Burnout, Anxiety, and Resilience Among Nurses During Wartime: Evidence from a Cross-Sectional Study

Abstract Background The “Iron Swords” War that began in October 2023 created unprecedented challenges for Israeli healthcare workers. Nurses, who are particularly vulnerable to occupational stressors, face heightened risks of burnout and psychological distress during wartime conditions. This study examined the relationship between personal resilience and burnout among hospital nurses working during the Iron Swords War in Israel and assessed the prevalence of burnout, anxiety, and stress while identifying risk and protective factors. Methods In this cross-sectional study, an electronic questionnaire was distributed to hospital nurses working in Israeli hospitals to measure demographic characteristics, resilience using the Connor-Davidson 10-item Resilience Scale (CD-RISC-10), anxiety and stress using the Depression, Anxiety, and Stress Scale (DASS-21), and burnout using the Copenhagen Burnout Inventory (CBI). Mediation analysis was conducted using the PROCESS macro to examine the relationships between anxiety, stress, resilience, and burnout. Results Of the 465 nurses who completed the survey, 80.6% reported extremely severe anxiety, whereas 35.4% exhibited extremely severe stress. While 53.3% showed moderate burnout levels, only 7.7% demonstrated high burnout. The mean ± standard deviation resilience score was 20.4 ± 8.2. Significant risk factors for elevated anxiety and stress included night shift work, working > 180 hours/week, and having family members in military service during the war. Mediation analysis revealed that stress partially mediated the relationship between anxiety and burnout (B = 0.3210, p p < 0.01) and demonstrated a protective effect. Multiple regression identified sex, resilience, anxiety, and stress as significant predictors of burnout, explaining 48.1% of the variance. Conclusions Despite extremely high levels of anxiety and stress, nurses maintained moderate burnout and resilience levels during wartime. The protective role of resilience and the mediating effect of stress highlight the importance of targeted interventions focusing on stress management and resilience building, particularly for high-risk groups.