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Review

Shifts in Research Focus on Factors Associated with Burnout Among Nurse Managers Before and During the COVID-19 Pandemic: An Integrative Review

by
Mizuka Matsumoto
1,*,
Yukari Hara
1,*,
Thomas Mayers
2,3 and
Tomoko Omiya
1
1
Department of Public Health Nursing, Division of Health Science, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
2
School of Medicine, Keio University, 4-1-1 Hiyoshi, Kohoku-ku, Yokohama 223-8521, Japan
3
Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
*
Authors to whom correspondence should be addressed.
Occup. Health 2026, 1(2), 22; https://doi.org/10.3390/occuphealth1020022
Submission received: 29 January 2026 / Revised: 19 May 2026 / Accepted: 26 May 2026 / Published: 2 June 2026
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Abstract

The COVID-19 pandemic intensified concerns about burnout in healthcare leadership, yet evidence specific to nurse managers remains fragmented. This integrative review synthesized recent research, organized burnout-associated factors using the Job Demands–Resources (JD–R) model, and examined pre-pandemic and pandemic-era shifts in research focus. Following Whittemore and Knafl’s methodology, four databases (Ichushi-Web, PubMed, CINAHL, and MEDLINE) were searched for peer-reviewed quantitative, qualitative, and mixed-methods studies published from 1 April 2019 to 31 August 2025 that examined burnout levels, prevalence, or related factors among nurse managers. Extracted findings were mapped to Job demands, Job resources, and Personal resources and compared according to the data-collection period. Twenty-five studies were included, with substantial heterogeneity in burnout instruments and cutoff values. Core job demands related to managerial responsibility, workload, and resource management were identified throughout the literature, while pandemic-era studies additionally highlighted frequent protocol changes, heightened uncertainty, and fear of infection. Key resources included organizational support, positive team communication, peer support, and adequate workload and material resources, and resilience was more frequently reported in pandemic-era studies. Overall, the findings demonstrate how crisis-related shifts in demands and resources shape burnout risk among nurse managers and support the application of JD–R–informed, context-adaptive prevention strategies. They also underscore the need for standardized burnout assessment and more robust interventional and longitudinal research.

1. Introduction

The coronavirus disease 2019 (COVID-19) pandemic triggered unprecedented and rapid disruptions to global healthcare systems and economies, resulting in widespread psychological distress [1]. A large-scale epidemiological analysis of 335 emerging infectious disease (EID) events occurring between 1940 and 2004 demonstrated a steady increase in the frequency of such events since the 1940s, peaking in the 1980s and remaining high thereafter [2]. Moreover, estimates from the Global Health 2050 Lancet Commission suggest that there is approximately a 50% probability of another pandemic occurring by 2050 with the potential to result in more than 25 million deaths [3]. Given that excess mortality attributable to the COVID-19 pandemic reached an estimated 14.9 million deaths [4], the potential impact of future large-scale pandemics on global health is substantial. Examining the impact of the COVID-19 pandemic, therefore, provides critical insights for strengthening preparedness for future global health crises, including strategies to protect the mental health of healthcare workers.
During the COVID-19 pandemic, the mental health of frontline healthcare workers emerged as a major public health concern. Numerous studies have reported persistently high prevalence rates of psychiatric symptoms and disorders among healthcare workers following the outbreak [5,6,7,8]. Compared with other occupations, healthcare workers faced a substantially higher risk of viral exposure [9], alongside rapidly evolving clinical and managerial protocols and heightened uncertainty related to the risk of transmitting infection to family members [10,11]. Among mental health outcomes, burnout had the highest reported prevalence, affecting approximately 44% of healthcare workers [12]. Furthermore, multiple studies have consistently shown that nurses are more susceptible to burnout than other healthcare professionals [13,14,15]. Burnout among nurses has been associated with impaired decision-making [16], reduced productivity [17], and declines in the quality of patient care [18].
In the 11th Revision of the International Classification of Diseases (ICD-11), burnout is classified as an occupational phenomenon and conceptualized as a syndrome resulting from chronic workplace stress that has not been successfully managed [19]. It is characterized by three core dimensions: (1) feelings of energy depletion or exhaustion; (2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s work; and (3) reduced professional efficacy [19]. Within this occupational framework, leadership has been widely recognized as a critical factor in both the development and mitigation of burnout among nursing staff [20,21,22]. In the Japanese context, nurse managers are responsible for planning, organizing, coordinating, controlling, and transforming human, material, financial, informational, and time resources to ensure the delivery of optimal nursing care [23]. Nurse managers (for the purposes of this study) are defined as individuals who hold a nursing license and occupy formal leadership roles involving the management of departments, organizations, or staff, or whose leadership responsibilities are officially recognized by a certifying body. Their role is fundamental to organizational sustainability and development, as they indirectly support nurses in effectively utilizing their professional competencies [23]. Consequently, burnout among nurse managers is not merely an individual concern; it may have serious organizational repercussions, including increased burnout among nursing staff, reduced quality of care, and decreased organizational efficiency.
Despite the central role of nurse managers, evidence concerning burnout in this population remains limited compared with that for frontline nurses. A systematic review conducted by Membrive-Jiménez et al., which synthesized literature published up to March 2019, provided valuable insights into nurse manager burnout. This review was conducted to identify the prevalence, severity, and associated factors of burnout among nursing managers, revealing that nurse managers are at high risk of burnout; however, the analysis primarily focused on demographic correlates and did not sufficiently examine multidimensional factors such as job-related and organizational determinants [24]. To the best of the authors’ knowledge, no subsequent systematic synthesis has comprehensively examined factors associated with burnout among nurse managers, which is particularly important given the post-pandemic context. As a result, critical knowledge gaps remain regarding the determinants of burnout in this key professional group, limiting the ability of nursing organizations to prepare effectively for future pandemic-related crises.
Within the nursing field, the Job Demands–Resources (JD–R) model has demonstrated strong generalizability across occupational sectors, study designs, and cultural contexts and is widely regarded as a robust theoretical framework for examining burnout [25,26,27]. The model conceptualizes burnout as a dynamic process resulting from an imbalance between job demands and available resources [25,26,27], making it particularly well-suited for investigating burnout among nurse managers.
Based on these considerations, the aim of this integrative review was to systematically synthesize evidence on burnout among nurse managers published from April 2019 onward and to examine shifts in research focus before and during the COVID-19 pandemic through categorization of burnout-related factors according to the JD–R model. Importantly, the purpose of these comparisons was not to identify definitive temporal changes in burnout itself, but rather to explore observed shifts in research focus across the pandemic period. Given the heterogeneity of included variables and the inconsistency with which burnout-related factors were examined across studies, the academic significance of this review lies in clarifying which aspects of burnout researchers prioritized during different stages of the pandemic. Because the variables selected by researchers are likely to reflect the practical challenges being experienced in clinical settings at the time of data collection, identifying shifts in research focus may also provide valuable insight for anticipating and responding to future healthcare crises, including pandemics.
The World Health Organization (WHO) declared COVID-19 a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 and subsequently characterized it as a pandemic on 11 March 2020 [28]. Accordingly, the period from 1 April 2019 to 11 March 2020 was defined as the pre-pandemic phase, and the period from 12 March 2020 onward as the pandemic-era phase. Although the WHO declared that COVID-19 no longer constituted a PHEIC on 5 May 2023, this declaration did not signify the end of the pandemic itself [28].
The research questions guiding this review were as follows:
  • What is currently known about factors associated with burnout among nurse managers?
  • What similarities and differences exist in the focus of research on factors related to burnout among nurse managers before and during the COVID-19 pandemic?

2. Materials and Methods

2.1. Study Design

This study was conducted in accordance with the integrative review methodology proposed by Whittemore and Knafl [29,30]. Integrative reviews allow the inclusion of diverse study designs, including both quantitative and qualitative research, and are well-suited to developing a multifaceted understanding of complex phenomena [29]. A previous systematic review in this field focused primarily on quantitative studies, arguably resulting in insufficient examination of the multidimensional factors associated with burnout among nurse managers [24]. To comprehensively explore burnout-related factors, it is essential to incorporate qualitative research alongside quantitative evidence in order to capture additional perspectives; therefore, an integrative review approach was considered the most appropriate for this study.

2.2. Theoretical Framework

In the present review, the revised JD–R model [31] was used as a framework to operationalize burnout-associated factors into workplace-related domains (job demands and job resources) and individual-level domains (personal resources), thereby providing a structured basis for data extraction and synthesis. As previously noted, the JD–R model [25,26,27], which has been recognized for its high generalizability and robustness in the nursing field, is a model that explains the mechanisms underlying burnout and is well-suited for examining burnout among nurse managers. Unlike the original model, which focused on the balance between job demands and job resources, the revised JD–R model incorporates personal resources as a third core component, capturing the interaction between individual and workplace factors in burnout development [32,33]. Accordingly, this study adopted the expanded JD–R model presented in Figure 1 as the analytical framework.
The operational definitions applied in this review were as follows:
  • Job demands: physical, psychological, social, or organizational aspects of work that require sustained physical or psychological effort [34].
  • Job resources: physical, psychological, social, or organizational aspects of work that reduce job demands, promote personal growth and learning, and facilitate the achievement of work goals [34].
  • Personal resources: individuals’ perceptions of their ability to control and influence their environment effectively, including self-related characteristics associated with resilience [33,35].

2.3. Search Strategy

A systematic literature search was conducted using four electronic databases: Ichushi-Web, PubMed, and CINAHL and MEDLINE via the EBSCO database. To ensure the comprehensiveness and accuracy of the literature search, guidance was provided by librarians at the Tohoku University Medical Library. As the most recent systematic review on nurse manager burnout covered publications up to March 2019 [24], this review targeted studies published from 1 April 2019 to 31 August 2025 in order to capture evidence generated before and during the COVID-19 pandemic. The literature search and screening process was conducted from 1 August 2025 to 7 October 2025. The search strategies used for each database are presented in Table 1. Additionally, no manual searches or citation tracking beyond those listed in Table 1 were conducted.

2.4. Study Selection

Study eligibility was determined using the PECO framework [36], defined as follows:
  • Population: nurse managers.
  • Exposure: the COVID-19 pandemic.
  • Comparator: pre-pandemic versus pandemic-era conditions.
  • Outcome: burnout-related factors, burnout scores, and burnout prevalence.
Eligible studies included quantitative, qualitative, and mixed-methods research published in peer-reviewed journals. No restrictions were imposed regarding country of origin, language of publication, or sample size. Studies were excluded if they involved mixed professional samples without independent data for nurse managers, were published prior to March 2019, or the full text could not be retrieved.
The study selection process involved two stages: initial screening based on titles and abstracts, followed by full-text assessment to confirm eligibility [37]. Screening was primarily performed by one reviewer (M.M.) using predefined eligibility criteria. To enhance methodological rigor and reduce selection bias, screening procedures were guided by the prespecified protocol described above, and eligibility decisions were reviewed through discussion among the research team (seven members in total). Studies with ambiguous or borderline eligibility were examined collectively, and discussions continued until consensus was reached among all researchers. The overall selection process was reported in accordance with the PRISMA flow diagram to improve transparency and consistency in study identification and selection [38].

2.5. Data Extraction and Analysis

Data extraction was conducted using a standardized evidence table that included the following items: first author, publication year, study design, participants, key personal characteristics of nurse managers, burnout measurement instruments, main findings (e.g., burnout-related factors, burnout levels, and prevalence), and quality appraisal results.
Study quality was assessed using a two-point evaluation framework adapted from Whittemore and Knafl [29]. To ensure consistency, predefined evaluation criteria were applied across all included studies. Two domains were assessed: (1) methodological rigor and (2) relevance to the research question. For quantitative studies, methodological rigor was evaluated based on the validity and reliability of measurement instruments, sample size, and response rate. For qualitative studies, transparency of data analysis procedures and clarity in reporting findings were used as indicators. Relevance was determined by whether burnout was a primary focus of the study. Studies failing to meet criteria in one or more domains were rated as “lower quality”. Lower-quality studies were retained but assigned less interpretive weight during synthesis, consistent with integrative review methodology [29]. To ensure greater rigor in our interpretation, only factors extracted from studies rated as “high quality” were used for the analysis of shifts in research focus.
The burnout-related factors were subsequently extracted and categorized according to the three domains of the JD–R model: Job demands, Job resources, and Personal resources. Classification of factors was informed through collaborative discussion among members of the research team with prior experience conducting research using the JD–R model. Factors considered conceptually ambiguous or difficult to classify were reviewed collectively during research meetings, and categorization decisions were finalized only after consensus had been reached among all participants. The included studies and their findings were further classified as pre-pandemic (1 April 2019–11 March 2020) or pandemic-era (12 March 2020–31 August 2025) according to their data collection periods.

3. Results

3.1. Results of the Database Search and Study Selection

A total of 742 records were identified through database searching (Ichushi-Web, n = 5; PubMed, n = 62; EBSCO databases, n = 675). After removal of 49 duplicates, 693 records remained and were screened by title and abstract, resulting in the exclusion of 618 records. Four of the remaining 75 studies could not be retrieved. The full texts of the retrieved 71 studies were assessed for eligibility, of which 46 were excluded for the following reasons: wrong population (n = 8), absence of nurse manager-specific data or inability to independently extract data for nurse managers (n = 8), burnout outcomes could not be directly extracted (n = 21), inappropriate study design (n = 8), and discrepancies between reported results in the tables and text (n = 1). Ultimately, 25 studies met the inclusion criteria and were included in the review. Figure 2 presents the PRISMA flow diagram illustrating the study screening process.

3.2. Overview of Included Studies

Table 2 presents the characteristics of the included studies [39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63], arranged in ascending order by year of publication and alphabetically by first author for studies published in the same year. Based on the predefined two-point quality appraisal, six studies were rated as “low quality.” Among the 25 included studies, 16 employed observational designs, 2 used mixed-methods approaches, 4 were interventional studies, and 3 were qualitative studies. Regarding geographical distribution, studies conducted in North America were most common (n = 10), followed by Asia (n = 8), Europe (n = 6), and South America (n = 1). No studies conducted in Africa or Oceania met the inclusion criteria.
With respect to burnout measurement instruments, 10 studies [41,42,44,48,49,50,51,54,61,62] used versions of the Maslach Burnout Inventory (MBI) [64]. Five studies [40,47,55,56,58] employed the burnout subscale of the Professional Quality of Life Scale (ProQOL) [65], three [52,53,57] used the Copenhagen Burnout Inventory (CBI) [66], one study [43] used the Burnout Characterization Scale (BCS) [67], one [39] used the Pines–Aronson (PA) Scale [68], and another study [63] used the Oldenburg Burnout Inventory (OLBI) [69]. Two studies used burnout questionnaires developed specifically for their respective research contexts [46,59]. Cutoff values for burnout were determined independently across studies and, in some cases, were not explicitly reported [40,41,42,44,47,48,52,54,57,61]. In addition, burnout prevalence and severity were reported using heterogeneous metrics, including means, medians, and percentages, reflecting substantial variation in reporting formats.
The job titles used to describe nurse managers varied across studies depending on national context, organizational structure, and historical naming conventions. To ensure consistency, nurse managers were classified into four hierarchical levels based on the frameworks proposed by Hølge-Hazelton [70] and Munday [71]: (1) nurse directors overseeing the entire nursing organization; (2) middle managers supervising divisions or departments; (3) first-line managers responsible for individual units; and (4) clinical leaders who concurrently held managerial responsibilities. The definitions used in each study were reviewed and mapped to the appropriate category within this classification system.
Table 3 summarizes the evidence from the included studies focusing on burnout-associated factors, burnout scores, and prevalence estimates. Across studies, burnout was conceptualized either as a multidimensional construct (e.g., emotional exhaustion, depersonalization, reduced personal accomplishment) or as overall burnout, depending on the measurement tool and study design. In the included studies, burnout among nurse managers before and during the pandemic time was associated with numerous individual, organizational, and contextual factors, with substantial variability in burnout levels across settings and countries [39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63]. Across the included studies, higher burnout was commonly associated with occupational and organizational stressors, including high workload, staff shortages, role conflict and ambiguity, inadequate administrative support, limited resources, communication difficulties, and increasing leadership demands [39,40,41,42,43,44,45,46,48,50,52,58,59]; pandemic-related studies further noted uncertainty, moral burden, fear, rapid protocol changes, and resource scarcity as major contributors [50,62]. In contrast, lower burnout was linked to protective organizational and personal resources such as strong organizational support, effective leadership, job control, work–life balance, meaningful work, resilience, psychological capital, self-compassion, and supportive workplace cultures [40,41,42,43,44,45,46,47,50,51,52,53,56,59,61,63]. Demographic and professional characteristics (e.g., age, gender, education, and years of experience) were frequently not associated with burnout [44,51,55,58], although some studies reported domain-specific gender differences and higher burnout at certain managerial levels [39,50,57]. Burnout scores and prevalence varied widely depending on measurement tools and cut-off values, ranging from mild to severe, with emotional exhaustion being the most frequently reported burnout dimension among studies using multidimensional burnout scales [49,50,51,53,59]. Several studies reported moderate-to-high levels of burnout among substantial proportions of nurse managers [49,50,51,53,59], and some intervention studies showed modest reductions in burnout scores [47,54,55,56].

3.3. Organization of Burnout-Associated Factors Based on the JD–R Model

Table 4 presents a comparative synthesis of burnout-associated factors categorized according to the JD–R model (job demands, job resources, and personal resources) across pre-pandemic and pandemic-era periods. To enhance interpretive rigor, only factors extracted from studies rated as high quality in the methodological appraisal (n = 19) were included in this synthesis. Factors presented in the same row across the pre-pandemic and pandemic-era columns indicate burnout-associated factors that were reported in studies from both periods, whereas factors appearing in only one column may reflect context-specific associations or research emphases.
Across both pre-pandemic and pandemic-era periods, consistently reported job demands included responsibility and psychological burden associated with managerial roles [41,45,46,51,60,62], long working hours or on-call duties [41,51,58], and the management of staffing and material shortages [45,46,59,62]. Pandemic-era studies additionally identified context-specific job demands, including continuous changes in protocols [62], difficulty balancing empathy for families with patient safety requirements [62], fear and uncertainty related to the pandemic [62], and role uncertainty during incidents [60]. Key job resources identified in both periods included organizational support [45,46,50,52,59], good interpersonal relationships and effective communication [46,52,62], and expansion of nurse managers’ discretion [41,52]. Additional pandemic-era resources comprised appropriate workload and material resources [52], the permeation of a positive organizational culture [52], and support from colleagues [62]. With respect to personal resources, leadership capacity [40,50], overall satisfaction [40,63], sense of purpose or meaning as a manager [46,59], and resilience [41,50,51,52,61,63] were repeatedly associated with lower burnout. Pandemic-era studies further identified positive personality traits [51] and achievable healthy lifestyle habits [59] as additional personal resources.

4. Discussion

This integrative review focused on nurse managers and systematically identified job demands, job resources, and personal resources associated with burnout, analyzing the shifts in research focus before and during the COVID-19 pandemic. Burnout interventions are generally categorized into organizational-level and individual-level approaches; however, previous research suggests that their overall effects tend to be modest [69]. Two major reasons for this limited efficacy have been identified: insufficient consideration of burnout components, namely, job demands and job and personal resources, and inadequate attention to individual variability in characteristics and coping responses [69]. By restricting the focus to nurse managers, a group with a distinct professional role, and organizing burnout-associated factors using the JD–R model while accounting for pandemic-related temporal and contextual changes, this study provides insight into how research attention regarding job demands and resources shifted during the crisis. These findings contribute to a theoretical understanding of nurse manager burnout and offer important insights for designing effective, context-adaptive burnout prevention strategies during future pandemics. There follows a discussion of key aspects of our findings.

4.1. Overview of Research on Nurse Manager Burnout

Among the 25 studies included in this review, observational designs predominated, accounting for 16 studies, indicating a relative scarcity of interventional and longitudinal research. This suggests that research on nurse manager burnout remains largely focused on describing prevalence and identifying associated factors, rather than establishing causal relationships or evaluating targeted interventions. Although four interventional studies were identified, only the RISE program demonstrated effectiveness in reducing burnout through a randomized controlled trial [56], while progressive muscle relaxation exercises were shown to be beneficial in a quasi-experimental study [47]. These findings show a need for more focused research on interventions to address burnout among nurse managers.
Geographically, the included studies were concentrated in North America, Asia, and Europe, with no eligible studies conducted in Africa or Oceania. This uneven distribution raises concerns regarding the generalizability of current evidence, as findings may be disproportionately reflective of healthcare systems with relatively well-established resources and infrastructures. With respect to measurement, although the MBI was most frequently used, a wide range of instruments, including ProQOL and CBI, were employed, often with inconsistent or unspecified cutoff values. This heterogeneity complicates cross-study comparisons and synthesis, indicating the importance of standardized burnout assessment methods and harmonized cutoff criteria.

4.2. Burnout-Associated Factors Based on the JD–R Model

4.2.1. Job Demands

Across both pre-pandemic and pandemic-era periods, key job demands included managerial responsibility [41,45,46] and psychological burden [51,60,62], long working hours [41,58], and resource and personnel management during times of shortage [45,46,59,62]. These demands reflect universal burdens inherent to nurse manager roles and are consistent with previous findings identifying long working hours as a major contributor to burnout [24]. Nurse managers are expected to maintain organizational functioning even under conditions of limited human and material resources, which likely intensifies role-related stress and burnout risk.
Pandemic-specific job demands included frequent protocol changes, difficulty balancing empathy for families with patient safety, and fear and uncertainty related to infection [62]. During the COVID-19 pandemic, infection control guidelines issued by governmental bodies and professional organizations were frequently updated, requiring nurse managers to make rapid, high-stakes decisions under constrained conditions [62]. In parallel, visitation restrictions imposed substantial ethical and emotional challenges, as nurse managers were required to balance infection prevention with compassionate care for patients’ families [62]. Uncertainty surrounding evolving protocols, infection risk, and crisis response further intensified managerial pressure and role ambiguity during critical incidents [60,62]. Collectively, these studies suggest that nurse managers experienced increased decision-making responsibility and emotional burden, which may have contributed to increased burnout during the pandemic period. Conversely, managing relationships with subordinates, identified as a job demand in pre-pandemic studies [45,46], was not prominently reported in post-pandemic qualitative studies [60,62]. This pattern in the literature may suggest that research attention during crisis situations shifted toward how nurse managers prioritized tasks directly related to organizational survival and safety, such as infection control and staffing, over interpersonal coordination and how they reallocated psychological and physical resources accordingly.

4.2.2. Job Resources

Job resources common to both periods included organizational support [45,46,50,52,59], positive interpersonal relationships and communication [46,52,62], and expanded managerial discretion [41,52]. These foundational resources are not specific to crisis situations and align with prior research emphasizing the protective role of organizational support and communication in mitigating burnout [24]. Resources identified specifically during the pandemic included appropriate workload and material resources, permeation of a positive organizational culture, and peer support [52,62]. Under the extreme pressures of the pandemic, collaborative workplace cultures and tangible organizational support were frequently described as protective factors against burnout. In contrast, resources identified only in the pre-pandemic period included work–life balance, flexible work arrangements [40,46], and intrinsic job satisfaction [43]. These findings suggest that under normal conditions, maintaining balance between professional and personal life and finding intrinsic meaning in work play important roles in preventing burnout. Satisfaction limited to physical workspace or facilities alone, however, was not associated with burnout [43].

4.2.3. Personal Resources

Personal resources consistently identified before and during the pandemic included leadership capability [40,50], overall life satisfaction [40,63], sense of purpose as a manager [46,59], and resilience [41,50,51,52,61,63]. These factors suggest that internal resources like self-efficacy, purpose, and adaptive coping are protective factors against burnout across contexts. In contrast, external recognition and evaluation by others were not significantly associated with burnout [40,41]. Taken together, these findings indicate that internal personal resources, including self-efficacy, sense of purpose, and reflective and adaptive coping capacities, may play a more central protective role against burnout across contexts than external validation.
Pandemic-era-specific personal resources included positive personality traits [51] and maintainable healthy lifestyle habits [59]. Additionally, the number of studies addressing resilience increased following the pandemic, suggesting heightened recognition of its importance in crisis contexts. Traits such as agreeableness, conscientiousness, goal orientation, and openness may contribute to reduced burnout, while perceived ability to sustain healthy routines appears to support psychological well-being under prolonged stress.

4.3. Practical Implications for Preparing for Future Crisis Situations

Based on the JD–R components identified, this review highlights priority areas for burnout prevention during possible future pandemics. Effective interventions should integrate both organizational-level and individual-level approaches [72]. Within the JD–R framework, reducing job demands is theoretically preferable [31]; however, doing so often requires substantial structural and staffing investments, which may be infeasible during crises. Moreover, external stressors may rapidly exceed existing organizational capacity regardless of preparedness. Consequently, strengthening job resources and personal resources may represent a more practical and immediately actionable strategy during pandemics.
At the organizational level, fostering a culture of mutual support and collaboration was frequently identified as an important job resource. Initiatives such as Schwartz Center Rounds [73] and the DAISY Award program [74] may facilitate emotional sharing, enhance recognition of professional contributions, and strengthen organizational cohesion. Given that nurse managers play a central role in shaping workplace culture [23], proactive engagement in such initiatives may simultaneously enhance their own job resources and reduce burnout risk.
At the individual level, although personality traits are relatively stable and less amenable to intervention [75], resilience represents a modifiable personal resource. Mindfulness-based intervention programs [76] and systems thinking educational programs [77,78] have shown promise in enhancing resilience among nurse managers. As nurse managers often hold decision-making authority regarding program implementation, actively introducing and participating in such initiatives may strengthen their personal resources and those of other nurses under their supervision. Importantly, resilience was identified as a protective factor both before and after the pandemic, indicating that resilience-building efforts should be sustained during non-crisis periods to enhance preparedness for future emergencies.

4.4. Limitations

This study has some limitations that should be acknowledged. First, study screening and selection were conducted by a single reviewer, which, while acceptable for an integrative review, may introduce selection bias. However, predefined criteria and team discussions during the screening process were used to enhance methodological rigor. Secondly, the decision not to search for gray literature may have introduced publication bias. However, to ensure a minimum standard of methodological quality, this paper focused exclusively on peer-reviewed academic journals. Thirdly, the use of a two-point evaluation framework to assess the quality of the literature is limited and may be insufficient for determining methodological rigor. However, the use of a two-point evaluation framework for quality assessment is recommended for reviews designed to synthesize studies with different research designs. In addition, geographical bias is evident, as most included studies were conducted in North America, Asia, and Europe, with no eligible studies from Africa or Oceania. Consequently, the identified job demands and resources may primarily reflect healthcare systems in high- and middle-income countries, limiting applicability to settings with severely constrained medical resources. Finally, heterogeneity in burnout measurement tools, role definitions, and report formats poses challenges in synthesizing evidence. Burnout scales, cutoff values, and report formats varied widely across studies, and the scope of authority and responsibility associated with the term “nurse manager” differs across countries and healthcare systems. These factors necessitate caution when making direct cross-national analyses. Future research should prioritize the standardization of burnout assessment methods and incorporate multivariable analyses that account for cultural and systemic differences.

5. Conclusions

This integrative review systematically synthesized burnout-associated factors among nurse managers and examined shifts in research focus before and during the COVID-19 pandemic using the JD–R model. By focusing on a professional group with distinct managerial responsibilities, this study identified differences in the burnout-related factors reported across pre-pandemic and pandemic-era studies. The findings may help inform potential priority areas for burnout prevention during future pandemics and contribute to the development of sustainable nursing management systems. Advancing this field will require harmonization of burnout scale cutoff values, establishment of standardized assessment frameworks, and multidimensional analyses that incorporate cultural and contextual factors.

Author Contributions

Conceptualization, M.M., Y.H. and T.O.; methodology, M.M. and Y.H.; formal analysis, M.M. and Y.H.; resources, M.M. and Y.H.; data curation, M.M. and Y.H.; writing—original draft preparation, M.M., Y.H., T.M. and T.O.; writing—review and editing, M.M., Y.H., T.M. and T.O.; visualization, M.M., Y.H., T.M. and T.O.; supervision, T.O.; project administration, Y.H. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

This study is an integrative review based on previously published literature. No new datasets were generated or analyzed, and data sharing is therefore not applicable.

Acknowledgments

During the preparation of this manuscript, the authors used Gemini 3 for the purposes of translation of the manuscript. The authors have reviewed and edited the output and take full responsibility for the content of this publication.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
BCSBurnout Characterization Scale
CBICopenhagen Burnout Inventory
CINAHLCumulative Index to Nursing and Allied Health Literature
COVID-19Coronavirus Disease 2019
EBSCOEBSCOhost (database platform)
EIDEmerging Infectious Disease
GSGeneral Survey
HSSHuman Services Survey
ICD-11International Classification of Diseases, 11th Revision
ICUIntensive Care Unit
IQRInterquartile Range
JD–RJob Demands–Resources (model)
MBIMaslach Burnout Inventory
MBI-GSMaslach Burnout Inventory—General Survey
MBI-HSSMaslach Burnout Inventory—Human Services Survey
MeSHMedical Subject Headings
MEDLINEMedical Literature Analysis and Retrieval System Online
OLBIOldenburg Burnout Inventory
OROperating Room
PAPines–Aronson (Burnout) Scale
PECOPopulation, Exposure, Comparator, Outcome
PHEICPublic Health Emergency of International Concern
PRISMAPreferred Reporting Items for Systematic Reviews and Meta-Analyses
ProQOLProfessional Quality of Life Scale
RISERISE program (psychoeducational group program)
SARS-CoV-2Severe Acute Respiratory Syndrome Coronavirus 2
SDStandard Deviation
WHOThe World Health Organization

References

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Figure 1. The revised Job Demands-Resources (JD-R) model (Adapted from [31]).
Figure 1. The revised Job Demands-Resources (JD-R) model (Adapted from [31]).
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Figure 2. PRISMA flow diagram.
Figure 2. PRISMA flow diagram.
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Table 1. Search strategy used for each database.
Table 1. Search strategy used for each database.
DatabaseSearch FormulaFilters/Notes
Ichushi-Web(Psychological Burnout/TH AND Nurse Manager/TH)Original research articles only; case reports excluded
PubMed(“Nurse Administrators” [MH] AND “Burnout, Psychological” [MH])MeSH terms used
EBSCO (CINAHL and MEDLINE)Burnout AND (Administrator OR Executive OR Manager OR Leader) AND TI nurs * NOT reviewPeer-reviewed articles only; MEDLINE records excluded to avoid duplication
Note: * This asterisk is used for prefix matching.
Table 2. Study and participant characteristics.
Table 2. Study and participant characteristics.
First Author/YearStudy DesignCountryParticipants: (Total, Nurse Manager Positions)Main Personal Characteristics of Nurse ManagersBurnout ScaleQuality Assessment
Irinyi 2019 [39]Cross-sectional HungaryTotal nurses (n = 1201): nurse directors: 2.3%; middle managers: 20.9%; nursing staff: 76.8%No DataPAHigh
Kelly 2019 [40]Mixed methodsUnited StatesNurse managers (n = 672) *: nurse directors (n = 100); middle managers (n = 142); first-line managers (n = 430)F: 89.9%; Nursing experience (Mean ± SD): 17.24 ± 10.26: first-line managers < middle managers < nurse directorsBurnout subscale of ProQOLHigh
Nakayama 2020 [41]Cross-sectional JapanTotal nurses (n = 355), managerial position (n = 261): first-line managers: 22%; assistant first-line managers: 51%; nursing staff (n = 94)F: 98%; Married: 76%; Have children: 70%; Have someone to consult: 98%; Nursing experience ≥ 15 yrs.: 100% (including staff); Nursing experience 21–30 yrs.: 59%MBI, Japanese versionHigh
Cha 2020 [42]Cross-sectional South KoreaTotal nurses (n = 188): nurse directors: 9.6%; middle managers: 14.9%; first-line managers: 14.9%; nursing staff: 60.6%Administrative department: 100%MBI-GSLow: Independent burnout factors for nurse managers were not calculated.
Garcia 2021 [43]Cross-sectional BrazilTotal nurses (n = 122): Nurse managers: 47.5%; nursing staff: 52.5% No DataBCSHigh
Giannouli 2021 [44]Pilot GreeceClinical leaders (n = 162)Age (M; Mean ± SD): 48.87 ± 7.32; Age (F; Mean ± SD): 49.23 ± 7.37; Married/cohabiting: 100%; Yrs. of experience (M; Mean ± SD): 20.65 ± 8.44; Yrs. of experience (F; Mean ± SD): 21.45 ± 7.85MBILow: Insufficient description of variables. No numerical data reported for analysis between burnout and other variables.
Sadati 2021 [45]Qualitative IranNurse managers (n = 11): nurse directors (n = 1); assistant nurse directors (n = 2); middle managers (n = 6); first-line managers (n = 2)No DataSemi-structured interviewHigh
Prochnow 2021 [46]Mixed methodsUnited StatesNurse managers (n = 212): nurse directors: 11.2%; middle managers: 35.4%; first-line managers: 33.1%; clinical leaders: 20.3%Age (Mean): 50.3; F: 91.8%; Married: 82.7%; Hospital employment: 57.7%; Management experience (Mean): 12.9Original questionnaireHigh
Semerci 2021 [47]Quasi-experimental Turkeyfirst-line managers (n = 30)No DataBurnout subscale of ProQOLHigh
Galura 2022 [48]Cross-sectional United StatesTemporary first-line managers (n = 179)Age (Mean ± SD): 41.6 ± 6.94; F: 68.0%; Master’s degree: 47.7%; Professional leadership certification: 82%; Management experience (Mean ± SD): 6.28 ± 3.85MBI-GSLow: Factors associated with burnout were not identified.
Lucas 2022 [49]Cross-sectional FranceHealthcare professionals (n = 6935): nurse directors (n = 126)Age: M ± SD 54.42 ± 6.33; M: 27.8%MBI, Spanish versionHigh
Luo 2022 [50]Cross-sectional ChinaNurse managers (n = 458); middle managers and above: 58.3%Age (Mean ± SD): 42.0 ± 19.8; F: 98.7%; Bachelor’s degree or higher: 84.5%; Nursing experience (Mean ± SD): 20.1 ± 7.0; Management experience ≥ 1 yrs.: 100%; Management experience (Mean ± SD): 7.0 ± 4.8MBI-HSS, Chinese versionHigh
Membrive-Jiménez 2022 [51]Cross-sectional Spainmiddle managers (n = 86)Age (Mean ± SD): 46.65 ± 7.16; F: 58.1%; Married/In a relationship: 82.6%; Have children: 88.4%; Fixed morning shift: 80.2%; On-call duty: 48.8%; Yrs. as a nurse (Mean ± SD): 281.67 ± 90.192 months; Management experience (Mean ± SD): 128.24 ± 114.41 months; Nursing experience (Mean ± SD): 20.1 ± 7.0MBI, Spanish versionHigh
Montgomery 2022 [52]Cross-sectional United StatesNurse managers (n = 86): nurse directors: 7.1%; middle managers: 35.7%; first-line managers: 42.9%; clinical leaders: 14.3%No DataCBIHigh
Pallesen 2022 [53]Cross-sectional DenmarkFirst-line managers (n = 31)Age (Mean): 47.6; F: 97%; No formal management education: 45%; Management experience over 5 yrs.: 52%; Management experience 3–5 yrs.: 19%; Management experience 0–2 yrs.: 29%; Number of employees (Mean): 30.7CBILow: Small sample size.
Sawyer 2022 [54]Quasi-experimental United StatesNurse managers (n = 32) *: nurse directors; middle managers; first-line managers; assistant first-line managersManagement experience Before intervention (Median): 5; Management experience After intervention (Median): 9.5; Clinical managers Before intervention: 100%; Clinical managers After intervention: 100%MBI-GSLow: Insufficient description of MBI; small sample size.
Sarıbudak 2023 [55]Quasi-experimental TurkeyFirst-line managers (n = 16)Age (Mean ± SD): 32.87 ± 4.47; F: 87.5%; Management experience (Mean ± SD): 10.75 ± 5.61Burnout subscale of ProQOL-4, Turkish versionLow: Did not focus on burnout.
Sawyer 2023 [56]Randomized controlled trialUnited StatesFirst-line managers (n = 80)F: Intervention group 82.1%, Control group 92.1%; Married: Intervention group 61.5%, Control group 76.3%; Master’s degree: Intervention group 20.5%, Control group 31.6%; Age (Mean ± SD): Intervention group 43.97 ± 10.60, Control group 44.76 ± 9.24Burnout subscale of ProQOLHigh
Alenezi 2024 [57]Cross-sectional United StatesNurse managers (n = 210): nurse directors; middle managers; first-line managers; assistant first-line managersNo DataCBIHigh
Bunch 2024 [58]Cross-sectional United StatesFirst-line managers (n = 54): first-line managers; assistant first-line managersAge (Mean ± SD): 39.7 ± 8.7; F: 98.1%; Married/Cohabiting: 84.9%; Have dependent children: 72.2%; Master’s or PhD: 53.7%; Nursing experience (Mean ± SD): 16.3 ± 8.1; Management experience at current institution (Mean ± SD): 5.9 ± 5.8; Weekly work hours at workplace (Mean ± SD): 47.3 ± 6.9; Weekly work hours at home (Mean ± SD): 6.6 ± 8.3Burnout subscale of ProQOL-5High
Melnyk 2024 [59]Cross-sectional United StatesFirst-line managers (n = 125): first-line managers: 86.4%; assistant first-line managers: 13.6%F: 89.6%; Age 40s (Most common): 34.4%; Academic Medical Center/Health System (Most common): 51.2%; Direct reports: 40%; Day shift: 95.2%; Work hours: 8–10 h/day: 70.4%Original questionnaire, Sensitivity and specificity verifiedHigh
Zhang 2024 [60]Qualitative ChinaFirst-line managers (n = 15)Clinical department: 100%; F: 80%; Management experience (Mean): 39.67; Age (Mean): 9.07Semi-structured interviewHigh
Hu 2025 [61]Cross-sectional ChinaNurse managers (n = 784); nurse directors; middle managers; first-line managers≤36 yrs. (Most common): 27.4%; F: 98.2%; Master’s degree: 3.0%; Married: 95.5%; Management experience ≤ 4 yrs. (Most common): 27.0%; First-line managers (Most common): 79.7%; General hospital: 93.4%; Weekly work hours ≥ 41: 87.6%MBI, Chinese versionHigh
Sanabria-Delgado 2025 [62]Qualitative SpainFirst-line managers (n = 12)Management experience ≥ 12 months: 100%; Unit admitting COVID-19 patients: 100%; Age (Mean): 51.4; Master’s level education: 25%; Management experience (Mean): 11.5MBI
Semi-structured interview		High
Urban 2025 [63]Cross-sectional United StatesNurse managers (n = 105): nurse directors; middle managers; first-line managersNo DataOLBIHigh
Notes: * Subjects of quantitative survey; Abbreviations: F, Female; M, Male; MBI, Maslach Burnout Inventory; HSS, Human Services Survey; GS, General Survey; CBI, Copenhagen Burnout Inventory; OLBI, Oldenburg Burnout Inventory; ProQOL, Professional Quality of Life Scale; PA, Personal Accomplishment subscale.
Table 3. Burnout-associated factors and burnout outcomes among nurse managers.
Table 3. Burnout-associated factors and burnout outcomes among nurse managers.
First Author/YearMain Findings: Burnout-Associated Factors and Scores
Irinyi 2019 [39]Factors associated with higher burnout: Being a manager vs. nursing staff
Kelly 2019 [40]Factors associated with higher burnout: Lack of leadership experience; Low satisfaction with collaboration
Factors associated with lower burnout: High overall satisfaction; High satisfaction with work–life balance
Factors with no association: Position differences among nurse managers; Perceived evaluation; Perception of collaboration at work
Nurse Manager Burnout Scores (Mean ± SD): first-line managers: 23.29 ± 5.7; middle managers: 23.42 ± 5.77; nurse directors: 23.19 ± 5.56; total nurse managers: 23.30 ± 5.69
Nakayama 2020 [41]Factors associated with higher burnout: Role conflict; Role ambiguity; Underutilization of skills; Fluctuation in workload; Subjective physical symptoms; Age 40s
Factors associated with lower burnout: Overtime < 5 h; Possess qualifications; Self-esteem; Job control; Responsibility for people
Factors with no association: Quantitative workload; Cognitive demands
Nurse Manager Burnout Scores (Mean): Emotional Exhaustion: 15.68; Depersonalization: 11.53; Reduced Personal Accomplishment: 20.98
Cha 2020 [42]Factors associated with lower burnout: Being a manager
Nurse Manager Burnout Scores (Mean ± SD): nurse directors: 2.04 ± 0.58; middle managers: 2.93 ± 0.96; first-line managers: 3.07 ± 0.94
Garcia 2021 [43]Factors associated with higher burnout: Occupational stress
Factors associated with lower burnout: Satisfaction with hierarchical relationships; Intrinsic job satisfaction; Being a manager vs. Care nurse
Factors with no association: Satisfaction with physical work environment
Nurse Manager Burnout Scores (Mean ± SD): Emotional Exhaustion: 2.4 ± 0.7 (Moderate); Depersonalization: 1.6 ± 0.3 (Mild); Disappointment with work: 1.7 ± 0.5 (Moderate)
Giannouli 2021 [44]Factors with no association: Demographic variables: Age, Gender, Yrs. of experience, Education, etc.; Emotions at work; Emotional labor strategies; Emotional regulation style; Physical and psychological interpersonal distance at work; Job satisfaction; Emotional intelligence; State anxiety; Group cohesiveness; Arrogance
Nurse Manager Burnout Scores (Mean ± SD): Burnout: 3.24 ± 1.11
Sadati 2021 [45]Factors associated with higher burnout: Dealing with issues beyond primary duties; Responding to both patients and subordinates; Inadequate organizational response; Multifaceted pressure; Staff shortages
Prochnow 2021 [46]Factors associated with higher burnout: Difficulties in communication and interpersonal relationships; Increased expectations for nurse managers; Managing daily workload; Addressing and improving staff morale; Insufficient flexible work arrangements and lack of remote work opportunities; Addressing daily challenges with limited resources; Lack of administrative support
Factors associated with lower burnout: Ensuring work–life balance; Engaging in meaningful work; Providing high-quality care or being part of it
Semerci 2021 [47]Factors associated with lower burnout: Continuing progressive muscle relaxation for ≥2 months;
Nurse Manager Burnout Scores (Median, IQR): Before intervention: 18.50, 13.75–26.25; After 1st intervention: 17.00, 12.75–20.00; After 2nd intervention: 14.00, 9.00–19.00
Galura 2022 [48]Nurse Manager Burnout Scores (Mean ± SD): Exhaustion: 3.88 ± 1.17 (Moderate); Cynicism: 2.68 ± 1.04 (Moderate); Lack of Professional Efficacy: 5.86 ± 0.53 (Severe)
Lucas 2022 [49]Factors associated with lower burnout: Nurse managers vs. Nursing assistants, nursing staff, OR nurses, medical administrators, senior medical administrators, physicians
Prevalence of burnout among nurse managers (%): Emotional Exhaustion: 23.0%; Depersonalization: 14.3%; Reduced Personal Accomplishment: 27.0%; Burnout: 45.2%; Severe Burnout: 3.2%
Luo 2022 [50]Factors associated with higher burnout: Nurse directors vs. Middle managers and below
Factors associated with lower burnout: Organizational support; High nurse manager leadership; High resilience; Medical/Surgical vs. ICU/Emergency ward staff; Pediatrics vs. ICU/Emergency ward staff; Gynecology, Obstetrics, Psychiatry, OR vs. ICU/Emergency ward staff
Nurse Manager Burnout Scores (Mean ± SD): Burnout: 28.8 ± 18.5
Prevalence of burnout among nurse managers (%); Emotional Exhaustion: 39.3% (Moderate–Severe); Depersonalization: 22.5% (Moderate–Severe); Reduced Personal Accomplishment: 40.8% (Moderate–Severe)
Other implications: Serial multiple mediation effect: Organizational support → Nurse manager leadership → Resilience → Burn out; Mediation effect: Organizational support → Resilience → Burnout
Membrive-Jiménez 2022 [51]Factors associated with higher burnout: Neuroticism; Depressive symptoms; Anxiety; On-call duties; Conscientiousness *
Factors associated with lower burnout; Extraversion *; Conscientiousness *; Agreeableness *; Openness *
Factors with no significant association with burnout: Demographic variables: Age, Gender, Marital status, Number of children; Work-related variables: Shift type, Yrs. of experience as a nurse manager, Yrs. of experience as a nurse
Prevalence of burnout among nurse managers (%): Emotional Exhaustion: Moderate 30.6% Severe 22.4%; Depersonalization: Moderate 36% Severe 21%; Personal Accomplishment: Moderate 28.2% Severe 14.1%; Burnout: Severe 34.1%
Montgomery 2022 [52]Factors associated with higher burnout: Intention to leave
Factors associated with lower burnout: Nurse manager Authority enhancement *; Fair and manageable workload; Constructive relationships between first-line and middle managers; Effective relationships between nurse managers and nursing staff; Adequate budgeted resources; Generative culture *; Culture of meaning *; Better practice environment; Resilience
Nurse Manager Burnout Scores (Mean ± SD): Personal Burnout: 54.76 ± 22.48; Work-related Burnout: 52.81 ± 21.49; Client-related Burnout: 38.09 ± 22.66
Pallesen 2022 [53]Other implications: Mean resilience scores in both the low and high personal burnout groups were at the upper end of the normal range; The high personal burnout group was 6.6 yrs. younger on average than the low personal burnout group; The proportion of participants with formal management education was slightly lower in the high personal burnout group (50.0%) compared to the low personal burnout group (57.1%)
Nurse Manager Burnout Scores (Mean ± SD): Personal Burnout: 42.9 ± 18.6; Work-related Burnout: 39.1 ± 19.5; nursing staff-related Burnout: 25.7 ± 18.7
Prevalence of burnout among nurse managers (%): Personal Burnout: 32.3 (Severe); Work-related Burnout: 29.0 (Severe); Client-related Burnout: 6.5 (Severe)
Sawyer 2022 [54]Factors with no significant association with burnout: Educational program fostering joy and satisfaction in work, strengthening managerial roles, and promoting healthy self-care behaviors
Nurse Manager Burnout Scores (Median, IQR): Exhaustion: Before intervention: 2.0, 0.8–3.6; After intervention: 1.9, 0.8–3.0; Cynicism Before intervention: 0.8, 0.2–2.4 After intervention: 0.8, 0.2–1.6; Professional Efficacy Before intervention: 5.5, 4.7–5.8 After intervention: 5.5, 5.0–6.0
Sarıbudak 2023 [55]Factors with no significant association with burnout: Program improving knowledge and coping skills for compassion fatigue
Nurse Manager Burnout Scores (Mean ± SD): Pre-intervention: 17.06 ± 5.18 (Mild); Post-intervention: 15.81 ± 5.23 (Mild)
Sawyer 2023 [56]Factors associated with lower burnout: Psychoeducational group program RISE (Effect observed from immediately post-intervention to 1 month)
Nurse Manager Burnout Scores (Mean ± SD): Pre-intervention: 23.06 ± 6.45 (Moderate); Post-intervention: 21.47 ± 6.23 (Mild); 1-month follow-up: 20.97 ± 5.02 (Mild); 3-month follow-up: 22.41 ± 7.44 (Mild); 6-month follow-up: 21.97 ± 7.75 (Mild)
Alenezi 2024 [57]Factors associated with higher burnout: Female gender (Associated only with Personal Burnout); Male gender (Associated only with Client-related Burnout)
Nurse Manager Burnout Scores (Mean ± SD): Total Personal Burnout: 54.8 ± 15.6, F: 56.2 ± 16.4, M: 49.3 ± 10.0; Total Work-related Burnout: 53.0 ± 14.8, F: 53.6 ± 15.7, M: 50.6 ± 9.8; Total Client-related Burnout: 37.0 ± 19.2, F: 34.8 ± 19.4, M: 45.3 ± 15.7
Bunch 2024 [58]Factors associated with higher burnout: Weekly work hours at workplace; Weekly work hours at home; Intention to leave for a non-nursing position outside the organization since pandemic onset; Intention to transfer to a non-managerial nursing position within the organization within the next 6–12 months
Nurse Manager Burnout Scores (Mean ± SD): Burnout: 29.0 ± 5.3 (Moderate)
Factors with no significant association with burnout: Intention to transfer to a non-managerial nursing position within the organization since pandemic onset; Intention to leave for a nursing position outside the organization since pandemic onset; Intention to leave for a non-nursing position outside the organization since pandemic onset; Intention to leave for a nursing position outside the organization within the next 6–12 months; Intention to leave for a non-managerial position outside the organization within the next 6–12 months; Demographic variables: Age, Yrs. of experience as a nurse, Yrs. of experience in current organization, Weekly work hours at workplace, Weekly work hours at home
Prevalence of burnout among nurse managers (%): Mild: 9.3; Moderate: 88.9; Severe: 1.9
Melnyk 2024 [59]Factors associated with higher burnout: Stressful work environment; Staff shortages in the unit
Factors associated with lower burnout: Work environment supportive of personal wellness; Perceived ability to practice healthy lifestyle habits daily; Organization supportive of taking leave for medical visits; Perceived importance to the workplace
Factors with no significant association with burnout: Supporting nursing staff well-being as a manager
Prevalence of burnout among nurse managers (%): Burnout: 54.4
Zhang 2024 [60]Factors associated with higher burnout: Uncertainty of specific duties and expected roles during patient safety incidents; Unclear communication methods with patients and staff during patient safety incidents *; Significant mental burden despite no direct responsibility for patient safety incidents *
Hu 2025 [61]Factors associated with higher burnout: Perceived stress
Factors associated with lower burnout: High job satisfaction; High psychological capital
Nurse Manager Burnout Scores (Mean ± SD): Emotional Exhaustion: 15.49 ± 11.24; Depersonalization: 4.12 ± 5.35; Reduced Personal Accomplishment: 37.93 ± 9.55
Sanabria-Delgado 2025 [62]Factors associated with higher burnout: Fear of the pandemic; Uncertainty due to the pandemic; Pressure to make critical decisions with limited information during the pandemic; Frequent protocol changes during the pandemic; Difficulties in staffing during the pandemic; Shortage of material resources during the pandemic; Managing scarce resources during the pandemic; Balancing empathy for families and patient safety during the pandemic; Being blamed by nurses during the pandemic; Lack of support from colleagues during the pandemic
Factors associated with lower burnout: Words of gratitude from colleagues and family
Prevalence of burnout among nurse managers (%): Severe Emotional Exhaustion: 25; Severe Depersonalization: 50 Severe Reduced Personal Accomplishment: 25
Urban 2025 [63]Factors associated with higher burnout: High stress; High life satisfaction
Factors associated with lower burnout: High life satisfaction; High self-compassion *; High resilience
Nurse Manager Burnout Scores (Mean ± SD): Burnout: 36.35 ± 6.96; Exhaustion: 2.37 ± 0.45; Disengagement: 2.16 ± 0.48
Prevalence of burnout among nurse managers (%): Exhaustion: 59.1; Disengagement: 46.4
Notes: * Definitions of terms: Self-compassion: Kindness toward oneself in times of difficulty; Authority enhancement: The authority to create a patient safety culture; Conscientiousness: The ability to regulate and control impulses and to maintain and apply a sense of duty; Extraversion: Openness to interpersonal relationships and the ability to achieve set personal goals; Agreeableness: Respect and tolerance toward others; Openness: The tendency to explore and enjoy new personal experiences; Generative culture: A culture that values nurturing the next generation, sharing knowledge, and supporting growth; Culture of meaning: A culture where the meaning and purpose of work can be realized; Patient safety incident: Potentially dangerous events that unintentionally occurred to patients. ** Levels (Mild, Moderate, or Severe) in the Nurse Manager Burnout Scores indicate the level of the mean burnout score based on cut-off values established in each study. Abbreviations: OR, Operating Room; ICU, Intensive Care Unit; SD, Standard Deviation.
Table 4. Synthesized Burnout-Related Factors among Nurse Managers before and during the COVID-19 Pandemic Using the JD–R Framework.
Table 4. Synthesized Burnout-Related Factors among Nurse Managers before and during the COVID-19 Pandemic Using the JD–R Framework.
JD-R Model ComponentsPre-PandemicPandemic-Era
Job demandsResponsibility and role-related burden as a manager [41,45,46]Responsibility and pressure associated with the managerial role [51,60,62]
Long working hours [41]Long working hours and on-call duties [51,58]
Resource and staffing management during shortages [45,46]Resource and staffing management during shortages [59,62]
Continuous changes in protocols [62]
Difficulty balancing empathy for families with patient safety [62]
Fear and uncertainty related to the pandemic [62]
Role uncertainty during critical incidents [60]
Role ambiguity and additional tasks [41,45]
Managing and maintaining subordinate morale [46]
Responding to both patient and staff needs [45]
Managing daily workload [46]
Job resourcesOrganizational support [45,46]Organizational support and supportive organizational climate [50,52,59]
Effective interpersonal relationships and communication [46]Effective interpersonal relationships and communication [52,62]
Expanded managerial discretion [41]Expanded managerial discretion [52]
Adequate workload and material resources [52]
Permeation of a positive organizational culture [52]
Support from colleagues [62]
Utilization of professional expertise and skills [41]
Ensuring work–life balance [40,46]
Flexible work arrangements [46]
Intrinsic job satisfaction [43]
Personal resourcesLeadership capacity of nurse managers [40]Leadership capacity of nurse managers [50]
Overall life and job satisfaction [40]Overall life and job satisfaction [63]
Sense of purpose and contribution as a manager [46]Meaning derived from the managerial role [59]
Resilience [41]Resilience [50,51,52,61,63]
Positive personality traits [51]
Achievable healthy lifestyle habits [59]
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Matsumoto, M.; Hara, Y.; Mayers, T.; Omiya, T. Shifts in Research Focus on Factors Associated with Burnout Among Nurse Managers Before and During the COVID-19 Pandemic: An Integrative Review. Occup. Health 2026, 1, 22. https://doi.org/10.3390/occuphealth1020022

AMA Style

Matsumoto M, Hara Y, Mayers T, Omiya T. Shifts in Research Focus on Factors Associated with Burnout Among Nurse Managers Before and During the COVID-19 Pandemic: An Integrative Review. Occupational Health. 2026; 1(2):22. https://doi.org/10.3390/occuphealth1020022

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Matsumoto, Mizuka, Yukari Hara, Thomas Mayers, and Tomoko Omiya. 2026. "Shifts in Research Focus on Factors Associated with Burnout Among Nurse Managers Before and During the COVID-19 Pandemic: An Integrative Review" Occupational Health 1, no. 2: 22. https://doi.org/10.3390/occuphealth1020022

APA Style

Matsumoto, M., Hara, Y., Mayers, T., & Omiya, T. (2026). Shifts in Research Focus on Factors Associated with Burnout Among Nurse Managers Before and During the COVID-19 Pandemic: An Integrative Review. Occupational Health, 1(2), 22. https://doi.org/10.3390/occuphealth1020022

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