Recently, I interviewed a mother whose son is fighting a difficult disease in an intensive care unit at Lucile Packard Children's Hospital Stanford. I asked the mom what made it bearable. Her immediate answer? "The nurses." Her son's nurses were extending their skill, empathy and willingness to work as a team to her entire family. To her, it meant a lot.
This mom's story about the value of having engaged caregivers came to mind as I reported on new Stanford research about burnout among staff in neonatal intensive care units. Burned-out caregivers are the opposite of fully engaged: They feel emotionally exhausted and may struggle to work effectively with colleagues. Past research has shown that burnout can also decrease quality of care, which is why hospitals are investing in programs to try to prevent it.
To better understand what factors are linked to burnout, a group of Stanford researchers led by Daniel Tawfik, MD, and Jochen Profit, MD, studied caregivers in 41 California neonatal intensive care units. The findings appear today in Pediatrics.
Of the 1,934 doctors, nurse practitioners, registered nurses and respiratory therapists surveyed, about a quarter were experiencing burnout. But the rates varied significantly between hospitals.
"Burnout really tends to cluster," Tawfik told me. "It was more prevalent in the large-volume and busier NICUs we sampled."
Burnout was also more common in institutions where electronic health records were used, even after the initial adjustment to these systems. Because NICU patients are increasingly being treated in large referral centers and more hospitals are adopting electronic health records, "it's an important thing to recognize that these changes might drive burnout," Tawfik said.
Somewhat surprisingly, the researchers saw no link between caring for sicker patients and experiencing more burnout. However, burnout was linked to having a lot of new patients. Hospitals with high NICU admission rates had the highest levels of burnout, and the association was stronger in nurses than physicians.
Nurses' workload with new patients may be underappreciated, Tawfik said. To head off burnout, hospital leaders might try increasing nursing time allocated to new patients. "That would recognize that it's so time-intensive and labor-intensive to admit a new patient, orient a new family and go through treatments that are clustered at the beginning of an admission," he said.
Several hospitals are already using other strategies to reduce burnout, such as the Stanford WellMD center, which provides Stanford physicians with a variety of resiliency tools.
The good news, according to Tawfik, is that his team's findings suggest there are ways to move the needle on burnout, even in settings where the patients are very sick. "These factors linked to burnout really seem to be organizational rather than patient-related," he told me.
Previously: How does burnout affect NICU caregivers and their patients? An Rx for physician burnout and Stanford's "time banking" program helps emergency room physicians avoid burnout
Photo by Jeff Wong