Toward a Unified Framework of Burnout and Workload in Emergency Care Nursing: A Systematic Review and Conceptual Integration
DOI:
https://doi.org/10.31674/mjn.2026.v17i05.016Abstract
Background: Due to the urgent and unpredictable nature of their clinical settings, emergency care nurses are frequently exposed to high work demands. These persistent pressures can contribute to emotional exhaustion, reduced job satisfaction, and, ultimately, burnout, which significantly impacts their mental health and overall performance. Objectives: This study aims to synthesize the existing theory of burnout and workload in emergency nursing and integrate it into a framework model, addressing gaps in the existing literature. Methods: A systematic literature review was conducted using PRISMA guidelines. A total of 900 relevant articles published between 2022 and 2024 from the Scopus and Science Direct databases were analyzed. This review includes studies on burnout and workload models relevant to emergency nursing. Results: This review identified 11 relevant articles highlighting the link between burnout and workload. It deliberately prioritized studies that concurrently address validated theoretical models of burnout, operational definitions or measurements of workload, and empirical data from emergency department nurses. This tripartite criterion ensured conceptual coherence and contextual relevance, aligning with our aim to develop an integrated framework. Conclusions: This review underscores that burnout among emergency nurses is inextricably linked to multidimensional workload drivers ranging from shift intensity and patient acuity to environmental stressors and cannot be effectively mitigated through isolated interventions. By synthesizing empirical evidence into a unified theoretical framework, this study provides a foundation for context-sensitive, system-level strategies that simultaneously address structural demands and enhance psychological resilience, ultimately safeguarding both workforce well-being and patient care quality in high-acuity settings.
Keywords:
Burnout Professional, Emergency Nursing, Healthcare Workforce, WorkloadDownloads
References
Arnold, T. C., Polifroni, E. C., & Beck, C. T. (2026). A mixed methods exploration of compassion satisfaction, compassion fatigue, and emergency nurses caring ability. Journal of Emergency Nursing, 52(2), 380–392. https://doi.org/10.1016/j.jen.2025.05.003
Barnard, N. B., Rothmann, S., De Beer, L. T., & Lubbe, W. (2023). Burnout of emergency nurses in a South African context: The role of job demands and resources, and capabilities. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1119063
Benjamin, E. (2024). The work of patient flow management: A grounded theory study of emergency nurses. International Emergency Nursing, 74, 101457. https://doi.org/10.1016/j.ienj.2024.101457
Boulton, O., Farquharson, B., & Hoyle, L. (2025). The complexity of emergency nurse retention and turnover pre- and post-Covid 19: A scoping review. Journal of Advanced Nursing, 1–17. https://doi.org/10.1111/jan.70467
Caulfield, R., Wiseman, T., Gullick, J., & Ogilvie, R. (2023). Factors preceding occupational distress in emergency nurses: An integrative review. Journal of Clinical Nursing, 32(13–14), 3341–3360. https://doi.org/10.1111/jocn.16461
Chahbounia, R., & Gantare, A. (2023). A pilot study to assess the effect of coaching on emergency nurses’ stress management. Nursing Reports, 13(1), 179–193. https://doi.org/10.3390/nursrep13010019
Chen, Y., Li, Y., Wei, G., Ma, F., Hu, Q., & Ding, L. (2026). The relationship between compassion fatigue and nursing working environment in emergency department nurses in tertiary hospital: A cross-sectional study. International Emergency Nursing, 86. https://doi.org/10.1016/j.ienj.2026.101803
Edú‐valsania, S., Laguía, A., & Moriano, J. A. (2022). Burnout: A review of theory and measurement. International Journal of Environmental Research and Public Health, 19(3). https://doi.org/10.3390/ijerph19031780
Galanis, P., Vraka, I., Fragkou, D., Bilali, A., & Kaitelidou, D. (2021). Nurses’ burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of Advanced Nursing, 77(8), 3286–3302. https://doi.org/10.1111/jan.14839
Gawthorne, J., Mccloughen, A., Branch, J., Mcphillips, O., Scott, D., & Curtis, K. (2026). Applying behaviour change theory to develop an implementation strategy for nurseinitiated protocols in the Emergency department. Journal of Advanced Nursing, 82(5), 5194–5205. https://doi.org/10.1111/jan.70169
Ghiya, M., & Wilson, W. (2022). What’s new in emergencies, trauma and shock – burnout in emergency physicians. Journal of Emergencies, Trauma, and Shock, 15(2), 75–76. https://doi.org/10.4103/jets.jets_76_22
Giostra, V., & Maiorano, T. (2025). What resilience skills do emergency workers need during a widespread phase of a socio-health emergency? A focus on the role of hardiness and resilience. Social Sciences, 14 (1), 8. https://doi.org/10.3390/socsci14010008
Grande, R. A. N., & Berdida, D. J. E. (2026). Australian critical care multinational intensive care unit nurses’ moral courage, resilience, neutralisation, injury, and distress: A cross-sectional and mediation analysis study. Australian Critical Care, 39(3), 101595. https://doi.org/10.1016/j.aucc.2026.101595
Güngör, S., & Sönmez, B. (2025). Work intensification and occupational fatigue on nurses: A cross-sectional and correlational study. BMC Health Services Research, 25(1), 163. https://doi.org/10.1186/s12913-025-12325-4
Habeger, A. D., Connell, T. D. J., Harris, R. L., & Jackson, C. (2022). Promoting burnout prevention through a socio-ecological lens. Delaware Journal of Public Health, 8(2), 70–75. https://doi.org/10.32481/djph.2022.05.008
Hagen, M. H., Jaccheri, L., Papavlasopoulou, S., Hartvigsen, G., & Sæter, T. (2026). Digital psychosocial follow ‑ up for survivors of childhood critical illness: Protocol for a systematic literature review. Systematic Reviews, 15(30), 2–7. https://doi.org/10.2196/preprints.89825
Hetherington, D., Wilson, N. J., Dixon, K., & Murphy, G. (2024). Emergency department Nurses’ narratives of burnout: Changing roles and boundaries. International Emergency Nursing, 74, 101439. https://doi.org/10.1016/j.ienj.2024.101439
Hu, L., Fan, X., Tang, Y., Zhan, B., Zhu, Y., & Chen, Y. (2025). The mediating role of resilience in the relationship between positive emotionality, perceived social support, and psychological well-being among university students: A mixed-methods study. SAGE Open, 15(4). https://doi.org/10.1177/21582440251385869
Huang, H., Su, Y., Liao, L., Li, R., & Wang, L. (2024). Perceived organizational support, self‐efficacy and cognitive reappraisal on resilience in emergency nurses who sustained workplace violence: A mediation analysis. Journal of Advanced Nursing, 80(6), 2379–2391. https://doi.org/10.1111/jan.16006
Jachmann, A., Loser, A., Mettler, A., Exadaktylos, A., Müller, M., & Klingberg, K. (2025). Burnout, depression, and stress in emergency department nurses and physicians and the impact on private and work life: A systematic review. JACEP Open, 6(2), 100046. https://doi.org/10.1016/j.acepjo.2025.100046
Jimenez-Garcia, S., & Flor-Martinez, A. (2026). Interventions for preventing or reducing nurse burnout: A systematic review and meta-analysis. International Journal of Nursing Studies, 178, 105391. https://doi.org/10.1016/j.ijnurstu.2026.105391
Jimenez-Garcia, S., Lazaro, E., & Vizcaya-Moreno, F. (2026). Resilience as a mediator between burnout and health among nurses during the COVID- 19 pandemic: A cross- sectional survey in late 2021. Nursing Open, 13(4), e70526. https://doi.org/10.1002/nop2.70526
Junaković, I. T., & Macuka, I. (2021). Job demands, job control, and social support as predictors of job satisfaction and burnout in Croatian palliative care nurses. Archives of Industrial Hygiene and Toxicology, 72(3), 225–231. https://doi.org/10.2478/aiht-2021-72-3556
Khamisa, N., Madala, S., & Fonka, C. B. (2025). Burnout among South African nurses during the peak of COVID-19 pandemic: A holistic investigation. BMC Nursing, 24, 290. https://doi.org/10.1186/s12912-025-02938-9
Khan, B. M., Hameed, W., Tharani, A., & Khan, B. (2026). Burnout and coping strategies among healthcare professionals in the emergency departments of public and private tertiary hospitals in Karachi. BMJ Open, 16, e111829. https://doi.org/10.1136/bmjopen-2025-111829
LaFontaine, A. (2025). One element of the emergency department nurse burnout epidemic – who can help? Based on a qualitative exploratory case study. International Journal of Healthcare Management, 18(1), 141–153. https://doi.org/10.1080/20479700.2024.2405324
Leep-Lazar, K., Ma, C., Vaughan, V., & Witkoski, A. (2026). Job demands resources, mental health, and intention to leave among early-career nurses: A cross-sectional study. International Journal of Nursing Studies, 178, 105396. https://doi.org/10.1016/j.ijnurstu.2026.105396
Lei, Y., Cheng, R., Xiong, C., Chen, Q., Zhang, Z., & Chang, H. (2026). Serial mediation of affective domain ability and feedback-seeking behaviour in the relationship between career adaptability and transition shock among novice nursing interns: A multicenter cross-sectional study. BMC Medical Education, 26, 656. https://doi.org/10.1186/s12909-026-08967-5
Li, M., Wei, J., Yang, S., Tian, Y., Han, S., Jia, G., De Ala, M., Song, R., & Wei, B. (2024). Relationships among perceived social support, mindful self-care, and resilience among a sample of nurses in three provinces in China: A cross-sectional study. Frontiers in Public Health, 12, 1334699. https://doi.org/10.3389/fpubh.2024.1334699
Liao, L., Wu, Q., Su, Y., Li, R., & Wang, L. (2025). Coping styles mediated the association between perceived organizational support and resilience in emergency nurses exposed to workplace violence: A cross‐sectional study. Nursing & Health Sciences, 27(1). https://doi.org/10.1111/nhs.70018
Luo, M., Hou, H., Jiang, Y., Li, J., Li, S., & Xia, Z. (2024). Emergency nurses’ experience in caring for unidentified patients: A qualitative study. International Emergency Nursing, 74, 101455. https://doi.org/10.1016/j.ienj.2024.101455
Masih, S., Nisar, M., & Iqbal, T. (2026). The association of leadership with nurses’ turnover intention: A wo-wave cross-sectional study. International Journal of Nursing Studies Advances, 10, 100459. https://doi.org/10.1016/j.ijnsa.2025.100459
Nagel, C., Lindstrom, P. N., Westergren, A., Persson, S. S., & Nilsson, K. (2025). Nurses’ health and work experiences during the COVID-19 pandemic in Swedish prehospital and hospital care: A deductive content analysis through the lens of the swAge model. BMC Public Health, 25(1), 304. https://doi.org/10.1186/s12889-024-21152-x
Nantsupawat, A., Kutney-Lee, A., Abhicharttibutra, K., Wichaikhum, O. A., & Poghosyan, L. (2024). Exploring the relationships between resilience, burnout, work engagement, and intention to leave among nurses in the context of the COVID-19 pandemic: A cross-sectional study. BMC Nursing, 23(1), 1–8. https://doi.org/10.1186/s12912-024-01958-1
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Medicine, 18(3), 1–15. https://doi.org/10.1371/JOURNAL.PMED.1003583
Parizad, N., Nazmi, P., Hosseingholipour, K., & Abedi, Z. (2026). The predictive power of job content, subjective workload, and job burnout on cognitive failures in nurses working in emergency departments. International Emergency Nursing, 85, 101746. https://doi.org/10.1016/j.ienj.2026.101746
Paul, J., Lim, W. M., Bresciani, S., Cass, A. O., & Hao, A. W. (2021). Scientific procedures and rationales for systematic literature reviews (SPAR-4-SLR). International Journal of Consumer Studies, 45(5), O1-O16. https://doi.org/10.1111/ijcs.12695
Pien, L., Wang, C., Cheng, W., Lin, Y., Chou, K., & Hsu, C. (2025). The relationship between resilience and mental health status among nurses with workplace violence experiences: A cross‐sectional study. International Journal of Mental Health Nursing, 34(1), e13497. https://doi.org/10.1111/inm.13497
Power, H., Skene, I., & Murray, E. (2022). The positives, the challenges and the impact; An exploration of early career nurses experiences in the emergency department. International Emergency Nursing, 64, 101196. https://doi.org/10.1016/j.ienj.2022.101196
Provost, J., Gosselin, E., & Rochefort, C. M. (2026). The omission of nursing care in emergency departments: A conceptual analysis using Walker & Avant ’ s methodology. Journal of Advanced Nursing, 82, 1750–1759. https://doi.org/10.1111/jan.17017
Ranta, M., Lönnroos, E., Miettinen, M., Kouvo, A., & Lammintakanen, J. (2024). Emergency nurses’ and physicians’ perceptions and self-assessed competence in providing care to older patients. International Emergency Nursing, 74, 101443. https://doi.org/10.1016/j.ienj.2024.101443
Rantung, G., Griffiths, D., & Moss, C. (2024). The social processes that emergency nurses use to achieve sustainability: A constructivist grounded theory. Journal of Advanced Nursing, 81(2), 1005-1018. https://doi.org/10.1111/jan.16297
Riedel, A., Messenger, D., Fleischman, D., & Mulcahy, R. (2021). Consumers experiencing vulnerability: A state of play in the literature. Journal of Service Marketing, 36(2), 110–128. https://doi.org/10.1108/JSM-12-2020-0496
Romero-Carazas, R., Almanza-Cabe, R. B., Valero-Ancco, V. N., Espíritu-Martínez, A. P., Espinoza-Casco, R. J., Garro-Aburto, L. L., Vizcarra-Quiñones, A. M., Samaniego-Montoya, C. M., Denegri-Velarde, M. I., & Ochoa-Tataje, F. A. (2024). Burnout and Physical activity as predictors of job satisfaction among Peruvian nurses: The Job Demands-Resources theory. Journal of Primary Care & Community Health, 15. https://doi.org/10.1177/21501319241256265
Schablon, A., Kersten, J. F., Nienhaus, A., Kottkamp, H. W., Schnieder, W., Ullrich, G., Schäfer, K., Ritzenhöfer, L., Peters, C., & Wirth, T. (2022). Risk of burnout among emergency department staff as a result of violence and aggression from patients and their relatives. International Journal of Environmental Research and Public Health, 19(9), 4945. https://doi.org/10.3390/ijerph19094945
Somma, D., Finocchi, A., Campagnini, S., Marra, E., Pedrini, C., Pinna, S., Szczepanska, M. A., Fasano, A., Cecchi, F., Falotico, E., & Mannini, A. (2026). Technologies for the three-dimensional assessment and treatment of unilateral spatial neglect in individuals with stroke: A systematic review. Journal of NeuroEngineering and Rehabilitation, 23, 35. https://doi.org/10.1186/s12984-025-01839-x
Soola, H., Ajri-Khameslou, M., Mirzaei, A., & Bahari, Z. (2022). Predictors of patient safety competency among emergency nurses in Iran: A cross-sectional correlational study. BMC Health Services Research, 22(1), 1–10. https://doi.org/10.1186/s12913-022-07962-y
Soto-Castellón, M. B., Leal-Costa, C., Pujalte-Jesús, M. J., Soto-Espinosa, J. A., & Díaz-Agea, J. L. (2023). Subjective mental workload in Spanish emergency nurses. A study on predictive factors. International Emergency Nursing, 69, 101315. https://doi.org/10.1016/j.ienj.2023.101315
Tang, L., Wang, F., & Tang, T. (2024). Exploring the relationship between family care, organizational support, and resilience on the professional quality of life among emergency nurses: A cross-sectional study. International Emergency Nursing, 72, 101399. https://doi.org/10.1016/j.ienj.2023.101399
Wang, L., Zhang, X., Zhang, M., Wang, L., Tong, X., Song, N., Hou, J., Xiao, J., Xiao, H., & Hu, T. (2024). Risk and prediction of job burnout in responding nurses to public health emergencies. BMC Nursing, 23(1), 1–13. https://doi.org/10.1186/s12912-024-01714-5
Wang, Q., Zhang, G., Yue, G., & Liu, X. (2026). Job satisfaction and burnout among emergency nurses: A bibliometric and visualized analysis. International Emergency Nursing, 86, 101802. https://doi.org/10.1016/j.ienj.2026.101802
Wu, S., Sun, Y., Zhong, Z., Li, H., Ding, B., & Deng, Q. (2025). The effect of moral distress on emergency nurses’ job burnout: the mediating roles of hospital ethical climate and moral resilience. Frontiers in Public Health, 13, 1562209. https://doi.org/10.3389/fpubh.2025.1562209
Xia, F., Li, G., Xu, L., Li, L., Chen, X., & Li, Q. (2026). Addressing factors associated with nursing workforce instability: the mediating effect of professional identification between perceived responses to capitalization attempts and job burnout in newly recruited nurses. Frontier in Public Health, 14, 1784834. https://doi.org/10.3389/fpubh.2026.1784834
Yuan, Z., Yu, D., Zhao, H., Wang, Y., Jiang, W., Chen, D., Liu, X., & Li, X. (2021). Burnout of healthcare workers based on the effort-reward imbalance model: A cross-sectional study in China. International Journal of Public Health, 66, 599831. https://doi.org/10.3389/ijph.2021.599831
Zhang, X., Tian, W., Tang, X., Jia, L., Meng, X., Shi, T., & Zhao, J. (2024). Mediating role of resilience on burnout to well-being for hospital nursing staff in Northeast China: A cross-sectional study. BMJ Open, 14(11), e081718. https://doi.org/10.1136/bmjopen-2023-081718
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