Critical care work during and after COVID-19: Exploring changing identities and practices associated with recovery from burnout
As the Canadian population has aged and increased utilization of critical care services, clinicians working in critical care face alarmingly high rates of burnout, with prevalence ranging from 40% to 70%. These high rates of burnout are associated with factors such as moral distress, long work hours, and the burdens of end-of-life decision-making unique to critical care work. Burnout syndrome is comprised of emotional exhaustion, depersonalization or cynicism, and reduced personal accomplishment. Those who are suffering from burnout have higher rates of alcohol use and dependence, depression, posttraumatic stress disorder, and suicidal ideation. The effects of burnout are experienced by patients (quality of care, medical errors, suboptimal attitudes), critical care settings (reduced safety climate, decreased job satisfaction and retention), and ultimately the Canadian health system (economic loss). The impact of burnout among critical care clinicians has been amplified by COVID-19. In addition to the health and mental health impacts among the general population (e.g., anxiety around illness, quarantine, social isolation, grief and loss), critical care clinicians contend with health risks associated with working in critical care (e.g., transmission of virus), increased pressure and stress in critical care units, and psychological and emotional impacts of caring for those very ill and dying from COVID-19.
Research on the prevention of burnout has indicated that daily life practices outside work (leisure, exercise, family life) is helpful in reducing the incidence of burnout syndrome, but has failed to establish if these factors facilitate recovery after someone has already experienced burnout. In addition, the limited research on burnout recovery processes suggests that recovery appears to involve changes in daily life practice, changes in meanings and values, and changes in personal and professional identities. However, it remains unclear how clinicians remain in, or return to health care work after burnout, and what practices and changes in identity are helpful in their recovery. Focusing on the connections between identity and recovery may provide a powerful new direction for the field.
This proposed longitudinal qualitative study will explore clinicians’ subjective experience of their changing identities and practices used in recovery from burnout. In the midst of, and on the heels of the COVID‑19 pandemic, and with the rising need to recruit and retain critical care clinicians in the Canadian health system, our project is timely and significant. Mitigating burnout has been identified by the critical care community and an area of focus for the Critical Care Strategic Clinical Network. As the start of a larger program of study across Canada, our proposed study has the potential to substantially expand how scholars in the fields of career development, counselling, human resources management, occupational therapy, critical care, and work adjustment understand recovery from burnout. Findings from this study are expected to expand these fields through producing much-needed knowledge into potentially important connections between identity and recovery from burnout and sustaining employment or returning to work. This project may also have important implications for knowledge uses such as critical care clinicians themselves, career professionals, workers, organizations, policy makers, and other stakeholders with an interest in promoting healthy recovery practices to support recovery from burnout. Furthermore, our study will foster the scholarly development of graduate students whom we will train in all phases of the research process.