By Tony Whitehouse, Council member
Have we learnt nothing from burn-out failures of the past? asks Tony Whitehouse. I was struck by the high number of colleagues whom I knew as my trainers in anaesthetics that had started their life as a consultant working in ICU but had given it up. Emboldened by my newly found seniority, I enquired why. While a few said that they were forced to do sessions in the ICU because of providing workload cover, most gave their reason: “burn-out”.
As one comes to the end of training, the trainee-mentor interaction changes. Conversations that were once about ventilator settings or antibiotic dosing moved to ones about wives, families and interests outside the hospital. It sometimes felt to me a bit like a sixth-former going to the pub with their teachers. During those conversations, I learned that many of my colleagues had given up their ICU career because they were worn down by their workload.
With the aftershocks of the junior doctor strike still rumbling, and as a consultant at the mid-point of his career, I find myself mulling over whether I will be able to sustain the work intensity that I’ve maintained for the 25 years or so. Some of my senior colleagues remember the days of being single-handed ICU consultants and yet have survived to work to this day. My perception is that even their tenacity is being broken by a working day that can be relentless. Since starting as a consultant over 10 years ago, patient expectations have increased and the APACHE scores (how sick they are) are higher. And yes, my expectations have increased too; why shouldn’t a 95 year old get admitted to and survive ICU?
I believe that these changes in mind-set have impacted on the NHS workforce. Sitting down for a coffee with our nurses reveals a group who are being worn down by the unremitting workload.
“In the past, you would have had a bit of a quieter time in August, but not now” they say.
Our nursing turnover is high; we have lost some of our best staff to areas of healthcare that have a more controlled working pace. And yet, the drive for making staff work at full pelt, all the time is regarded as “efficient”. Have we learnt nothing from the burn-out failures of the past?
Whilst the NHS contract negotiations are likely to concentrate on how many hours a doctor, nurse or AHP works, their metric is wrong. If you were to buy a 3 year old car, you also want to know how many miles it has been driven – a car that has been driven a long distance is more likely to break down compared with one whose milometer hasn’t been so troubled. In ICU, it’s not just how often your week on the ICU comes around or how many shifts you do, it’s what you pack into it when you are there that also matters.
Editorial note: Stress is more prevalent among health professionals compared to the general population. For example, 28 % of doctors experience psychological distress compared to 18 % among the general population. See this list of services if you need advice.
At this year’s State of the Art session ‘Who cares for the carers? Staff welfare and morale in the ICU’ we invite critical care staff to help us unravel the reason behind the crucial 10 % gap from a critical care perspective. Share your experience on Twitter by using #10percentgap #icssoa2016.