Burnout and Compassion Fatigue Among ICU Nurses: A Systematic Review of Predictors, Protective Factors and Workforce...

Burnout and compassion fatigue are prevalent among intensive care unit (ICU) nurses and may undermine workforce stability and patient safety. This systematic review synthesises risk factors, protective variables and interventions associated with burnout and compassion fatigue in ICU nurses.

To synthesise evidence on predictors, protective factors and interventions influencing burnout and compassion fatigue among ICU nurses, with emphasis on workforce retention.

A systematic review was conducted following PRISMA 2020. Searches were performed from database inception to 7 November 2025 in MEDLINE (PubMed), Embase, Web of Science, Scopus, CINAHL and PsycINFO, with supplementary hand-searching and grey literature/trial registry screening. Eligible studies included quantitative, qualitative and mixed-methods research reporting burnout and/or compassion fatigue outcomes in ICU nurses. Two reviewers independently screened records and extracted data; disagreements were resolved by consensus and third-reviewer adjudication. Risk of bias/quality appraisal was performed using design-appropriate tools, and findings were synthesised narratively due to heterogeneity.

Twenty studies were included. The included literature identified consistent occupational and organisational contributors to burnout, particularly emotional exhaustion, including high workload, staffing constraints, moral distress and suboptimal leadership or team support. Compassion fatigue/secondary traumatic stress was associated with repeated exposure to suffering, traumatic clinical events and inadequate psychological support, while compassion satisfaction and supportive work environments showed protective associations. Intervention studies (e.g., resilience, mindfulness, structured support programmes) generally demonstrated reductions in burnout-related outcomes, but intervention content, duration and outcome measures varied substantially.

Overall, the evidence supports a consistent association between ICU work stressors and burnout/compassion fatigue, with moderate strength for organisational risk factors and low-to-moderate strength for intervention effectiveness due to heterogeneity and variable study quality. Future studies should use standardised definitions and outcome measures and strengthen experimental designs.

For critical care nurses, unit leaders should prioritise ICU-specific structural prevention approaches including adequate nurse-to-patient staffing, workload and alarm-burden management, protected breaks and psychologically safe team culture. Access to timely peer support, debriefing after traumatic events and end-of-life care, and leadership practices that reduce moral distress (e.g., shared decision-making and ethics support) should be paired with evidence-informed well-being programmes tailored to the ICU context.