Nurses Burnout: A Concept Analysis Using Walker and Avant’s Method

Abstract

Nurse burnout is a critical and growing challenge that threatens the sustainability of healthcare systems, the safety of patients, and the well-being of the nursing workforce. It is typically defined as a multidimensional syndrome involving emotional exhaustion, depersonalization or detachment from work, and a reduced sense of professional efficacy. Research links burnout to a host of negative outcomes, including higher rates of clinical errors, lower job and patient satisfaction, absenteeism, presenteeism, and staff turnover. The COVID-19 pandemic has significantly amplified the scope and severity of burnout among nurses. However, conceptual ambiguity and overlaps with related conditions such as depression, compassion fatigue, and moral distress have limited the clarity needed for effective research, policy-making, and intervention design. This concept analysis, based on a systematic review of 21 peer-reviewed studies published between 2020 and 2025 and conducted according to PRISMA 2020 guidelines, applies Walker and Avant’s eight-step method to clarify the defining attributes, antecedents, consequences, and empirical referents of nurse burnout. The findings highlight three defining features emotional exhaustion, depersonalization, and diminished efficacy as well as key antecedents such as high nurse-to-patient ratios, long or rotating shifts, sustained emotional labor, understaffing, limited autonomy, poor leadership, and lack of material support. The consequences of burnout span individual (anxiety, depression), patient (missed care, safety events), and systemic levels (staff turnover, increased costs, operational instability). Empirical referents identified include validated tools such as the MBI, CBI, and OLBI, along with organizational indicators like staffing levels, overtime, absenteeism, and patient outcomes. The analysis distinguishes burnout from similar constructs and emphasizes its chronic, work-specific nature. Ultimately, nurse burnout is a measurable, actionable concept that requires system-level strategies, including improved staffing models, supportive leadership, and adequate resource provision. Integration of digital solutions like predictive analytics and acuity-based e-rostering, alongside ongoing monitoring and cross-setting validation, is essential to reducing burnout, improving retention, and protecting patient safety.