Burnout in critical care nurses is linked to longer length of stay for patients, according to the authors of a recent study.1
“The literature about burnout in clinicians, and in the ICU [intensive care unit] in particular, has grown significantly over the past few years,” says Lakshmana Swamy, MD, MBA, the study’s lead author and a pulmonary/critical care fellow at Boston Medical Center/VA Boston Healthcare.
The effect of burnout on clinicians and health systems is clear, especially regarding the costs of turnover. “Unfortunately, one missing item has been the impact of burnout on critically ill patients,” Swamy laments.
Researchers analyzed burnout in critical care nurses at 113 VA sites between 2013 and 2017, based on 12,540 nurse responses to the VA All Employee Survey. Overall burnout rates increased from 30% in 2014 to 33.6% in 2017. Based on burnout rates over time, hospitals were divided into three groups: High, medium, and low burnout. Compared to the lowest burnout group, medium and high burnout sites were less likely to be rated as a “best place to work.” Also, turnover rates were likely to be higher among the medium and high groups.
The study revealed significantly longer lengths of stay in the highest burnout group. “Many studies have used ICU length of stay as an important clinical outcome,” Swamy says.
Considering longer length of stay is a possible consequence of burnout, there is an ethical concern that patients are harmed when exposed to healthcare systems with high rates of clinical staff burnout, according to Swamy. Six sites out of 111 were characterized as high burnout. “Interestingly, these sites did not have a higher ICU complexity rating or differences in weighted case severity,” Swamy observes.
The link between burnout and length of stay could be because of inefficiencies in patient care that prolong illness and contribute to delays in transfer of care. “The answer here is not to protect patients from burned-out staff. That is a backward approach,” Swamy argues.
Rather, closer attention must be given to clinician well-being. “Patients, clinicians, and health systems suffer when critical care clinicians burn out,” Swamy adds.
- Swamy L, Mohr D, Moss M, et al. Characterizing trends in ICU nurse burnout in VA and relation to outcomes. Am J Respir Crit Care Med 2020;201:A4638.