The Society of Critical Care Medicine has put together two free toolkits to address clinician workload, well-being, and burnout, providing resources and tools that reflect the uniqueness of the ICU.
While stress and burnout among intensive care unit (ICU) staff existed long before COVID-19, the pandemic created a high-pressure, coals-to-diamond situation that significantly exacerbated the problem and brought it widespread attention. It became clear that resources were needed to help ICUs address staff well-being.
The Society of Critical Care Medicine (SCCM) stepped up to the challenge. With the help of funding and support from the Centers for Disease Control and Prevention (CDC), SCCM created a task force of critical care clinician experts in workload, well-being, and burnout who developed well-being resources and tools specifically for bedside staff and leaders that reflect the uniqueness of the ICU.
The task force began by defining the four potential sources of stress injury that occur in the ICU environment:
- Burnout: stress due to an imbalance between job demands and resources leading to exhaustion, detachment, cynicism, and reduced efficacy
- Trauma: exposure to the impact of trauma, either directly or indirectly
- Loss: loss of patients, professional identity, and family time, including microlosses
- Moral Injury: suffering based on exposure to circumstances that violate someone’s moral values and beliefs in ways that erode integrity and moral capability
The task force determined that there were plenty of resources for healthcare workers to engage in for their individual wellness. Wanting to create something unique and useful, the task force focused on developing practical, ICU team-based resources. The resulting products—the Well-Being Gap Analysis Toolkit and the Moral Injury Well-Being Toolkit—can be used by teams in various ways, depending on their needs.
Well-Being Gap Analysis Toolkit
Each ICU team is different, which means their needs are different. The first step in the Well-Being Gap Analysis Toolkit is an assessment ICU teams take to prioritize statements based on importance to that team.
The assessment is divided into eight categories:
- Workload and job demands
- Efficiency and resources
- Control and flexibility
- Work/life integration
- Social support and community at work
- Organizational culture and values
- Meaning and mattering at work
- Ethical community
Each category includes between four and eight statements, and the team agrees on how often each applies, choosing from these responses: nearly always, usually, sometimes, nearly never, or not applicable. For example, in the workload and job demands category, one statement reads, “The number of patients I or my team is caring for allows everyone to get out of work on time.”
Instead of overwhelming users with all available information, the assessment helps teams know where to start by stratifying what will be most useful to that team. They can fill out the assessment together, or each team member can fill it out individually and then come together to discuss it.
The recommendations section of the toolkit provides solutions and tips for all the categories, including links to relevant resources such as templates and supportive literature and prioritizes the resources based on the answers the team provides in the assessment.
“When developing the toolkit, we had a lot of interesting conversations about how various teams are doing things, which made our toolkit richer,” said E. Kate Valcin, DNP, RN, NEA-BC, CCRN, CNL, FCCM, cochair of the Well-Being Gap Analysis Toolkit Task Force. “For example, one of the templates in the workload and job demands category is a business plan. Most clinicians haven’t done that. The plan walks them through things like how to ask for another staff member and how to prove the team needs another piece of equipment. There are a lot of useful things in the toolkit that help people navigate the system and give them more control.”
Because the needs of individual teams vary and there is no one-size-fits-all solution, the resources vary. “The resources include different approaches to specific issues because what works for one team may not work for another,” said Beth Epstein, PhD, RN, HEC-C, FAAN, cochair of the Well-Being Gap Analysis Toolkit Task Force. “They include actionable things people can do individually and other things it would take the team to do.”
Moral Injury Well-Being Toolkit
Teams may choose to complete the Moral Injury Well-Being Toolkit in addition to or instead of the Well-Being Gap Analysis Toolkit. While moral distress is common in the ICU, moral injury occurs when demands exceed the clinician’s coping resources and result in deep insult to core values. The Moral Injury Well-Being Toolkit is designed to help critical care clinicians prepare for and expect moral and ethical dilemmas in the ICU. The toolkit provides common morally injurious scenarios and helps clinicians practice navigating them calmly instead of in a panic state. Teams learn how to address moral distress and prevent it from becoming moral injury.
“The potential for moral injury is embedded in everyday healthcare activities,” said Richard Westphal, PhD, RN, FAAN, consultant to the Moral Injury Well-Being Toolkit Task Force. “Just as we have tools for navigating common, high-risk clinical situations, these tools help ICU teams navigate common and high-risk moral distress.”
Healthcare systems can be part of the problem by sometimes blaming workers for their lack of coping ability. Scenarios in the Moral Injury Well-Being Toolkit should be used from an organizational perspective to ensure that the systems themselves are part of the solution. The toolkit contains eight moral injury scenarios:
- Cardiac arrest
- Drug shortages
- Recognition
- Disrespect
- Beyond burnout
- End-of-life discussion
- Adverse event
- Shared decision-making
The scenarios include guiding questions for the team to discuss, including what sources of moral distress are present in the scenario and how system and work environment issues contribute to the risk of moral injury. A team member facilitates the discussion of the problem and proposed solutions. For example, in the end-of-life discussion scenario, the team can discuss being an observer rather than a participant in the team, potential communication silos and barriers, and strategies such as developing lay language for patients and families for common medications used at the end of life.
The team can use the toolkit in whatever way it best fits into their workday, such as during a 30-minute lunch-and-learn, part of grand rounds, or folded into other ongoing activities. Teams can use the scenarios to develop and practice specific skills or as part of new employee orientation. The toolkit can be especially valuable for encouraging dialog in small community hospitals that lack resources.
To learn more about SCCM’s well-being resources and download the toolkits, visit
sccm.org/wellbeing.
