“You have to ask yourself when you've had enough”: An ethnography of multi-level nurse burnout cultural impacts in the emergency department

• Burnout impacts 50-55% of emergency department nurses; nurse burnout cultural impacts in this setting are under-explored. • This ethnography revealed an explanatory model of nurse burnout impacts, “The Pathway of Burnout”. • cultural clash was identified between pervasive nurse burnout culture and a culture of patient safety.