Let's Talk It Out

Understanding the connection between safe learning environments and better patient care

By Abdullah Alismail, PhD, RRT-NPS, FCCP
June 14, 2024 | SPRING 2024 ISSUE

Ever since I was a respiratory therapy student, all the way until my last day working at bedside before transitioning to academia, one of the most fun and exciting places to work was in high-intensity, fast-paced areas like an ICU or emergency room. I’ve always referred to us ICU clinicians as adrenaline junkies. However, this kind of excitement has its ups and downs.

One of the key reasons I became a respiratory therapist was because I knew I would be able to save lives and provide that breath of life to others. When a patient arrives at the emergency room short of breath and you can make a difference—nothing beats that.

However, I still remember the days when I felt mentally and emotionally exhausted after my long, 12-hour shifts. When I got home, I wouldn’t want to talk to anyone; I would just go out for a walk or run. This wouldn’t happen after every shift, but when it did, it was usually due to a specific incident or difficult case, losing a patient, or an increase in workload.

As clinicians working in high-stress areas, negative emotions can impact our mental health and can cause issues such as depression. Therefore, we try to hold any negative emotions in so we can take care of the next patient. Unfortunately, this gets worse when there’s a lack of communication or debrief with team members, or when we don’t feel empowered to ask a question or simply share a concern. Examples like this would increase my emotional exhaustion and cause the feeling of burnout. Thus, debrief and communication will be beneficial to prevent this.

“We try to hold any negative emotions in so we can take care of the next patient. ”

Interestingly, it is not only specific patient-related events that create emotional exhaustion and burnout for clinicians. The environment itself can add to the stress. For example, in a study that was done to investigate the relationship between alarm fatigue and burnout among nurses, alarms in the critical care units were shown to be independently associated with exhaustion, specifically emotional exhaustion.1 Scott and colleagues also provided a great review on mechanical ventilator alarms and their effect on clinicians—to the point where clinicians became desensitized to those alarms.2 All of this has been documented as critically related to patient safety and clinician psychological safety.3,4,5,6

When I became a clinical faculty member overseeing student rotations at various sites, I thought I would suffer less from emotional exhaustion, but I was wrong. Mentorship and guidance are a key component of a clinician educator’s role. This is where students are introduced to the concept of psychological safety and given the tools they will need.

I remember many scenarios when I would intentionally walk with students outside of the clinical area just to debrief or “talk it out.” Students need to learn that their own mental health and psychological safety are directly related to patient safety once they are practicing independently.

Knowing that we are not alone is very important. Debriefing with our team members is where learning occurs. It empowers us to speak up and share our concerns, ask questions about an event, admit a mistake, or simply vent.

“Students need to learn that their own mental health and psychological safety are directly related to patient safety.”

The amount of literature that highlights what clinicians experience is increasing. During the COVID-19 pandemic, these challenges and concerns spiked to the point where some clinicians encountered social isolation, stigmas, emotional exhaustion, and stress.7,8 This simply added to the current literature.

This shows the need for more education, research, and guidance for clinicians to shed light on the importance of mental health to overcome burnout. The literature clearly shows that hospitals and institutions that implement tools for psychological safety—such as team empowerment and increased communication—ensure a safe environment for learners and better patient safety.

The concept of psychological safety is a critical component of our day-to-day tasks and is embedded in what we do as clinicians. In a recent journal CHEST® article by Santhi Kumar, MD, she highlights components of team behavior that play key roles in psychological safety, such as collaboration, engagement, and patient safety with team members.9 Connecting with members of your team empowers them to ask questions and share their concerns, and it improves patient safety from a quality improvement standpoint.10 Students are often—if not always—afraid to speak up. Dr. Kumar explained some of the apprehension that many learners or beginners feel regarding speaking up: “The impact of speaking up can be wide-ranging. It could result in a poor evaluation or an unenthusiastic letter of recommendation for trainees… The result of our silence can lead to a loss of productivity, dissatisfaction, and patient harm.”9

“Knowing that we are not alone is very important. Debriefing with our team members is where learning occurs.”

To ensure success in psychological safety, certain factors must be considered: the individual (learner, clinician, provider, educator, leader), the team dynamic (communication among members, empowerment, trust, closed-loop communication), and environmental readiness (safe environments, protocols such as debrief and Team Strategies and Tools to Enhance Performance and Patient Safety [TeamSTEPPS®], etc). Knowing that clinician well-being is tied to a variety of dynamic factors and stakeholders places the responsibility on all (clinicians, educators, administrators, leaders, units, and institutions) to create a safe and empowering environment.

Dr. Abdullah Alismail

Dr. Abdullah Alismail is an Associate Chair and Associate Professor in the Department of Cardiopulmonary Sciences at Loma Linda University. He is the Program Director of both the Respiratory Care (Entry-level), BS, and Master of Science in Respiratory Care (MSRC) Programs. He also serves as a member of the CHEST Education Committee and Educator Development Subcommittee. Dr. Alismail is an Associate Editor of several peer review journals in the field of pulmonary medicine and medical education. His research interests are in medical education, pulmonary medicine, respiratory care, and innovation.


  1. Ding S, Huang X, Sun R, et al. The relationship between alarm fatigue and burnout among critical care nurses: a cross-sectional study. Nursing in Critical Care. 2023;28(6):940-947. Accessed May 8. 2024.
  2. Scott JB, Vaux LD, Dills C, Strickland SL. Mechanical ventilation alarms and alarm fatigue. Respiratory Care. 2019;64(10):1308-1313. Accessed May 8, 2024.
  3. Sendelbach S, Funk M. Alarm fatigue: a patient safety concern. AACN Advanced Critical Care. 2013;24(4):378-386. Accessed May 8, 2024.
  4. Storm J, Chen HC. The relationships among alarm fatigue, compassion fatigue, burnout and compassion satisfaction in critical care and step-down nurses. Journal of Clinical Nursing. 2021;30(3-4):443-453. Accessed May 8, 2024.
  5. Movahedi A, Sadooghiasl A, Ahmadi F, Vaismoradi M. A grounded theory study of alarm fatigue among nurses in intensive care units. Australian Critical Care. 2023;36(6):980-988. Accessed May 8, 2024.
  6. Nyarko BA, Yin Z, Chai X, Yue L. Nurses’ alarm fatigue, influencing factors, and its relationship with burnout in the critical care units: a cross-sectional study. Australian Critical Care. 2024;37(2):273-280. Accessed May 8, 2024.
  7. Evans DL. The impact of COVID-19 on respiratory therapist burnout. Respiratory Care. 2021;66(5):881-883. Accessed May 8, 2024.
  8. Miller AG, Roberts KJ, Smith BJ, et al. Prevalence of burnout among respiratory therapists amidst the COVID-19 pandemic. Respir Care. 2021;respcare.09283.
  9. Kumar S. Psychological safety: what it is, why teams need it, and how to make it flourish. Chest. 2024;165(4):942-949. Accessed May 8, 2024.
  10. Dietl JE, Derksen C, Keller FM, Lippke S. Interdisciplinary and interprofessional communication intervention: how psychological safety fosters communication and increases patient safety. Front Psychol. 2023;14. Accessed May 8, 2024.

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