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Perceived Nonbeneficial Treatment of Patients, Burnout, and Intention to Leave the Job Among ICU Nurses and Junior and Senior Physicians

Schwarzkopf, Daniel, MSc1; Rüddel, Hendrik, MD1,2; Thomas-Rüddel, Daniel O., MD1,2; Felfe, Jörg, PhD3; Poidinger, Bernhard, MD1,2; Matthäus-Krämer, Claudia T., MA1; Hartog, Christiane S., MD1,2; Bloos, Frank, MD, PhD1,2

doi: 10.1097/CCM.0000000000002081
Online Clinical Investigations

Objectives: Perceiving nonbeneficial treatment is stressful for ICU staff and may be associated with burnout. We aimed to investigate predictors and consequences of perceived nonbeneficial treatment and to compare nurses and junior and senior physicians.

Design: Cross-sectional, multicenter paper-pencil survey on personal and work-related characteristics, perceived nonbeneficial treatment, burnout, and intention to leave the job.

Setting: Convenience sample of 23 German ICUs.

Subjects: ICU nurses and physicians.

Interventions: None.

Measurements and Main Results: A total of 847 questionnaires were returned (51% response); 778 had complete data for final multivariate analyses. Nonbeneficial treatment was in median perceived “sometimes.” Adjusted for covariates, it was perceived more often by nurses and junior physicians (both p ≤ 0.001 in comparison to senior physicians), while emotional exhaustion was highest in junior physicians (p ≤ 0.015 in comparison to senior physicians and nurses), who also had a higher intention to leave than nurses (p = 0.024). Nonbeneficial treatment was predicted by high workload and low quality collaboration with other departments (both p ≤ 0.001). Poor nurse-physician collaboration predicted perception of nonbeneficial treatment among junior physicians and nurses (both p ≤ 0.001) but not among senior physicians (p = 0.753). Nonbeneficial treatment was independently associated with the core burnout dimension emotional exhaustion (p ≤ 0.001), which significantly mediated the effect between nonbeneficial treatment and intention to leave (indirect effect: 0.11 [95% CI, 0.06–0.18]).

Conclusions: Perceiving nonbeneficial treatment is related to burnout and may increase intention to leave. Efforts to reduce perception of nonbeneficial treatment should improve the work environment and should be tailored to the different experiences of nurses and junior and senior physicians.

1Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.

2Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.

3Department of Work and Organizational Psychology, Helmut Schmidt University, Hamburg, Germany.

Drs. Hartog and Bloos contributed equally to this work.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Support, in part, by grants from the German Federal Ministry of Education and Research (BMBF) via the integrated research and treatment Center for Sepsis Control and Care (FKZ 01EO1002). Mr. Schwarzkopf and Ms. Matthäus-Krämer were funded in full and Dr. Thomas-Rüddel was supported, in part, by the Center for Sepsis Control and Care.

Mr. Schwarzkopf received support for article research from the German Federal Ministry of Education and Research (BMBF). Dr. Rüddel received support for article research from the BMBF; disclosed government work; and received funding from a consultancy in a private lawsuit and as a lecturer at Symposium “Sepsis and Rehabilitation” (Median Klinik Bad Tennstedt, Germany). His institution received funding from the BMBF. Dr. Thomas-Rueddel’s institution received funding from the BMBF. Dr. Poidinger’s institution received funding from the BMBF. Dr. Hartog disclosed other support. Her institution received funding from the BMBF. Dr. Bloos disclosed other support (Lecture honoraria from Biosyn, Gilead, and CSL Behring). His institution received funding from the BMBF. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: Daniel.Schwarzkopf@med.uni-jena.de

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