Compromised Integrity, Burnout, and Intent to Leave the Job in Critical Care Nurses and Physicians

Abstract

OBJECTIVES: To describe relationships between compromised integrity (CI), burnout, and intent-to-leave (ITL) practice in critical care (CC) and noncritical care (non-CC) nurses and physicians. DESIGN: CC nurses (RNs) and physicians (MDs) from the American Medical Association Coping with COVID survey were matched by gender, race, years in practice, and role with non-CC clinicians to determine likelihood of ITL in relation to burnout and CI. SETTING: U.S. Healthcare organizations; July—December 2020. SUBJECTS: One hundred sixty-five CC RNs and 148 CC MDs (n = 313) matched with 165 non-CC RNs and 148 non-CC MDs from 83 healthcare organizations. MEASUREMENTS AND MAIN RESULTS: Burnout was measured with a single, validated question that mainly reflects emotional exhaustion (EE), and CI was determined by asking if respondents worried about doing things that compromised their integrity moderately or to a great extent. ITL included those moderately, likely, or definitely, intending to leave. Burnout correlated strongly with CI (tetrachoric r = 0.704 [0.606–0.803]; P < 0.001). Of 626 subjects, 59% experienced burnout, 24% CI, and 33% ITL. CC RNs experienced burnout more often (76%) than non-CC RNs (62%; P < 0.01) and CC MDs (51%; P < 0.001). CI was more frequent in CC RNs (44%) than non-CC RNs (23%) and CC MDs (16%; P < 0.001). In multivariate regressions, CC clinicians experiencing burnout had 50% greater odds of ITL than non-CC clinicians experiencing burnout; odds of ITL were substantially higher (odds ratio, 2.8–3.2) in those with CI regardless of location or burnout. In the ICU, those feeling valued by their organization had one-third the odds of ITL. CONCLUSIONS: Burnout (EE) is high (>50%) among CC RNs and MDs, which may result in losses of CC clinicians while demand rises. Preventing CI independent of burnout may reduce turnover in all settings and especially in ICUs. Feeling valued may promote staff retention.

Ten areas for ICU clinicians to be aware of to help retain nurses in the ICU

“…A perception that patients are not being cared for humanely or that care given is inappropriate [5,23] can promote disillusion and frustration. End-of-life care, in particular, is not always as good as it could or should be for ICU patients.…”

“…The coronavirus disease 2019 (COVID-19) crisis has been followed by a serious increase in the shortage of intensive care unit (ICU) personnel, especially nurses, exacerbating a problem that pre-dated the pandemic… and this on a global scale. The reasons are not difficult to elucidate and primarily relate to the prolonged, excessive workload during the pandemic period, often with denial of vacation time; the significant emotional burden associated with the high patient death rate; and the moral distress associated with being unable to provide the usual high quality standard of care, because of the sheer numbers of patients being admitted [1][2][3][4][5]. Personal anxieties around catching the virus and/or passing it on to one's family, and restrictions and limitations associated with the strict safety measures, including reduced communication and contact with patients and their relatives that resulted in a de-humanizing of care, added to the physical and mental exhaustion felt by healthcare staff [1-4, 6, 7].…”

Moral distress and moral injury and their interplay as a challenge for leadership and management: The case of Croatia

“…The hierarchical regression analysis has confirmed that higher morally distressing experiences led to severe symptoms of moral injury among our respondents. This sheds new insight and can be worthy of consideration for the nursing field in general as a moral injury might be misunderstood under moral distress or when related to the consideration or decision to leave a profession and position cofounded with burnout (Hancock et al, 2020; Karakachian & Colbert, 2019; Laurs et al, 2019; LeClaire et al, 2022; Linzer & Poplau, 2021; Naboureh et al, 2021) failing to treat it timely and adequately. If left unaddressed, such an issue will affect the mental health of health care workers and, subsequently their tendency to resign from their employment or occupation.…”

Association of burnout and intention-to-leave the profession with work environment: A nationwide cross-sectional study among Belgian intensive care nurses after two years of pandemic

“…The impact of COVID-19 on the risk of burnout and intention-to-leave the job and the profession seems to be increased among ICU nurses compared to before the pandemic and after the first wave (Bruyneel et al, 2021b;Butera et al, 2021;Vermeir et al, 2018). This can be explained by several elements including the lack of personal protective equipment, fear of being contaminated, increased mortality rates compared to normal, successive waves, societal expectations, and accumulation over time (Bruyneel et al, 2021b;Khan et al, 2022;LeClaire et al, 2022;Moradi et al, 2021). Hospitals have implemented, in a variable and heterogeneous way, several internal measures (e.g., psychologists, debriefing, meditation) which may have influenced the results with ICU nurses in Belgium (Paquay et al, 2022;Servotte et al, 2020;Van Den Heede et al, 2022).…”

“…As of this time, the country has experienced seven waves, mainly in the autumn and winter of December 2021 (Dellicour et al, 2021;Molenberghs et al, 2020;Natalia et al, 2022). During the COVID-19 pandemic, frontline nurses were exposed to higher levels of stress and traumatic events that could increase the risk of burnout (Guixia and Hui, 2020;Hu et al, 2020;LeClaire et al, 2022;Moradi et al, 2021). A study conducted after the first wave of COVID-19 showed a high risk of emotional exhaustion (38%) among French-speaking ICU nurses in Belgium (Bruyneel et al, 2021b).…”