The impact of workplace stress on nursing professionals’ well-being   and balance: a silent killer

Binu Joe; B. Kalyani; Raja Ganapathy; Chetanmala K.; Anjani Devi Nelavala; Rajveer S. Khatodiya; Deepa N. R.; Mohammed Umar

doi:10.18203/2349-3259.ijct20253342

Authors

Binu Joe Department of Child Health Nursing, Murlidhar College of Nursing, Rajkot, Gujarat, India
B. Kalyani Department of Obstetrics and Gynaecological Nursing, Dr. C. Sobhanadri Siddhartha School of Nursing, Chinnoutpalli, Vijayawada, Andhra Pradesh, India
Raja Ganapathy Department of Mental Health Nursing, Dhaman Health Assurance Hospital, Kuwait City, Kuwait
Chetanmala K. Department of Community Health Nursing, College of Nursing RIMS, Imphal, Manipur, India
Anjani Devi Nelavala Department of Mental Health Nursing, Narayana College of Nursing, Nellore, Andhra Pradesh, India
Rajveer S. Khatodiya Department of Forensic Nursing, Baba Farid University of Health Sciences, Faridkot, Punjab, India
Deepa N. R. Department of Obstetrics and Gynaecological Nursing, ESIC College of Nursing, Kalaburagi, Karnataka, India
Mohammed Umar Department of Nursing, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-3259.ijct20253342

Keywords:

Workplace stress, Nursing professionals, Well-being, Work-life balance, Concept analysis, Burnout

Abstract

Workplace stress is a pervasive threat to the physical and psychological health of nursing professionals, affecting their well-being, work-life balance, and patient outcomes. The demanding nature of the nursing profession, particularly in resource-constrained environments, places nurses at high risk for chronic stress. This umbrella concept analysis aims to synthesize and analyze existing conceptual literature on workplace stress and its implications for the well-being and balance of nursing professionals. A systematic umbrella review methodology was employed, retrieving reviews and concept analyses from five databases (PubMed, CINAHL, Scopus, PsycINFO, Web of Science). A total of 43 eligible studies (systematic reviews, meta-analyses, and concept analyses) published between 2000 and 2024 were analyzed. Conceptual frameworks were mapped using Walker and Avant's and Rodgers’ evolutionary methods of concept analysis. Common antecedents of workplace stress include high workload, role ambiguity, poor leadership, and organizational injustice. Consequences span psychological distress, burnout, emotional exhaustion, physical illness, and attrition. Key attributes include chronic exposure to stressors, emotional labor, and perceived lack of control. Interventions such as mindfulness-based stress reduction, improved leadership, and supportive work environments show moderate success. Workplace stress remains a silent but potent killer of nursing well-being. Clear conceptual understanding, proactive policy measures, and system-wide interventions are needed to safeguard nurse health and sustain quality care.

Metrics

Metrics Loading ...

References

Jennings BM. Work stress and burnout among nurses: role of the work environment. Nurs Outlook. 2008;56(3):132-8.

Van Bogaert P, Clarke S, Willems R, Mondelaers M, Meulemans H, Van de Heyning P, et al. The impact of unit-level nurse practice environment and burnout on nurse-reported outcomes. J Clin Nurs. 2014;23(11-12):1664-74. DOI: https://doi.org/10.1111/j.1365-2702.2009.03128.x

World Health Organization. Occupational health: stress at the workplace. 2022. Available at: https:// www.who.int/health-topics/occupational-health. Accessed on 12 May 2025.

Rani R, Singh N, Mathur A, Kumar S. Stress among nurses in India: a review. Int J Community Med Public Health. 2020;7(1):401-5.

Zhang X, Wang J, Hao Y, Wu K, Jiao M, Liang L, et al. Prevalence and factors associated with burnout of frontline healthcare workers in fighting against the COVID-19 pandemic: evidence from China. Front Psychol. 2021;12:680614. DOI: https://doi.org/10.3389/fpsyg.2021.680614

Gelsema TI, van der Doef M, Maes S, Janssen M, Akerboom S, Verhoeven C. A longitudinal study of job stress in nursing. Int J Nurs Stud. 2006;43(4):455-68.

Walker LO, Avant KC. Strategies for theory construction in nursing. 5th edition. Upper Saddle River (NJ): Prentice Hall. 2011;5.

Rodgers BL. Concept analysis: an evolutionary view. In: Rodgers BL, Knafl KA, editors. Concept development in nursing. Philadelphia: Saunders. 2000;77-102.

McVicar A. Workplace stress in nursing: a literature review. J Adv Nurs. 2003;44(6):633-42. DOI: https://doi.org/10.1046/j.0309-2402.2003.02853.x

Laschinger HK, Finegan J, Shamian J, Wilk P. Structural empowerment, burnout, and work satisfaction. J Nurs Adm. 2001;31(5):260-72.

Erickson RJ, Grove WJ. Emotional labor and health care. Sociol Health Illn. 2007;29(2):195-212.

Epstein EG, Hamric AB. Moral distress, ethical climate, and nurse retention. J Clin Ethics. 2009;20(4):330-42. DOI: https://doi.org/10.1086/JCE200920406

Duchscher JB. Transition shock: the initial stage of role adaptation for newly graduated registered nurses. J Adv Nurs. 2009;65(5):1103-13. DOI: https://doi.org/10.1111/j.1365-2648.2008.04898.x

Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality. JAMA. 2002;288(16):1987-93. DOI: https://doi.org/10.1001/jama.288.16.1987

Alenezi AM, Aboshaiqah AE, Baker O. Work-related stress among nurses in Saudi Arabia. Ann Saudi Med. 2018;38(1):18-25.

Santos SR, Barros C, Carolino E. Self-efficacy and control in nursing stress. Int J Nurs Sci. 2015;2(2):134-40.

Dewe PJ, O’Driscoll MP, Cooper CL. Coping with work stress: a review and critique. Chichester (UK): Wiley-Blackwell. 2010. DOI: https://doi.org/10.1002/9780470711712

Maslach C, Jackson SE, Leiter MP. Maslach burnout inventory manual. 3rd edition. Palo Alto (CA): Consulting Psychologists Press. 1996.

Xie Z, Wang A, Chen B. Nurse burnout and its association with occupational stress in a cross-sectional study in China. Int J Nurs Stud. 2011;48(5):629-34.

McHugh MD, Kutney-Lee A, Cimiotti JP, Sloane DM, Aiken LH. Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Aff (Millwood). 2011;30(2):202-10. DOI: https://doi.org/10.1377/hlthaff.2010.0100

Tawfik DS, Scheid A, Profit J, Shanafelt TD, Trockel M, Adair KC, et al. Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors. Mayo Clin Proc. 2018;93(11):1571-80. DOI: https://doi.org/10.1016/j.mayocp.2018.05.014

Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103-11. DOI: https://doi.org/10.1002/wps.20311

Figley CR. Compassion fatigue: psychotherapists’ chronic lack of self-care. J Clin Psychol. 2002;58(11):1433-41. DOI: https://doi.org/10.1002/jclp.10090

Peters E. Compassion fatigue in nursing: a concept analysis. Nurs Forum. 2018;53(4):466-80. DOI: https://doi.org/10.1111/nuf.12274

Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during COVID-19 pandemic. BMJ. 2020;368:m1211. DOI: https://doi.org/10.1136/bmj.m1211

Schaufeli WB, Bakker AB. Job demands, job resources, and their relationship with burnout and engagement: a multi-sample study. J Organ Behav. 2004;25(3):293-315. DOI: https://doi.org/10.1002/job.248

Hobfoll SE. Conservation of resources theory: its implication for stress, health, and resilience. In: Folkman S, editor. The Oxford handbook of stress, health, and coping. Oxford: Oxford University Press. 2011;127-47. DOI: https://doi.org/10.1093/oxfordhb/9780195375343.013.0007

Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer Publishing. 1984.

Karasek RA. Job demands, job decision latitude, and mental strain: implications for job redesign. Adm Sci Q. 1979;24(2):285-308. DOI: https://doi.org/10.2307/2392498

Siegrist J. Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol. 1996;1(1):27-41. DOI: https://doi.org/10.1037//1076-8998.1.1.27

McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998;338(3):171-9. DOI: https://doi.org/10.1056/NEJM199801153380307

Taylor C, Graham J, Potts HW, Candy J, Richards MA, Ramirez AJ. Developing a conceptual model of compassion fatigue. J Adv Nurs. 2013;69(9):2134-46.

Poghosyan L, Clarke SP, Finlayson M, Aiken LH. Nurse burnout and quality of care: cross-national investigation in six countries. Res Nurs Health. 2010;33(4):288-98. DOI: https://doi.org/10.1002/nur.20383

Yoon S, Kim J, Kim H. Workplace violence and nurses’ turnover intention: the mediating role of work engagement. J Nurs Scholarsh. 2020;52(5):559-66.

Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PLoS One. 2016;11(7):e0159015. DOI: https://doi.org/10.1371/journal.pone.0159015

Bridgeman PJ, Bridgeman MB, Barone J. Burnout syndrome among healthcare professionals. Am J Health Syst Pharm. 2018;75(3):147-52. DOI: https://doi.org/10.2146/ajhp170460

Lo WY, Chien LY, Hwang FM, Huang N, Chiou ST. Work stress and intention to leave among nurses in Taiwan: a nationwide cross-sectional survey. J Nurs Res. 2018;26(1):24-30.

Chatterjee S, Chakraborty T, Mitra S. Nursing stress and its influencing factors in Indian nurses. Indian J Occup Environ Med. 2016;20(2):95-100.

Da Silva RM, Goulart CT, Guido LA, do Carmo Cruz Robazzi ML, de Oliveira Gomes RP. Strategies for coping with occupational stress in emergency care nursing. Rev Lat Am Enfermagem. 2014;22(3):386-93.

Gunasingam N, Burns K, Edwards J, Dinh M, Walton M. Reducing stress and burnout in junior doctors: a review of the solutions. Med Educ. 2015;49(5):458-64.

Fink DS, Galea S. The mental health consequences of COVID-19 and physical distancing. JAMA Intern Med. 2020;180(6):817-8. DOI: https://doi.org/10.1001/jamainternmed.2020.1562

Choi KR, Skrine Jeffers K, Logsdon MC. Moral distress and burnout among frontline nurses during COVID-19 pandemic: a cross-sectional survey. Int J Nurs Stud. 2021;117:103851.

Chang Y, Chan HJ. Optimism and proactive coping in relation to burnout among nurses. J Nurs Manag. 2015;23(3):401-8. DOI: https://doi.org/10.1111/jonm.12148

Dimitrios T, Konstantinos D. Occupational stress, job satisfaction, and working environment among Greek nurses. J Nurs Manag. 2010;18(3):379-88.

Peters D, Jackson D, Andrew S, Halcomb E, Salzberg M, Giles T, et al. The experience of workplace stress in community health nurses: a qualitative systematic review. J Nurs Scholarsh. 2018;50(6):622-31.

Shah MK, Gandrakota N, Cimiotti JP, Ghose N, Moore M, Ali MK. Prevalence of and factors associated with nurse burnout in the US. JAMA Health Forum. 2021;2(7):e211513. DOI: https://doi.org/10.1001/jamanetworkopen.2020.36469

Maslach C, Leiter MP. Burnout: a multidimensional perspective. In: Schaufeli WB, Maslach C, Marek T, editors. Professional burnout: recent developments in theory and research. Washington (DC): Taylor & Francis. 1997;19-32. DOI: https://doi.org/10.4324/9781315227979-3

Chor WPD, Ng WM, Cheng L, Situ W, Chong JW, Ng LYA, et al. Burnout among emergency healthcare workers during the COVID-19 pandemic: a meta-analysis. Am J Emerg Med. 2021;46:96-104. DOI: https://doi.org/10.1016/j.ajem.2020.10.040

Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the COVID-19 outbreak. Lancet Psychiatry. 2020;7(3):e14. DOI: https://doi.org/10.1016/S2215-0366(20)30047-X

International Council of Nurses. ICN calls for data on healthcare worker infections and deaths. Geneva: ICN. 2020.