Burnout and the working environment of healthcare professionals – improvements are needed

Burnout among residents was the topic of an abstract from Doctor Alan R. Sigal and colleagues at the Instituto Cardiovascular De Buenos Aires in Argentina. In total, 312 residents from different provinces in Argentina completed the self-administered survey to determine burnout levels across different specialties (cardiology, n=148 [47%]; other clinical specialties, n=112 [36%]; surgical specialties, n=52 [17%]).

Using the Maslach Burnout Inventory, 24% of all residents screened exhibited burnout. Of note, cardiology residents had a higher burnout incidence (28%) than residents of other specialties (17%) (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.02–3.45; p=0.04). A nonsignificant trend towards higher levels of lack of personal realisation was found among cardiology residents (OR 1.67; 95% CI 0.97–2.88; p=0.06). The authors suggested that further research should be carried out to determine causation and create less stressful work environments to prevent burnout.

Set up around 10 years ago, part of the remit of the European RN4CAST project was to consider the impact of adequate nurse–patient ratios and work environment on patient safety and the quality of care.¹ Here at ESC Congress 2020, two abstracts were presented by researchers at the University of Genoa (Italy) who used data from the Italian RN4CAST databases, RN4CAST@IT and RN4CAST@IT­Ped. These studies investigated the relationship between work environment and emotional exhaustion in nurses employed in adult and paediatric cardiology, respectively.

As part of RN4CAST@IT, Doctor Milko Zanini et al examined responses from 290 nurses working in adult cardiology. The nurses completed a web survey in 2015 on several topics including nurse–patient ratios, skill mix, their working environment measured by the Practice Environment Scale of the Nursing Work Index (PES-NWI) and emotional exhaustion assessed using the Maslach Burnout Inventory. The main finding was that after adjusting for skill mix and staffing levels, better working environment conditions reduced the risk of cardiology nurses developing high levels of emotional exhaustion by 96% (OR 0.038; 95% CI 0.011–0.136).

As part of RN4CAST@IT­Ped, a similar study by Doctor Annamaria Bagnasco et al analysed the responses of 85 nurses working in paediatric cardiology who completed a web survey in 2017–2018. The main finding was that after adjusting for skill mix and staffing levels, a better working environment reduced the risk of paediatric cardiology nurses developing high levels of emotional exhaustion by 81% (OR 0.195; 95% CI 0.062–0.591).

Taken together, Dr. Zanini and Dr. Bagnasco questioned what effects such high levels of emotional exhaustion are having on the quality of patient care and suggested these results are used as the first step towards implementing work environment improvements.