Intensive care units (ICUs) are emotionally and physically taxing environments that can lead to high levels of stress and burnout among nursing staff.^1,2 The ICU nurses frequently experience burnout, which is a serious concern because it affects not only the nurses’ personal health but also patient care and overall health outcomes.^1,3 Burnout has been a major concern for healthcare workers (HCWs) from an early stage, but especially during the coronavirus disease 2019 (COVID-19) pandemic.⁴ The HCWs faced unprecedented challenges, including increased workloads and emotional stress because of overcapacity.⁵ The burden placed on medical professionals during the pandemic resulted in greater awareness of the risk of burnout in HCWs.⁴ The shortage of nurses, particularly specialist nurses (SN), has contributed to the escalation of workplace stress within intensive care environments:

Moreover, according to the Democratic Nursing Organisation of South Africa (DENOSA), from 2013 to 2022, the total number of nurses registered with the South African Nursing Council (SANC) increased by merely 4% (from 260 000 to 271 000), despite the country’s population expanding by 14% (from 52.9 million to 60.6 million) over the same period.⁷ In addition, ongoing budget reductions by the South African government project a 2.5% increase in healthcare funding for the 2024/2025 fiscal year; however, this is substantially overshadowed by the anticipated 6.5% inflation rate within the medical sector.⁸ Consequently, numerous healthcare providers, including nurses, are expected to face unemployment, leading to heightened nurse-to-patient ratios and an increased risk of burnout (DENOSA^7,8). Studies have shown that the ICU is considered one of the hospital’s most challenging and stressful environments.⁹ The ICU environment can cause physical and mental health problems for patients and the healthcare team working there.¹⁰ The symptoms of burnout, such as diminished personal accomplishment (PA), depersonalisation (DP), and emotional exhaustion (EE), are common in healthcare settings.^11,12 This is particularly true for ICU nursing staff, who face specific pressures such as challenging decision-making, high patient acuity, and end-of-life care. Alarmingly high burnout rates among ICU nurses have been reported globally, with negative impacts on patient safety, job satisfaction, and staff turnover rates.¹³ A recent meta-analysis of 113 international studies found that more than one-tenth of nurses experience burnout, representing a prevalence of 11.23% of nurses globally.¹⁴ The prevalence was highest in sub-Saharan Africa and lowest in Europe and Central Asia.¹⁵ These rates were coupled with a nursing shortage, especially in regions with limited healthcare resources, which further challenges the provision of standard care to critically ill patients. According to Chuang et al., risk factors for burnout are mainly related to age, sex, ICU working experience, nursing experience, working environment, organisational factors, workload, shift work, marital status, and educational degree.¹⁶ Younger and less experienced ICU nurses may be at a higher risk of burnout because of difficulties in coping with the workload and complexities in the ICU.^16,17 Men are identified as being at higher risk, and work teams with more women are associated with a decreased burnout rate.^18,19 Having a supportive family unit is important, as single and childless individuals are at an increased risk of burnout. Factors such as frequent night shifts and long working hours have been identified as contributing to burnout.²⁰ These factors, coupled with a nursing shortage, especially in regions with limited healthcare resources, may further impose a challenge on the provision of standard care for critically ill patients. Burnout in nurses is a direct result of excessive workloads and the entrenched dynamics of employment bureaucracies within the system.²¹ The workload and work environment are plagued by systemic issues such as irregular hours, ‘voluntary’ overtime, rotating shifts, and understaffing. There is a significant disconnect between expectations and the reality of nursing as a profession.²² Burnout significantly affects ICU nurses’ physical and mental well-being, as well as the workplace, quality of nursing care, and patients’ conditions and recovery. It leads to physical symptoms including fatigue, anxiety, sleep disorders, headaches, insomnia, frequent flu-like illnesses, and reduced concentration and memory.²³ There is limited research specifically focused on the prevalence of burnout and associated risk factors at South African hospitals, despite the widely acknowledged significance of burnout among ICU nursing staff. It is crucial to understand the extent of burnout and the contributing factors in this particular setting to develop targeted therapies that meet the specific needs of ICU nurses. This study aims to assess the prevalence of, and risk factors associated with, burnout among nurses working in the ICU by measuring burnout using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS [MP]) and correlating it with demographic data to determine whether there are specific risk factors in this population.

The study achieved a 67.46% response rate, which is 141 ICU nurses at the hospital.

Table 1 revealed a pronounced gender disparity in the nursing workforce, with a higher proportion of female nurses (n = 125, 89%) compared to male nurses (n = 15, 11%), a statistically significant difference (p < 0.001). The age distribution indicates that most respondents were between 40 years old and 49 years old (63.46%), predominantly single (n = 75, 55%), and most of the nurses had 1–3 children (n = 115, 83%). In addition, a substantial number of respondents were PN with over 10 years of experience (n = 63, 46%). Overall, 51.1% of the ICU nurses sampled suffer from burnout. The study revealed that 44.7% experience high EE, and about one-third have moderate levels. Furthermore, 97.2% report high DP and low PA of 95%, with no participants feeling high levels of achievement.

Table 2 shows that females exhibited a greater percentage of high exhaustion (46%) compared to males (33%), while males exhibit a higher percentage of moderate exhaustion (53%) compared to females (31%). Despite these differences, statistical analysis indicates no significant relationship between gender and EE levels with the Chi-squared test result (χ² = 3.00, df = 2, p = 0.223). Differences in EE levels show a trend of increasing with increasing age, but the chi-squared test result of (χ² = 2.90, df = 4, p = 0.575) suggests no significant relationship between age and exhaustion levels. Table 2 highlighted a significant relationship is found between the category of nurse and occupational exhaustion levels. Professional nurses had the highest percentage in the high exhaustion category (46%), while SN showed the highest percentage in the moderate exhaustion category (56%), with the chi-squared test result (χ² = 11.74, df = 4, p = 0.019). No significant relationships are identified between marital status, number of children, experience, extra remunerative work, preferred shift, and occupational exhaustion levels.

The relationship between socio-demographic variables and DP scores reveals that most variables, as presented in Table 3, including gender, age, marital status, category of nurse, experience, extra remunerative work, and preferred shift, do not show significant associations with DP scores, as indicated by their p-values exceeding the 0.05 threshold. However, an exception is the number of children, which demonstrates a significant relationship with DP scores (p = 0.003). Specifically, individuals with no children or four or more children exhibit higher instances of moderate and low DP scores compared to those with one to three children, who predominantly show high DP scores. Although not statistically significant, a greater proportion of younger nurses (20–49 years) had a high DP compared to older nurses.

The relationship between socio-demographic variables and PA scores, using Pearson’s Chi-squared tests (Table 4), indicates that none of the socio-demographic variables show significant associations with PA scores, as all p-values are greater than 0.05. For instance, both women and men report low PA scores (98% and 93%, respectively), and similar trends are observed across different age groups, marital status, and other variables. When applying the strict three-dimensional criterion (high EE, high DP and low PA concurrently), 72 of the 141 nurses met all three thresholds (Table 5). This corresponds to a burnout prevalence of 51.1%

Among the 141 ICU nurses surveyed, 51.1% met the criteria for burnout, with high EE reported by 44.7% and high DP by 97.2%. In addition, none reported high levels of PA. According to the SANC statistics of 2023, about 89% of registered nurses are women, and a significant proportion belong to the age group of 35–50. Likewise, many South African nurses have more than a decade of professional experience and reflect the ageing profile of the nursing workforce at the national level.²⁴ A statistically significant association was found between the PN category and higher EE (p = 0.019), and between the number of children and DP scores (p = 0.003). These findings reflect a critical burden of burnout in working mothers. Based on the three-dimensional definition of burnout, the observed prevalence (51.1%) is broadly comparable to estimates reported in international literature. A systematic review conducted in 2023 by Papazian et al. reported a burnout prevalence of approximately 44% among ICU healthcare professionals, increasing to about 61% during the COVID-19 pandemic. While the prevalence reported in this study falls within this range, it is important to observe that none of the studies included in the meta-analysis were conducted within African settings, and most originated from high-income countries. Differences in healthcare system resources, staffing levels, patient acuity, and structural constraints within low- and middle-income settings may therefore influence variations in burnout prevalence and should be taken into account when interpreting these findings.

Burnout remains a contested construct with no universally accepted operational definition.^3,14 Although the MBI conceptualises burnout across three related dimensions,^11,12 different studies apply varying thresholds and criteria, which complicates comparisons across settings. In this study, we adopted the strict three-dimensional criterion to reduce misclassification^11,31; however, alternative approaches may yield different prevalence estimates. These methodological differences should be considered when interpreting the findings. The cross-sectional design of the study does not account for changes in levels of burnout over time. To better understand how burnout evolves and the factors that contribute to its development, longitudinal studies would be necessary. It is also important to consider that there may be other unmeasured factors influencing burnout that were not accounted for in the study, such as organisational culture, support systems, or personal coping mechanisms. Furthermore, the reliance on self-reported data to measure burnout and socio-demographic factors may impact the results. Participants may have underreported or over-reported their levels of burnout because of social desirability or to communicate the level of their distress. Furthermore, the study could have inherent biases because of the voluntary nature of participation, where those experiencing higher levels of burnout might be more inclined to participate (a cry for help), thus skewing the results.

The study focused on burnout, measured by the MBI-HSS (MP), among ICU nursing staff and associated risk factors. The study found that 51.1% of participants experienced burnout, with a confidence interval ranging from 42.8% to 59.3%. Notably, nurses reported significantly higher levels of EE and a lower sense of PA. The analysis showed that demographic and occupational variables did not significantly impact burnout levels, but different nursing categories played a role. This emphasises the need for interventions to address burnout in ICU nurses to enhance staff well-being and thereby improve patient care.