The importance of the team composition in ICUs

A higher proportion of female nurses among intensive care teams may decrease individuals' risk of professional burnout, according to Swiss researchers who studied the factors related to burnout in the high-stress setting of the intensive care unit (ICU).

The research was published online in the articles-in-press section of the American Thoracic Society's American Journal of Respiratory and .

Burnout is believed to be a to . It can lead to emotional instability, feelings of failure and low production or an urge to leave the job.

"Avoiding and understanding burnout is especially important now, given the projected shortage of ICU , in addition to the intensity and costliness of training these specialized professionals," noted Paolo Merlani, MD, attending physician at the University Hospital of Geneva.

To evaluate risk of burnout among different individual in different settings, the researchers used a self-administered questionnaire that captured , , subjective stress and risk of burnout. They evaluated more than 3,000 individuals in 72 Swiss ICUs. In addition to individual characteristics, they analyzed center-level factors (e.g., proportion of female caregivers among nurses and physicians) and patient-related factors.

In addition to the finding that a higher proportion of female nurses reduced overall risk of burnout, the researchers found more gender-related differences. While female caregivers were more likely to say that they experienced stress, they were more resistant to burnout than their male colleagues.

"This could be due to a methodological bias," said Dr. Merlani. "Indeed, female caregivers may have found it easier to admit their distress than did males….Men may be less inclined to express their distress."

Interestingly, the researchers also found that stress was not always associated with burnout. "One explanation may be that that being burned out may lessen the resistance to stress and therefore may contribute to a vicious cycle where the role of each factor might be confounding," wrote Dr. Merlani.

Of all the professions examined, nurse-assistants were at highest risk for burnout. "Since the participation to end-of-life and post-mortem care is known in the literature to increase the psychological burden and the risk of burnout and since these caregivers are usually less numerous in ICUs, the unavoidable consequence is that they are more frequently confronted to these difficult situations than others. This could be one of the causes of the increased risk of burnout in nurse-assistants," said Dr. Merlani.

Finally, Dr. Merlani and colleagues found that among women caregivers, those who were young, single and without children were at the highest risk for burnout.

"Our study could open a new frontier concerning burnout in ICUs, highlighting the importance of the team composition," said Dr. Merlani. "Of course, our results should be confirmed in a prospective multicenter, multinational study. Whether the results can be exported to other medical settings where team-working is pivotal remains for the moment an interesting question to be investigated."

"In the meanwhile," he continued, "ICU heads should ascertain that personnel at higher risk would be especially taken care of, and that resources should be provided to afford psychological support and promote a team culture. This could finally also increase the number of women staying in ICUs, thereby reducing the overall risk of ."

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