Discussion Guide for the Bazan Article

Burnout results from ineffectively managed chronic workplace stress and is characterized by emotional exhaustion, depersonalization (eg, cynicism or disengagement), and a diminished sense of personal accomplishment (eg, inefficacy) in one’s occupation. Burnout is partially induced by a supposed imbalance between a worker’s job demands (eg, workload) and job resources (eg, support from colleagues and supervisors) that disproportionately affects clinicians in acute care settings. Before the COVID-19 pandemic, the prevalence of burnout among acute care clinicians was about 40%, but it surged to roughly 60% by the end of 2021. Although this alarming trend seems to be reversing toward prepandemic levels, the fact remains that clinician burnout has pervasive and deleterious consequences. Not only do clinicians suffering from burnout struggle to manage their mental health, driving some to consider suicide, but they are also more susceptible to medical errors that put the well-being of their patients at risk. Finally, clinician burnout is a significant driver of professional turnover and job abandonment, leaving our nation’s remaining health care workforce inadequately equipped for future public health crises. Thus, addressing the need for interventions that mitigate burnout is imperative.To examine effects of a 6-week mindfulness bundle toolkit (MBT) on stress and burnout symptoms among intensive care unit (ICU) nurses caring for patients with COVID-19.In this quasi-experimental study, a convenience sample of 42 registered nurses was recruited from 2 COVID-19–designated ICUs within a southwestern US tertiary care hospital. The MBT started with a 1.5-hour guided mindfulness, yoga, and spirituality training session. In the following 6 weeks, the charge nurse or shift lead led participants through a guided reflection at the start of each shift. During the 6 weeks, participants were encouraged to use a dedicated therapeutic room equipped with blue light therapy, blackout curtains, nature- or relaxation-based music/sound therapy, a yoga mat, a bean bag chair, healthy snacks, and a massage chair. The investigators collected self-reported measures of stress and burnout before, immediately after, and 6 weeks after the 6-week intervention.The authors reported statistically significant decreases in stress-related experiences and burnout symptoms from before to 6 weeks after the intervention. Specifically, the severity of emotional exhaustion symptoms decreased by 33%, and severity of depersonalization symptoms decreased by 23%. Mean scores for personal accomplishment improved during the study period but not significantly.The study findings show that the 6-week MBT reduces stress and burnout in ICU nurses caring for patients with COVID-19. These findings underscore the promise of implementing low-cost and pragmatic mindfulness-based interventions to support the psychological well-being of ICU nurses.In March 2020, as the COVID-19 pandemic escalated, Gisele Bazan’s ICU was designated as her facility’s first COVID unit. With less than a week to prepare, she coordinated with infection prevention teams, safety officers, and other leaders to implement training, policies, and workflows. “We had just completed education and training literally days before our first patient arrived,” she recalls. In mid-2020, she began observing significant emotional changes among her nursing staff. “Nurses who had been able to detach themselves emotionally from situations were now visibly affected,” she notes. Recognizing the toll on her team, she sought to implement a project to address burnout. Her educational background gave her insight into the importance of intervening and measuring outcomes. Initially conceived as a quality improvement project, the initiative evolved into a complete research study. “I was very naive,” she admits. “I didn’t think it would become a research project, but once I understood the requirements, I knew it had to be done right.”Ms Bazan leveraged her connections within her facility’s research council, a university partnership, and her extensive network to assemble a multidisciplinary team. This team included bedside caregivers, educators, and non-ICU staff, ensuring diverse perspectives. “Being a magnet facility, we needed bedside caregivers to have input,” she explains. Her leadership emphasized collaboration, meticulous planning, and a shared commitment to staff well-being. Reflecting on the experience, she cites time constraints, balancing multiple roles, and navigating the complexities of research as her most significant challenges. Yet, her administration’s support was instrumental in the project’s success. “I had the best administration support anybody could ask for,” she shares.Ms Bazan sees the MBT as a practical, adaptable approach to mitigate burnout among ICU nurses that can be easily replicated in other ICU and health care settings. To her, a key strength of the intervention is its individualized approach, as solutions for burnout are not one-size-fits-all. “Some people may enjoy yoga, while others prefer music therapy,” she explains. The MBT empowered nurses to choose what worked best for them by offering an array of evidence-based interventions.Consistent with extant evidence that suggests burnout is an individual manifestation of a suboptimally functioning health care system, Ms Bazan emphasizes that administrative backing was crucial for this project’s success. This model demonstrates how health care systems can foster resilience among staff by integrating wellness initiatives into organizational culture.This feature briefly describes the personal journey and background story of the EBR article’s lead investigators, discussing the circumstances that led them to undertake the line of inquiry represented in the research article featured in this issue.Gisele N. Bazan, MSN, RN, CCRN, has dedicated 19 years to the nursing profession. She began her bedside career in the ICU, where she worked for nearly a decade. She has taken on progressively complex roles during her career, including 9 years as a nursing educator and, most recently, as a nurse manager. Her journey reflects a deep commitment to staff development and patient care, particularly in the high-pressure critical care environment.Gisele Bazan’s foray into research was unplanned but transformative. When considering the challenges of undertaking this initiative, she reflects on the experience of navigating institutional review board approval, managing a large team, balancing roles, and navigating logistical hurdles, like the intricacies of data collection. “You need to give yourself grace when learning new things,” she says. Despite these challenges, she emphasizes the value of persistence and collaboration. “Research is a big undertaking,” she notes. “But with the right support, it’s absolutely doable.” As a novice researcher, she relied on mentorship from experienced colleagues, including her mentor and coauthor, Dr Joann Long, whose guidance was instrumental throughout the process.Ms Bazan continues to inspire others by mentoring her team through evidence-based practice initiatives. She takes pride in seeing her colleagues grow and develop a passion for research. Her work exemplifies the belief that challenges are opportunities for growth and improvement, especially when supported by strong teamwork and dedication to bettering patient care.