Workforce, Workload, and Burnout Among Intensivists and Advanced Practice Providers: A Narrative Review

Abstract

Objectives: To assess—by literature review and expert consensus—workforce, workload, and burnout considerations among intensivists and advanced practice providers. Design: Data were synthesized from monthly expert consensus and literature review. Setting: Workforce and Workload section workgroup of the Academic Leaders in Critical Care Medicine Task Force. Measurements and Main Results: Multidisciplinary care teams led by intensivists are an essential component of critical care delivery. Advanced practice providers (nurse practitioners and physician assistants) are progressively being integrated into ICU practice models. The ever-increasing number of patients with complex, life-threatening diseases, concentration of ICU beds in few centralized hospitals, expansion of specialty ICU services, and desire for 24/7 availability have contributed to growing intensivist staffing concerns. Such staffing challenges may negatively impact practitioner wellness, team perception of care quality, time available for teaching, and length of stay when the patient to intensivist ratio is greater than or equal to 15. Enhanced team communication and reduction of practice variation are important factors for improved patient outcomes. A diverse workforce adds value and enrichment to the overall work environment. Formal succession planning for ICU leaders is crucial to the success of critical care organizations. Implementation of a continuous 24/7 ICU coverage care model in high-acuity, high-volume centers should be based on patient-centered outcomes. High levels of burnout syndrome are common among intensivists. Prospective analyses of interventions to decrease burnout within the ICU setting are limited. However, organizational interventions are felt to be more effective than those directed at individuals. Conclusions: Critical care workforce and staffing models are myriad and based on several factors including local culture and resources, ICU organization, and strategies to reduce burden on the ICU provider workforce. Prospective studies to assess and avoid the burnout syndrome among intensivists and advanced practice providers are needed.

Burnout and Joy in the Profession of Critical Care Medicine

“…1). healthcare professionals and critical care clinicians, in particular [3,4,[10][11][12][13][14][15][16][17][18].…”

“…The effects of clinician burnout syndrome are far reaching. In addition to adversely affecting the well-being of individual clinicians, burnout syndrome can have major adverse consequences for patient-care and the healthcare system [3,4,10].…”

Intensivist Burnout

“…Indeed, the number of nights worked, consecutive work days, and days since last nonworking week have been identified as independent risk factors for intensivist burnout, and taking a weekend off between working weeks is protective. 8 Finally, workload in a typical ICU is not static-there are frequent surges in activity, so-called strain, in which human and physical resources may be inadequate to meet the demands of spikes in acuity from new admissions and patients who are unstable. Strain contributes to stress and burnout.…”

Chronic Exposure to High Altitude and Job Burnout Among Chinese Military Personnel at Qinghai-Tibet Plateau: The Mediating Effect of Fatigue and Moderating Effect of Deployment Duration

“…First, due to hypoxia and complicated terrain on the plateau, the workload of drivers on the plateau are much heavier than that at sea level in the case of equal number of transportation tasks. The heavy workload is a risk factor of job burnout [31][32][33]. Monotonous landscape along the way during transportation duty on the plateau makes plateau drivers feel bored.…”