Burnout Syndrome (BOS) is a work related mental health condition defined by three dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment. As mounting expectations and inherent stresses have increased in the workplace, BOS is reaching epidemic proportions in the healthcare profession. Being a critical care nurse is a challenging and sometimes overwhelming profession due to high patient mortality and morbidity, and daily confrontations with ethical dilemmas. Our multidisciplinary research team that combines expertise in critical care medicine, nursing, psychiatry, and psychology made the seminal observation that intensive care unit (ICU) nurses have significantly higher rates of symptoms of anxiety and depression, posttraumatic stress disorder (PTSD), and BOS. These disorders initiate a negative cycle resulting in an unacceptably high ICU nursing turnover rate of at least 17-20% per year. ICU nursing turnover is expensive costing in excess of $65,000 for each newly hired critical care nurse. ICU nursing turnover also diminishes nursing productivity, staff morale, and patient quality of care. Presently, there are no interventions to reduce BOS in ICU nurses. Because many of the stresses on ICU nurses are inherent to caring for critically ill patients, our multidisciplinary group has focused on enhancing the ability of ICU nurses to adapt to their work environment. Resiliency is a multidimensional psychological characteristic that enables one to thrive in the face of adversity and bounce back from hardships and trauma. Importantly, resiliency can be learned. Developed over 10 years ago, Mindfulness Based Cognitive Therapy (MBCT) synergistically combines mindfulness training and cognitive behavioral therapy and can increase resiliency. We hypothesize that a MBCT based resiliency program will build resiliency, reduce BOS, and ultimately diminish the high rate of ICU nursing turnover. In this R34 application, we propose three aims:
Aim #1 : To adapt and optimize a MBCT resiliency program specifically for ICU nurses. For this aim, we will engage multiple stakeholder groups to assist the protocol adaptation.
Aim # 2: To conduct a pilot clinical trial to determine acceptability of the MBCT resiliency program and the control intervention. In this aim, we will also identify the most feasible randomization level to minimize contamination between the control and intervention groups.
Aim #3 : By performed exit interviews with ICU nurses, we will determine the attributable contribution of BOS to the turnover rate for ICU nurses. Collectively, this proposal will pave the way for a properly designed large multi-center trial of a MBCT resiliency program (MBCT-ICU) to determine its ability to decrease BOS symptoms; and allow nurses to more effectively care for patients in the challenging ICU environment.

Public Health Relevance

Each year, critical care nurses treat more than 5 million patients that require admission to an intensive care unit (ICU). Due to their stressful work environment, these nurses have higher rates of anxiety and depression symptoms, burnout syndrome (BOS), and posttraumatic stress disorder (PTSD). ICU nurses are also leaving the nursing profession at rates of at least 17-20% per year. This excessive ICU nursing turnover rate directly increases healthcare costs, decreases nursing productivity, and reduces the quality of nursing care. There are currently no interventions for ICU nurses that reduce their anxiety and depression symptoms, BOS, or PTSD. Therefore, we plan to adapt and pilot test a Mindfulness Based Cognitive Therapy (MBCT) Resiliency Program for ICU nurses (MBCT-ICU). This proposal will pave the way for a larger multi-center clinical trial that will determine whether the MBCT-ICU will reduce symptoms of BOS and also diminish the excessively high rate of ICU nursing turnover.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Planning Grant (R34)
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Special Emphasis Panel (ZAT1-HS (25))
Program Officer
Reider, Eve
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University of Colorado Denver
Internal Medicine/Medicine
Schools of Medicine
United States
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Costa, Deena Kelly; Moss, Marc (2018) The Cost of Caring: Emotion, Burnout, and Psychological Distress in Critical Care Clinicians. Ann Am Thorac Soc 15:787-790
Mealer, Meredith; Moss, Marc (2018) Should all ICU clinicians regularly be tested for burnout? We are not sure : Conceptual considerations that precede screening for burnout syndrome in ICU clinicians. Intensive Care Med :
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Mealer, Meredith (2016) Burnout Syndrome in the Intensive Care Unit. Future Directions for Research. Ann Am Thorac Soc 13:997-8
Mealer, Meredith; Schmiege, Sarah J; Meek, Paula (2016) The Connor-Davidson Resilience Scale in Critical Care Nurses: A Psychometric Analysis. J Nurs Meas 24:28-39