Burnout, anxiety, and resilience among nurses during wartime: evidence from a cross-sectional study

The Iron Swords War that began in October 2023 created unprecedented challenges for Israeli healthcare workers. Nurses, who are particularly vulnerable to occupational stressors, face heightened risks of burnout and psychological distress during wartime. This study examined the relationship between personal resilience and burnout among hospital nurses working during the Iron Swords War in Israel and assessed the prevalence of burnout, anxiety, and stress while identifying factors associated with lower burnout.

In this cross-sectional study, an electronic questionnaire was distributed to hospital nurses working in Israeli hospitals to measure demographic characteristics; resilience, the Connor-Davidson 10-item Resilience Scale (CD-RISC-10); anxiety and stress, the Depression, Anxiety, and Stress Scale (DASS-21); and burnout, the Copenhagen Burnout Inventory (CBI). Mediation analysis was conducted via the PROCESS macro to examine the relationships among anxiety, stress, resilience, and burnout.

Of the 465 nurses who completed the survey, 80.6% reported extremely severe anxiety, whereas 35.4% reported extremely severe stress. While 53.3% reported moderate burnout levels, only 7.7% reported high burnout. The mean ± standard deviation resilience score was 20.4 ± 8.2. Factors associated with elevated anxiety and stress included night shift work, working > 180 h/month, and having family members in military service during the war. The results of the mediation analysis revealed that stress partially mediated the relationship between anxiety and burnout (B = 0.3210, p < 0.001). Resilience was significantly and negatively correlated with burnout (r = - 0.282, p < 0.01), suggesting an inverse association. Multiple regression revealed that sex, resilience, anxiety, and stress were significantly associated with burnout, explaining 48.1% of the variance. The 8.6% response rate represents a major limitation affecting generalizability, and findings should be interpreted as preliminary insights rather than definitive population estimates.

Despite extremely high levels of anxiety and stress, nurses maintained moderate burnout and resilience levels during wartime. The role of resilience and the mediating role of stress highlight the importance of targeted interventions focused on stress management and resilience building, particularly for high-risk groups.

Not applicable.