According to this study:

* Severe symptoms of "burnout syndrome" affects around a third of ICU nurses.

* Preventing conflict, participating in ICU research groups, and paying attention to issues in end-of-life care lessen the risk of severe burnout syndrome.

The independent risk factors in "burnout syndrome" among nurses in the ICU are identified for the first time in a recently published study, an important step in developing strategies to counteract this common but little understood problem. The adverse outcomes associated with the syndrome include diminished well-being, diminished quality of the care provided, absenteeism, and high rates of turnover.

Burnout syndrome was identified first in high-stress occupations in the service sector in the 1970s, most conspicuously among health care professionals in all specialties. Prevalent among both physicians and nurses, the syndrome has been defined as the "inability to cope with emotional stress at work" and as "excessive use of energy and resources leading to feelings of failure and exhaustion." In addition to diminished well-being, burnout syndrome is associated with symptoms of depression, although symptoms tend to be confined more to the workplace.

Responses to a survey questionnaire involving more than half (165) of the ICUs throughout France revealed that approximately one-third of 2,392 respondents reported severe symptoms of burnout syndrome; 81% were nurses, 15% were nursing assistants, and 4% were head nurses. The survey included items from the Maslach Burnout Inventory, which is used to establish the presence of burnout syndrome and to assess its severity according to three domains--emotional exhaustion, depersonalization (unfavorable attitudes toward patients and cynicism concerning them), and the lack of a sense of accomplishment derived from work. Clinical symptoms of the syndrome include fatigue, headache, difficulties in eating and sleeping, irritability, emotional instability, and rigidity in personal relationships. The social climate of the workplace and a heavy workload have been identified as significant contributing factors.

Multivariate analysis of the data revealed four principal domains that can be associated with the syndrome among critical care nurses--personal characteristics (including age); prevailing organizational factors such as the ability to make decisions about the work schedule and participation in an ICU research group; the quality of relations at work, including conflicts with patients and relationships with physicians and nurse managers; and end-of-life situations, including providing care to dying patients and the number of decisions to withhold life-sustaining measures made in the preceding week.

The authors' recommendations for counteracting burnout syndrome include instituting strategies for preventing conflict in the ICU, nurses' participation in ICU research projects and in making decisions with physicians, and improving the management of care provided at the end of life. The authors note that further interventional studies need to be conducted in those areas.

Limitations of the study include the absence of a definition of "conflict" in the questionnaire; the sample's inclusion of staff members other than nurses (nursing assistants and nurse bedside managers), in whom burnout syndrome might be assessed differently; and possibly, the use of a self-administered questionnaire rather than a semistructured interview.

CP