Systematic review on occupational stress and its risk factors among nurses
DOI:
https://doi.org/10.56294/nds2025419Keywords:
occupational stress, nurses, burnout, patient safety, healthcare workforceAbstract
Introduction: occupational stress is a major challenge in nursing, with implications for workforce well-being, patient safety, and health system resilience. Nurses face multidimensional stressors, including workload, shift work, and limited resources, which may vary across global and regional contexts.
Objective: This systematic review aimed to synthesize recent evidence on the prevalence, determinants, and consequences of occupational stress among nurses, with attention to universal and context-specific risk factors.
Method: Guided by the PRISMA 2020 framework, a comprehensive search was conducted in PubMed, CINAHL, Scopus, and PsycINFO, covering studies published between January 2015 and March 2024. Eligible studies included nurses working in hospital or healthcare settings and assessed occupational stress using validated tools. Data extraction and quality appraisal were performed independently by two reviewers using the Joanna Briggs Institute (JBI) Critical Appraisal Tools.
Results: Fifteen studies met inclusion criteria, conducted across Asia, Africa, the Middle East, and Europe. Reported prevalence of occupational stress ranged from moderate to high. Common determinants included heavy workload, shift work, inadequate staffing, role ambiguity, limited managerial support, and workplace violence. The COVID-19 pandemic further intensified stress, driven by infection risk and inadequate protective equipment. Context-specific stressors included resource shortages in low- and middle-income countries and political instability in regions such as Jordan and Palestine. Consequences included burnout, emotional exhaustion, turnover intention, and adverse effects on patient safety and care quality.
Conclusion: Occupational stress among nurses remains a significant global issue with critical personal and systemic consequences. Multilevel interventions—targeting organizational support, staffing, safe workplaces, and resilience-building—are urgently required, especially in resource-limited and conflict-affected settings.
References
Nakase’s K, Ouzounian C. Factors influencing stress and job satisfaction of nurses working in psychiatric units. Health Sci. 2008;2(4):183-195.
Guppy T, Tim M. Occupational stress among nurses: prevalence and predictors. Int J Nurs Stud. 2017;54:25-33.
Kassa DH, Aengus AD, Meetu BT. Assessment of occupational stress and associated factors among nurses in East Gujjar zone public hospitals. Clin Med Res. 2019;6(2):43-48.
Mohite N, Shinde M, Galvani A. Occupational stress among nurses working at selected tertiary care hospitals. Int J Sci Res. 2018;3(6):26-27.
Rogers B. Occupational and Environmental Health Nursing: Concepts and Practice. Philadelphia: Elsevier; 2003.
Okita S, Daitoku S, Abe M, et al. Potential predictors of susceptibility to occupational stress in Japanese novice nurses: a pilot study. Environ Health Prev Med. 2017;22(1):20.
Zhou L, Quansah PE, Owusu-Marfo J. Nursing stress factors and turnover intention among newly recruited nurses in China. Nurs Open. 2022;9(6):2697-2709.
Werke EB, Were ZS. Occupational stress and associated factors among nurses working at public hospitals of Addis Ababa, Ethiopia. Front Public Health. 2023;11:1147086.
Bardhan R, Heaton K, Davis M, et al. Psychosocial job stress and health risk in emergency department nurses: a cross-sectional study. Int J Environ Res Public Health. 2019;16(18):3243.
Mesa MDLA, Barbera MDC, Montesinos MJL, et al. Stress in nursing graduates and healthcare assistants in surgical areas. Infirmarian Global. 2021;20(1):204-213.
Lin PC, Chen CH, Pan SM, et al. Association between rotating shift work and occupational stress in nurses. J Occup Health. 2023;57(4):307-315.
Maslach C, Leiter MP. Understanding burnout: new models. World Psychiatry. 2016;15(2):103-111.
Dall’Ora C, Ball J, Reinius M, Griffiths P. Burnout in nursing: a theoretical review. Hum Resour Health. 2020;18(1):41.
Baye Y, Demeke T, Birhan N, Samahan A. Nurses’ work-related stress and associated factors in Ethiopian hospitals. PLoS One. 2020;15(3):e023034.
Sardinia H, Kumiki F, Bloch B. Comparison of job stress among emergency department nurses with other specialties. QJ Nurs Manag. 2018;6(3):48-56.
Babapour R, Ghassan-Mozaffari N, Kazemi AF. Nurses’ job stress and its impact on quality of life and caring behaviors: a cross-sectional study. BMC Nurs. 2022;21(1):75.
Baldwin A, Griffiths P, Dall’Ora C. Nurse stress, burnout, and implications for patient care. J Adv Nurs. 2025;81(3):689-698.
Kruczek A, Basińska MA, Janicka M. Coping flexibility in nurses: moderating role of age and seniority. Int J Occup Med Environ Health. 2020;33(4):507-521.
Darity AF, Tackie V, Akosua DR. Occupational stress and its effects on nurses in Ghana. SAGE Open Nurs. 2023;9:1-11.
Al-Hawara KM. Exploring the relationship between occupational stress and organizational commitment among nurses in Jordan. Dirasat: Admin Sci. 2013;40:127-143.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Moola S, Munn Z, Tufanaru C, et al. Chapter 7: Systematic reviews of etiology and risk. In: Aromataris E, Munn Z, eds. JBI Manual for Evidence Synthesis. Adelaide: JBI; 2020.
Baye, Y., Demeke, T., Birhan, T., Getachew, A., & Belay, W. (2020). Nurses’ work-related stress and associated factors in Harar, Eastern Ethiopia: A cross-sectional study. PLOS ONE, 15(8), e0236782. PLOS
Zaghini, F., Fiorini, J., Piredda, M., Fida, R., & Sili, A. (2020). The role of occupational stress in the association between emotional labour and burnout among nurses: A multiple mediation model. Professioni Infermieristiche, 73(2), 111–120. ساينس دايركت
Lim, J.-Y., Kim, G.-M., & Kim, E.-J. (2022). Factors associated with job stress among hospital nurses: A meta-correlation analysis. International Journal of Environmental Research and Public Health, 19(10), 5792. https://doi.org/10.3390/ijerph19105792 MDPI
Galanis, P., Vraka, I., Fragkou, D., Bilali, A., & Kaitelidou, D. (2021). Nurses’ burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of Advanced Nursing, 77(8), 3286–3302. PMC
Bekele Werke, E., & Shewangizaw Weret, Z. (2023). Occupational stress and associated factors among nurses working at public hospitals of Addis Ababa, Ethiopia, 2022: A hospital-based cross-sectional study. Frontiers in Public Health, 11, 1147086. PMC
Zhang, W., Ma, X., Yu, S., Zhang, X., Mu, Y., Li, Y., Xiao, Q., & Ji, M. (2023). Occupational stress, respect, and the need for psychological counselling in Chinese nurses: A nationwide cross-sectional study. Public Health, 225, 72–78. https://doi.org/10.1016/j.puhe.2023.09.003 PubMed
Gmayinaam, V. U., Tampouri, I., & Agyapong, J. K. (2024). Work-related stress: Prevalence, causes and coping strategies among nurses in secondary and tertiary healthcare facilities in Ghana. BMC Public Health, 24, 1767. BioMed Central
Zhong, Y., Jin, D., & Dong, X. (2025). Levels and related factors of occupational stress among nurses in a low-fertility context. Frontiers in Psychology, 16, 1471640. Frontiers
Long, L., Chen, Z., Yuan, J., & Zeng, C. (2025). Association between workplace violence and occupational stress among emergency department nurses: A cross-sectional study. Frontiers in Public Health, 13, 1603651. Frontiers
Alkhawaldeh, A., Ta’an, W., & Alzghoul, M. (2025). Sources and predictors of occupational stress among public health nurses in Jordan. Public Health Nursing. Advance online publication. Wiley Online Library+1
Oweidat, I. A., Rababa, M., Khrais, H. I., & Thawabieh, A. (2025). Work stressors and intention to leave among Jordanian nurses in isolation units: A cross-sectional correlational study. Heliyon, 11(4), e31703. BioMed Central
Li, Y., Bai, J., Han, P., & Liu, T. (2024). Association of nurse burnout with patient safety, quality of care, and patient satisfaction: A systematic review and meta-analysis. JAMA Network Open, 7(5), e2412330. jamanetwork.com
Narbona-Gálvez, S., Romero-Cuesta, J., Ruiz-Cárdenas, J. D., & Olmedilla, A. (2024). Novice nurse stress in unfamiliar scenarios: Clinical implications. Frontiers in Public Health, 12, 1365597. Frontiers
Dziedzic, B., Łuczyk, K., Małyszczak, M., & Książek, T. (2025). Occupational stress and social support among nurses. Frontiers in Psychology, 16, 1265776. PMC
Jaradat Y, Qtait M. Occupational Stress and Associated Risk Factors Among Nurses in Hebron Hospitals: A Cross-Sectional Study from the West Bank, Palestine. SAGE Open Nurs. 2025;11:23779608251374155. Published 2025 Aug 29. doi:10.1177/23779608251374155
Qtait M, Alia MF, Jaradat Y. The Impact of Rotating Shift Work on Nurse Burnout: A Systematic Review of Contributing Factors and Organizational Strategies. SAGE Open Nursing. 2025;11. doi:10.1177/23779608251374232
Alqaissi N, Qtait M, Jaradat Y, et al. Psychological Challenges of Nurses Working at Hospitals in South West Bank, During War on Gaza Strip. Disaster Medicine and Public Health Preparedness. 2025;19:e209. doi:10.1017/dmp.2025.10105
Qtait , M. 2023. Systematic Review of Time Management Practices Among Nurse Managers. Africa Journal of Nursing and Midwifery. 25, 2 (Aug. 2023), 11 pages. DOI:https://doi.org/10.25159/2520-5293/13507.
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Copyright (c) 2025 Yousef Jaradat, Obaida Mahareq, Salsabeel Ganazreh, Thabet Manasreh, Malak Shaban (Author)
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