The effect of workload on the development of burnout syndrome in Covid-19 intensive care nurses: a systematic review

Silvano Biagiola1, Norma Alfieri2, Sofia Di Mario3, Giulia Evangelista2, Daniela Grima2, Susanna Sodo2, Giuseppe La Torre2

1UPCM Salvador Mundy, Rome, Italy; 2Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy; 3PhD student of Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.

Summary. Background. Nowadays, it is well-known that burnout is a syndrome that mainly affects the helping professions. The nursing profession is obviously among those categories of workers that can develop burnout and, precisely because of its proximity to people who suffer associated with high workloads characterized by high emotional impacts. Aim. The aim of this systematic review is, therefore, to highlight whether the high nursing workload during the pandemic has contributed to the onset of burnout syndrome in nurses who served in intensive care units (ICUs) dedicated to the care of Covid-19 patients. Methods. A systematic review was carried out. The main scientific databases were consulted, such as PubMed, Scopus, Web of Sciences and CINAHL analyzing all the papers present in literature. Using PRISMA guidelines, fifteen articles were included in the review. The protocol for this review has been registered on PROSPERO, the international prospective register of systematic reviews (PROSPERO ID: CRD42024502094). The quality assessment of the articles included in this review was conducted using the Newcastle-Ottawa Scale (NOS) for observational studies. Results. In accordance with the literature, all the 15 included studies documented high levels of burnout among ICU professionals, nevertheless those levels were greater than the ones registered in the pre-pandemic period. In Covid-19 era, nurses experienced higher levels of burnout compared to other professions and working as a nurse was identified as an independent risk factor for increased risk of burnout. As reported by all included studies, the overwhelming severity of Covid-19 patients entailed a significant increase in workload for health care providers, particularly nurses. Ultimately, this increase showed a significant correlation with increased burnout risk. Conclusions. The review highlights the correlation between workload and burnout of nurses in Covid-19 intensive care units. It is expected that this and other studies will contribute to a better understanding of the importance of assigning the adequate workload to nurses.

Key words. Burnout, Covid-19, intensive care unit, nursing workload.

L’effetto del carico di lavoro sullo sviluppo della sindrome da burnout negli infermieri di terapia intensiva Covid-19: una revisione sistematica.

Riassunto. Premessa. Oggi è noto che il burnout è una sindrome che colpisce soprattutto le professioni di aiuto. La professione infermieristica appartiene ovviamente alle categorie di lavoratori che possono sviluppare il burnout e, proprio per la sua vicinanza a persone che soffrono, è associata ad alti carichi di lavoro caratterizzati da un elevato impatto emotivo. Scopo. Lo scopo di questa revisione sistematica è evidenziare se l’elevato carico di lavoro infermieristico durante la pandemia abbia contribuito all’insorgenza della sindrome da burnout negli infermieri che hanno prestato servizio nelle unità di terapia intensiva (ICU) dedicate all’assistenza dei pazienti affetti da Covid-19. Metodi. È stata condotta una revisione sistematica. Sono state consultate le principali banche dati scientifiche, come PubMed, Scopus, Web of Sciences e CINAHL, analizzando tutti gli articoli presenti in letteratura. Utilizzando le linee guida PRISMA, quindici articoli sono stati inclusi nella revisione. Il protocollo di questa revisione è stato registrato su PROSPERO, il registro prospettico internazionale delle revisioni sistematiche (ID PROSPERO: CRD42024502094). La valutazione della qualità degli articoli inclusi in questa revisione è stata condotta utilizzando la Newcastle-Ottawa Scale (NOS) per gli studi osservazionali. Risultati. In accordo con la letteratura, tutti i 15 studi inclusi hanno documentato alti livelli di burnout tra i professionisti dell’ICU; tuttavia tali livelli erano maggiori di quelli registrati nel periodo pre-pandemico. Nell’era Covid-19, gli infermieri hanno sperimentato livelli più elevati di burnout rispetto ad altre professioni e il fatto di lavorare come infermiere è stato identificato come un fattore di rischio indipendente per l’aumento del rischio di burnout. Come riportato da tutti gli studi inclusi, l’eccessiva gravità dei pazienti affetti da Covid-19 ha comportato un significativo aumento del carico di lavoro per gli operatori sanitari, in particolare per gli infermieri. In definitiva, questo aumento ha mostrato una correlazione significativa con l’aumento del rischio di burnout. Conclusioni. La revisione evidenzia la correlazione tra il carico di lavoro e il burnout degli infermieri nelle unità di terapia intensiva Covid-19. Si prevede che questo e altri studi contribuiranno a una migliore comprensione dell’importanza di assegnare un carico di lavoro adeguato agli infermieri.

Parole chiave. Burnout, carico di lavoro infermieristico, Covid-19, unità di terapia intensiva

Introduction

The concept of burnout, as we understand it today, is deeply rooted in the pioneering research of Christina Maslach in the early 1980s1. It is thanks to her contribution, often based on the collection of direct testimonies from workers who were coping with this syndrome, that we now have a deeper understanding of the signs, symptoms, and occupational fields most susceptible to the development of this disorder. Nowadays, burnout is known as a syndrome that predominantly affects the helping professions. It is mainly characterized by three interrelated dimensions: emotional exhaustion, depersonalization and reduced personal accomplishment1. Maslach’s approach, heavily reliant on firsthand accounts from workers grappling with burnout, has significantly enriched our comprehension of its manifestations, symptoms, and the occupational environments most prone to its emergence. In the years since Maslach’s initial studies, the definition of burnout has evolved to be recognized universally as a psychological syndrome particularly prevalent among professions centered on caregiving and support1. Characterized by a triad of symptoms – emotional exhaustion, depersonalization, and a sense of diminished personal accomplishment – burnout not only undermines individual health and well-being but also impairs professional efficacy and productivity1,2. Maslach’s pioneering work laid the foundation for a better understanding of the factors that contribute to burnout and highlighted the importance of addressing this problem in professions that provide care and support to others1,2. The nursing profession is undoubtedly one of the workers’ categories most at risk of developing burnout; this risk is due to the specific characteristics of this profession, which include close proximity to suffering people, intense emotional impacts, and demanding workloads2. There are several definitions of nursing workload in the literature. An interesting Italian literature review3 points out that workload includes all activities, both caring and not caring, that a nurse is required to perform. From this premise, both care intensity (i.e. the time devoted to care) and care complexity (i.e. the skills required of the workers to meet the patient’s needs) emerge. It is important to note that an increase in either of these dimensions leads to an increase in the overall workload, resulting in an increase in work-related stress3. Nurses who work in intensive care units are particularly exposed to emotional stress4 and often have to endure an exhausting workload5. It is already known in the literature that critical care nurses are more susceptible to burnout6,7. Thus, nurses working in intensive care units are more at risk than nurses working in other settings8 of developing burnout syndrome. The Covid-19 pandemic has significantly increased nurses’ workload and exacerbated pre-existing problems in the National Health System, such as severe staff shortages.

Covid-19 has severely affected the lives and the mental and physical health of all the workers involved. Workplace stress was high among healthcare workers and was associated with reduced psychological health9. After more than a year of the pandemic, the mental health of physicians, nurses and healthcare workers began to be a problem, their psychological resilience collapsed. This specific condition has been defined as “pandemic stress” and is entirely new to current clinical practice because it is a non-conventional, suspended, sub-acute, persistent individual community stress that can evolve in subtle ways (second peak) and that develops through different phases, moving from acute stress (alarm) to subsequent chronic stress10. This condition involves a psychosocial and economic effort on one side and an effort in damage management and reconstruction on the other10.

Burnout syndrome results from a prolonged and intense response to job stress and occurs when a worker is drained by the load of obligations and tasks to be performed.

The main causes of burnout, apart from emotional overload, are related to work organization and human resources, such as lack of appropriate personal protective equipment, demanding work shifts, or being not well-trained11. The consequent strain on the mental and physical well-being of nurses and other healthcare workers is now recognized as a critical concern, with factors such as organizational demands, lack of proper protective equipment, and the emotional burdens of care contributing to an escalating crisis in worker burnout11,12. The relationship between the increased workload of intensive care nurses during the Covid-19 pandemic and various outcomes, such as burnout, stress, and job satisfaction, has been a focal point of recent research. The pandemic has intensified the already challenging environment of intensive care units (ICUs), highlighting the critical impact of workload increases on nursing staff. This essay explores this relationship, emphasizing the consequences for nurse well-being and the broader implications for healthcare systems. During the Covid-19 pandemic, ICUs across the globe experienced unprecedented patient influxes, significantly elevating the workload for nurses. This increase was not merely in the number of patients but also in the complexity and intensity of care required, given the severe health complications associated with Covid-199,11. Nurses were tasked with managing complex ventilator systems, administering multiple therapies, and providing round-the-clock care to critically ill patients, all while adhering to stringent infection control measures.

The aim of this systematic review is, therefore, to highlight whether the high nursing workload during the Covid-19 pandemic contributed to the onset of burnout syndrome in nurses who worked in intensive care units caring for SARS-CoV-2 patients.

Materials and methods

Identification of relevant studies

The review was conducted by following the recommendations of the PRISMA Statement13. The protocol for this review has been registered on PROSPERO, the international prospective register of systematic reviews (PROSPERO ID: CRD42024502094). Accordingly, the authors drafted a protocol based on the PIOS (population, intervention, outcome, and setting) (table 1).




Study selection and eligibility criteria

The eligibility criteria for the inclusion of the studies to be reviewed were defined. A systematic review was conducted in February 2024 by consulting the major electronic databases of scientific interest such as PubMed, Scopus, Web of Sciences and CINAHL. All the relevant literature was collected: experimental studies, case-control studies, randomized controlled trials (RCTs), cross-sectional and longitudinal studies. The following keywords were combined using the Boolean operators “AND” and “OR” to search the database: burnout, nursing workload, intensive care unit and Covid-19. All articles in which the population of interest is nurses who have worked in Covid-19 intensive care units and/or in an ICU where Covid intensive care beds were also present will be included. The effect of workload on nurses’ mental health must be mentioned and taken into account in the articles, and the degree of burnout of the staff members must have been measured. Therefore, all articles published between 2020 and 2024 in English and Italian are included. All other articles with a different sample than the one mentioned, or working in departments other than intensive care units are excluded. In February 2024, eligible studies were selected through a multi-step approach (title reading, abstract, and full-text assessment) by four independent researchers.

In the first phase, the results obtained from the research were imported into Zotero, a software for the management of bibliographic references, and duplicates were eliminated. In the second phase, each article uploaded to the database was carefully and independently examined. Initially, they were analyzed by reading the title and abstract. Thereafter, the irrelevant ones were excluded while those relevant for full-text reading were selected. Articles that did not answer the research questions were excluded after an in-depth reading by four reviewers who worked independently. To ensure accurate data collection, the extracted data were compared independently by each reviewer. Discrepancies and disagreements were discussed and resolved through a consensus session with a fifth-party researcher.

Quality assessment

A quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) for observational studies. The Newcastle-Ottawa Scale (NOS) was developed to assess the quality of nonrandomized studies with its design, content and ease of use directed to the task of incorporating the quality assessments in the interpretation of meta-analytic results. This is a validated, easy-to-use scale of 8 items in three domains: selection, comparability, and exposure/outcome for case-control or cohort studies, respectively. Each item can be given one point, except comparability, which has the potential to score up to two points. Studies are rated from 0-9, with those studies rating 0-3 (poor quality), 4-6 (fair quality), and 7-9 (good/high quality). The NOS scale adapted for cross-sectional studies was used to assess the quality of cross-sectional studies14. This scale was a modified version of the NOS scale, as also used by several other studies that have felt the need to adapt the NOS scale so as to appropriately assess the quality of cross-sectional studies. Through a search of the literature, we found that a NOS score of 7 or more can be considered a “good” or “very good” study15. To ensure accurate data collection, the extracted data were compared independently by each reviewer. Discrepancies and disagreements were discussed and resolved through a consensus session with a fifth-party researcher.

Results

Fifteen papers were included in the review. Research began in January 2024. The initial search across different electronic databases (i.e. PubMed, Scopus, Web of Science, CINAHL) yielded 311 citations. First, a total of 124 duplicate papers were excluded, accompanied by the removal of 110 publications from the title/abstracts screening. Seventy-seven articles were sought for retrieval and read in full text. Among the 77 full-text articles screened, 62 were excluded. At the end of the process, 15 studies were included in the review. The procedure for their selection has been graphically summarized in the PRISMA Flowchart (figure 1).




The same selection strategy was used for data extraction: five different reviewers collected the data and any disagreement was resolved by a consensus session. The main characteristics of the fifteen papers included in the systematic review are summarized in the data extraction table (table 2).
















For each paper, the following points are reported: first author, country of the authors, years of publication, title, study design, type of study population, number of participants, burnout assessment tool, workload indicator, correlation between burnout and workload.

The selected articles were carried out in different countries around the world: Belgium, Canada, Turkey, South Korea, USA, Thailand, Qatar, Saudi Arabia, Italy, Brazil, Sweden. This allows us to have a broader view of the phenomenon studied from different perspectives and points of view. The quality assessment was performed independently by five reviewers using the NOS scale adapted for cross-sectional studies. Thirteen studies were classified as very good/good quality16-28, one as fair quality29 and one as poor quality30. Common biases were related to non-randomized sampling process, reduced sample size or insufficient respondent’ rate. Some studies used self-reporting questionnaires as an assessment tool. Thus, lack of standard or validated methods to report workload led to low rating, besides control for confounding factors has been carried out only in a few studies.

Population only ICU nurse

Using the Maslach Burnout Inventory scale (MBI), Bruyneel et al.18,20 reported high prevalence of burnout between Covid-19 ICU nurses in Belgium both in 2021 and 2023. In 2021, 89% of interviewed nurses reported concomitant increase of perceived workload, consistently in 2023 higher patient-to-nurse ratio was significantly associated with a higher risk two MBI dimensions (emotional exhaustion and depersonalisation) at multivariate analysis.

In 2022, a Canadian study investigated the mental health impact of SARS-CoV-2 outbreak on 425 critical care nurses (CCNs), including 87.7% of intensive care nurses30. Interviewed nurses described their job during the pandemic as struggling, constantly short-staffed and increased over limit for safe and high-quality care standards. Hundred percent of the sample reported moderate to high burnout at evaluation with Professional Quality of Life scale (ProQoL), moreover forty four percent were thinking of leaving their job.

Afterwards in 202322, 42% of 131 nurses working in three South Korean ICUs were reported as having high burnout level by MBI: emotional exhaustion had the highest score at 24.39 (±11.09), followed by a decreased sense of self-achievement at 21.89 (±9.26), and dehumanization at 10.56 (±6.53) points. Approximately 64.1% answered that workload has increased during the pandemic, and 18.3% reported a sharp weighting in their duties. The average number of patients assigned to each nurse was 2.98 (±0.74), with more than 70% having three patients and 9.9% having four or more.

This evidence is further supported by studies performing comparison between pre-pandemic and pandemic periods. Across Belgium, Turkey and the USA, burnout and workload significantly increased during Covid-19 outbreak.

By means of two surveys released in January and then in May 2020, Butera et al.19 reported a 15.5% increase in the risk of burnout among intensive and critical care nurses between pre and post pandemic; logistic regression identified the pandemic increased workload reported by 89.1% of participants as a risk factor for high risk of EE and high risk of DP (OR=4,03, 95%IC 2.10-7.72, p<0.001. OR=2.44, 95%IC 1.27 - 4,68, p<0.01, respectively).

In a Turkish study, ICU nurses described significant differences between working conditions before and during pandemics21. Burnout among ICU nurses was evaluated through Burnout Measure-Short version (BMS): mean BMS score was 20.93±2.03 points during pre-pandemic period, significantly increasing to 56.02±2.46 points during the pandemic period (p=0.001). During Covid-19, those nurses reported the increase of weekly working-hours burden (from 48.52±6.82 hours/week in the pre-pandemic period to 55.34±10.14 hours/week) and of nurse-per-patient ratio (from 1:2 before pandemic, 1:3 during pandemic). Moreover, authors quantified workload using the “Individual Workload Perception Scale-Revised-IWPS-R”, thus a significant increase between pre-pandemic and pandemic scores was identified (IWPS-R score for workload, mean±SD, higher scores indicate low perceived workload: before pandemic 15.73±1.46, during pandemic 7.29±1.11; p=0.001). Ultimately, univariate analysis found a significant inverse correlation between burnout risk measured by BMS and work hours in the pandemic ICU, weekly work hours, and the nurse: patient ratio (p<0.05).

Moll et al.16 surveyed nurses and other critical care health-professionals in 2017 and in 2020, reporting during the Coronavirus outbreak a global significant increase of workload domain at evaluation with “Areas of Worklife Survey” across all professionals (p<0.001). Moreover, during pandemic, nurses showed the greatest increase of burnout at MBI evaluation among all the professionals (pre-pandemic prevalence 58% vs post pandemic prevalence 72%; p<0.0001).

Heterogeneous sample

An Italian study involving Covid-19 ICU professionals from Milan in 202126, reported an overall burnout level of 60.3% at MBI. Nearly the same percentages of burnout were found among nurses and physicians (61.9% vs 57.7%, respectively). Compared to the pre-pandemic period, both nurses and physicians declared an increase of workload/number of assigned patients (51,9% vs 68,8%, respectively), nonetheless, nurses had longer shift and a higher number of night shifts per month than physicians.

Concurrently, Lasalvia et al.27 surveyed a Covid-19 hospital in Verona. Percentages of HCWs reporting high risk of burnout measured through Maslach Burnout Inventory General Survey (MBI-GS) was considerably higher than those reported in Italy before the Covid-19 pandemic. Being a nurse increased the risk of burnout in the emotional exhaustion (EX) and cynicism (CY) dimension as compared with physicians (EX: OR 1.75; 95%CI 1.23 to 2.49, CY: OR 1.69; 95%CI 1.17 to 2.45). Authors formulated ad hoc questions to explore changes in perceived workload; 65.3% reported increased workload and 59.6% affirmed that they had to carry out tasks they previously did not have to perform.

In 2022 a large study including 986 Healthcare Workers (HCWs) from Thailand23, reported higher prevalence of burnout at MBI among Covid-19 ICU professionals than among non-ICU workers. At multivariate analysis, being a nurse as well as being an Covid-19 ICU worker revealed as significant risk factors for burnout (i.e. OR for high risk in at least two MBI domains: OR 2.95, 95%IC 1.32-6.56, p=0.008; OR 3.01, 95%IC 1.60-5.63, p=0.001, respectively). In addition, a workload of 49-56 working-hours per week was a risk factor for depersonalization too (OR 1.66, 95%CI 0.99-2.77, p=0.049).

Another study from Qatar24 found that weekly workload of >50 hours and working as a nurse were significant risk factors for increased risk of burnout among HCWs during pandemic (adjusted odds ratio [aOR]=1.974, 95%CI 1.22-3.2, p=0.006; aOR=2.776, 95%CI 1.52-5.10, p=0.001, respectively). In this study, overall burnout prevalence was 64,5% and in the burnout group 49.8% were nurses.

Among 104 ICU workers from Saudi Arabia interviewed in 2022 by Shbeer et al.25, 46% of respondents connected workload to occupational burnout. Those ICU HCWs gained higher scores for all MBI-subscales compared to a norm sample.

In a sample of HCWs coming from six public ICUs in Brazil, de Medeiros et al.28 found 48.6% of participants with high levels of emotional exhaustion, and 29.4% with high levels of depersonalization. Most of HCWs from high DP and high EE groups had increased workload compared with HCWs from groups with lower DP and EE (DP 89.7% vs 77.5%; p=0.02; EE 86% vs 76.4%; p=0.04). Then, increased workload was identified as an independent determinant for both DP and EE at multiple logistic regression analysis (OR 2.37; 95% CI 2.02-5.50; p=0.04; OR 1.89; 95% CI 1.04-3.58; p=0.03, respectively).

In a small sample of HCWs from a tertiary Turkish hospital with 62.7% of nurses29, almost three quarters of participants reported heavy workload during pandemic (working ≥200 h/month), at least half had a moderate increase of EE (median score, min-max: 20, 4-30): furthermore, high percentages of poor sleep quality (96.1%), anxiety (51.0%) and depression (51.0%) were documented.

More recently, Escher et al.17 compared results of different online surveys distributed in 2018, 2020 and 2021 to five Swedish Covid-19 ICUs. In the questionnaire, the Oldenburg Burnout Inventory (OLBI) was used to assess work-related stress and exhaustion. Compared with data collected in 2018, exhaustion was significantly higher during the pandemic in both 2020 and 2021 surveys (p<0.001). Also, longer work exposure and working during both the first and second Covid-19 waves showed a positive correlation with exhaustion coefficients (p=0.019 and p=0.012, respectively).

As shown, studies present high heterogeneity among methods for burnout and workload assessment, thus it was not possible to perform a meta-analysis of the data.

Discussion

The Covid-19 pandemic had an enormous impact on the entire National Healthcare System and on the healthcare professionals. The aim of this systematic review was to assess whether or not the increased workload during this period contributed to the development of burnout syndrome in nurses who cared for SARS-CoV-2 patients in intensive care units.

All articles included in this systematic review reported an increase in at least one of the three dimensions of burnout syndrome as a result of increased workload, defined as perceived workload16,19,21,22,25-27,30,31, patient-to-nurse ratio20-22,26,30, work-hours per week21,23,24,28, work-hours per month29 or base hours17, long shifts or high numbers of night shifts26.

In the scientific literature, the high workload perceived by nurses during the Covid-19 period has also been associated with other aspects such as the complexity of the technology used, the patient’s criticality, traumatic episodes and feelings of frustration related to the patients’ death, fear and apprehension regarding the newness of the pathology and its repercussions, the threat of infection, the separation from family and change of home32. This personal and work-related overload may have contributed to the increase in burnout among intensive care nurses, exhausting their ability to cope with the daily demands32. The increased work demands resulted not only in physical, but also emotional and moral repercussions as they led staff to have to change their work practices and prioritize life-sustaining care33. In a qualitative study on the work experiences of critical care nurses during the Covid-19 pandemic, staff emphasized that they had to make decisions contrary to core nursing values, reporting that they felt like “bad nurses”33. The consequences of prolonged moral distress cannot be ignored, as they may contribute to the intention to leave the intensive care unit34 and the development of anxiety, depression, insomnia and burnout syndrome35,36. According to a recent systematic review, the prevalence of burnout among healthcare workers in intensive care and emergency rooms during the Covid-19 period was high, ranging from 49.3% to 58%36. However, these results are not very different from those obtained in the pre-pandemic period and there is insufficient evidence to understand whether this prevalence increased due to the pandemic36. The intensive care unit, in fact, is considered a totally different environment from general wards and has long been associated with a higher prevalence of burnout due to the higher work intensity associated with it, the high degree of difficulty in managing the patient, and the increased emotional stress from the patient and family members37. Among all healthcare professionals, intensive care nurses were found to be at higher risk for burnout and other mental health outcomes during the pandemic36,38,39. Furthermore, in Schneider et al.’s systematic review38, it was found that working in high-risk hospitals and/or having direct contact with suspected or infected patients was a strong risk factor for poor mental and physical health outcomes. Having symptoms of psychological illnesses were themselves risk factors for turnover, burnout and other health outcomes leading to a downward cycle of increasingly poor well-being outcomes38. Certain demographic characteristics such as gender and age also seem to have outcomes on the mental health of healthcare professionals. Being female increases the risk of experiencing burnout, probably due to higher workload, lower work-life balance and differences in job roles and responsibilities40,41. The risk of burnout is higher in younger healthcare professionals42 and with less social support from friends and family43.

In fact, burnout can be considered a wake-up call signaling deeper psychological distress, often preceding the development of more specific mental disorders such as:

• depression: this is one of the most frequent consequences of burnout. The feeling of emptiness, loss of interest, and demotivation typical of burnout can evolve into a full depressive picture44;

• generalized anxiety: constant anxiety, excessive worrying, and difficulty relaxing are common symptoms of both burnout and generalized anxiety35,36;

• sleep disorders: insomnia, frequent awakenings, and difficulty falling back asleep are often associated with both burnout and anxiety and depressive disorders45;

• somatoform disorders: burnout can also manifest through physical symptoms such as headaches, muscle aches, and gastrointestinal complaints, which may persist even after work stress has subsided46.

It is complex to establish precise rates of transition from burnout to psychiatric disorder, as many factors can influence this process (personality, social support, burnout severity, etc.).

With this in mind, social, organizational, and governmental support plays a key role in how global pandemic epidemics are experienced by healthcare professionals. In fact, it has been shown that adequate support has the potential to have a significant impact on their overall well-being38.

Strengths and limitations of the study

An obvious limitation of our study is that we only addressed the systematic review to nurses and only intensive care nurses represent a limited sample for the study of the phenomenon. Surely other nurses and healthcare workers who worked in other types of wards under the Covid-19 pandemic could have shown us other parameters regarding workload during the pandemic period and the subsequent development of burnout. The Covid-19 pandemic has affected all hospital departments to a greater or lesser degree. Such a specific research question precludes certain characteristics that might relate to burnout, such as stress management and tools that nurses might use to cope with and/or prevent burnout. A strength lies in the fact that our review represents and synthesizes what was a stark reality of the landscape and situations nurses faced during the pandemic period. This represents a point of reflection for all health care companies for a better management of the nursing workload in certain types of wards, such as intensive care, also in view of possible other health emergencies.

Practical implication

A diversified approach is necessary to address the issue of excessive workload and its correlation with burnout. In order to minimize nurse burnout, policies and healthcare organizations should give priority to methods that lessen the workload for nurses. These tactics include hiring more workers, maximizing the number of patients to nurses, instituting flexible scheduling to avoid working too much overtime, and giving patients access to stress-reduction options and mental health services. Additionally, nurses’ resilience and job happiness can be increased by creating a supportive work environment that values teamwork, recognition, and professional development. Enhancing personal accomplishment and reducing emotions of depersonalization can also be achieved by giving nurses decision-making autonomy and chances for skill development.

More research is necessary to fully understand the complex and multifaceted phenomena of burnout in the caring professions. The caregiver exhibiting indications of emotional exhaustion, depersonalization, and diminished realization is an individual who does not acknowledge their personal agency in overseeing their own health. Consequently, they are a part of an operational framework devoid of comprehension and cognizance regarding health promotion principles and their advantages across the board. An organization that doesn’t prioritize improving the health and well-being of its sociomedical staff and patients, preferring to treat and care for sick individuals and illnesses. In order to identify dysfunctional features and improve occupational well-being through preventive interventions and by ensuring support channels for workers in difficulties, it is imperative that the phenomena be adequately investigated in the various working situations.

Conclusions

This review emphasizes the correlation between workload and burnout in intensive care units that have cared for Covid patients. Healthcare organizations should try as much as possible to reduce the workload of nurses in order to ensure better health and enable them to care for people optimally. The importance of the nurse, as a fundamental tool for caring for people, was clear during the pandemic: this should be a reason for health care organizations to listen to them, in order to make them aware of the great importance of the mental health of these health workers. The important connection between increased workload and ICU nurses’ well-being has been highlighted by the Covid-19 pandemic. Maintaining high levels of patient care and assuring the resilience of healthcare systems will depend critically on giving nursing staff health and happiness top priority as they continue to negotiate the challenges posed by the pandemic. The data points to a clear correlation between the increased effort that nurses face and the prevalence of burnout. The lengthy and intensive care needed during the pandemic, in addition to low staffing levels, higher patient-to-nurse ratios, and the psychological burden of tending to critically ill or dying patients, are the main causes of this link. Together, these elements have harmed nurses’ physical and mental health as well as their sense of professional fulfillment and job satisfaction. The emergence of burnout in nurses has significant consequences for the standard of patient care. Burnout-affected nurses are more likely to have lower motivation, less empathy, and poorer decision-making skills, all of which can have a detrimental effect on patient outcomes. Burnout also raises turnover rates, which exacerbates workforce shortages and feeds a vicious cycle of increasing workloads and burnout among remaining employees.

Conflicts of interests: the authors have no conflict of interests to declare.

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