh et al. (2019) stated that only high-quality methods in studies would allow for the recommendation of stress-management interventions for use in clinical settings. If healthcare organizations and policymakers invest in research and support innovation in the development of strategies, critical care nurses will access the best evidence and the most effective interventions to prevent and recover from burnout.

Conclusion

Burnout and stress are among the issues critical care nurses face at work that have become an epidemic, with significant consequences for individual nurse health. The issues affect the health of critical care nurses and the sustainability of the healthcare workforce. The issue must be addressed across individual, organizational, and system levels, as it will assist in preventing and alleviating critical care nurse burnout and stress. Critical care nurses and their employers should advocate for and engage in individual, organizational, and system-level interventions to enhance mental or emotional self-care. The advocacy should also focus on building a supportive work environment, using evidence-based practices, and calling for policy change. The priority and resources to protect the health and well-being of critical care nurses must move up the hierarchy of clinical priorities to include attention from healthcare organizations, professional associations, and policymakers.