Moral distress and burnout among cardiovascular surgery intensive care unit healthcare professionals: A prospective cross-sectional survey

Abstract

Background: The intensive care unit (IGU) is a busy, high stress, complex environment in which health care professionals routinely provide numerous forms of advanced life support and life sustaining measures to a wide mix of critically ill patients. Frontline ICU professionals directly involved in patient care may be subjected to considerable psychosocial stressors and be susceptible to moral distress and burnout.

Purpose: To describe and compare the prevalence and contributing factors to moral distress and burnout among ICUprofessionals in a large quaternary cardiovascular surgery ICU (CVICU).

Methods: Web-based survey of ICU professionals (registered nurses [RN]/nurse practitioners [NP]; registered respiratory therapists [RRT]; allied health [AH] and physicians [MD]) working in a 24-bed CVICU at the Mazankowski Alberta Heart Institute, between June 15-29, 2015. The survey captured sociodemographic data and integrated the Moral Distress Scale-Revised, the Maslach Burnout Inventory', and a validated job satisfaction questionnaire.

Findings: One hundred sixty-nine providers completed the sur- vey (response rate 88%). The majority of respondents were aged 26-34 years old (45%), female (79%), married or common law (50%), full-time employed (78%) and had been working in the CVICU for >5 years (46%). Moral distress scores were highest among RN/NP (med [IQR] 80 [57-110]) and RRT (85 [61-104]) compared to AH (54 [39-66]) and physicians (66 [43-82], p=0.05). The highest-ranked sources of moral distress were related to controversies on end-of-life care ("Continue to participate in the care for a hopelessly ill person who is being sustained on a ventilator, when no one will make a decision to withdrawal support") and poor communication ("witness healthcare providers giving false hope' to a patient or family"). High, moderate and low levels of burnout syndrome were found in 64.0%, 22.7% and 13.3% of respondents with significantly greater levels among non-physician professionals (p<0.001). Job satisfaction was highest for physicians compared with other professionals (p<0.001). The item "the recognition you get for good work" was consistently rated as poor across all groups. Moral distress and burnout scores were positively correlated (p<0. 001), whereas both were neg- atively correlated with job satisfaction (p<0.001 for both). This was primarily driven by RN/NP scores.

Conclusion: Moral distress and burnout are common in health- care professionals in a large academic cardiovascular surgery ICU, in particular among nurses and respiratory therapists. Both moral distress and burnout have a negative perception on job satisfaction. These findings will direct strategies to mitigate moral distress and burnout along with enhancing patient care and improving the workplace environment.