Relationship between nurse burnout, patient and organizational outcomes: Systematic review

Association Between Psychological Empowerment and Intent to Stay Among Military Hospital Nurses: The Mediating Effects of the Practice Environment and Burnout

AIMS

To explore the impact of psychological empowerment on nurses' intent to stay in military hospitals as well as the mediating effects of the practice environment and burnout in this context.

DESIGN

This study employed a cross-sectional survey approach and followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for reporting.

METHODS

A total of 1225 nurses from nine military hospitals were recruited via convenience sampling. Questionnaires were distributed and collected via the Questionnaire Star platform. The study variables, including psychological empowerment, the practice environment, burnout and intent to stay, were assessed via self-report questionnaires. SPSS 23.0 software was used to conduct descriptive and correlation analyses. Additionally, PROCESS Model 6 was employed to examine the mediating effects.

RESULTS

Psychological empowerment is positively associated with nurses' intent to stay. Mediation analysis revealed that the practice environment, burnout and the chain mediating effect of the practice environment and burnout accounted for 54.5%, 2.8% and 1.5% of the total effect respectively.

CONCLUSION

Psychological empowerment affects nurses' intent to stay not only directly but also indirectly via the practice environment and burnout.

IMPLICATIONS FOR THE PROFESSION

Nursing managers may consider utilising psychological empowerment as a management strategy to enhance nurses' perceived practice environment, reduce burnout and ultimately increase nurses' intent to stay. This approach has the potential to lower turnover rates among nurses.

PATIENT OR PUBLIC CONTRIBUTION

Questionnaires completed by nurses were used to explore the relationships among psychological empowerment, the practice environment, burnout and intent to stay in this context.

Occupational Burnout in Nurses Is due to Long-Term Work Stress Rather Than COVID-19 Pandemic Event

AIM

This study aims to explore occupational burnout among Chinese nurses from two perspectives: first, by comparing changes in emotional exhaustion, depersonalisation and personal accomplishment before and after the COVID-19 pandemic; and second, by identifying long-term work-related stressors and structural factors contributing to burnout.

DESIGN

A mixed-methods approach was adopted, combining a systematic review with qualitative interviews. The qualitative component involved semi-structured interviews with 53 hospital-employed nurses from various departments and regions across China, focusing on the three core dimensions of occupational burnout.

METHODS

The systematic review included both Chinese and English-language studies published between 2016 and 2023 that used the Maslach Burnout Inventory to assess burnout among nurses. A total of 22 studies met the inclusion criteria, selected independently by two researchers using the JBI critical appraisal tool. In parallel, the qualitative interviews explored nurses' subjective experiences and coping strategies related to work stress, emotional fatigue and professional identity.

RESULTS

Bayesian factor analysis indicated no significant differences in emotional exhaustion (BF01 = 2.202), depersonalisation (BF01 = 2.761) or personal accomplishment (BF01 = 2.747) before and after the pandemic. Qualitative findings revealed that burnout was primarily driven by long-standing systemic stressors, including promotion pressure, clinical workload, organisational demands and work-family conflict. Although many nurses relied on self-regulation strategies to maintain psychological stability, they continued to experience ongoing physical and emotional exhaustion. Some reported emotional numbness, but most retained empathy and a strong sense of responsibility. Their sense of personal accomplishment often stemmed from patient recovery and recognition of professional value.

CONCLUSION

Occupational burnout among Chinese nurses remained largely stable before and after the COVID-19 pandemic. Its root causes stem from persistent work-related stressors and systemic issues, rather than the pandemic itself. Effective mitigation requires institutional strategies, including better staffing, clear career pathways and sustained emotional support.

IMPACT

Short-term crisis responses alone are insufficient to address enduring burnout. Nursing leadership should prioritise systemic reforms-such as optimising shift schedules, defining promotion channels and integrating regular psychological support-to enhance nurse well-being and care quality.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Global prevalence and contributing factors of nurse burnout: an umbrella review of systematic review and meta-analysis

INTRODUCTION

Nurse burnout negatively impacts patient care quality, safety, and outcomes, while harming nurses' mental health, job satisfaction, and retention. It also imposes financial burdens on healthcare organizations through absenteeism, reduced productivity, and higher turnover costs, highlighting the need for research to address these challenges. The umbrella review methodology was selected to integrate evidence from multiple systematic reviews and meta-analyses, offering a broad and in-depth summary of existing research to guide practice and policy. This approach equips stakeholders with a holistic understanding of the multifaceted impacts of nurse burnout, facilitating the design of effective interventions that support nurses, enhance healthcare delivery, and optimize patient outcomes. Consequently, this umbrella review aims to evaluate the global prevalence and contributing factors of nurse burnout.

METHODS

This umbrella review included 14 systematic reviews and meta-analyses identified from various databases. The quality of each study was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR II). Data were extracted using Microsoft Excel and analyzed with STATA 17.0. Heterogeneity was measured using Higgin's I2 Statistics, and summary prevalence estimates were calculated with the Der Simonian-Laird random-effects model. Meta-regression and subgroup analyses were conducted to identify the source of high heterogeneity. Publication bias was assessed using funnel plots and Egger's regression test, with the former providing a visual assessment of bias and the latter offering a statistical method to detect asymmetry.

RESULTS

The global prevalence of nurse burnout was evaluated in three areas: emotional exhaustion (33.45%, 95% CI 27.31-39.59), depersonalization (25.0%, 95% CI 17.17-33.00), and low personal accomplishment (33.49%, 95% CI 28.43-38.55). Emotional exhaustion was most common among nurses working during the COVID-19 pandemic (39.23%, 95% CI 16.22-94.68). Oncology nurses experienced the highest rate of depersonalization (42%, 95% CI 16.71-77.30), while nurses in intensive care units reported the highest rate of low personal accomplishment (46.02%, 95% CI 43.83-48.28).

CONCLUSIONS

Nurse burnout is prevalent worldwide, often marked by a sense of low personal accomplishment. Several factors contribute to this issue, including role conflict, negative emotions, family problems, moral distress, stress, commuting distance, predictability of work tasks, and workplace advancement.

Understanding burnout among operating room nurses: a qualitative study

Objective

This study aimed to explore the lived experiences of job burnout among operating room nurses and to provide an evidence-based foundation for developing targeted nursing interventions to mitigate job burnout in this population.

Method

A purposive sampling method, guided by the principle of maximum variation, was employed to recruit 14 operating room nurses from a tertiary Grade A hospital in Anhui Province in January 2025. A phenomenological research approach was adopted, utilizing semi-structured interviews for data collection. Interview data were analyzed using Colaizzi's seven-step method. Data collection continued until thematic saturation was achieved-meaning no new themes emerged in subsequent interviews.

Results

Eight major themes and thirteen subthemes were extracted. Among these, five major themes were identified as factors contributing to occupational burnout among operating room nurses, while three major themes were related to coping strategies. Specifically, the findings indicated that occupational burnout among nurses was closely associated with excessive workload, insufficient emotional support, career development stagnation, and the high-pressure dynamics of healthcare relationships. Nurses commonly reported a lack of professional fulfillment and an absence of effective strategies to cope with emotional exhaustion in their work.

Conclusion

Burnout among operating room nurses results from the interplay of multiple factors. This study identifies key mechanisms underlying burnout in nurses working in high-pressure environments, emphasizing the importance of improving organizational support, optimizing nurse-physician communication, and clarifying career development pathways. These findings provide a theoretical basis for the development of targeted nursing management strategies and interventions, which may effectively alleviate nurse burnout and enhance both nursing quality and team stability.

Latent Profiles of Nurses' Insomnia, Fatigue, Recovery, Psychological Distress and Burnout During the COVID-19 Pandemic: Examining the Role of Organisational Support

AIMS

To identify latent profiles of insomnia, fatigue, recovery, psychological distress and burnout among hospital nurses; examine variations in personal and work-related characteristics across profiles; investigate associations between profiles and outcomes such as patient care quality, nursing work satisfaction and workplace satisfaction; and assess the moderating role of organisational support on these relationships.

DESIGN

A cross-sectional descriptive study.

METHODS

This study analysed survey data from 2488 hospital nurses using latent profile analysis, multinomial logistic regression and hierarchical multiple linear regression.

RESULTS

Four well-being profiles emerged: low, average, above-average and high well-being. Profiles differed significantly in personal and work-related characteristics. Nurses in the high well-being profile were associated with better patient safety, care quality and satisfaction. Organisational support moderated the negative associations between low well-being profiles and nursing work and workplace satisfaction.

CONCLUSION

Tailored interventions addressing factors associated with low well-being and enhancing organisational support may be beneficial for improving nurse well-being, delivering high-quality care and supporting nurse retention in sustainable healthcare environments.

IMPLICATIONS

Healthcare organisations should prioritise nurse well-being through targeted interventions, adequate staffing, recovery opportunities and stress management resources to support a resilient and sustainable workforce.

IMPACT

The findings revealed the diversity of well-being patterns among hospital nurses and provided insights for identifying subgroups at higher risk of impaired patient safety, reduced care quality and dissatisfaction with nursing work and the workplace. Greater organisational support was associated with weaker negative relationships between poor well-being and nurse outcomes.

REPORTING METHOD

STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No direct patient or public contribution.

Knowledge, attitudes, practices, and burnout related to respiratory support among healthcare professionals in central China: a structural equation modeling study

BACKGROUND

Burnout, marked by emotional exhaustion and reduced clinical performance, may impair the effective application of noninvasive respiratory support (NIRS) and timely transition to invasive methods, potentially affecting patient outcomes. This study aims to identify the impact of burnout on the knowledge, attitudes, and practices (KAP) of healthcare professionals in the application of respiratory support, and further explore how other factors may influence these areas.

METHOD

A cross-sectional study was conducted from November 15, 2023, to December 14, 2023, at multiple hospitals in central China, involving key departments such as emergency, respiratory, cardiology, and critical care. Demographic information, alongside scores measuring KAP was gathered through the dissemination of questionnaires. Knowledge was assessed using a scoring system (range: 0-24), while attitude and practice were measured using 5-point Likert scales, with score ranges of 8-40 and 8-56, respectively. The Chinese version of the Maslach Burnout Inventory General Survey (MBI-GS) was used to assess occupational burnout.

RESULTS

A total of 517 valid questionnaires were enrolled, including 284 (54.9%) nurses, and 269 (52%) had worked for less than 10 years. The median scores for knowledge, attitude, practice, and burnout were 20, 26, 38, and 40, respectively. Participants from private hospitals exhibited burnout scores higher than 50. Burnout was negatively correlated with both attitude (r = -0.289) and practice (r = -0.206). Multivariate logistic regression showed that practice, as the dependent variable, was independently associated with a knowledge score below 20 (OR = 0.441, 95% CI: [0.297, 0.657]), an attitude score below 26 (OR = 0.493, 95% CI: [0.335, 0.724]), and burnout scores below 40 (OR = 0.539, 95% CI: [0.364-0.796]) were independently associated with practice. Age above 40 years (OR = 0.470, 95% CI: [0.264, 0.837]), being a nurse (OR = 0.627, 95% CI: [0.424, 0.928]), and lack of recent training in respiratory support (OR = 0.590, 95% CI: [0.403, 0.866]) were also associated with lower practice scores.

CONCLUSIONS

Healthcare professionals had sufficient knowledge, positive attitudes, and proactive practices regarding the application of respiratory support. However, the impact of burnout must not be overlooked, even for those scoring below the threshold (50 points), as burnout can still significantly affect clinical performance. Healthcare institutions should prioritize continuous education and training programs focusing on respiratory support, especially for high stress environment professionals, to enhance clinical practice and patient outcomes.

CLINICAL TRIAL NUMBER

not applicable.

Nurse stress and patient safety in the ICU: physician-led observational mixed-methods study

INTRODUCTION

Nurses working in intensive care settings are required to maintain constant vigilance, yet they often experience high stress and burnout, which can compromise the quality of patient care.

OBJECTIVES

To identify stress and burnout among intensive care nurses, contributing risk factors and impact on patient safety, while providing an opportunity for nurses to discuss their work-related challenges.

METHODS

Setting: Observational mixed-methods study done in intensive care unit (ICU), tertiary teaching hospital, Kerala, India in July 2024.

PARTICIPANTS

Thirty nurses in the ICU (all females, mostly aged 25-35 years, >5 years of work experience) completed standardised questionnaires on stress levels, workload, burnout and work satisfaction. From this group, six nurses underwent structured interviews. Purposive sampling was done to capture diverse experience and roles. Reported patient safety incident data were collected.Severity of stress, workload, burnout and work satisfaction were classified into high or low levels based on predefined cut-off scores.

RESULTS

86.7% reported moderate to high levels of combined outcomes of workload, stress or burnout, with 46.7% experiencing high levels of stress. Four major themes were identified in the qualitative analysis: stress, attitudes, patient safety and nurses' unmet demands and aspirations. Positive attitudes identified were passion, motivation and empathy. Key stressors included work overload, inadequate staffing, logistics, team and management support. Coping strategy was family-centred. A perceived need for a non-punitive, learning-oriented environment was identified for fostering patient safety culture. Nurses' demands included facility safety, managerial support and better resources, both man and machine.

CONCLUSIONS

Despite the specific challenges faced by ICU nurses in developing countries, they upheld positive values. Institutional leadership's commitment to implement patient safety culture and improve nurses' work environment is important. Future research should involve larger multicentre interventional studies.

An ecological approach to humanizing healthcare organizations for patients, providers, and communities

Healthcare delivery exposes care providers and leaders to suffering, loss, moral dilemmas, conflicts, and overwhelm. The cumulative effects of workplace stress and trauma have organizational impacts (turnover, cynicism, and conflict), personal impacts (burnout, mental illness, and traumatic stress), and patient care impacts (reduced empathy, poor communication, and errors). Organizations have attempted to address these issues largely through individual wellness offerings. A systematic approach is needed to create environmental conditions that support people to remain resilient, engaged, and compassionately connected in the face of constant trauma exposure. This article describes an ecological model for developing and sustaining resilience based in neuro and social science. It includes practical strategies to reshape leaders' understanding, perspectives, and competencies to enhance systemic well-being.

Undergraduate nursing students' personality and learning effectiveness in high-fidelity simulation education

AIM

To examine the correlation between undergraduate nursing students' personality and high-fidelity simulation learning effectiveness.

BACKGROUND

Simulation is a fundamental approach in nursing education, with learning outcomes associated with various factors. Personality, reflecting on one's way of learning, thinking and behaving, is a potential factor associated with simulation learning.

DESIGN

A descriptive correlational study was conducted.

METHODS

68 final year undergraduate nursing students completed an online survey following a high-fidelity nursing simulation. The five personality traits of neuroticism, extraversion, openness, conscientiousness and agreeableness were examined using the Neuroticism-Extraversion-Openness Five-Factor Inventory 3 (NEO-FFI-3). To investigate the relationship between personality and learning effectiveness, the revised English version of the Simulation Learning Effectiveness Inventory (SLEI) was also completed.

RESULTS

No significant association was found between the five personality traits and students' simulation learning effectiveness. However, the SLEI subscale of 'resources' was positively correlated with the trait of conscientiousness (r = 0.248, p = 0.04). In addition, students' nursing work experience was associated with their learning effectiveness in high- fidelity simulation. Nursing students scored the highest in the personality trait of agreeableness (35.04 SD 5.28) and the lowest in that of neuroticism (26.53 SD 7.33).

CONCLUSIONS

Understanding personality assists in the application of best practice simulation for undergraduate nursing students. The design and implementation of high-fidelity simulation needs to consider students' previous nursing work experience.

The Impact of Chaplaincy Departments on Hospital Patient Experience Scores

GOAL

Chaplaincy departments may be an important resource for directly improving patient experience, and they may indirectly provide staff support resources to address workplace well-being. However, there is little empirical evidence to support whether or not having a chaplaincy department is associated with positive benefits for acute care hospitals.

METHODS

This study used survey data from the American Hospital Association Annual Survey, the Area Health Resource File, and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data by the Centers for Medicare & Medicaid Services (CMS) to examine urban adult acute care hospitals between 2015 and 2019 and determine whether having a chaplaincy department impacted HCAHPS patient experience scores.

PRINCIPAL FINDINGS

Hospitals with chaplaincy departments reported higher HCAHPS global ratings and higher ratings of patients likely to recommend the hospital.

PRACTICAL APPLICATIONS

The study demonstrates that chaplaincy services may be an underutilized tool to improve patient experience scores. The scores are critical for hospital reimbursement, improved patient outcomes, and patient loyalty. In October 2022, CMS began allowing hospitals to start coding for chaplaincy service encounters. As a result, we may now see even more evidence demonstrating the positive relationship between chaplaincy services and other important hospital metrics.

Faculty perceptions of wellness at an academic medical center

BackgroundDespite national recommendations and decades of literature highlighting the importance of faculty wellness, gaps at academic medical centers remain. Multilevel wellness initiatives are necessary to create change and optimally support academic faculty.ObjectiveThe purpose of this study is to examine faculty perceptions of factors contributing to lack of wellness and proposed solutions in the context of current resources at our academic medical center in the Mid-Atlantic region of the United States.MethodsThe Georgetown University Medical Center Faculty Development Committee created a Wellness Task Force in response to a charge by leadership. The 11-member Task Force included faculty members from different disciplines: psychiatry, neurology, family medicine, pediatrics, nursing and oncology. Data collection occurred September 2021 to January 2022. Interviews and focus groups elicited faculty input on 1) factors that contribute to and detract from wellness and 2) strategies to enhance wellness within our academic medical center.ResultsFaculty described individual and organizational factors contributing to lack of wellness: challenges with balance; lack of connection, autonomy, resources and feeling valued; communication; culture; attention to diversity, equity, and inclusion; leadership; and workload. Proposed solutions included a comprehensive, centralized and consistent plan; culture change; incentives; increased autonomy, feelings of value, and resources.ConclusionsWellness as a budgetary priority and strategic initiative remains a critical goal for academic medical centers. Faculty perceptions of factors contributing to lack of wellness and proposed solutions underscore and add to national recommendations.

Improving Neonatal Abstinence Syndrome Outcomes and Nurse Experiences: Integrating Responsive Bassinets With Eat, Sleep, Console

BACKGROUND

The COVID-19 pandemic disrupted our practice of outpatient methadone weaning for pharmacologic management of infants with neonatal abstinence syndrome (NAS), resulting in increased average length of stay (ALOS). In response, we integrated a responsive Bassinet (SNOO), into our Eat, Sleep, Console (ESC) care model.

PURPOSE

Our primary aim through this quality improvement work was to explore whether integration of SNOO within our ESC care model had an impact.

METHODS

Using quality improvement methodologies, a retrospective chart review was conducted for neonates admitted to the NICU for NAS from December 2020 to September 2022 (N = 109). Study inclusion criteria were primary diagnosis of NAS, birth gestational age ≥35 weeks, and absence of other co-morbid diagnoses. Neonates were organized into two groups based on date of bassinet implementation. An online survey was sent to 76 NICU nurses 6 months post-implementation. Outcome measures included ALOS, number of sleep-related "yes" scores (indicating poor sleep), and nurse experience.

RESULTS

Of 109 infants, 13 met inclusion criteria ALOS declined by 17.38% (P=.57), and "yes" scores decreased by 41.72% (P=.52). Nurses reported an average of 2.43 hours saved per 12-hour shift.

IMPLICATIONS FOR PRACTICE AND RESEARCH

The addition of SNOO as a non-pharmacologic intervention within ESC care models for infants with NAS may lead to a decreased average length of stay, improved infant sleep, and improved nursing experience (such as time savings).

Transformational and Abusive Leaders and Their Influence on Employee Physical Ill-being: A Multilevel Longitudinal Study Exploring Negative Motivational-Affective Mechanisms

While research on leadership and employee physical ill-being is burgeoning, the short- and long-term mechanisms through which leadership influences employee physical ill-being remain underexplored. This research, grounded in leadership theories and the Job Demand-Resource (JD-R) theory, examines how transformational and abusive leadership behaviors influence employee physical ill-being through two conflict-related negative motivational mechanisms (negative work-home interactions and job role conflict) and two negative affective mechanisms representing short-term (negative affect) and long-term (burnout) mechanisms. Employing a three-wave longitudinal design over 6 months (N = 234), our findings from a multilevel path analysis revealed that transformational and abusive leadership had respectful, negative and positive effects on employee physical ill-being via conflict-related negative motivational mechanisms and short- and long-term affective mechanisms. Notably, the influence of leadership behaviors on employee physical ill-being was more pronounced through the short-term affective mechanism (negative affect) than the long-term affective mechanism (burnout). Our findings provide a nuanced understanding of how leadership behaviors affect employee physical ill-being over time, shedding light on the dynamic interplay of motivational and affective pathways in this relationship.

Burnout syndrome and accidents in primary healthcare nursing workers: a scoping review

CONTEXT

Burnout syndrome is characterized by intense physical and psychological exhaustion related to work. Many professionals are exposed to this condition, but nursing workers stand out. Working in primary healthcare requires a lot of attention and constant demands that can lead to exhaustion and thus make them more vulnerable to occupational accidents. This study aimed to map the profile and summarize the available scientific evidence on burnout syndrome and its relationship with accidents among primary health care nursing workers, as well as ways of coping.

METHODS

A scoping review was carried out in the National Library of Medicine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science (WoS), Excerpa Medica DataBASE (Embase), PsycINFO-APA PsycNET (American Psychological Association) and Latin American and Caribbean Literature in Health Sciences (LILACS) databases, published in Portuguese, Spanish, or English, without a time frame. Partial research reports, editorials and response letters were excluded.

RESULTS

A total of 872 articles were found from primary sources and 11 from references cited in articles. After selection and application of eligibility criteria, a sample of 11 materials was obtained. The studies showed convergence in some findings that were grouped into the following categories: Profile and risk factors for occupational accidents associated with burnout; Risks and harm to patients; and Strategies for coping with and reducing accidents associated with burnout.

CONCLUSION

The materials were published mainly in English, produced in various regions of the world and using different methods. Primary healthcare nursing professionals providing direct patient care, with less experience and with a medium level of education were those who most frequently reported accidents resulting from burnout. Accidents involving biological and chemical materials were the most frequent and were associated with the need for very quick decision-making, little training, excessive demands and long working hours. There were repercussions on patient safety and accidents further aggravated the feeling of professional burnout. Coping measures include the use of stress and fatigue measurement instruments, training to reduce accidents and internet-based interventions. The studies' methodological quality suggests the need for more in-depth experimental research to suggest more assertive evidence.

Assessing Patient Satisfaction with Hospital Services: Perspectives from Bihor County Emergency Hospital, Romania

BACKGROUND/OBJECTIVES

The objective of this study is to assess overall patient satisfaction with hospital services, including cleanliness, ward conditions, and food quality. Another key goal is to determine patient willingness to return for future medical services and identify the factors influencing this decision. Moreover, the study explores the relationship between patient satisfaction and continuity of care, as indicated by previous hospitalizations.

METHODS

We conducted a retrospective cohort study to evaluate patient satisfaction at the Bihor County Emergency Clinical Hospital in Oradea, Romania. A standardized 40-item questionnaire was developed in accordance with the Framework Agreement on the provision of medical assistance within the Romanian healthcare system. The survey, which was administered over a four-year period (2019-2022), covered seven domains: demographic data, accessibility, hotel conditions, quality of care, patient safety and rights, overall satisfaction, and feedback. A total of 12,802 patients completed the questionnaire, and all statistical analyses were performed using R Studio.

RESULTS

This study analyzes patient-reported satisfaction and experiences in a large healthcare facility, based on data from 12,802 participants. Overall, 91% of respondents rated the hospital positively, with 62% giving an excellent score. Spiritual assistance was well received (71%), and 70% of patients expressed willingness to return for future medical needs. Hospital cleanliness and ward conditions were rated highly, with 71% of respondents reporting excellent experiences. Food quality was positively reviewed by 66% of participants. Most patients (95%) confirmed proper hygiene practices by medical staff, and 95% were informed about their diagnosis. However, only 67% were aware of the complaint submission process. The dataset spans 2019-2022, with the highest hospitalizations in 2020 (36%) and obstetrics, cardiology, and general surgery being the most common specialties.

CONCLUSIONS

This dataset reflects a high level of patient satisfaction across multiple dimensions of hospital services, including cleanliness, quality of care, and patient information. However, areas such as complaint handling and transparency in medication handling require further attention to improve the overall patient experience. The findings underscore the hospital's strong performance in meeting patient expectations while identifying key areas for continued improvement.

Virtual reality for stress management and burnout reduction in nursing: A systematic review protocol

BACKGROUND

Burnout is a pervasive issue in the nursing profession, with detrimental consequences for nurses' well-being, patient care, and healthcare systems. Virtual reality (VR) is a promising tool for delivering immersive and engaging interventions to manage stress and reduce burnout. This systematic review aims to synthesize the evidence on the effectiveness of VR interventions for stress and burnout in nursing, characterize the specific intervention approaches, and guide future research and practice.

METHODS

We will search for published and unpublished studies in PubMed, Web of Science, Embase, CINAHL, MEDLINE, The Cochrane Library, PsycINFO, and Scopus from database inception to the present. Randomized controlled trials, quasi-experimental studies, and pre-post studies examining VR interventions for stress and/or burnout in licensed nurses will be included. Two reviewers will independently screen studies, extract data, and assess risk of bias using the Cochrane Risk of Bias 2 tool for randomized trials and the ROBINS-I tool for non-randomized studies. If appropriate, meta-analysis will be performed to estimate pooled effects on stress and burnout outcomes. Subgroup and sensitivity analyses will explore the influence of intervention characteristics and study quality. Narrative synthesis will be conducted if quantitative synthesis is not possible. The review protocol follows the PRISMA-P guidelines and is registered in PROSPERO.

DISCUSSION

This systematic review will provide a comprehensive synthesis of the evidence on VR interventions for stress and burnout management in nurses. By critically appraising the research and identifying the most promising approaches, the review will guide the development and implementation of evidence-based VR programs to support nurses' well-being and address the urgent problem of burnout. The findings will also identify gaps in the literature and directions for future research to optimize the design and delivery of VR interventions for this high-need population. Systematic review registration: PROSPERO CRD42024604179.

"I can't endure it" vs. "I can handle it" - experiencing work fatigue risk for nurses: a qualitative study

BACKGROUND

Work fatigue has become a significant challenge for nursing staff, yet there is a paucity of qualitative research that explores their lived experiences in this context. This study aims to examine clinical nurses' experiences with work fatigue risk and to identify the hindering and facilitating factors contributing to this issue.

METHODS

In this study with descriptive phenomenological method, semi-structured interviews with 25 nurses conducted in the meeting room of a hospital from June to August 2024. Colaizzi's seven-step analysis method was used for data analysis.

RESULTS

Three main themes with twelve subthemes were identified. The primary themes included: (1) phases of work fatigue risk experience, (2) hindering factors of work fatigue risk management, and (3) facilitating factors of work fatigue risk management. Nurses faced a combination of facilitators and inhibitors in managing work fatigue. While some nurses demonstrated a positive attitude towards their work, others showed a strong intention to leave the profession.

CONCLUSIONS

Our findings offer a nuanced understanding of the dynamic stages of nurses' work fatigue experience, highlighting both hindering and facilitating factors that influence the management of work fatigue risk. Nurses encounter multiple challenges in managing work fatigue effectively, underscoring the need for comprehensive strategies. These strategies should address structural barriers while fostering individual resilience, ultimately promoting a healthier and more sustainable work environment.

Reimagining Work-Life Balance: The Impact of a 4-Day Workweek on Healthcare Leader Burnout and Well-Being

BACKGROUND

Globally, healthcare leaders are experiencing escalating levels of burnout and job dissatisfaction, which are exacerbated by increasing workforce turnover rates. Innovative solutions are urgently needed to address these challenges and stabilize healthcare leadership teams.

AIMS

This study evaluated the implementation of a 4-day workweek for nursing and respiratory leaders as a strategy to reduce burnout, enhance well-being, and improve workforce stability.

METHODS

Conducted at two hospitals in the United States, this 4-month pilot study was guided by the Institute for Healthcare Improvement's Joy in Work framework. Thirty-eight healthcare leaders voluntarily transitioned to a 4-day workweek. Biweekly, self-report surveys were used to measure burnout, job satisfaction, and joy in work. Follow-up surveys were conducted 6- and 12-months post-implementation to assess long-term outcomes and scalability.

RESULTS

Burnout decreased from 61% to 4%, job satisfaction increased from 71% to 96%, and joy in work rose from 34% to 86%. No changes in patient safety, satisfaction, or hospital-acquired conditions were observed. Qualitative feedback emphasized enhanced work-life balance, improved morale, and decreased emotional exhaustion while identifying challenges related to workload redistribution and ensuring 24/7 accountability. Follow-up data confirmed sustained improvements in well-being and scalability without adversely impacting organizational outcomes.

Factors Contributing to Well-Being Among Hospital-Based Nurses

BACKGROUND

Nationally and in Hawaii, nurses are in crisis with high rates of distress, burnout, and intent to change jobs. Organizations need evidence-based strategies to support nurse well-being.

PURPOSE

Informed by the National Academy of Medicine Factors Affecting Clinician Well-Being Model, this study aimed to identify individual and external factors associated with nurses' well-being.

METHODS

In December 2023, an online survey of hospital-based nurses from two major hospitals, representing various unit types, was conducted in Hawaii. Survey measures included individual (role, personal characteristics, skills/abilities) and external factors (organizational, environmental) that support clinician well-being. The outcome (well-being) was measured using the well-being index (scores ranged from -2 [excellent] to 9 [very poor]). The analysis included general linear modeling with stepwise backward selection.

RESULTS

The final sample included 552 nurses. Years of experience were evenly distributed, and the majority worked ≥ 36 h/week (85.9%), worked in intensive-focused or other specialties units (53.8%), and identified as female (87.3%). The nurses identified their race/ethnicity as 27% Filipino, 23% White, 14% Japanese, 11% Other Asian, 6.1% Hispanic, 5.1% Native Hawaiian/Pacific Islander (NHPI), and 14% mixed or other race. The average well-being score was 2.8 (SD = 2.3). NHPI had the lowest (Mean ± SD = 2.2 ± 2.2), and Filipino and White nurses had the highest well-being scores (3.0 ± 2.2; 3.0 ± 2.0, respectively), although no significant racial/ethnic difference was found. Several internal and external factors were significantly associated with well-being. For example, working ≥ 36 h/week, reports of experienced burnout, having primary caregiving responsibility outside of work, lower self-reported physical health, and the experience of workplace violence all increased average well-being scores (worsened well-being). In contrast, having higher personal resilience, no leadership responsibilities, the belief that their organization is responsive to complaints and concerns, and appropriate ancillary staff to support their work all decreased average well-being scores (improved well-being).

LINKING EVIDENCE TO ACTION

Healthcare organizational leaders and policymakers must urgently correct system issues contributing to burnout, suboptimal mental health, decreased well-being, and attrition among nurses. Healthcare organizations should cultivate wellness cultures and provide infrastructure that offers evidence-based interventions to support nurses' well-being.

Innovation, Wellness, and EBP Cultures Are Associated With Less Burnout, Better Mental Health, and Higher Job Satisfaction in Nurses and the Healthcare Workforce

BACKGROUND

Staff shortages as well as poor nurse and clinician well-being are currently an epidemic within the health workforce and pose a substantial risk to healthcare quality and safety. Creating a strong wellness culture is one strategy to address the issue, but there is a paucity of research that investigates how other types of organizational cultures are related to nurses' mental health and well-being.

AIMS

To describe the relationships among innovation culture, wellness culture, evidence-based practice (EBP) culture, and clinician well-being (healthy lifestyle behaviors, burnout, depression, stress, anxiety, and job satisfaction).

METHODS

A cross-sectional descriptive correlational study design was used with a convenience sample of nurses, physicians, and allied health professionals from a Magnet-recognized health system in the United States. An online wellness survey collected data with the variables of interest using valid and reliable scales. Pearson's r correlations assessed the relationship among innovation culture, wellness culture, and EBP culture. A series of regressions examined if each type of culture was associated with clinician well-being.

RESULTS

The analytic sample included 199 respondents. Innovation culture had a strong and significant correlation (p ≤ 0.0001, r > 0.7) with both clinician well-being and EBP cultures. Wellness and EBP cultures also were correlated (p ≤ 0.0001, r = 0.592). Higher ratings of each type of culture were significantly associated with higher job satisfaction as well as higher ratings of both mental and physical health. Further, higher ratings on each culture scale were significantly associated with reduced stress, anxiety, depression, burnout, and job satisfaction.

LINKING EVIDENCE TO ACTION

This is the first study to establish correlations among innovation culture, EBP culture, and wellness culture as well as to find that these three types of cultures are associated with clinician well-being outcomes and job satisfaction. Since culture strongly impacts the healthcare workforce's mental health and job satisfaction, leaders need to focus on an organizational-wide strategic approach that builds a sustained culture that supports clinician well-being, innovation, and EBP.

Digital Artifacts of Self-Representation: A Critical Qualitative Analysis of Nursing Memes

Stereotypes in mass media depict harmful and inaccurate portrayals of nurses and nursing work. As memes are understood to be units of culture, they may be examined as artifacts, deepening understandings of contemporary culture. This critical qualitative analysis of nursing memes from two popular social media platforms seeks to identify current cultural narratives and social meanings of nursing reproduced within the public domain. Memes were selected from popular hashtags and nursing meme accounts with more than 2500 followers. Memes were included if they followed traditional meme format and content-centered discourses of gender, race, and other aspects of power and oppression within nursing and healthcare systems. Our analysis employed a qualitative descriptive design within an overarching critical social theoretical framework. We identified that nursing memes reproduced stigmatizing and discriminatory narratives of patients and perpetuated harmful notions of "who" nurses are and "what" nurses do, while also drawing attention to systemic challenges facing the profession. Memes therefore serve as a valuable artifact for communicating contemporary cultural narratives about nursing and nursing work. Generating and distributing memes to raise awareness of systemic pressures may serve as a valuable social strategy toward advocating for systemic shifts in nursing and healthcare to address persistent challenges.

Relationship between head nurse leadership and nurses' burnout: parallel mediation of job demands and job resources among clinical nurses

BACKGROUND

Many elements in the workplace contribute to nurses' burnout experiences, affecting patient safety and the healthcare organizations' efficiency. Leaders' presence and conduct are the most potent "master" factors in every work setting. Although previous studies have shown that head nurse leadership, job demands, job resources, and job burnout are significantly related, the interaction mechanism remains unclear. This study investigates the parallel mediating roles of job demands and job resources between head nurse leadership and job burnout in nursing staff.

METHODS

A cross-sectional, anonymous, and confidential online survey was conducted from March to June 2024 to collect data from 579 registered nurses in four hospitals in Hunan provinces. The independent variable was head nurse leadership, the mediating variables were job demands and resources, and the dependent variable was job burnout. Parallel mediation analysis was performed using the PROCESS macro in SPSS.

RESULTS

This study found that head nurse leadership negatively relates to nurses' burnout. The parallel mediation analysis suggests that job resources and job demands play parallel roles in the relationship between head nurse leadership and job burnout. As predicted, head nurse leadership weakened job burnout through job resources and contributed to job burnout through job demands.

CONCLUSION

This study finding highlights the importance of head nurse leadership in decreasing nurses' job burnout and reveals two potential mechanisms through which head nurse leadership is related to nurses' burnout. By understanding the role of head nurse leadership, job demands, and job resources, interventions can be targeted to improve nurses' mental health.

Assessing the Impact of Burnout on Nurse Safety Behaviors and Patient Safety Competence: A Latent Profile Analysis Study

Aim: This study examines the association between burnout, nurse safety behaviors, and patient safety competency among nurses working in cancer hospitals using person-centered and variable-centered methodologies. Background: Burnout is prevalent among nurses worldwide, with cancer hospital nurses exhibiting high levels of burnout. Burnout correlates with a higher incidence of adverse events and diminished patient safety. Nurse safety behaviors and patient safety competency play protective roles in ensuring patient safety. Methods: This study used a cross-sectional online survey and included 2092 eligible nurses, with 95.0% being female. We invited nurses from cancer hospitals in 12 provinces in China to complete an online survey from April to June 2023. Through the online Questionnaire Star platform, invited nurses provided demographic information and completed the Maslach Burnout Inventory, the Nurse Safety Behaviors Scale, and the Patient Safety Competency Scale. Latent profile analysis was used to identify heterogeneous characteristics of nurse burnout. Results: From a person-centered perspective, nurse burnout was categorized into three latent profiles: "high achievement stable type" (70.3%), "high-efficiency contradictory type" (6.6%), and "high-pressure adaptive type" (23.1%). From a variable-centered perspective, patient safety competency partially mediated the relationship between burnout profiles and nurse safety behaviors. Conclusion: This study identified three heterogeneous latent profiles of burnout among cancer hospital nurses and highlighted the significant impact of excessive working hours and lack of safety training on burnout across different job titles and income levels. Additionally, it verified the mediation effect of patient safety competency between burnout profiles and nurse safety behaviors. Future treatments should focus on high-risk populations by offering improved safety training and suitable work schedules to reduce burnout. Furthermore, personalized measures to enhance nurses' safety competencies should be adopted to improve burnout and safety behaviors. This study integrates person-centered and variable-centered methods, offering new insights and underscoring the critical role of safety in mitigating burnout.

Factors associated with burnout among Chinese operating room nurses: a meta-analysis

BACKGROUND

Burnout is prevalent among nursing staff, especially in the operating room, which is a high-intensity, high-pressure and fast-paced work environment. As the prevalence of nurse burnout increases, reducing the burnout of operating room nurses helps to improve the physical and mental health of nurses. Thus, stabilising the nursing team can also guarantee the quality of medical care, which in turn improves patient satisfaction. In this study, we conducted a meta-analysis based on the Pearson correlation coefficient to quantitatively analyse the factors related to burnout among operating room nurses and to provide a reliable basis for preventing and intervening in burnout among operating room nurses.

METHODS

CNKI, Wanfang Database, Wipro Database, China Biomedical Database, PubMed, Web of Science, Embase, CINAHL and Cochrane Library Database were searched, and the keywords 'operating room', 'nurses', 'burnout' and the corresponding English terms were used for the search. The time limit for the search was set from the creation of the databases to April 2024. Two researchers with evidence-based knowledge conducted the search, independently screened the literature according to the inclusion and exclusion criteria, extracted the information and assessed the quality of the included literature using the quality assessment criteria for observational studies recommended by the Agency for Healthcare Quality and Research, and performed a meta-analysis of the literature using the r value as an indicator of the outcome in RevMan 5.4 software.

RESULTS

A total of 25 papers were included, with a sample size of 6,061 cases. The quality of the literature was moderate. The meta-analysis showed that job stress (r = 0.56, 95% confidence interval [CI]: 0.42-0.68, I2 = 86%), work-family conflict (r = 0.52, 95% CI: 0.36-0.64, I2 = 82%), willingness to leave (r = 0.42, 95% CI: 0.34-0.49, I2 = 0%) and hidden absenteeism (r = 0.49, 95% CI: 0.41-0.57, I2 = 55%) were positively correlated with burnout (p < 0.01), job immersion (r = - 0.39, 95% CI: - 0.40 to - 0.32, I2 = 0%), social support (r = - 0.46, 95%: - 0.58 to - 0.33, I2 = 74%), psychological capital (r = - 0.53, 95% CI: - 0.60 to - 0.45, I2 = 72%) and well-being (r = - 0.54, 95% CI: - 0.73 to - 0.27, I2 = 88%) were negatively correlated (p < 0.01).

CONCLUSIONS AND RECOMMENDATION

This study shows that burnout of operating room nurses is related to various factors, such as job stress, social support, work-family conflict, psychological capital and well-being. Therefore, it is suggested that hospital management should alleviate the burnout of operating room nurses from the multi-dimensional aspects of improving the work environment, enhancing social support and improving personal psychological capital and well-being to effectively alleviate burnout.

TRIAL REGISTRATION

(PROSPERO) International prospective register of systematic reviews: CRD42024547524.

Exploring Well-Being Disparities: A Comparative Analysis of Urban and Rural Clinicians Using the NIOSH Worker Well-Being Questionnaire

BACKGROUND

Clinician well-being is crucial to the healthcare system, particularly during the COVID-19 pandemic, which intensified psychological distress among clinicians. This study examines well-being disparities between rural and urban clinicians using the NIOSH Worker Well-Being Questionnaire (WellBQ).

METHODS

A cross-sectional survey was conducted with 222 clinicians from one urban and three rural hospitals in North Carolina between September and December 2022. The WellBQ assessed well-being across five domains. Data analysis identified concerning thresholds based on positive and negative responses, with discrepancies resolved through independent reviews and focus group validation.

FINDINGS

In the work evaluation and experience domain, rural hospitals reported concerns with time paucity and work overload, while urban hospitals focused on work-related fatigue and job engagement. Rural hospitals noted issues with job benefits, health programs, and schedule flexibility, whereas urban hospitals emphasized the lack of supportive work culture and management trust. Both settings reported concerns in the physical environment and safety climate domain, including sexual harassment, physical violence, and bullying. Health status concerns in rural hospitals included overall stress and poor mental health, while urban hospitals highlighted chronic health conditions and risky drinking.

CONCLUSION

This study identified significant well-being disparities between rural and urban clinicians, with urban hospitals showing higher concerning thresholds. Future research should refine these thresholds, explore workplace violence causes, and assess long-term impacts on clinician well-being.Applications to Practice:This study reveals significant well-being disparities between rural and urban clinicians, emphasizing the need for tailored occupational health interventions.

Creating Organisational Working Conditions Where Nurses Can Thrive: An International Action Research Study

Background: Attracting and retaining sufficient numbers of nurses is an international challenge. The group most difficult to retain are newly qualified nurses within their first five years of practice or earlier. A recent US study reported that approximately 25 percent of nurses leave within the first year of graduation. Health organisations play a crucial role in providing workplace cultures where nurses feel empowered and can thrive. Research needs to focus on improving organisational culture, yet most approaches to supporting and retaining nurses have used top-down, management-designed interventions. This article describes a collaborative international programme of research. Methods: This innovative international theory-driven multi-site action research programme adopts a longitudinal co-design approach based on principles of appreciative inquiry to develop and implement organisational support for newly qualified nurses. It integrates the Institute for Health Improvement (IHI) Framework for Improving Joy at Work and the Thriving at Work model, both focused on improving the well-being of the healthcare workforce and health service outcomes. Each year, a new group of nurses during their first-year orientation is invited to participate. Over five years, each cohort will then participate in an annual survey, focus groups, and co-design meetings with nurse leaders/managers, generating new solutions developed through open dialogue for subsequent testing driven by these key stakeholders. Expected outcomes: This research will generate a new co-design management model to improve systems of support that may assist nurse retention and thriving that can be shared with other nursing organisations. It will provide an understanding of the effectiveness of current support for nurses by their employers from the perspective of those nurses whilst providing evidence about what extra support nurses would like from their employers. Conclusions: This international research programme gives agency to nurses and organisational nurse leaders/managers to co-design interventions for building positive work environments where early-career nurses can thrive. This programme will capture what works, where, how, and with whom, ultimately benefiting both individual nurses and the overall effectiveness and sustainability of healthcare systems.

The mediating role of emotional intelligence in the relationship between technostress and burnout prevention among critical care nurses a structural equation modelling approach

BACKGROUND

Critical care nurses frequently experience high levels of technostress due to the increasing demands of healthcare technology, which contributes to burnout. Emotional intelligence has been shown to buffer stress in demanding environments, potentially mitigating burnout. However, its mediating role in the relationship between technostress and burnout among critical care nurses remains underexplored.

AIM

This study aims to examine the mediating role of emotional intelligence in the relationship between technostress and burnout among critical care nurses.

METHODS

A cross-sectional study was conducted among 180 critical care nurses from two hospitals in Damnhour City, Egypt. Data were collected using the Technostress Questionnaire, Copenhagen Burnout Inventory (CBI), and Emotional Intelligence Scale. Structural Equation Modeling (SEM) was used to test the hypothesized relationships between technostress, emotional intelligence, and burnout, with bootstrapping employed to assess mediation.

RESULTS

Technostress was positively correlated with burnout (r = 0.56, p < 0.01), while emotional intelligence was negatively correlated with both technostress (r = -0.45, p < 0.01) and burnout (r = -0.49, p < 0.01). SEM analysis revealed that emotional intelligence significantly mediated the relationship between technostress and burnout (indirect effect = 0.23, p = 0.002), reducing burnout levels.

CONCLUSION

Emotional intelligence plays a crucial role in mitigating the effects of technostress on burnout among critical care nurses. Targeted interventions to enhance emotional intelligence may help reduce burnout in technology-driven healthcare environments.

Kienski Woloski Wruble A. Creating a Supportive Work Environment: A Cognitive Behavioral Approach for Nurse Leaders

PURPOSE

This article focuses on identifying cognitive behavioral (CB) techniques that can help nurse supervisors more effectively navigate interpersonal challenges, reduce workplace stress, improve team cohesion, and, ultimately, enhance overall organizational performance and staff well-being.

APPROACH

Through a comprehensive review of leadership literature and clinical management practices, we determined that CB techniques could be integrated into nursing management. Two hypothetical scenarios within this context are offered, where CB techniques can enhance nursing leadership effectiveness.

CONCLUSIONS AND RECOMMENDATIONS

CB techniques offer a humanistic approach to nursing leadership through: (1) providing tools for leaders to reframe challenges and frustrations, particularly in resource-limited settings; (2) offering stress-management strategies for nursing leaders; and (3) enhancing communication skills, self-awareness, and team motivation. These applications can potentially improve both staff and management satisfaction, ultimately improving patient care quality. Healthcare organizations should consider incorporating CB techniques into their leadership development programs. We suggest practical ways to implement these techniques in daily nursing management, emphasizing the importance of creating supportive and safe work environments and provide recommendations for future research. This perspective extends the cognitive behavioral approach beyond its traditional therapeutic context into nursing leadership, providing a novel theoretical framework for understanding and enhancing leadership development in healthcare settings.

Burnout Among Hospital Nurses in Kazakhstan

Background: Burnout is an important psychological condition that affects the work performance of nurses. It occurs under long-term psychological or emotional stress associated with the work of a nurse. As a result, symptoms such as emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA) may be experienced. The purpose of this study was to determine the syndrome of "burnout" using three subscales-emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA)-among nurses providing round-the-clock nursing care in multidisciplinary hospitals in the Republic of Kazakhstan. Methods: A cross-sectional study was conducted among nurses in the Republic of Kazakhstan working in round-the-clock care. In total, 284 respondents participated in the online survey. The Maslach Burnout Inventory for Medical Personnel (MBI-HSS-MP) was used for collecting data. Results: The results demonstrated that burnout occurred among 61.97% of hospital nurses in the Republic of Kazakhstan. EE was identified among 29.23% of the respondents, DP in 60.92% of the respondents, and PA in 38.73%. Burnout, according to these indicators, occurred in 25.7% (EE), 19.37% (DP), and 12.68% (PA) of nurses. The level of burnout was higher among young nursing specialists and more frequent in the southern region of the Republic of Kazakhstan. Conclusions: This study revealed a high level of burnout among nurses providing round-the-clock care in multidisciplinary hospital settings. These findings have implications for further research into the impact of burnout on nurses' work and for developing interventions to reduce potential risks to nursing staff health and improving the quality of nursing care.

LGBTQ+ Inclusive Policies, Nurse Job Outcomes, and Quality of Care in Hospitals

Importance

Despite emphasis on the establishment of inclusive hospital policies, the impact of these policies on employees and organizations remains unknown.

Objective

To evaluate the association between inclusive policies for lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender minority (LGBTQ+) and nurse job outcomes as well as nurse-reported quality of care.

Design, Setting, and Participants

This cross-sectional study analyzed 4 survey datasets from 2021: the RN4CAST-NY/IL, including registered nurses from New York and Illinois, and the Healthcare Equality Index (HEI) data. The HEI evaluates and scores US health care facilities that voluntarily participate based on their LGBTQ+ inclusivity in policies, such as nondiscrimination policies and LGBTQ+ inclusive clinical services. The study used American Hospital Association Annual Survey data for hospital characteristics and Magnet organization data to classify hospitals by Magnet status. Data analyses were performed in December 2024.

Main Outcomes and Measures

Nurse job outcomes included burnout and job dissatisfaction. Quality of care outcomes included nurses' perceptions of care quality and their likelihood of recommending their hospital. The independent variable was LGBTQ+ Healthcare Equality Leader (HEI Leader) status, which signified hospitals with the highest levels of LGBTQ+ inclusion. Multilevel logistic regression models included nurse-level (age, race and ethnicity, gender, and years of experience at the current hospital) and hospital-level (Magnet status, size, teaching status, specialized service capability, and ownership) covariates.

Results

A total of 7343 nurses (mean [SD] age, 44.9 [13.4] years; 6584 [89.6%] women) from 111 hospitals were included in the study. Nurses in hospitals with HEI Leader status had lower odds of high burnout (adjusted odds ratio [AOR], 0.69; 95% CI, 0.52-0.92) and lower odds of job dissatisfaction (AOR, 0.62; 95% CI, 0.45-0.86) compared with those in hospitals without the status. They also had higher odds of reporting excellent or good quality of care (AOR, 1.83; 95% CI, 1.23-2.73) and higher odds of recommending their hospital (AOR, 1.72; 95% CI, 1.19-2.50).

Conclusions and Relevance

In this cross-sectional study, nurses in hospitals with high LGBTQ+ inclusion reported more favorable job outcomes and care quality. Hospitals should understand that implementing LGBTQ+ inclusive policies goes beyond compliance or diversity; it is essential for improving the work climate, enhancing staff well-being, and optimizing care delivery.

A network analysis of self-compassion and burnout in a sample of nurses

BACKGROUND

In the nursing profession, the concept of self-compassion has been associated with burnout. However, to date, the fine-grained relationships between different dimensions of self-compassion and symptoms of burnout have not been investigated. Network analysis provides a new avenue for exploring the fine-grained correlation paths of two related variables.

AIM

To analyse the nuanced associations between self-compassion and burnout using network analysis in a large cohort of Chinese nurses.

DESIGN

A cross-sectional multi-centre survey design study.

METHODS

Participants were recruited from 30 hospitals in China between April and May 2022. These nurses completed the Chinese Maslach Burnout Inventory-General Survey (C-MBI-GS) and Self-Compassion Scale-Short Form (SCS-SF). Network analysis was performed to illustrate the complex nuanced relationships between self-compassion and burnout.

RESULTS

A total of 1467 nurses (age 32.2 [18-56] years; 89.9% were female) participated in the study. Nodes Mindfulness and Isolation had the highest centralities measured by strength. Nodes Mindfulness, reduced personal accomplishment and Isolation were the most negative and positive influential nodes that bridged self-compassion and burnout. There were no differences in terms of gender, age, professional title and job tenure in the structure or connectivity of the self-compassion and burnout network.

CONCLUSION

Different components of self-compassion were specifically associated with different dimensions of burnout in registered nurses. Among these, Mindfulness, Isolation and Reduced personal accomplishment were the three most important components of self-compassion for burnout symptoms.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPACT

Understanding the intricate connections between self-compassion and burnout will allow hospital administrators to prioritize the elements of Mindfulness and Isolation within self-compassion and the dimension of Reduced personal accomplishment within burnout when designing preventative measures and interventions aimed at reducing nurse burnout.

Job-Related Factors Associated with Burnout and Work Engagement in Emergency Nurses: Evidence to Inform Systems-Focused Interventions

INTRODUCTION

Nurses working in the emergency department experience high rates of burnout. The purpose of this study was to determine job-related factors affecting the well-being of emergency nurses.

METHODS

In this cross-sectional study data were collected through multiple methods. An anonymous survey was used to collect data on emergency nurses' perceptions of the work environment, self-reported outcomes of well-being, and demographic characteristics. Administrative and electronic health record data were used to collect team and ED-level variables. Descriptive statistics, linear models, and Lasso regression were used to analyze data.

RESULTS

Fifty-three percent (n = 175/337) of responding emergency nurses reported high burnout. High levels of psychological safety were linked to lower levels of burnout (P<.05) and increased work engagement (P<.05). Perceptions of adequate compensation were inversely associated with burnout (P<.01). Workplace violence from patients (P<.01) and peers (P<.001) was associated with higher levels of burnout, and workplace violence from peers was associated with lower levels of work engagement (P<.05). Recognition (P<.05) and well-being support from the organization (P<.01) were associated with higher levels of work engagement.

DISCUSSION

To improve emergency nurse well-being, systems-focused interventions should address nurse compensation, psychological safety among the ED team, workplace violence, and meaningful recognition of nurses and well-being support from the organization.

Experiences of Nurses Regarding Self-Care: A Qualitative Systematic Review and Meta-Synthesis

Nurses are susceptible to burnout, making it crucial for them to engage in self-care. This review consolidated the experiences of nurses regarding self-care. Seven electronic databases were searched from inception till October 2024: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, and ProQuest Dissertations and Theses Global. The enhancing transparency in reporting the synthesis of qualitative research statements and Sandelowski and Barroso's guidelines guided this review. Quality appraisal of included studies was conducted using the Critical Appraisal Skills Program tool. Data were thematically synthesized. Confidence in review findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach. Three main themes were identified from the 24 included studies: (1) Being a nurse: An occupational hazard towards self-care, (2) Catalyst towards self-care, and (3) Call to action. Nurses' poor engagement in self-care practices were due to work-related challenges (e.g., working hours), poor self-care awareness, and negative influence from their colleagues and leaders. Conversely, nurses were motivated to engage in self-care when they received encouragement from their peers and leaders.

Burnout Profiles Among French Pediatric Health Care Professionals: A Cluster Analysis

The aim of our study was to identify burnout profiles among pediatric nurses and physicians, and their specificities concerning sociodemographic characteristics, occupational stress, stress specific to pediatric caregivers, and coping. Conducted on a sample of 195 French pediatric health care professionals, a cluster analysis showed 2 endpoint profiles (Engagement, Burnout) and 3 intermediate profiles (Overextended, Disengaged, Ineffective). The Burnout profile showed the highest median scores on hours worked per week, occupational stress, stress related to working conditions, and relationships with colleagues and superiors. The Overextended profile reported more stress related to working conditions than did other intermediate profiles. The Disengaged profile showed the second lowest median score on stress related to relationships with colleagues and superiors and less social support-seeking than other profiles. The Ineffective profile used less problem-focused coping than the Engagement and intermediate profiles. Intervention for the well-being of these professionals should focus primarily on improving their working conditions.

The role of motivation in the initiation and maintening mentoring relationships among nurses and midwives

AIM

To understand clinicians' motivations to engage in mentoring to support newly graduated nurses and midwives working in hospital settings.

BACKGROUND

Nursing and midwifery literature has established the benefits of mentoring and challenges that affect the effectiveness of formal mentoring programmes. No studies have explored hospital nurses' and midwives' motivations to mentor in the absence of the obligatory status and associated rewards of institutionalised mentoring.

METHODS

A qualitative descriptive study with 35 nurses and midwives working in three public hospitals in the western, northern and northwestern parts of Uganda. Data were collected using semistructured interviews. Reflexive thematic analysis was applied to interpret the data. We have adhered to COREQ reporting guidelines.

RESULTS

The study revealed three salient themes that capture nursing and midwifery professionals' mentoring perspectives. Participants expressed confidence in their inherent mentoring capacities and were often motivated by a desire to reciprocate prior mentoring experiences. Their mentoring approaches varied between self-focused and other-focused motivations, with some overlap in perspectives on hierarchical versus relational mentoring. Across the board, there was a strong consensus on the need of mentoring for individual clinicians, healthcare institutions and the broader profession. The study highlights five opportunities that can be harnessed to design future mentoring programmes.

CONCLUSIONS

The findings delineate a complex interplay between self-centred and altruistic mentoring motivations, aligning with hierarchical or mutually beneficial mentoring paradigms.

IMPLICATIONS FOR NURSING POLICY

Nurse managers should tailor mentoring programmes to align with these intrinsic motivations, affirm the enduring need for mentoring, and leverage existing institutional resources to create both acceptable and efficient mentoring frameworks.

Prescription for change: Unveiling burnout perspectives among pharmacy leaders

Background

Burnout among pharmacists is increasingly pertinent, with growing demand for effective interventions. Burnout can lead to reduced productivity, increased job turnover, medical errors, poor patient satisfaction, and other negative outcomes for patients and providers. Growing attention to burnout in the pharmacy profession highlights the need for personal, organizational, and systemic solutions. However, the uptake and relative efficacy of different approaches remain unclear, particularly within community pharmacy practice. This study sought the viewpoint of community pharmacy leaders (i.e., community pharmacy managers, district managers, franchisees, owners, and executives from various pharmacy organizations) to characterize burnout from their perspectives.

Methods

This qualitative study followed a grounded theory approach. Community pharmacy leaders were interviewed using a semistructured format to gather in-depth insights into their experiences and perspectives on burnout and engagement.

Results

Sixteen people were interviewed; interviews lasted 30 to 65 minutes, averaging 51 minutes long. Six themes were identified: perceived disconnection between front-line staff and pharmacy decision-makers, overwhelming work demands, cautious optimism toward the expanding scope of pharmacy practice, the importance of employee recognition and appreciation, appropriateness and use of existing work resources, and multimodal, systemic responsibility and solutions to burnout.

Conclusion

Addressing burnout requires a multifaceted approach involving personal, organizational, and systemic interventions. Evidence from this study provides valuable insights into the feasibility and efficacy of specific interventions, informing future strategies to enhance workplace well-being and engagement. The study highlights the importance of managing job demands and maximizing resources, emphasizing that personal approaches alone are insufficient and that organizational and systemic interventions are crucial.

Validation of the Russian version of the Copenhagen Burnout Inventory among nurses in Kazakhstan and Kyrgyzstan

Objectives

This study aimed to validate the Russian version of the Copenhagen Burnout Inventory (R-CBI) among nurses in Kazakhstan and Kyrgyzstan and explored factors contributing to burnout.

Methods

The original Copenhagen Burnout Inventory (CBI) was translated into the R-CBI using a rigorous forward-backward method and reviewed by experts. Between July and November 2022, 1,530 nurses were recruited through convenience sampling method from various nursing settings in Kazakhstan and Kyrgyzstan to test the scale's reliability and validity, including confirmatory factor analysis (CFA), internal consistency reliability, and concurrent validity. A linear regression analysis was conducted to identify influencing factors of burnout.

Results

The content of the R-CBI is consistent with the original CBI, consisting of 19 items with three dimensions. The Cronbach's α coefficient is 0.926 in Kazakhstan and 0.922 in Kyrgyzstan, ranging from 0.830 to 0.898 for three dimensions. The CFA results among nurses in Kazakhstan and Kyrgyzstan supported the three-factor structure of R-CBI with good fit indices. Concurrent validity was established through significant correlations (P < 0.001) with job satisfaction questionnaire (r = -0.457), Depression Anxiety Stress Scales (r = 0.506 in depression, r = 0.485 in anxiety, r = 0.564 in stress), and WHO-5 Well-Being Index (r = -0.528). The overall burnout level was 36.1 ± 17.6 and 37.5 ± 17.4 in Kazakhstani and Kyrgyzstani nurses, respectively. Significant influencing factors of burnout included gender, age, educational level, and COVID-19 infection history.

Conclusions

The R-CBI was proved to be a reliable and valid tool for assessing nurses' burnout in Kazakhstan and Kyrgyzstan.

The Relationship Between Commuting Stress and Nurses' Well-Being: Considering Gender Differences

Aim: This research explores how and why commuting stress influences Chinese nurses' well-being. Background: A daily work commute may result in a significant psychological risk factor that can lead to harmful physiological and mental health consequences. Emerging research indicates that nurses experience long-lasting negative effects on their mental health, including burnout, due to the stress of a daily work commute. Methods: The study employed a cross-sectional design involving 380 registered nurses from state-owned hospitals in southern China. Hypotheses were tested using the PROCESS macro developed by Hayes [1]. Results: The stress of commuting indirectly influences nurses' well-being through increased emotional exhaustion. There is an interaction between commuting stress and nurses' gender such that the indirect effect of commuting stress on well-being is stronger for female nurses. Conclusions: The spillover effect of commuting stress in the nursing profession is often underestimated. However, this study underscores its significant impact on nurses' emotional exhaustion and well-being. The research findings emphasize that commuting stress contributes to emotional exhaustion and a decline in nurses' well-being. Implications for Nursing Management: Healthcare organizations should leverage these findings to reinforce the importance of self-care for nurses and to provide nurses with resources to help decrease the potential negative outcomes of commuting stress. The study also shows that female nurses may experience a more pronounced association between commuting stress and emotional exhaustion. As such, healthcare organizations should develop gender-specific interventions and support systems that address the unique challenges faced by female nurses in relation to commuting stress.

The Relationship Between Staffing, Nurses' Emotional Exhaustion, and Adverse Patient Events in Critical Care Units in Sultanate of Oman

Background: Ensuring safe practices remains a top priority for healthcare policymakers. However, limited evidence has examined the link between individual, work-related factors, and patient safety within critical care units in Oman. Aim: To assess the relationship between staffing levels, job-related emotional exhaustion, and adverse patient events among nurses working in critical care units. Design: A cross-sectional study was conducted to collect data from critical care nurses in Oman. Nurses were recruited using a stratified proportional sampling method. Results: A total of 694 critical care nurses participated in the study. More than half (64.1%) of the critical care nurses experienced higher levels of emotional exhaustion. Significant predictors of adverse patient events included nurse staffing level (r = 0.09, p < 0.001), emotional exhaustion (β = 0.25, p < 0.001), hospital type (being affiliated with nonteaching hospitals) (p=0.021), and nationality (β = -0.15, p < 0.001). Conclusion: The occurrence of nurse-reported adverse events was associated with several key variables, including nurse staffing levels, emotional exhaustion, hospital type, and nationality. Implications for Nursing Management: To improve patient safety, healthcare policymakers should prioritize optimizing nurse staffing levels and implement strategies to reduce emotional exhaustion, particularly in nonteaching hospitals and among specific nurse demographics.

Workplace Wellness Support Enhances Health and Mental Well-Being in Optometrists

Purpose

To (1) assess rates of burnout in Fellows of the American Academy of Optometry and (2) assess associations among perceptions of workplace wellness support with lifestyle behaviors and health and wellness indicators (ie, anxiety, depression, stress, burnout, mattering to the workplace, and workplace is not stressful).

Methods

A survey collected sample characteristics and outcomes of interest from 321 Fellows.

Results

Thirty-two percent reported burnout. Females and those working in academia were significantly more likely to report being burned out at work. Compared to Fellows with low perceptions of workplace wellness support, Fellows with high perceptions of support were significantly more likely to report mattering to their workplace, a non-stressful workplace environment, and no burnout.

Conclusion

Promoting workplace wellness support may improve perceptions of mattering, stressful workplace environments, and rates of self-reported burnout in optometrists.

Identifying Contextual Workplace Stressors in a Division of Plastic and Reconstructive Surgery

Background

Healthcare professionals in plastic and reconstructive surgery (PRS) face unique stressors that contribute to burnout, increasing the risk of errors and compromising patient care. Despite this, there is limited research on PRS burnout in the United States. This study aimed to measure burnout rates and identify high-impact improvement targets within a PRS division at a US academic medical center.

Methods

A sequential mixed-methods study was conducted, involving systems analysis and contextual design methods. All surgeons (n = 5) and nonsurgeons (n = 9) were invited to participate (total n = 14). Burnout rates were measured, and workplace stressors were identified using surveys, focus groups, and contextual inquiries. High-impact, low-effort improvement targets were determined through impact-effort matrices.

Results

Survey data from 13 respondents revealed an 85% burnout rate. Three focus groups and 14 contextual inquiries were conducted. After 13 participants validated and prioritized 2 affinity diagrams and provided 24 high-priority stressors, 8 respondents completed 2 surveys that yielded 6 high-impact/low-effort targets for organizational improvement efforts.

Conclusions

This study highlights the high prevalence of burnout in PRS and identifies specific improvement targets for both surgeons and nonsurgeons. Findings suggest strategies such as improving respect and recognition for surgeons and streamlining clinic flow for nonsurgeons. Implementing these targeted improvements can enhance the well-being of healthcare professionals and ultimately improve patient care. The study's methods can be replicated by other healthcare organizations to identify and address burnout-related issues effectively.

Exploring Nurses' Personal and Professional Values and Care Quality: A Convergent Mixed-Methods Analysis

BACKGROUND

Professional standards and the Codes of Ethics from the International Council of Nurses and American Nurses Association are frameworks driving professional practice and are linked to positive patient and nursing outcomes.

OBJECTIVE

To describe qualitative themes extracted from narrative responses on how nurses' personal values influence nursing care and converge with quantitative results assessing personal values, professional values, and the practice environment, a key component of nurse satisfaction and subsequent care quality.

METHODS

A convenience sample of nurses across 19 sites within a large nonprofit healthcare system was surveyed. Quantitative measures included the Short Schwartz's Value Survey for personal values, the Nurses Professional Values Scale-3 for professional values, and the Practice Environment Scale of the Nursing Work Index, assessing practice settings. Concurrently, nurses were asked, "How do your values influence the care you provide?" Responses were examined using a descriptive qualitative method for thematic analysis.

RESULTS

The sample included qualitative (n = 408) and quantitative (n = 671) responses. Six qualitative themes emerged: patient-centered care, professionalism/integrity of practice, advocacy, dissonance, golden rule/ethics of reciprocity (religiosity), and perseverance. Themes converged with the mean personal values of achievement, self-direction, universalism, benevolence, tradition, and conformity, and diverged with hedonism, security, and stimulation. All professional values factor means and work environment subscale means converged.

CONCLUSIONS

Findings highlight convergence and divergence between qualitative and quantitative responses from nurses, offering new insights into the themes of dissonance, perseverance, and religiosity. The findings present valuable opportunities to enhance recruitment and retention strategies.

Work-Related Strain, Sense of Coherence and Intercultural Sensitivity Among Mental Health Nurses in Qatar: A Cross-Sectional Study

Migrant nurses face many challenges as they adapt and assimilate into their new working environments. The aim of this cross-sectional study was to investigate the perceptions of work-related strain, sense of coherence and intercultural sensitivity among nurses who were employed at a public mental health facility in Qatar. We used three self-report questionnaires: the work-related strain inventory, sense of coherence scale and an intercultural sensitivity scale. A cohort of 136 nurses voluntarily engaged in the study. The majority of participants were male, migrated from South Asia and were in their mid-30s. The study found that both sense of coherence and intercultural sensitivity were inversely proportional to work-related strain. Work-related strain was found to be lower than expected; the factors that appear to protect against work-related strain include longer clinical experience, a high sense of coherence, and intercultural sensitivity. Additionally, greater age and extended clinical experience, combined with a history of work in three or more countries, associated with higher scores on the sense of coherence scale. Lastly, being female, having a postgraduate degree and holding a senior-level position were associated with increased intercultural sensitivity. As nurses' migration across national and international borders increases in response to global demand, this study has important implications for nursing administrators, educators and policymakers in relation to the development and implementation of strategies to enhance nurses' sense of coherence and intercultural sensitivity and prevent work-related strain. Trial Registration number: NCT04196751.

Effectiveness of a Brief Mindfulness-Based Intervention on Compassion Fatigue and Compassion Satisfaction in Pediatric Nurses

BACKGROUND

Unlike other medical practitioners, nurses working in pediatric intensive care units face uniquely challenging workplace conditions because they care for preterm newborns and critically ill patients. These workplace challenges led to increased compassion fatigue (i.e., burnout and secondary traumatic stress) and decreased compassion satisfaction. Compassion fatigue and compassion satisfaction strongly influence the quality of care and patient outcomes, and these need to be addressed through effective interventions such as mindfulness-based interventions.

AIM

This study aimed to examine the impact of a brief mindfulness-based intervention on compassion fatigue and compassion satisfaction among pediatric intensive care nurses.

METHODS

A quasi experimental study with a pretest posttest design was used to recruit 204 nurses: 102 in the intervention group and 102 in the control group with randomization by hospital (n = 4). The brief mindfulness-based intervention was delivered over 6 weeks. Data were collected using a demographics questionnaire and the Professional Quality of Life Scale, Version 5.

RESULTS

The intervention group's mean scores of burnout and secondary traumatic stress were significantly lower postinterventions compared with the control group. Similarly, the mean compassion satisfaction score for the intervention group indicated a significant improvement post-intervention compared with the control group. Additional evidence for the effectiveness of the intervention was the disappearance of low compassion satisfaction, high burnout, and high secondary traumatic stress categorizations postintervention in the intervention group, contrary to the control group.

LINKING EVIDENCE TO ACTION

Implementing brief mindfulness-based interventions can improve pediatric intensive care nurses' well-being by reducing burnout and secondary traumatic stress while enhancing compassion satisfaction. By using the study's findings, nurse managers can make these practices essential for high-quality care and effective workforce management.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: ACTRN12622000389707.

Prevalence and risk factors for burnout, missed nursing care, and intention-to-leave the job among intensive care unit and general ward nurses: A cross-sectional study across six European countries in the COVID-19 era

OBJECTIVE

This study aimed to compare the prevalence of burnout, missed nursing care, and intention-to-leave the job among nurses working in general care units and intensive care units (ICUs), and to analyse the risk factors for these outcomes between the two groups.

DESIGN

This was a cross-sectional study involving online surveys of nurses at participating hospitals conducted between November 2020 and July 2021 as part of the Magnet4Europe initiative.

SETTING AND PARTICIPANTS

A convenience sample was recruited, consisting of 67 acute care hospitals in 6 countries: Belgium, England, Germany, Ireland, Norway, and Sweden. In total, data for 1,150 ICU nurses and 5,145 general ward nurses (1,901 from surgical wards and 3,250 from medical wards) were analysed.

RESULTS

The prevalence of burnout was significantly lower among nurses in ICUs (27.1 % vs. 30.3 %), missed care from care was significantly less frequent (65.5 % vs. 75.4 %), while intention-to-leave was similar (28.1 % vs. 29.2 %) compared with nurses in general wards. Nurses working in a better work environment and with lower workloads had statistically significant lower rates of burnout and intention-to-leave their job compared to those working in a poorer work environment and with higher workloads. Country-specific analysis showed a higher burnout rate and the intention-to-leave the job for nurses working in Germany, Ireland, Scandinavia, and the England compared to Belgium.

CONCLUSIONS

ICU nurses did not have a higher risk of burnout and had significantly lower risks of missing care and intention-to-leave, compared to nurses in general wards. A better work environment and lower perceived workload were consistently associated with reduced risks for all outcomes studied.

IMPLICATIONS FOR CLINICAL PRACTICE

National policies should prioritize creating healthy work environments, reducing workloads, and addressing country-specific challenges to lower burnout rates, minimize missed care, and decrease the intention to leave the job among ICU and general ward nurses.

Mitigating the impact of emotional exhaustion among young intensive care unit nurses: A structural equation model based on the conservation of resources theory

BACKGROUND

As the backbone of the intensive care unit nursing team, young nurses' emotional and psychological well-being is related to the physiological health and life outcomes of critically ill patients.

AIM

Exploring the impact of access to and utilization of organizational resources on emotional exhaustion among intensive care unit nurses.

STUDY DESIGN

A cross-sectional survey. SPSS 27.0 was used for descriptive analysis and Pearson correlation analysis. AMOS 25.0 was used to construct the structural equation model and conduct the Bootstrap test.

RESULTS

A total of 447 valid questionnaires were ultimately included, with a validity rate of 91.2%. The results showed that the turnover intention of young intensive care unit nurses was high (2.06 ± 0.67). Emotional exhaustion positively predicts nurses' turnover intentions (β = 0.30, p < .001). Inclusive leadership (β = 0.075, 95% CI: 0.04 to 0.116, p < .001) and distributive justice (β = 0.090, 95% CI: 0.059 to 0.132, p < .001), as organizational resources, respectively moderate the relationship between emotional exhaustion and turnover intention, and play a chain-mediated role in their relationship (β = 0.055, 95% CI: 0.036 to 0.081, p < .000). Additionally, the study did not show a direct effect of emotional exhaustion on work engagement (β = -0.07, p = .083). Instead, this relationship is mediated through distributive justice (but not inclusive leadership) (β = -0.203, 95% CI: -0.258 to -0.146, p < .001). At the same time, inclusive leadership and distributive justice serve as serial mediators in the mechanism by which emotional exhaustion affects work engagement (β = -0.125, 95% CI: -0.167 to -0.096, p < .000).

CONCLUSIONS

This study emphasizes that organizational resources can effectively alleviate the impact of emotional exhaustion among young intensive care unit nurses.

RELEVANCE TO CLINICAL PRACTICE

Health care institutions and nursing managers need to recognize the importance of utilizing organizational resources and take necessary measures to alleviate emotional exhaustion among intensive care unit nurses. By implementing effective policies, they can enhance nurses' work engagement and retain nursing talent.

The Effect of Nurses' Perceived Social Support on Job Burnout: The Mediating Role of Psychological Detachment

AIMS

To investigate the impacts of social support and psychological detachment on nurses' job burnout, as well as to validate psychological detachment's mediating effect.

DESIGN

The study was conducted using a questionnaire-based cross-sectional design.

METHODS

From October 2023 to March 2024, convenience sampling was used to distribute electronic questionnaires (including a general information questionnaire, the Maslach Burnout Inventory, the Psychological Detachment Scale, and the Social Support Scale) to investigate the current state of job burnout, psychological detachment, and social support among nurses. A total of 325 nurses were included in the study. The statistical analysis was performed using SPSS 29.0 software and the SPSS Process 4.1 plug-in.

RESULTS

Results showed that both social support and psychological detachment were negatively correlated with job burnout. Excluding general demographic characteristics, social support was negatively associated with job burnout through psychological detachment, where psychological detachment mediated social support and emotionally exhausting job burnout with a mediating effect of 8.93%.

CONCLUSION

Nurses' job burnout can be mitigated by both social support and psychological detachment, with psychological detachment acting as a mediation of the effect of social support.

IMPACT

Nursing managers should take measures to enhance the social support of nurses appropriately. At the same time, it is necessary to arrange work reasonably and establish a solid communication mechanism to improve nurses' psychological detachment and reduce nurses' job burnout.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public involvement.

Self-compassion and work engagement among clinical nurses: the mediating role of moral resilience

Background

As the workload of clinical nursing continues to increase, the mental health of nurses has emerged as a critical area of concern. Self-compassion, moral resilience, and work engagement are essential components in enhancing the mental health of clinical nurses. Although it is well-established that self-compassion significantly contributes to improved work engagement, there remains a notable lack of research investigating the specific mechanisms through which self-compassion influences work engagement, particularly from the perspective of moral resilience. This study aimed to address this gap by examining the relationships among self-compassion, moral resilience, and work engagement in clinical nurses, while also validating the mediating role of moral resilience in the relationship between self-compassion and work engagement.

Methods

This study utilized a convenience sampling method to conduct a cross-sectional online survey involving 844 clinical nurses from four tertiary A hospitals in Xi'an, China, between January and March 2024. Participants completed self-report questionnaires that included the Self-Compassion Scale, the Rushton Moral Resilience Scale, and the Utrecht Work Engagement Scale. The data analysis involved descriptive statistics, the Mann-Whitney U test, the Kruskal-Wallis H rank-sum test, Spearman correlation analysis, and the SPSS PROCESS macro.

Results

A significant positive correlation was observed between clinical nurses' self-compassion and moral resilience (r = 0.700, p < 0.01). Additionally, a significant positive correlation was identified between self-compassion and work engagement (r = 0.455, p < 0.01). Furthermore, there was a significant positive correlation between moral resilience and work engagement (r = 0.510, p < 0.01). Mediation analysis indicated that moral resilience partially mediates the relationship between clinical nurses' self-compassion and work engagement. The overall effect of self-compassion on work engagement (β = 0.493) consists of both a direct effect (β = 0.251) and an indirect effect mediated by moral resilience (β = 0.242). Notably, the mediating effect accounts for 49.09% of the total effect.

Conclusion

Clinical nurses' moral resilience plays a mediating role in the relationship between self-compassion and work engagement. Nursing managers should prioritize fostering and enhancing the self-compassion and moral resilience of clinical nurses to effectively elevate their levels of work engagement. These targeted interventions can ultimately improve not only the mental health and professional well-being of nurses but also the overall quality of care delivered in medical institutions.

Organisational-level risk and health-promoting factors within the healthcare sector-a systematic search and review

Introduction

The healthcare sector is globally experiencing increasing demands and workplace interventions on an organisational level is sought to create healthy workplaces. The aim of this study was to provide an overview of Nordic research on the work environment and health of healthcare professionals, with a focus on identifying organisational-level risk and health-promoting factors.

Methods

This systematic search and review was based on an analysis of studies published in peer-reviewed journals between 1 January 2016 and 3 January 2023. The selected studies investigate the relationships between organisational-level risk and health-promoting factors and measures of health and well-being among healthcare professionals during ordinary operations. To increase applicability, this systematic search and review was limited to the Nordic countries as they share the same context with a publicly-funded widely accessible healthcare system. A total of 2,677 articles were initially identified, with 95 original studies meeting the criteria for relevance and quality.

Results

Identified organisational risk and health-promoting factors were categorised into five categories: work schedule distribution, operations design and work methods, ergonomic conditions, working conditions and personnel policies, and the organisation's ethical environment. In addition, two themes across the categories emerged, providing further insight into the implications for practice. The first theme emphasises risk and health-promoting factors in the actions that employers take to fulfil the organisation's goals. The second theme emphasises risk and health-promoting factors in connection with the ability of employees to do their jobs at a level of quality they deem acceptable.

Conclusion

Several organisational-level risk and health-promoting factors were identified, and the results indicate that the actions that employers take to fulfil the health-care organisation's goals and promote the ability of employees to provide high-quality care are important for the health and wellbeing of healthcare employees.

Adaptation of meaning-centered psychotherapy for healthcare providers to buffer work-induced distress and improve wellbeing

Healthcare providers (HCPs) face high rates of distress, experienced as burnout, moral distress, compassion fatigue, and grief. HCPs are also experiencing a crisis in meaning whereby distress is associated with disconnection from meaning in work and, in turn, a lack of meaning in work can further perpetuate distress for HCPs. Although scalable systems-level solutions are needed to tackle multidimensional HCP distress, it is also necessary to address HCP suffering at individual, team, and institutional levels. Targeted interventions to alleviate HCP distress are limited. Meaning-centered psychotherapy (MCP), a brief, evidence-based, intervention first developed for persons with advanced cancer, holds promise to mitigate HCP distress. This study adapted MCP for HCPs through feedback from a multidisciplinary sample of clinicians trained in MCP and working in healthcare settings. A survey was distributed electronically between November and December 2023 to HCPs previously trained in MCP assessing quantitative and qualitative feedback on the appropriateness of MCP for HCPs, the relevance of MCP session topics and exercises, and implementation barriers and facilitators. Descriptive statistics on relevant participant ratings were calculated; a matrix analysis approach was used for qualitative data. Forty participants, primarily mental health providers, expressed that MCP principles were highly relevant for HCPs and offered key insights on appropriate intervention modifications, including the need for a primary focus on meaning in professional life, reduced intervention length, and delivery in group format. Feedback informed critical adjustments to promote appropriateness and acceptability of MCP-HCP which is poised for pilot testing to determine its feasibility and preliminary efficacy for HCPs.