Aim This study explored the degree of burden of chronic exposure to difficult ethical decisions on health care providers (HCP) in Swiss level III NICUs.

Methods 224 questionnaires were sent to neonatologists and nurses of all level III NICUs. Demographical information, attitudes and behaviours towards ethical decisions, and the impact of those decisions on HCP’s health and private life were collected.

Results 52 neonatal physicians and 60 nurses (27 men, 85 women, overall response rate 50%) took part in this survey. Altogether, 78% stated that the ethical dilemmas/decision-making represent a burden to them. 87% experience this burden as momentary. In nearly 40%, this burden affects private life; in another 48% it occasionally impact on private life. 25% of physicians and 10% nurses suffer from exhaustion. Most of the respondents find relief from stress through their hobbies (70%) and discussions with family members and friends (74%). The most used coping strategies are debriefings after ethical discussions, team discussions and support from hospital pastoral care. Professional moderation of debriefings was only rarely available (10%).

Conclusion Chronic exposure to stressful situations represents a burden for the majority of HCP working in NICU environment. Exhaustion is far more frequent than physical and psychosomatic symptoms. Hobbies and social contacts are important coping strategies. Given the potential of chronic burden to not only affect health of caregiver but also to shape the attitudes of caregivers in daily neonatal intensive care medicine, the importance of team debriefings and support under professional guidance cannot be stressed enough.