Preventing Burnout Among Healthcare Professionals Working in Operating Rooms

Burnout is a daily issue that particularly affects the operating room. Improvement in organisation and communication could create a more positive work environment in the operating room.

Burnout: A Daily Issue

Burnout is a current public health problem whose prevalence varies between countries. Among healthcare professionals, the prevalence can reach up to twice the prevalence observed in the general population (Audegond 2025).

By impairing cognitive functions, the ability to concentrate, react and make decisions, it becomes a source of errors that may have serious consequences for patients. A key factor in the development of burnout among healthcare workers is the lack of recognition. Burnout stems from an imbalance between excessive investment and insufficient acknowledgement. It is a condition fuelled by the desire to help and do well, which is what makes burnout so complex (Bastien 2020). During the COVID-19 period, burnout prevalence increased, highlighting contributing factors such as lack of support at work, staffing shortages, and reduced interpersonal relationships (Afonso et al. 2024).

Burnout in the Operating Theatre: A Mismatch Between Expectations and Recognition

The operating theatre is a place of vulnerability. Professionals face a high patient volume, time and space constraints, and demands for productivity and efficiency. This heavy workload allows for a wide range of potential errors.

Surgical procedures are known to be a major contributor to adverse events (Madrid et al. 2025). An observational study found higher rates of burnout among operating theatre nurses compared with general ward nurses (Li et al. 2025). Interviews with nurses working in operating theatres identified several risk factors. They reported unreasonable schedules, leaving little room for social or family time, and personal activities. There appeared to be a lack of opportunities for promotion and career development, limiting ambition and motivation.

A mismatch between effort and recognition also emerged as a key factor. A general issue of lack of recognition was noted: inadequate pay for the level of effort, limited career progression, and insufficient support from peers and management. This lack of recognition is also expressed through limited participation in decision-making and discussions concerning the patient. This exclusion leads to passivity and detachment from the situation, fostering a low sense of personal achievement. Working in the operating theatre requires significant effort and personal commitment (Li et al. 2025). Constant vigilance, readiness to react, and heavy responsibilities are expected. When working in the operating room, it often becomes a priority. A lack of recognition for that kind of dedication can quickly lead to burnout symptoms.

Moreover, the operating theatre can be a traumatic environment. One study showed that exposure to traumatic events, for instance a sudden patient death, was associated with higher rates of burnout (Wang et al. 2021).

Among surgeons, a qualitative study identified additional factors associated with burnout. Eighty percent mentioned productivity pressure as a source of stress: time and resource deficits, the need to prioritise and hurry certain tasks. The time missing was often taken from that allocated to building relationships with the patient: postoperative visits, communication and interaction with patients.

Frustration from poor organisation was also highlighted, such as the feeling of losing time between procedures. This lack of resources was sometimes interpreted as a sign of institutional disrespect for their work.

Again, we observe an imbalance between institutional pressure for productivity, the stress generated by such demands, and a lack of organisation and support which may be perceived as a lack of institutional recognition (Hughes et al. 2023).

Anaesthesiologists also suffer from those constraints. During the COVID-19 pandemic, an increase in anaesthesiologist burnout was observed, highlighting factors that should be considered to improve workplace environment. Improved support from leadership was described by more than half of anaesthesiologists as a change that could provide significant benefit. This shows once again a need for better work recognition and respect. Other aspects to consider were reduced weekly hours and increased schedule flexibility, in favour of a better work–life balance (Afonso et al. 2024). Indeed, high workload is associated with a higher incidence of burnout (Sanfilippo et al. 2017).

Communication at the Heart of the Operating Theatre

Communication is part of the non-technical skills required in the operating theatre. More than half of perioperative complications are linked to communication problems (Etherington et al. 2019).

A qualitative study emphasised the importance of clear directives for the successful completion of a procedure. Communication errors, such as discrepancies between the planned procedure and the one listed in the scheduling form, or a different surgeon being present, led to poor preparation and frustration among nurses, potentially becoming a source of error.

A climate of trust enables nurses to ask questions, better understand expectations, anticipate requests, and speak up when noticing an error. Nurses also recognise the need for calm and silence during critical moments and describe using silent communication methods when not addressing the surgeon directly (Skramm et al. 2021). A serious environment is clearly needed while a patient is being operated on, but it is important that team members also have lighter moments together. Team-building activities could therefore be of interest in helping to create an open atmosphere. Knowing each other outside those serious moments can help with communication during critical moments. A study from South Korea found that burnout prevalence was lower among staff with better communication skills (Lee et al. 2022).

Operating theatre relationships are characterised by hierarchical imbalance. Doctors tend to be decision-makers and more actively participate in discussions than nurses. Doctors are more often male, and older, while nurses are more often younger women. Although these disparities appear to be slowly decreasing, they may partly explain unequal listening and participation in discussions.

Team integration and team stability are essential components of effective communication. Communication is most productive when team members contribute equally, explicitly share common goals, and act as a cohesive unit rather than as individuals. The need for a specific communication system in the operating theatre has been described before. Standardised communication protocols, similar to those used in aviation, could help team members communicate effectively in complex situations and respond appropriately (Etherington et al. 2019).

Indeed, some communication habits were taken from aviation communication. For example, the expression “sterile cockpit” is used to describe a quiet environment, where unnecessary conversations are prohibited to reduce dangerous distractions. This idea is often needed during a surgical procedure. Task interruption is a major risk of surgical errors. The aim is to find a balance between a positive place where every actor feels free to talk and a serious environment during critical times. It can be the leader’s role to ensure every actor understands when it is a critical time. The leader can be explicitly designated with the words “you have control” to reduce ambiguity (Hardie et al. 2020).

The surgical safety checklist of the World Health Organization was also derived from aviation habits. This checklist showed a beneficial effect on postoperative infections, pneumonias, haemorrhages requiring transfusion, urgent intubation and sepsis (Sotto et al. 2021).

Aviation also uses call signs to rapidly attract attention in cases of emergency. It is very important to give direct and clear orders. Being able to clearly address a request leads to better efficiency and task repartition.

The Theatre Cap Challenge in 2017 consisted of caps labelled with participants’ names and roles. Impersonal requests can lead to frustration and bitterness. They can create distance between team members and, moreover, poor reactivity and assistance during critical situations. It can be difficult to know every person in an operating room; there are many workers and there can be residents or students. Knowing a person’s name and role facilitates clear and appropriate directives. Several studies using a labelled cap as an intervention showed greater willingness to communicate and improved directness, leading to better teamwork (Thota et al. 2023).

As a non-technical skill, communication should be considered as a competence to improve. Some tools, such as the SBAR (Situation, Background, Assessment and Recommendation), appear to improve communication quality and lower errors; the SBAR is now recommended in some countries (Von Dossow and Zwissler 2016). Better communication training would lead to less anxiety, fewer errors and less guilt, and thus fewer burnout symptoms. Simulation training can also be of interest and now has a more important place during anaesthesiology residency (Rochlen et al. 2016).

A study by the French Society of Anaesthesia and Intensive Care showed that incivility is particularly common in the operating theatre. Nurses were more frequently targeted than doctors. Incivility was independently associated with burnout but did not appear to impact empathy towards patients (Raft et al. 2025). Being insulted by a surgeon was independently associated with depersonalisation (Wang et al. 2021). Every team member should be able to regulate their emotions, as disagreements can quickly create tension (Li et al. 2025).

We therefore observe a need for communication training and organisation at two levels. First, communication during the procedure must be structured, clear and designed to trigger coordinated reactions at critical moments, reducing errors. More generally, communication within the team must be open and respectful, fostering a positive culture around error management, preventing verbal aggression during disagreements, and preserving team morale.

Burnout Prevention Strategies

Several interventions have been shown to reduce burnout symptoms in the operating theatre. An interventional study showed that music reduced emotional exhaustion. This practice appears increasingly common in operating rooms (Kacem et al. 2025).

Microbreaks can also reduce emotional exhaustion and depersonalisation, while improving the sense of personal achievement. They also enhance patient safety and satisfaction. Nurses emphasised the need for structured organisation for these breaks; without it, they occur less frequently. Break organisation must consider staff rotation, timing and frequency. Some clinical situations, such as patient instability, naturally prevent breaks from being taken, and patient safety must always remain the priority (Gao et al. 2025).

Noise is another modifiable factor. Higher levels of emotional exhaustion and depersonalisation were observed in noisier operating rooms, such as during orthopaedic surgery (Wang and Wu 2025).

In anaesthesia, artificial intelligence has been tested to schedule operating lists. The system considered each doctor’s preferences, applying more than 400 rules. After six months, emotional exhaustion had decreased, and there were fewer changes of anaesthetist during a procedure. Handover during surgery can lead to information gaps, causing stress and errors (Sumrall et al. 2025).

There is a vicious cycle between errors and burnout in the operating theatre. Cognitive impairments caused by burnout can lead to mistakes, and mistakes have significant mental health repercussions. Errors contribute to depersonalisation and low personal achievement. Among surgeons, higher rates of addiction, hypertension and cardiovascular disease have been observed.

These consequences align with the concept of the “second victim”: psychological harm from exposure to traumatic events and physical harm from chronic stress. Poor recognition of burnout and inaccurate self-diagnosis were also noted.

An important avenue for addressing burnout is improving its management. This should begin with better education on errors—how to respond, how to accept them, and how to foster a climate of trust within teams. Such an approach helps reduce errors through improved learning. A structured screening and support programme could include teleconsultations and organised access to psychiatric care (Awuah et al. 2024).

All these measures are useful and necessary, but it would be unrealistic to think they can solve burnout alone. Burnout is an organisational problem that would need an entire healthcare system reform to be fully addressed.

A Culture of Burnout

Burnout risk factors seem to be rooted in healthcare systems. There are several organisational culture perspectives. Clan culture is described as a family-like environment that provides psychological safety. Adhocracy culture leads to constant research to improve care, encouraging creativity and promoting development and efficiency. Market culture prioritises productivity and performance and can therefore create competition between healthcare workers. Lastly, hierarchy culture is based on leaders, who have major responsibilities, and can lead to poor implication from other healthcare workers. Each culture has its benefits and inconveniences. A positive organisational culture would need a combination of all cultures: prioritising innovation and progress to improve patient care, enhancing leadership training to provide a supportive work environment, and strengthening team building and communication (Wei and Mahadi 2025).

Shame and blame culture are often reported in the operating room. Surgical training has been identified as having the highest rate of shame and harassment, leading to low self-confidence and poor personal accomplishment (Boehm et al. 2019).

The surgeon is often seen as the team leader, the “captain of the ship”, taking responsibility for their entire team in the eyes of the patient, making errors unacceptable and creating a blame culture. Each error feels individual whereas it is systemic. Blaming one person is an easy solution to a complex problem; blaming one person for a mistake without acknowledging the whole accumulation of errors can be inappropriate in a teamwork environment (Dickey et al. 2003).

Surgical errors can be devastating for the patient and are therefore intolerable. The surgeon creates an unrealistic expectation of perfection, doomed to failure. The pursuit of perfection, while guiding improvement, silences surgeons who are suffering. Excessive working hours are normalised and are sometimes seen as necessary to be a good surgeon. Suffering is also normalised through dehumanisation. Operating room workers witness traumatising cases that become their everyday life. To deal with those cases, it is expected of them to be strong, and sometimes even emotionless. Empathy can sometimes be mistaken for weakness. Emotional distance seems to be a part of job expectations (Callon and Rabeharisoa 1999).

Responsibilities are also carried by anaesthesiologists during stressful scenarios, such as cardiac arrest, difficult airway management and other life-threatening situations (Sanfilippo et al. 2017). Being exposed to those traumatic events every day forces their normalisation, and then sometimes detachment or depersonalisation. An association between burnout symptoms and alexithymia, a difficulty in identifying and acknowledging emotions, has been observed (Vittori et al. 2022).

The organisational culture of healthcare institutions plays a crucial part in the normalisation of suffering. This minimisation is so rooted in the healthcare system that it can become integrated in our minds. Fear of colleagues’ judgement creates a vicious environment. The absence of distress recognition brings about silence, a survival mechanism. Disengagement and apathy become responses to “organisational deafness”. Sometimes, it seems as though the only answer would be to quit the job, but in healthcare, devotion is central, and healthcare workers often feel that leaving bad working conditions would be like abandoning patients, unfairly.

Therefore, suffering is incorporated into their everyday life and minimised to become bearable. In that way, suffering becomes a taboo, a shame, through which sacrifice culture lives. Wanting to work less appears as laziness and not being able to hold the pressure is seen as a weakness. A qualitative study highlights that healthcare systems should be managed by persons who have a healthcare background, and not by people who have a management or economics background (Glauzy and Montlahuc-Vannod 2025).

Conclusion

Burnout is a daily issue in the operating room where stress is permanent and exigencies are high.

Burnout is obviously a very complex issue, and it would be unrealistic to think it can be solved with one unique solution. It should be seen as a multifactorial problem that needs to be worked through across different facets. Stress at work starts with inadequate preparation; education, anticipation and training can help reduce anxiety symptoms, errors and the vicious circle of burnout symptoms. Productivity expectations need adequate resources. Motivation and participation need inclusion and work recognition to be maintained. Communication, central in the operating room, is a skill that can be learnt. Better communication can lead to less stress, frustration and misunderstanding. Team members’ relationships could also be reinforced to ensure better support from peers. Additionally, burnout relies on staff shortages and organisational issues that can only be solved at a systemic level.

Stopping burnout appears to be an impossible goal as healing people will always have high expectations, the need for efficiency and constant progress dynamic. However, working in a better environment does not necessarily mean less efficient care for patients; it would also benefit patients.

Preventing burnout among healthcare workers in the operating room is a dynamic that should be considered globally. Although it is important that every team tries to implement small changes such as microbreaks, meditation and music, burnout is a much more complicated issue that would need complex solutions. Opening up about burnout and its factors is crucial in highlighting the need for recognition from organisations. Accepting that burnout is not a weakness, but rather a systemic flaw, can help its prevention. It is important to continue studying burnout to improve its management.

Conflict of Interest

Lucie Toullec: none declared. Samir Jaber: consulting fees from Drager, Medtronic, Mindray, Comen, Baxter, and Fisher & Paykel. Audrey De Jong: remunerations for presentations from Medtronic, Drager, and Fisher-Paykel.