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Ethical climate and intention to leave among critical care clinicians : an observational study in 68 intensive care units across Europe and the United States

(2020) INTENSIVE CARE MEDICINE. 46(1). p.46-56
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Abstract
PurposeApart from organizational issues, quality of inter-professional collaboration during ethical decision-making may affect the intention to leave one's job. To determine whether ethical climate is associated with the intention to leave after adjustment for country, ICU and clinicians characteristics.MethodsPerceptions of the ethical climate among clinicians working in 68 adult ICUs in 12 European countries and the US were measured using a self-assessment questionnaire, together with job characteristics and intent to leave as a sub-analysis of the Dispropricus study. The validated ethical decision-making climate questionnaire included seven factors: not avoiding decision-making at end-of-life (EOL), mutual respect within the interdisciplinary team, open interdisciplinary reflection, ethical awareness, self-reflective physician leadership, active decision-making at end-of-life by physicians, and involvement of nurses in EOL. Hierarchical mixed effect models were used to assess associations between these factors, and the intent to leave in clinicians within ICUs, within the different countries.ResultsOf 3610 nurses and 1137 physicians providing ICU bedside care, 63.1% and 62.9% participated, respectively. Of 2992 participating clinicians, 782 (26.1%) had intent to leave, of which 27% nurses, 24% junior and 22.7% senior physicians. After adjustment for country, ICU and clinicians characteristics, mutual respect OR 0.77 (95% CI 0.66- 0.90), open interdisciplinary reflection (OR 0.73 [95% CI 0.62-0.86]) and not avoiding EOL decisions (OR 0.87 [95% CI 0.77-0.98]) were all associated with a lower intent to leave.ConclusionThis is the first large multicenter study showing an independent association between clinicians' intent to leave and the quality of the ethical climate in the ICU. Interventions to reduce intent to leave may be most effective when they focus on improving mutual respect, interdisciplinary reflection and active decision-making at EOL.
Keywords
Intent to leave, Ethical climate, Interdisciplinary reflection, Decision-making, Respect, JOB-SATISFACTION, BURNOUT SYNDROME, MORAL DISTRESS, OF-LIFE, NURSES, TURNOVER, IMPACT, ICU, COLLABORATION, QUALITY

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MLA
Van den Bulcke, Bo, et al. “Ethical Climate and Intention to Leave among Critical Care Clinicians : An Observational Study in 68 Intensive Care Units across Europe and the United States.” INTENSIVE CARE MEDICINE, vol. 46, no. 1, 2020, pp. 46–56, doi:10.1007/s00134-019-05829-1.
APA
Van den Bulcke, B., Metaxa, V., Reyners, A. K., Rusinova, K., Jensen, H. I., Malmgren, J., … Benoit, D. (2020). Ethical climate and intention to leave among critical care clinicians : an observational study in 68 intensive care units across Europe and the United States. INTENSIVE CARE MEDICINE, 46(1), 46–56. https://doi.org/10.1007/s00134-019-05829-1
Chicago author-date
Van den Bulcke, Bo, Victoria Metaxa, Anna K. Reyners, Katerina Rusinova, Hanne I. Jensen, J. Malmgren, Michael Darmon, et al. 2020. “Ethical Climate and Intention to Leave among Critical Care Clinicians : An Observational Study in 68 Intensive Care Units across Europe and the United States.” INTENSIVE CARE MEDICINE 46 (1): 46–56. https://doi.org/10.1007/s00134-019-05829-1.
Chicago author-date (all authors)
Van den Bulcke, Bo, Victoria Metaxa, Anna K. Reyners, Katerina Rusinova, Hanne I. Jensen, J. Malmgren, Michael Darmon, Daniel Talmor, Anne-Pascale Meert, Laura Cancelliere, László Zubek, Paulo Maia, Andrej Michalsen, Erwin J. O. Kompanje, Peter Vlerick, Jolien Roels, Stijn Vansteelandt, Johan Decruyenaere, Elie Azoulay, Stijn Vanheule, Ruth Piers, and Dominique Benoit. 2020. “Ethical Climate and Intention to Leave among Critical Care Clinicians : An Observational Study in 68 Intensive Care Units across Europe and the United States.” INTENSIVE CARE MEDICINE 46 (1): 46–56. doi:10.1007/s00134-019-05829-1.
Vancouver
1.
Van den Bulcke B, Metaxa V, Reyners AK, Rusinova K, Jensen HI, Malmgren J, et al. Ethical climate and intention to leave among critical care clinicians : an observational study in 68 intensive care units across Europe and the United States. INTENSIVE CARE MEDICINE. 2020;46(1):46–56.
IEEE
[1]
B. Van den Bulcke et al., “Ethical climate and intention to leave among critical care clinicians : an observational study in 68 intensive care units across Europe and the United States,” INTENSIVE CARE MEDICINE, vol. 46, no. 1, pp. 46–56, 2020.
@article{8636532,
  abstract     = {{PurposeApart from organizational issues, quality of inter-professional collaboration during ethical decision-making may affect the intention to leave one's job. To determine whether ethical climate is associated with the intention to leave after adjustment for country, ICU and clinicians characteristics.MethodsPerceptions of the ethical climate among clinicians working in 68 adult ICUs in 12 European countries and the US were measured using a self-assessment questionnaire, together with job characteristics and intent to leave as a sub-analysis of the Dispropricus study. The validated ethical decision-making climate questionnaire included seven factors: not avoiding decision-making at end-of-life (EOL), mutual respect within the interdisciplinary team, open interdisciplinary reflection, ethical awareness, self-reflective physician leadership, active decision-making at end-of-life by physicians, and involvement of nurses in EOL. Hierarchical mixed effect models were used to assess associations between these factors, and the intent to leave in clinicians within ICUs, within the different countries.ResultsOf 3610 nurses and 1137 physicians providing ICU bedside care, 63.1% and 62.9% participated, respectively. Of 2992 participating clinicians, 782 (26.1%) had intent to leave, of which 27% nurses, 24% junior and 22.7% senior physicians. After adjustment for country, ICU and clinicians characteristics, mutual respect OR 0.77 (95% CI 0.66- 0.90), open interdisciplinary reflection (OR 0.73 [95% CI 0.62-0.86]) and not avoiding EOL decisions (OR 0.87 [95% CI 0.77-0.98]) were all associated with a lower intent to leave.ConclusionThis is the first large multicenter study showing an independent association between clinicians' intent to leave and the quality of the ethical climate in the ICU. Interventions to reduce intent to leave may be most effective when they focus on improving mutual respect, interdisciplinary reflection and active decision-making at EOL.}},
  author       = {{Van den Bulcke, Bo and Metaxa, Victoria and Reyners, Anna K. and Rusinova, Katerina and Jensen, Hanne I. and Malmgren, J. and Darmon, Michael and Talmor, Daniel and Meert, Anne-Pascale and Cancelliere, Laura and Zubek, László and Maia, Paulo and Michalsen, Andrej and Kompanje, Erwin J. O. and Vlerick, Peter and Roels, Jolien and Vansteelandt, Stijn and Decruyenaere, Johan and Azoulay, Elie and Vanheule, Stijn and Piers, Ruth and Benoit, Dominique}},
  issn         = {{0342-4642}},
  journal      = {{INTENSIVE CARE MEDICINE}},
  keywords     = {{Intent to leave,Ethical climate,Interdisciplinary reflection,Decision-making,Respect,JOB-SATISFACTION,BURNOUT SYNDROME,MORAL DISTRESS,OF-LIFE,NURSES,TURNOVER,IMPACT,ICU,COLLABORATION,QUALITY}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{46--56}},
  title        = {{Ethical climate and intention to leave among critical care clinicians : an observational study in 68 intensive care units across Europe and the United States}},
  url          = {{http://dx.doi.org/10.1007/s00134-019-05829-1}},
  volume       = {{46}},
  year         = {{2020}},
}

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