Concise Critical Appraisal: Professional Development Despite ICU Burnout and Staff Shortages

Professional development is essential to maintaining medical competence and enhancing therapeutic knowledge and skills. Since 1935, continuing medical education ensured that clinicians practice medicine of the highest quality, including ethical, social, and personal skills.¹ Unfortunately, competencies in clinical updates, research, and scientific writing can be negatively affected by workload, stress, limited resources, and burnout. This Concise Critical Appraisal describes two articles that illuminate the associations among the COVID-19 pandemic, clinician well-being, and burnout—an article by Lobo et al on the perceptions of critical care shortages, resource use, and clinician well-being² and an article by Moll et al comparing the effects of the pandemic among critical care professions.³
 
Lobo et al evaluated the effect of Brazil’s limited resources during the COVID-19 pandemic on end-of-life decisions and healthcare clinician burnout.² A survey administered in June 2020 and March 2021 (coinciding with COVID-19 surges) evaluated the effects of emotional distress, burnout, and decreased family input on patient decisions about maintaining life-sustaining therapies. The 1985 respondents noted shortages of intensivists, ICU nurses, ICU beds, N95 masks, and noninvasive and invasive mechanical ventilators. One-quarter of healthcare clinicians reported that families were given less input decisions, including decisions on CPR, in which only 30% to 40% of families in southern Brazil were involved.
 
Burnout was higher during the second surge than the first surge (71% vs. 61%), largely because of staff contracting COVID-19, ICU nurse shortages, high (> 10) COVID-19 patient volume, and concerns about personal finances caused by the pandemic. The article also describes the association between burnout and social stigma outside the hospital, highlighting the juxtaposition of healthcare clinicians being praised as heroes while facing isolation and anger from the public. The authors describe the effect of healthcare clinicians’ levels of exhaustion, frustration, and disheartening experiences as a major hindrance on continued pursuit of professional development.
 
The findings by Lobo et al complement the findings of Moll et al and further illuminate the global impact that the pandemic caused on healthcare, especially ICUclinicians.³ Using the Maslach Burnout Inventory of Health and Human Service and Areas of Worklife Survey, healthcare clinicians of different backgrounds were surveyed in 2017 and 2020. Using 22 variables grouped in three domains—emotional exhaustion, depersonalization, and personal accomplishment—clinicians were evaluated for symptoms of burnout by evaluating six work environment areas—workload, sense of control, reward, community, fairness, and values. Of the 710 respondents during the pandemic, nurses were disproportionally impacted more (72%) due to increases in emotional exhaustion, depersonalization, and reduction in personal achievement and development. The authors also highlight the disproportionate increase of burnout between genders. Of the 58% of physicians who reported burnout, burnout was higher in woman versus men (71% vs. 60%). The findings illustrate the importance of not considering the ICU team as a single entity, but tailoring interventions to individual professions.
 
As demonstrated in these two articles, the COVID-19 pandemic imposed unprecedented hardships on ICU clinicians. Among other variables, including the significant increase in morbidity, mortality, staff shortages, and medical equipment scarcities, the pandemic has led to a substantial psychological, physical, ethical, and financial burden felt by nearly every ICU clinician throughout the world. Early in the pandemic, clinicians were expected to maintain professional development while very little was known about SARS-CoV2. Clinicians were forced to care for critically ill patients infected with an organism for which we had little to no training, knowledge, or experience.
 
In addition, shortages in personal protective equipment, medications, and ventilators dramatically affected our ability to care for patients.² Clinicians constantly searched medical resources for the safest and most effective ways of helping their critically ill patients. As the pandemic persevered, staff shortages and ICU burnout, regardless of specialty, became a growing problem. Burnout negatively affects ICU clinicians’ quality of life, organizational commitment, job satisfaction, and overall performance, consequently adversely impacting professional development.⁴ Unfortunately, burnout also results in patient and clinician dissatisfaction, emotional stress, patient harm, medical errors, and physical injury, especially in ICU nurses and female clinicians.³
 
COVID-19 disrupted professional development by significantly reducing—if not completely halting—the traditional practices of continued medical education through national and international society meetings, institutional lecture series, and international elective programs. However, the unplanned interruption also presented unexpected opportunities for innovation. Medical innovations in telemedicine, virtual learning, digital networking, disease surveillance, and artificial intelligence are helping clinicians continue their professional development while social distancing, dealing with staff shortages, and overcoming burnout.
 
The COVID-19 pandemic is catalyzing an innovative and unexpected transformation in medicine. Although staff shortages, limited resources, and burnout continue to impact our lives, we must find pioneering ways to enhance our medical skills and strengthen our interpersonal communication, technology, teaching, professionalism, and team-building skills.
 
References:

1. [No authors listed]. The good CPD guide: a practical guide to managed continuing professional development in medicine. Emerg Nurse. 2012 Feb 10;19(9):9.
2. Lobo SM, Creutzfeldt CJ, Maia IS, et al. Perceptions of critical care shortages, resource use, and provider well-being during the COVID-19 pandemic: a survey of 1,985 health care providers in Brazil. Chest. 2022 Jun;161(6):1526-1542.
3. Moll V, Meissen H, Pappas S, et al. The coronavirus disease 2019 pandemic impacts burnout syndrome differently among multiprofessional critical care clinicians: a longitudinal survey study. Crit Care Med. 2022 Mar 1;50(3):440-448.
4. Yang BK, Carter MW, Nelson HW. Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status. Geriatr Nurs. 2021 Nov-Dec;42(6):1356-1361.