The impact of health emergencies on nurses’ burnout: a systematic review and meta-analysis

Burnout is a prevalent occupational phenomenon among healthcare workers. To evaluate the current evidence on nurses' burnout and the impact of turnover intention during the pandemic is imperative. We aimed to comprehensively synthesize and quantify the impact of health emergencies caused by the COVID-19 pandemic outbreak on nurses' burnout and identify factors associated with the negative impact. Systematic searches were conducted in PubMed, Web of Science, EBSCO (ASP), Cochrane Library, and supplemented by a manual search, for publications from December 2019 to February 2023. A total of 176 articles involving 110,316 nurses were identified. The overall pooled estimate of the prevalence of burnout was 48% (95% confidence interval CI 42–55%). The mean score for overall burnout on the 22-item (7-point) Maslach Burnout Inventory (MBI) was 59.83 (95% CI 49.33 to 70.34). In the work environment, nurses who were exposed to COVID-19 (SMD 0.19, 95% CI 0.04 to 0.33) or worked in emergency departments and ICUs (SMD 0.10, 95% CI 0.06 to 0.14) scored higher for burnout compared to those in general wards. In the presence of increased burnout, overall burnout in nurses was associated with a sevenfold increase in depression (OR 7.40, 95% CI 3.82 to 14.35), a fourfold increase in anxiety (OR 4.14, 95% CI 2.15 to 7.98) and stress (OR 4.60, 95% CI 2.31 to 9.17), and a fourfold increase in low resilience (OR 4.06, 95% CI 2.13 to 7.76) in mental health outcomes. As burnout increased, turnover intention was nearly four times as likely compared with retention (OR 3.55, 95% CI 1.73 to 7.28), and it was related to the quality of care. The results of this meta-analysis indicate that half of the nurses experienced burnout during the COVID-19. Nurses' burnout is associated with the sustainability of healthcare organizations. Healthcare organizations and societies should invest more time and effort in implementing evidence-based strategies to mitigate nurses' burnout across specialties, especially in emergency medicine and for younger nurses in specialized departments, to better prepare for future public health emergencies.