National Academy of Medicine calls for action to address a crisis among clinicians.

As a nurse and researcher who has worked in the area of clinician burnout for many years, I was pleased to see attention to this issue by the National Academy of Medicine (NAM) in a recent consensus study report, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being.

Burnout, a syndrome of “emotional exhaustion, depersonalization, and lack of personal accomplishment” (Maslach et al. 2001. Job Burnout. Annu Rev Psychol. 52: 397-422), has far-reaching and troubling consequences for health care clinicians. The problem has grown to crisis levels: estimates indicate that 35%-45% of the nearly 4 million nurses in the U.S. are experiencing symptoms of burnout, and up to 54% of our physician colleagues experience it as well.

A ‘chronic imbalance’ of job demands with available resources.

Prominent among the factors contributing to burnout are the systemic patterns that erode professional fulfillment and well-being, many of which are beyond the control of individual clinicians.  Burnout represents a chronic imbalance of job demands with resources needed to meet them.

The National Academies of Science, Engineering and Medicine (NASEM), of which NAM is a part, convened a committee to examine the scientific evidence towards understanding the scope and consequences of burnout on the health care workforce and students, and to identify system-focused solutions that foster clinician well-being as a means for enhancing patient care.

Along with Dr. Sharon Pappas, chief nursing officer for Emory Healthcare and Emory University, I was one of the two nurses on the 17-member committee. The committee was tasked with reviewing and synthesizing the evidence. We also heard presentations from content experts, created a conceptual model of the factors that contribute to burnout, and deliberated together to develop consensus-based recommendations.

The committee concluded that while strong evidence was lacking to recommend specific systemic interventions, emerging evidence suggests that investments in strategies to improve work and learning environments can mitigate burnout and promote clinician well-being. The Committee recommended that health care and learning organizations align organizational structures and processes with organizational and workforce values, adopt human-centered system redesign principles, engage health system leaders to prioritize clinician well-being as part of their strategic agenda, adopt systematic measurement to monitor progress, and allocate sufficient resources to sustain measurable impact.

Six goals for addressing burnout.

We identified six overarching goals to address the crisis of burnout by creating healthier health care systems and cultures that support clinician well-being.

  • Goal 1. Create Positive Work Environments
  • Goal 2. Create Positive Learning Environments
  • Goal 3. Reduce Administrative Burden
  • Goal 4. Enable Technology Solutions
  • Goal 5. Reduce Stigma and Eliminate Barriers to Seeking Support Services
  • Goal 6. Invest in Research on Clinician Well-Being

Within each of the six goals there are specific recommendations for addressing a key aspect of burnout and clinician well-being. For more details, download the report:

http://nam.edu/clinicianwellbeingstudy.

Nurses in all roles and specialties should be familiar with the report and leverage its recommendations to engage leaders and interprofessional colleagues in new conversations aimed at dismantling the impediments to clinician integrity and well-being so that patients and their families receive the high quality, safe care they deserve.

– Cynda Hylton Rushton, PhD, RN, FAAN, Anne and George L. Bunting Professor of Clinical Ethics, Berman Institute of Bioethics/School of Nursing, Johns Hopkins University

Additional resources.

  • AJN’s editor-in-chief interviewed author Cynda Rushton about the committee work. Here’s the podcast.