The Operating Theatre Journal - Journal - Page 6
Navigating Burnout in Healthcare:
A Critical Examination of Operating Theatre Staff in the UK
In the fast-paced and demanding world of healthcare, burnout has
become an increasingly prevalent issue, impacting the well-being of
both medical professionals and the quality of patient care. This article
delves into the challenges faced by healthcare staff, with a particular
focus on those working in operating theatres in the UK—nurses,
operating department practitioners, allied professionals and doctors
alike. The unique stressors of the operating theatre environment
contribute signi昀椀cantly to burnout, necessitating a closer examination
and potential solutions.
De昀椀ning Burnout
Burnout, as recognised by the World Health Organization in the
International Classi昀椀cation of Diseases, is a syndrome characterized by
‘symptoms’ in three domains1:
1. feelings of energy depletion or exhaustion
2. increased mental distance from the job or feelings of negativity and
cynicism related to the job
3. reduced professional ef昀椀cacy.
In healthcare, the perpetual demands, emotional toll, and the need for
precision contribute to the vulnerability of staff to burnout. Burnout
is not classi昀椀ed as a ‘health condition’. Instead, it is and occupational
phenomenon and due to chronic, unmanaged, workplace stress. People
who are burned out are also at high risk of developing mental health
conditions for example depression and generalised anxiety disorder.
The size of the problem
Burnout amongst healthcare professionals were already an issue prior
to the COVID-19 pandemic which has potentially added to the extent of
the issue. Healthcare professionals were over three times more likely
to experience burnout during the pandemic compared to other types
of work
Research by The King’s Fund shows that NHS staff are 50 per cent more
likely to experience chronic stress, a known contributor to burnout 2.
The 2022 NHS staff survey reported that 39.7% of nurses and midwives
said that they ‘often’ or ‘always’ felt burned out from their work3.
In June 2023, the General Medical Council published its Workplace
experience document. It stated that 45% of doctors are at a moderate
to high risk of burnout4.
Surgeons appear to be amongst the group most vulnerable to burnout
with the nature of the job exposing them to multiple in昀氀uencing
factors, estimated to affect between 40% and 53%5.
Anaesthesia and intensive care medicine are characterized by their high
and stress levels. Both specialties deal with long working hours in highrisk, complex working environments involving multidisciplinary teams.
Prevalence rates of burnout from surveys of European anaesthetists are
variable, ranging between 6% and 18%6.
The Operating Theatre Environment
As a full time consultant anaesthetist working in the NHS, I am
immersed in the challenges you face on a regular basis. I often have
a unique overview of the multi -disciplinary teams who are having to
come together and ultimately deliver all the necessary parts, processed
and expertise to allow surgery to happen in a safe, timely and ef昀椀cient
manner.
The complexity of surgeries, coupled with the need for continuous
focus, adds to the stress. The ever-present risk of complications or
unexpected events ampli昀椀es the pressure on staff. Many entered the
profession to care, but now 昀椀nd themselves suffering from ‘compassion
fatigue’ unable to empathise with their patients or colleagues.
Causes of Burnout in Operating Theatres Environment:
• Long Working Hours:
Healthcare professionals working in operating theatres are often
subjected to extended shifts, with unpredictable schedules that disrupt
work-life balance. Long hours contribute to fatigue and reduce the time
available for rest and recovery. Shift patterns
• Emotional Toll:
Dealing with life-and-death situations, communicating with patients
and their families, and managing unexpected complications can take
a severe emotional toll. The need for empathy and compassion, while
maintaining professionalism, adds an extra layer of stress.
• Lack of Resources:
In some cases, operating theatres may face challenges related to
inadequate resources, including outdated equipment or shortages
in staff. This creates an additional burden on the existing team and
contributes to feelings of frustration and helplessness. An underlying
lack of capacity adds to the pressure experienced by staff in the
operating rooms: lack of hospital or critical care beds, lack of staf昀椀ng,
lack of facilities and equipment which can sometimes all occur on the
same day!
• Lack of control:
The operating room can be highly unpredictable: cases can overrun,
emergency work suddenly present itself and taking priority to name a
few. Staff have a duty and inherent want to care but the lack of control
on their lives: inside and outside work can impact in the longer term.
Though many of us thrive on the adrenaline rush and decision making,
the repeated expectations to work above and beyond your expected
shift patterns can eventually contribute to feelings of burnout7.
• Organisational Pressures:
Hospitals and healthcare institutions may impose unrealistic targets
and expectations on operating theatre staff. The pressure to
maintain ef昀椀ciency and productivity standards can lead to burnout as
professionals strive to meet these demands.
Individual factors contributing to burnout
Some studies report that in the majority of clinicians who experience
burnout it is due to systemic issues which contribute more than
individual characteristics8. However, it is worth considering some
character traits that could play a role in developing burnout.
• Seniority: there is a suggestion that less experienced pracitioners
can be more susceptible to burnout.
• Personality traits: including so called high achievers as well as
individuals who try to avoid rejection and disapproval.
• Coping styles: when practitioners lack 昀氀exibility to cope with
challenges eg emotion focussed versus problem focused.
• Emotional intelligence: if there is a lack of re昀氀ective ability,
rumination about work and poor work life balance3.
Signs of Burnout:
High Stakes and High Stress
Operating theatres are environments of high stakes, where splitsecond decisions and precise actions can be a matter of life and
death. The pressure to perform 昀氀awlessly, coupled with the intensity
of critical situations, places an immense burden on the shoulders of
healthcare professionals. We often have to perform ‘perfectly’ when
doing highly complex technical skills, yet it can be very hard to deal
with complications. Sometimes organisational issues that are out
of our control, means we have to accept suboptimal conditions and
compromise on the quality of care we strive to provide.
Recognising burnout is crucial for timely intervention. Common signs
include:
• Physical: Exhaustion, constant fatigue, disrupted sleep patterns,
and persistent physical ailments.
• Emotional: A sense of emotional numbness or detachment from
patients and colleagues.
• Performance: A decline in job performance, increased errors, and
dif昀椀culty concentrating.
Nature of Work
• Behavioural: cynicism, a negative attitude towards work, colleagues,
and patients, lack of empathy
Surgeons and theatre nurses often work long hours, facing physical and
mental exhaustion.
• Social: sense of isolation
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