title: Experience and endocrine stress responses in neonatal and pediatric critical care nurses and physicians.
abstract: OBJECTIVE
  Critical care is a working environment with frequent exposure to stressful events. High levels of psychological stress have been associated with increased prevalence of burnout. Psychological distress acts as a potent trigger of cortisol secretions. We attempted to objectify endocrine stress reactivity.
  
  
  METHODS
  Observational cohort study during two 12-day periods in successive years.
  
  
  METHODS
  A tertiary multidisciplinary neonatal and pediatric intensive care unit (33 beds).
  
  
  METHODS
  One hundred and twelve nurses and 27 physicians (94% accrual rate).
  
  
  METHODS
  Cortisol determined from salivary samples collected every 2 hrs and after stressful events. Participants recorded the subjective perception of stress with every sample. Endocrine reactions were defined as transient surges in cortisol of >50% and 2.5 nmol/L over the baseline.
  
  
  RESULTS
  During 7,145 working hours, we observed 474 (12.5%) endocrine reactions from 3,781 samples. The mean cortisol increase amounted to 10.6 nmol/L (219%). The mean occurrence rate of endocrine reactions per subject and sample was 0.159 (range, 0-0.43). Although the mean raw cortisol levels were lower in experienced team members (>3 yrs of intensive care vs. <3 yrs, 4.1 vs. 4.95 nmol/L, p < .001), professional experience failed to attenuate the frequency and magnitude of endocrine reactions, except for the subgroup of nurses and physicians with >8 yrs of intensive care experience. A high proportion (71.3%) of endocrine reactions occurred without conscious perception of stress. Unawareness of stress was higher in intensive care nurses (75.1%) than in intermediate care nurses (51.8%, p < .01).
  
  
  CONCLUSIONS
  Stress-related cortisol surges occur frequently in neonatal and pediatric critical care staff. Cortisol increases are independent of subjective stress perception. Professional experience does not abate the endocrine stress reactivity.
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Zurich, Switzerland. joachim.fischer@kispi.unizh.ch
authors.forename: J E
authors.initials: JE
authors.lastname: Fischer
authors.forename: A
authors.initials: A
authors.lastname: Calame
authors.forename: A C
authors.initials: AC
authors.lastname: Dettling
authors.forename: H
authors.initials: H
authors.lastname: Zeier
authors.forename: S
authors.initials: S
authors.lastname: Fanconi
mesh_terms: D000328:Adult; D001143:Arousal / Q000502:physiology*; D001364:Awareness; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007363:Intensive Care Units, Neonatal; D015278:Intensive Care Units, Pediatric; D008297:Male; D009726:Nurses / Q000523:psychology; D010348:Patient Care Team; D010820:Physicians / Q000523:psychology; D011446:Prospective Studies; D013315:Stress, Psychological / Q000150:complications*
chemical_list: D006854:Hydrocortisone