European Journal of Cardiovascular Medicine

Background: Healthcare professionals (HCPs) working in intensive care units (ICUs) face unique challenges due to the demanding nature of patient care and high mortality rates, potentially leading to burnout. Burnout, characterized by exhaustion and disengagement, can adversely affect both HCPs and patient care outcomes. Methodology: A single-center, questionnaire-based survey was conducted among HCPs working in ICUs of a tertiary care hospital in Bhubaneswar, Odisha. Demographic data and burnout levels were assessed using the Oldenburg Burnout Inventory (OLBI) questionnaire. Results: A total of 70 HCPs participated, with 82.8% exhibiting burnout levels exceeding two. High exhaustion (71.4%) and disengagement (80%) were prevalent. No significant gender differences were observed, but neonatal ICU staff reported lower burnout. Experienced HCPs exhibited lower burnout. Longer work durations and shorter sleep durations correlated with increased burnout. Discussion: Factors contributing to burnout include work duration, sleep duration, and work area. COVID-19 likely exacerbated burnout, though not directly assessed. Targeted interventions are crucial for mitigating burnout and improving patient care outcomes. Conclusion: Working in ICUs presents significant challenges for HCPs, leading to high burnout levels. Addressing burnout through periodic assessment and interventions is vital for enhancing job satisfaction and patient care quality in ICU settings

A single-center, questionnaire-based survey was carried out with HCPs working in the ICUs of a tertiary care hospital in East Odisha. HCPs, aged above 18 years and who worked in the ICU at least 2 h a day, every day for at least 1 month were included after obtaining ethical approval by the institutional ethics committee. HCPs who had a previous diagnosis of stress or any other psychological issue and HCPs who were not willing to participate in the study were excluded. The convenience sampling method was used for the recruitment of the participants. Survey was carried from May 2020 to September 2020. The survey included demographic data of the partici- pants and the validated English language Oldenburg Burnout Inventory (OLBI) [11] questionnaire. The OLBI questionnaire is a standardized and validated tool used for assessing burnout in HCPs. All the questions of OLBI are simple to understand for the participants and easy to ana- lyze for burnout. Demographic data collected were age, gender, health care profession, area of work (adult medical or neonatal ICU), duration of work per day, total days of work in the ICU during the working hours, and details of the nature of duty. The statistical analysis was carried out using R Software. Descriptive statistics were used for rep- resenting demographic data. Burnout rates among the gender, work area, and sleep duration at night categories were compared using an independent t-test. One-way ANOVA was used to compare burnout among different health care professions, clinical experience, and dura- tion of work per day. A p-value of <0.05 was considered statistically significant.

A total of 70 healthcare professionals (HCPs) participated in the study, with an average age of 22.48 ± 2.84 years. Among the participants, 59 (70%) identified as female and 21 (30%) as male. The majority of respondents were from the respiratory therapy department (interns) and clinical practitioners, followed by staff nurses. Specifically, 71.4% of participants worked in adult medical ICUs, while 28.5% worked in neonatal ICUs. Detailed demographic and work information for all HCPs can be found in Table 1.
The mean overall burnout level among all participants was 2.41 ± 0.29, with exhaustion levels at 2.39 ± 0.39 and disengagement levels at 2.41 ± 0.42. A cut-off burnout value of ≥ 2 was considered, revealing that approximately 58 (82.8%) HCPs exhibited a burnout value of ≥ 2. Peterson et al. [12] proposed a cut-off score of ≥ 2.25 for exhaustion and ≥ 2.1 for disengagement. According to this criterion, about 50 (71.4%) HCPs reported high exhaustion (≥ 2.25), while approximately 56 (80%) reported high disengagement (≥ 2.1). These findings suggest that between 71% and 81% of HCPs experienced a high level of burnout.
The analysis included a comparison of overall burnout, exhaustion, and disengagement among genders, health professions, work areas, overall clinical experience, duration of work per day, and duration of sleep at night. Detailed analysis results are presented in Table 2.

TABLE 1: Demographic and work details of the participants into the study
Demographic variables (n = 70)
Value (%)
Age (years), mean (SD)
22.48 (2.84)
Gender, n (%)
Male
21 (30)
Female
59 (70)
Profession, n (%)
Physicians
3 (4.2)

There were no discernible disparities in burnout, exhaustion, and disengagement between male and female healthcare professionals (HCPs). However, HCPs working in neonatal ICUs exhibited significantly lower levels of burnout, exhaustion, and disengagement compared to those in adult medical ICUs. Additionally, a correlation was observed between less sleep at night and higher levels of burnout, while longer ICU shifts were associated with increased burnout, exhaustion, and disengagement. Notably, no statistically significant distinctions were detected in burnout, disengagement, and exhaustion across different healthcare professions (p > 0.05).
TABLE 2 : Comparison of burnout, exhaustion, and disengagement scores of health care providers working in the intensive care units
Burnout components

The intensive care unit (ICU) is a specialized unit within hospitals that demands constant patient monitoring and intensive care. Healthcare professionals (HCPs) working in this environment are required to be physically and mentally present throughout their shifts. Apart from the demanding nature of their work and the risk of burnout, various factors contribute to the mental and physical strain experienced by HCPs, including mood, familial issues, organizational factors, psychological issues, stress, and household workload [2–5]. Prolonged exposure to high levels of burnout can lead to emotional stress, fatigue, and a loss of interest in life [6–7]. Additionally, it may result in alcohol dependence, sleep disturbances, cardiovascular abnormalities, and, in extreme cases, suicidal ideation [6–7]. Increased burnout levels can also lead to a decreased awareness of important events in the work environment, potentially compromising patient care. Healthcare professionals may begin to prioritize tasks less effectively, including universal precautions, infection control practices, and responding to alarms, all of which are critical for patient care. This study provides insights into the burnout levels among HCPs in the ICU and identifies factors that may help mitigate burnout.
Overall, our study found high levels of burnout, exhaustion, and disengagement among HCPs working in ICUs. Approximately 82.8% of HCPs exhibited a burnout level exceeding two. Applying the cutoff value for HCPs provided by Peterson et al. [12], 71.4% experienced high exhaustion, while around 80% experienced high disengagement. Similar findings were reported by Saravanabavan et al. [13], indicating a high prevalence of burnout among HCPs in tertiary care hospital ICUs. Guntupalli et al. [14] also reported moderate to high burnout rates ranging between 50% and 60% among Indian ICU HCPs. Both Saravanabavan et al. [13] and Guntupalli et al. [14] employed the Maslach Burnout Inventory-Human Service Survey (MBI-HSS), a validated tool for assessing burnout in HCPs. Conversely, Sidiq et al. [15] found lower burnout levels among doctors in North India, though the overall trend suggests a high prevalence of burnout (50%–80%) among Indian HCPs.
Our study did not find a significant difference in burnout levels between male and female HCPs. However, Sidiq et al. [15] reported slightly higher stress levels among females using the General Health Questionnaire. When comparing different work areas, HCPs in neonatal ICUs exhibited lower burnout compared to those in adult medical ICUs, with significantly higher disengagement observed among adult ICU staff. Lazaridou et al. [16] similarly found higher burnout levels in pediatric ICUs compared to neonatal ICUs, possibly due to the less intensive care required in neonatal settings and the presence of more experienced staff. Our study also observed that experienced HCPs exhibited lower burnout, exhaustion, and disengagement compared to their less experienced counterparts, consistent with findings by Aytekin et al. [17] and Özden et al. [18]. This underscores the importance of adequate training in low-stress clinical environments and structured observation periods in ICUs to help new staff acclimate and reduce burnout.
Additionally, our findings indicate that longer work durations in the ICU are associated with increased burnout and exhaustion among HCPs, consistent with research by Stimpfel [19]. Implementing shorter work shifts (less than 10 hours) with adequate breaks may mitigate burnout and stress in the ICU setting, as suggested by Cordoza et al. [20]. Sleep duration also emerged as a significant factor affecting burnout, with individuals sleeping more than 6 hours experiencing less burnout, disengagement, and exhaustion compared to those sleeping fewer than 5 hours. This aligns with findings by Wisetborisut et al. [21], who proposed that sufficient sleep and rest periods could protect HCPs from burnout. However, the precise relationship between sleep deprivation and burnout requires further investigation, as suggested by Metlaine et al. [22] and Stewart et al. [23].

In conclusion, working in the ICU presents unique challenges for healthcare professionals (HCPs), demanding constant vigilance and intensive care provision. Beyond inherent stress, factors like mood, familial issues, and organizational dynamics contribute to burnout. Prolonged exposure to high burnout leads to emotional distress, fatigue, and adverse health outcomes. Our study revealed high burnout levels among ICU HCPs, with significant exhaustion and disengagement.Though not directly assessed, the COVID-19 pandemic likely exacerbated burnout among HCPs. Periodic assessment and targeted interventions are essential for improving job satisfaction, psychological wellbeing, and patient care outcomes in ICU settings.

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