Critical Care Staff in Critical Condition

By Joy Victory
June 14, 2024 | SPRING 2024 ISSUE

Burnout is a common problem across the health care industry, but critical care staff, in particular, is struggling, studies show. Fortunately, as awareness of the problem has grown, so have the potential solutions.

It’s not just the life-or-death work environment and systemic health care problems that create severe job stress. However, those things certainly play a role, said Christopher Carroll, MD, FCCP, Medical Director of the Pediatric Intensive Care Unit at Wolfson Children’s Hospital in Jacksonville, FL, and CHEST Board Regent-at-Large.

Witnessing how socioeconomic conditions affect patients takes its toll. Every day, Dr. Carroll sees firsthand how extreme poverty affects families, including parents who can’t afford to take time off, even when their kids are in critical condition. Many of these kids are dependent on gastric feeding tubes and tracheostomy tubes—they are a “population that is all but invisible to the general population,” he noted.

Dr. Carroll and his staff sit with the knowledge that these kids often go home without the resources needed to recover. “We want to help them out but feel powerless to do so in the health care system in which we work,” he said.

Despite those challenges, Dr. Carroll maintains a positive mindset by considering his work a calling. “You really have to view this in a way where you say, ‘I am there to help people. I'm here to help this child and this family, and I'm going to do the best I can to do that,’” he said.

He also finds the burgeoning conversation around clinician burnout helpful. In the past, providers were simply expected to be resilient, ignoring personal trauma and grief. More recently, systemic and cultural problems are being discussed more openly—as are possible solutions.

One doctor tackling this issue head-on is Carlos Alviar, MD, Assistant Professor of Cardiology at New York University Grossman School of Medicine and Director of the Cardiac Intensive Care Unit and ECMO Program at Bellevue Hospital Center in New York City.

At CHEST 2023, Dr. Alviar co-led a session on the intersection between end-of-life care, professional burnout, and team engagement in critical care. Attendees were divided into small groups and given case examples that could be especially hard on staff. They then brainstormed strategies to deal with the emotional impacts, he said.

Attendees discussed the importance of having a proactive policy in which ICU staff members are routinely asked how they’re doing, rather than expecting them to take time to call a hotline or other service during their downtime.

Dr. Alviar also stressed the importance of helping staff members find purpose and foster creativity tailored to their interests—a project that he has instituted in his own cardiac critical care unit alongside Hannah Schimmer, DNP. “If they have a project or idea, something they feel really passionate about, what if we try to mentor this person? They can own that idea,” he said.

Co-Facilitator, Diego J. Maselli, MD, FCCP, Professor and Division Chief of Pulmonary Disease & Critical Care at the University of Texas at San Antonio, was initially worried whether the CHEST 2023 session would garner enough participants. “But before we knew it, the groups were actively discussing the cases,” he said. “And they were able to share their ideas on how to approach these complex problems in different ways.”

He said one of the most challenging aspects of working in critical care was having to deliver heartbreaking news to family members, sometimes multiple times in 1 day. And often, you may be doing this without active support or any formal training, in a setting where asking for help has traditionally been frowned upon.

“You learn by example. I learned from my professors when I was in training, and I’ve used some of their skills,” Dr. Maselli said. “There are lectures and courses [about handling family meetings], but [they’re] not universally required.”

At his ICU, where he manages about 60 staff members, he’s learned it’s helpful to create schedules that let people specialize in the areas they enjoy most—for example, in-unit procedures, research, or floor consults. He also makes sure to plan out the winter staffing schedule well in advance so people don’t have to worry about not having backup when the ICU is most likely to be at capacity or beyond.

Also promising: He’s noticed it’s becoming more common for ICU units to have a social-emotional component to their case debriefings. This can include requesting a moment of silence or a chance to express grief about the loss of a patient.

Still, without more data, it’s hard to know how often these things are happening—and, if they are, whether they’re helping. To address this knowledge gap, Dr. Alviar and his colleagues from the CHEST 2023 session developed an anonymous survey to hand out at medical conferences.

It asks about personal coping mechanisms and systemic support provided by the hospital (or employer). With the survey results, his team hopes to develop proactive interventions to prevent and treat burnout—a goal that is good for employee retention and patient outcomes.

“It’s something we haven't really talked about much,” he said. “And I think it's about time we start doing it.”