A Three-Pillar Framework for Nurse Well-Being: An Integrative Review of Multilevel Strategies

This study aimed to synthesize evidence on multilevel strategies that promote nurse well-being and resilience to support workforce sustainability.

Integrative review was guided by Whittemore and Knafl's methodology.

Systematic searches of CINAHL, PubMed, Web of Science and MEDLINE identified 2485 records published between January 2002 and December 2025. After removing duplicates and screening titles and abstracts, 161 articles underwent full-text review. Sources addressing nurse well-being, burnout, resilience and mental health were assessed for eligibility. Study quality was appraised using the Johns Hopkins Evidence-Based Practice tool. Fifty-two primary research studies were retained for the results synthesis.

Analysis revealed evidence organized within a three-pillar framework that integrates mental health promotion, burnout prevention and resilience building across individual, organizational and system levels. Unlike previous reviews focusing on single interventions, this framework shows that sustainable nurse well-being requires simultaneous, coordinated action across all three pillars. Evidence consistently identified adequate staffing, supportive leadership, and psychological safety as foundational enablers, with staffing adequacy showing the strongest associations with burnout reduction.

Nurse well-being requires integrated, multilevel solutions that combine individual skill development with organizational reform and supportive policy environments to ensure workforce sustainability.

This study provides actionable, evidence-based strategies for nursing leaders, educators and policymakers to foster healthy work environments that support nurse well-being, retention and quality patient care.