“We worked … as if nothing was happening”: Exploring multilevel burnout experiences and resources among health professionals in the context of compounding disasters in Puerto Rico.

Health professionals, including physicians and mental health workers, experience higher rates of burnout compared to the general U.S. population and other industries. These risks intensify in disaster contexts, threatening workforce well-being and sustainability. Between 2017 and 2020, Puerto Rico faced three compounding disasters: Hurricane Maria, a historic earthquake sequence, and the COVID-19 pandemic. Yet, no prior studies have examined multilevel factors contributing to burnout amid such compounding events. This study aimed to explore burnout-related stressors and resources among health professionals across task, social, and organizational levels during these disasters in Puerto Rico. Using an exploratory-descriptive qualitative design informed by the Resources, Emotions/Experiences and Demands model of burnout, semistructured interviews were conducted with 25 health professionals from diverse backgrounds. Thematic analysis revealed six key stressors: (1) cumulative stress, (2) intersecting patient health needs, (3) difficulty separating personal and professional life, (4) emotionally charged work environments, (5) collapsed health systems, and (6) insufficient economic support. Correspondingly, six multilevel resources addressed these stressors: (1) financial security, (2) authentic support, (3) dismantling power hierarchies and redistributing roles, (4) adaptive workspace overhauls, (5) onsite provisions, and (6) flexible expectations and professional autonomy. Findings underscore the compounded stress health professionals face navigating multiple disasters and emphasize the importance of leveraging resources across multiple levels to mitigate burnout risk. These insights inform strategies to support and sustain the health workforce in disaster-affected settings, particularly in the context of overlapping events. (PsycInfo Database Record (c) 2026 APA, all rights reserved).