Operating room burnout is the result of stress, tension, and fatigue that comes as a result of long hours, high patient loads, and the constant vigilance that is required to prevent life-threatening complications. It is a pervasive issue in the operating room (OR), where healthcare professionals face intense demands that can compromise patient care and well-being. Anesthesia providers, surgeons, and proceduralist physicians manage complex cases, closely monitor patients, and make rapid decisions, often under high-stakes and stressful conditions.
The pressure to maintain focus without breaks, administrative burdens, and limited support further compounds stress. Moreover, lack of sleep and disrupted circadian rhythms from unpredictable schedules can affect cognitive performance and emotional resilience. Burnout impacts the mental and physical health of these professionals and increases the risk of errors, communication breakdowns, and diminished team dynamics, all of which can affect patient outcomes.
The tensions experienced by OR staff can be contagious. Research on mirror neurons indicates that a person who witnesses a feeling such as anger or stress can experience it themselves. Once OR tensions are identified, however, they can be reduced using simple, cost-effective measures.
How tensions in the OR negatively impact staff and patient care
OR staff interpersonal dynamics, coupled with other stressors inherent to working in the OR, can cause stress for staff, affect workplace collaboration, and influence patient outcomes. Stress and burnout of surgical teams can impact provider clinical performance, professionalism, the incidence of medical errors, intention to stay in the profession, and provider quality of life. A study assessing anesthesiologist burnout levels since early 2020 found that of the respondents surveyed in November 2022, nearly 70 percent had a high risk for burnout, up more than 14 percent from March 2020. Additionally, almost 19 percent had burnout syndrome, a 37 percent increase from 2020. Research also substantiates the negative impact of stress and burnout on nurses, technologists, and other personnel.
In addition to the pressure of patient safety and high-stakes conditions, common stressors include complex procedures, inadequate staffing, unexpected complications, equipment malfunctions, distractions, and poor facility design. Teamwork dynamics, including poor communication, also compound OR stress levels.
Time constraints also have an impact on stress in the OR. For example, schedules can go awry when what was planned as a routine surgery becomes more complicated, or there is an issue with the instruments for the procedure that requires a delay to remedy. This adds to the pressure on the OR staff to adhere to rigorous schedules where rapid surgical turnovers are the norm. This can also cause anesthesia providers to feel pressured and anxious, a feeling exacerbated by their inability to spend quality time with patients, particularly those who are seriously ill or have comorbid health issues.
Best practices for reducing OR stress
Reducing OR personnel stress begins with identifying and recognizing the problem. It is often apparent how one person’s behavior can impact those around them. Leaders can observe body language and be aware of staff who appear anxious or miss work frequently, indicating there may be a stress-related problem. It is essential to have open communication with staff about workplace stress.
A study exploring healthcare workers and stress found the need to regularly provide psychological counseling to healthcare workers “to help them correctly recognize and deal with empathic emotions and promote transpersonal thinking and emotional regulation.” It also emphasized the importance of creating “an atmosphere conducive to good communication.”
Research on mirror neurons may be helpful when providing training. As the name suggests, mirror neurons mirror the actions and behaviors of others. In the early 1990’s researchers working withmacaque monkeys observed neural activity as the animals performed simple tasks, such as reaching for food. In addition to neurons firing when the monkeys executed certain actions, they also activated when they observed others performing the same action.
An editorial on advances in the study of mirror neurons and their impact on neuroscience says, “Mirror neurons play a crucial role in neuroscience by enabling individuals to understand and imitate the actions of others. This mirroring mechanism is believed to underlie processes such as empathy, imitation, social cognition, and even language development.” If negative feelings and behaviors are shared, positive ones can also be shared. For example, if most healthcare providers at a particular facility are relaxed and feel supported, this will spread through the environment and help create a culture of mutual support.
Organizational leaders can provide training on how workplace stress can impact staff and patient outcomes. They can also provide institutional support, such as wellness programs, peer mentorship, and resilience training for OR staff. A framework for implementing guidelines based on a literature review of breathing practices for stress and anxiety reduction found that breathing interventions significantly reduced stress. In another example, a randomized clinical trial of 129 practicing physicians in a yoga breathing and meditation program found that the program significantly reduced stress, anxiety, and depression and decreased insomnia.
Simple solutions for a complex problem
Operating room burnout is a multifaceted challenge, deeply ingrained in the high-stress, high-stakes nature of surgical environments. Although the problem is complex, solutions are within reach. By increasing awareness, identifying the root cause, fostering open communication, providing leadership support, and implementing simple yet effective stress-reduction techniques, teams can transform the OR into a space where healthcare professionals thrive. Ultimately, the well-being of OR staff is crucial not only for their own health but for the delivery of safe, high-quality patient care. Addressing burnout is not an option—it’s an imperative for the future of healthcare.
Ami Patel
Ami Patel, CRNA, APN, MSN (USA), MD Anesthesiologist (India), is a seasoned nurse anesthetist and leader with over 20 years of experience in anesthesia care, mentorship, and team management. She is a champion of the Anesthesia Quality Improvement Committee and clinical preceptor at Overlook Medical Center. A peer reviewer and published author in Cureus, Ami is dedicated to advancing patient safety and modern anesthesia techniques. She is an active member of AANA and Sigma Theta Tau International. Connect at [email protected].
