Hello and welcome. My name is Joseph Cavanaugh and today we're going to be talking about how to manage staff burnout during a pandemic, which I'm sure all of us are feeling a little bit of right about now. First, let us start by reviewing our objectives. We're going to start by defining burnout, what burnout is, and how it manifests in people. We're going to identify risk factors that may lead to burnout, especially in our critical care staff. We're going to review signs and symptoms of burnout so that staff may recognize it in themselves and others. Talk about ways to prevent burnout and then we're going to formulate a plan from the management side and the leadership side to help manage our staff when they do present with burnout. So what is burnout? Burnout has been described as prolonged stress or high levels of stress that can lead to emotional exhaustion, physical exhaustion, and mental exhaustion. It has been reported that 47% up to more than 50% of ICU staff have been affected by burnout at some point during their career. Chances are during a pandemic when stress is higher, this will exceed those numbers. When we discuss risk factors, two of the biggest risk factors are decreased resilience and decreased levels of grit. And when we're talking about resilience, we're referring to things such as optimism or being able to bounce back when things are difficult. Obviously decreased resilience leads to difficulty coping, which leads to a higher risk of burnout. When we're talking about grit, we're referring to things such as there's long-term goals, things that give you the ambition to show up to work every day. If you don't have grit and resilience, those alone are risk factors. There are also some personal risk factors and this can be a relationship status. What is going on at home may be affecting your work life and that can put you at higher risk of burnout. If you have alcohol or substance abuse or if you already have some mental disorders such as depression, these can all increase your risk of developing burnout, especially in the ICU. In addition to the personal risk factors discussed, there are also professional risk factors are listed here. The problem with professional risk factors is that they are often a catch-22 in a chicken-versus-the-egg conversation. A good example of this is the increased staff turnover. An increase in staff turnover can lead to decreased morale among other staff members, which in turn can cause burnout. On the other side, when you do have burnout, you'll see increased staff turnover as a result of that burnout. It's often a complication and it's something that we need to be aware of as staff members ourselves and as leaders, especially during a pandemic. When looking at ICU practitioners specifically, we meet many of the risk factors already mentioned. In addition, we are often dealing with patients with increased workload, increased severity of illness, we have an increase to end-of-life exposure, and we're dealing with a lot higher patient safety concerns in other areas of the hospital. This alone puts us at an increased risk of burnout. When looking at signs and symptoms of burnouts, one of the classic presentations is when time working is greater than the time spent recovering from work. Especially during a pandemic, we're going to see a lot of increased exposure to time working compared to the time that we're at home and recovering from work. The classic triad of presentation symptoms is the emotional and physical exhaustion we discussed earlier, depersonalization of work, and then decreased personal accomplishment. Now that we know what burnout is and things that may cause burnout, as well as some of the classic signs and symptoms, let's discuss how to manage burnout. And step one in managing burnout is to be aware of burnout and acknowledge that it actually exists. When looking at critical care specifically, as noted earlier, up to 47% of critical care staff can actually have burnout symptoms. When we're looking at physicians specifically, it's about 45% based on reports, with pediatric critical care being more than 70%. When looking at our ICU nurses, it ranges from 25 to 33%. However, 86% of nurses experience at least one of those clinical triad symptoms of burnout, and they have an annual turnover of about 20% across the country. And this is more than double what the national average is for other employees across the US. When we're looking at healthcare professionals in general, the burnout rate is about 50% or greater for those in the ICU. And this is taking into account pharmacists, which clinical pharmacists burnout is about 61%, as well as respiratory therapists, and occupational therapists, nutrition, things of those nature. So now that we're aware of burnout, and that it exists, and that it has a high prevalence in our critical care employees, we must next promote staff education and promote staff awareness of burnout and how to identify it in themselves as well as in their staff members. While self-awareness and self-reflection is often difficult for us to do, one thing that critical care employees are really good at doing is looking out for their teammates. So here are a list of some things that you can look out for in others that you're working with to help identify if they're at risk for burnout. Among those is increasing anger and frustration. So if you see co-workers maybe snapping or lashing out on employees that they work with that they normally wouldn't react, that can be a sign of burnout. Something else is when you see them calling out frequently, or they don't really have ambition to work. They're usually very happy go lucky at work. And now lately, they feel like they don't want to be there. They're complaining about working a lot. And then one of the last things is lack of empathy, where we see a lot of unfortunate patient situations in the ICU. And being an ICU worker, whether it's a nurse, physician, pharmacist, you often have to deal with empathetic situations. If they're making light of those situations, that can also be a sign of burnout. While it may be hard and uncomfortable for many of us to do, self-reflection is very important, especially during these times. Some things to look for when evaluating yourself for burnout is to look at physical as well as emotional symptoms. So emotional symptoms are similar to things we discussed about already. That exhaustion, whether mental, physical, that anger, frustration, where you may feel quick to just snap on co-workers. You may have physical symptoms such as GI problems, muscle tension, headache. And then there's often that feeling of being overwhelmed. Especially during a pandemic, this is something a lot of staff members are going to feel in themselves and in others. The most important part of identifying burnout is being able to manage it. And some of the basic ways of managing burnout, whether it's in yourself or in a staff member, is to really focus on those basic needs. Going back to one of the original things we said, is time working spent more than time recovering. So if you're feeling signs and symptoms of burnout, or a staff member is, really promote that sleep schedule. Having time to themselves to exercise. When you're at work, focus on those basic needs such as getting water and coffee if needed. Taking a few minutes to have food, whether it be lunch or just a snack. Taking time to go to the bathroom can make all the difference. You also have the mental health support which most institutions offer through their HR department for all employees. And then another thing is schedule flexibility. Maybe if you're dealing with more the severe patients every day for two, three weeks, maybe if you can work with a staff member and switch. Or if you see your co-workers really getting overwhelmed and becoming burnout because they're dealing with a one-to-one patient who may be on ECMO and prone and paralyzed, maybe offering to switch with them or help pick up some of the responsibilities so they don't feel so overwhelmed. And this brings us to our third and final step in managing burnout. That is leading during a pandemic. Strong leadership and what leaders can do to make it easier for their staff. While leading from the front is always a good strategy, it's now more so than ever during a pandemic. For leaders, you really need to focus on being calm and decisive. If you show signs of being flustered or overwhelmed, it's not going to resonate well with your staff and that's going to lead to them being overwhelmed a lot easier. One of the simplest things that we can do is really disseminate information among our staff members to keep them in the know. Practice that transparency and let them know what we're doing, how we're doing it, and what's coming down the pipeline. The focus on teamwork to keep that flexibility in the schedule and to keep the workload among staff members equally distributed is also really beneficial. Recognize your employees when they are doing good work, which during this time, especially with COVID-19, most of our staff are going above and beyond anything we would ever imagine. So really recognizing what they're doing for the team. And then be supportive and compassionate because there are going to be times when they feel overwhelmed and they may just need to cry or to sit down for a minute. Really support them and do what you can to help them so that they don't feel like they're a burden at those times. Some thousand foot views of things we can do as leaders that really make a difference as well as rotating staff. Limit the number of consecutive days with those high severity patients as discussed earlier. Really make sure that they have those days off. While PTO may be a hard thing to do during this time, really limit the number of days that they're bunching together. If they're doing three days in a row typically, maybe break that up so they're not here three days in a row for 14-16 hour days and feeling overwhelmed and burnt out. Planning ahead. We know that there's more to come with this pandemic, so really start identifying plans for the staff now and think of strategies that we can use in the future, whether it's using nurses from other units or really cross-training whoever we need to to get someone out there so that we can take the burden off of our staff who's been dealing with it on the front lines from day one. Some of the other things, being that I'm a pharmacist I'd be remiss if I didn't talk about, is really focusing on medications. You know, keeping IV pumps outside the room, using extended infusions when possible, batching medication times so that we're not going into the room as much as possible. All these things help decrease the amount of exposure the nurses, physicians, and everyone may have inside the room, which will also decrease stress in the long run. In conclusion, burnout is something that we have difficulty managing even outside of the pandemic, but during a pandemic, especially given our current situation, we really need to be aware of burnout. Look out for those signs and symptoms in your staff members as well as in yourself and hold each other accountable. Remember the importance of those self-care techniques, whether it's just basic needs, again, having water, having a snack, going to the bathroom when needed. We need to help each other with good teamwork skills and then strong leadership is really going to be the backbone here. Leaders really need to set the tone and show that they support their staff. If the staff feels supported, that promotes better teamwork and that will lead to decreased burnout in the long run. Thank you.

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