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How does burnout affect NICU caregivers and their patients?

a_nurse_examines_a_newborn_babyWe’ve all felt burned out at work due to prolonged stress — physically and emotionally exhausted, unmotivated, frustrated and maybe even cynical. But in the health-care field, burnout can harm patients as well as workers.

That concern prompted Stanford researchers to investigate the prevalence of caregiver burnout in neonatal intensive care units (NICUs) to determine whether it is correlated with healthcare-associated infections. The study is reported in the Journal of Perinatology.

The research team analyzed survey data from the California Perinatal Quality Care Collaborative, including responses from over 2,000 providers — physicians, nurses and other workers — in 44 California NICUs who cared for over 4,000 very low birth rate infants. One quarter of the respondents reported symptoms consistent with burnout on average, but burnout prevalence varied from 7.5 to 54.4 percent within each NICU.

I spoke recently with the study's lead author, Daniel Tawfik, MD, a critical care fellow at Lucile Packard Children’s Hospital Stanford.

What inspired you to investigate caregiver burnout in NICUs?

Throughout my medical training, I received very little education on the concepts of mindfulness and medical provider well-being. But the challenging experiences and stressful situations encountered every day in the hospital must have some impact on the providers’ mental health and the care they deliver to their patients. This study was a way to evaluate this relationship and hopefully spur greater awareness of burnout and encourage research to address its role in patient care.

What did you find? Were there any surprises?

We expected to find increased healthcare-associated infections in NICUs with high levels of burnout, since preventing infections in these vulnerable patients takes a great deal of vigilance. We were a little surprised that there wasn’t a strong relationship apparent when we analyzed the data. This may be due to the relatively small number of NICUs and the fact that infections were fortunately not very common in this group of infants.

Although our most recent analyses show increased burnout in large NICUs, our research group previously reported improved outcomes in large NICUs. It’s possible that the largest NICUs have increased burnout, but they also have systems in place to improve the quality of care — counteracting the effect that burnout may have on quality indicators.

We were also a little surprised to find that physician burnout [approximately 17 percent] was less prevalent than non-physician burnout [approximately 28 percent]. But this discrepancy is also in line with our previous studies in which nurses reported lower ratings of safety culture and a desire for more respect and input in decision-making. It’s possible that these differences contributed to increased burnout among nurses, who made up the majority of our survey respondents in our new study.

How can your results be used to improve NICU care?

These results highlight the prevalence of burnout among NICU providers, particularly among nurses. Whether or not this burnout affects quality of care in measurable ways, it suggests that we need interventions to prevent and reduce burnout in NICUs and likely in other care settings.

The NICU at Lucile Packard Children’s Hospital is one of several NICUs around the country participating in the WISER NICU Study, which is evaluating the effectiveness of burnout interventions such as daily recall of positive events using the Three Good Things tool. The study is being led by Stanford's Jochen Profit, MD, and Bryan Sexton, PhD, at Duke University who have been my mentors and co-authors. It’s our hope that if this intervention proves beneficial that it could be expanded to other hospital units and clinics.

Previously: An Rx for physician burnoutHelping families navigate the NICU and Done right, birthing centers could lower costs and improve safety, Stanford experts say
Photo by U.S. Navy

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