Nurse stress and patient safety in the ICU: physician-led observational mixed-methods study

Nurses working in intensive care settings are required to maintain constant vigilance, yet they often experience high stress and burnout, which can compromise the quality of patient care.

To identify stress and burnout among intensive care nurses, contributing risk factors and impact on patient safety, while providing an opportunity for nurses to discuss their work-related challenges.

Setting: Observational mixed-methods study done in intensive care unit (ICU), tertiary teaching hospital, Kerala, India in July 2024.

Thirty nurses in the ICU (all females, mostly aged 25-35 years, >5 years of work experience) completed standardised questionnaires on stress levels, workload, burnout and work satisfaction. From this group, six nurses underwent structured interviews. Purposive sampling was done to capture diverse experience and roles. Reported patient safety incident data were collected.Severity of stress, workload, burnout and work satisfaction were classified into high or low levels based on predefined cut-off scores.

86.7% reported moderate to high levels of combined outcomes of workload, stress or burnout, with 46.7% experiencing high levels of stress. Four major themes were identified in the qualitative analysis: stress, attitudes, patient safety and nurses' unmet demands and aspirations. Positive attitudes identified were passion, motivation and empathy. Key stressors included work overload, inadequate staffing, logistics, team and management support. Coping strategy was family-centred. A perceived need for a non-punitive, learning-oriented environment was identified for fostering patient safety culture. Nurses' demands included facility safety, managerial support and better resources, both man and machine.

Despite the specific challenges faced by ICU nurses in developing countries, they upheld positive values. Institutional leadership's commitment to implement patient safety culture and improve nurses' work environment is important. Future research should involve larger multicentre interventional studies.