Burnout in healthcare providers has long been a concern for clinicians, administrators, and patients. It affects all aspects of a person’s being, including mental, physical, emotional, and spiritual. In the ICD-11, the World Health Organization (2019) describes burnout as an occupational phenomenon “conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
- feelings of energy depletion or exhaustion
- increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
- reduced professional efficacy.”
Chipas & McKenna (2011, as cited in Vells et al., 2021) found that “nurse anesthetists are exposed to a variety of stressors that can affect personal health to the point of disability in the provider and an impaired ability to provide the best patient care.” Carefully examining burnout, specifically in Certified Registered Nurse Anesthesiologists (CRNAs), can identify stressors in the work environment, which, when addressed progressively, may lead to improved morale, increased retention, and increased retention and ultimately safer and higher-quality patient care. Dissecting this problem before it becomes unsolvable presents an opportunity to develop quality improvement programs for the institution and incorporate solutions for providers’ holistic health.
After reviewing the literature, Vells et al. (2021) found that burnout decreased when self-care activities were incorporated into the lives of the various study participants. They then designed a quality improvement project focused on implementing one or more of the following coping strategies: positive thoughts, exercise, mindfulness, meditation, and giving a co-worker positive reinforcement. Their study was designed to see if utilizing the above coping strategies would result in an improvement in one or more of the following categories based on Maslach’s Burnout Inventory: Emotional Exhaustion (EE), Depersonalization (DP), or Personal Achievement (PA). The burnout criterion most reported by the participants in their study was emotional exhaustion, and mean posttest scores showed a significant decrease in EE, and their findings suggested that their “project was successful in decreasing burnout for most nurse anesthetist participants experiencing burnout at extreme levels.”
Del Grosso et al. (2019) conducted an integrative review and discussed the challenges of defining and framing the concept of burnout in CRNAs. They noted the foundational problem of the actual idea of burnout and what it has become accepted to mean. Although the Maslach Burnout Inventory (MBI) is considered the gold standard for measuring burnout, the authors found that “the increase in attention to the theoretical foundations of burnout has allowed researchers to integrate empirical results within conceptual frameworks” (p. 206). Del Grosso et al. (2019) reported:
The burnout context has been extensively studied for more than 4 decades and is no longer considered an emerging problem but an occupational hazard in the healthcare industry. Given public expectations that healthcare delivery should be seamless, safe, and free from adverse events combined with administrative production pressures and the complex management for an aging population, the anesthesia provider is particularly prone to burnout. (p. 209).
“Our specialty is experiencing a period of mergers, rapid consolidation of practices, and a trend toward employed providers that has dramatically affected our autonomy… We are experiencing rising demand for anesthesia services while simultaneously facing a national shortage of nurses and physicians” (Tarantur et al. 2018). Tarantur et al. (2018) observed that “providers experiencing burnout may deliver lower quality care with associated lower patient satisfaction scores and are more likely to make medical errors. Therefore, health care professional distress may be a quality indicator that is worth measuring in medical centers.”
Tarantur & Deshur (2018) found that more than half of their anesthesia staff suffered from burnout; however, they also found that the stress of burnout had been mitigated by initiatives put in place such as implementing a system whereby CRNAs are given cases in one of their top two facilities 80% of the time, involving outside wellness professionals, and scheduling flexibility. They stressed that “more than ever, it is imperative that culture, morale and provider well-being become part of our core values” (2018).
Prudenzi et al. (2021) posited that work related distress and burnout lead to clinical errors and absenteeism in Health Care Providers (HCPs). Acceptance and Commitment Therapy (ACT) “uses a range of therapeutic methods to help individuals to improve their ‘psychological flexibility’ as a means to improve their well-being and efficacy at work and in other contexts” (p. 193). McCracken (2013, as cited in Prudenzi et al., 2021) defined psychological flexibility as “the ability to persist or to change behaviour in a setting of competing psychological influences, guided by values and goals dependent on what the situation at hand affords” (p. 193).
Through their systematic review and meta-analysis, Prudenzi et al. (2021) reported that “changes in the organisation of health care providers in the UK coupled with stress, burnout and psychological distress have been shown to contribute to staff errors (e.g. medications errors, prescribing faults) and poor patient safety” (p. 201). The authors also noted that “results from this meta-analysis suggest that ACT is a promising psychological intervention for improving a range of psychological outcomes (general distress, stress, burnout) in HCPs” (p. 201).
According to Sun et al. (2022), COVID-19 has had a severely detrimental effect on healthcare providers “making them psychologically ill-prepared to perform their normal tasks. Further, the situation has exacerbated existing psychological problems (e.g., stress and anxiety), substantially impeding individuals’ job performance” (p. 2). The authors studied the relationship between the COVID-19 pandemic and burnout in healthcare providers in Pakistan. They found that stress, depression and anxiety borne from the pandemic resulted in a decrease in the job performance of healthcare workers as well as their mental health; adding that “undoubtedly, the pandemic has made today’s employees vulnerable, and negatively impacted their workplace functioning” (p. 15).
CRNAs are front-line healthcare providers who encounter stressors from varied directions. These stressors include factors like scheduling, patient acuity, politics, time away from home, and staffing. Multiple studies have shown a correlation between professional burnout and a decrease in performance, concomitant with an increase in errors and job dissatisfaction. With the population becoming sicker, it has become harder to keep up with the demand for CRNAs – furthering the vicious cycle of burnout. It is imperative that this phenomenon continue to be studied, and solutions created and implemented.
References
Burn-out an “occupational phenomenon”: International Classification of Diseases. (2019, May 28). https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases
Del Grosso, B., & Boyd, A. S. (2019, June). Burnout and the Nurse Anesthetist: An Integrative Review. aana.com. https://www.aana.com/docs/default-source/aana-journal-web-documents-1/burnout-and-the-nurse-anesthetist-an-integrative-review-june-2019.pdf?sfvrsn=d49f0a19_6
Prudenzi, A., Graham, C. D., Clancy, F., Hill, D., O’Driscoll, R., Day, F., & O’Connor, D. B. (2021). Group-based acceptance and commitment therapy interventions for improving general distress and work-related distress in healthcare professionals: A systematic review and meta-analysis. Journal of Affective Disorders, 295, 192–202. https://doi.org/10.1016/j.jad.2021.07.084
Sun, J., Sarfraz, M., Ivascu, L., Iqbal, K., & Mansoor, A. (2022). How Did Work-Related Depression, Anxiety, and Stress Hamper Healthcare Employee Performance during COVID-19? The Mediating Role of Job Burnout and Mental Health. International Journal of Environmental Research and Public Health, 19(16), 10359. https://doi.org/10.3390/ijerph191610359
Tarantur, N., & Deshur, M. (2018, October). Anesthesia Professional Burnout—A Clear and Present Danger. Anesthesia Patient Safety Foundation. https://www.apsf.org/article/anesthesia-professional-burnout-a-clear-and-present-danger/
Vells, B., Midya, V., & Prasad, A. (2021). Experiences of Burnout Among Nurse Anesthetists. OJIN: The Online Journal of Issues in Nursing, 26(2). https://doi.org/10.3912/ojin.vol26no02ppt4
