Background

Nursing burnout is commonly discussed as a psychological, professional or workforce well-being problem. This framing is incomplete. Burnout also produces economic consequences through nurse turnover, sickness absence, presenteeism, reduced productivity, overtime dependence, recruitment and orientation costs, loss of experienced clinical capacity, and potentially avoidable deterioration in patient safety and quality of care.

Objective

This article examines the less visible economic pathways through which nursing burnout affects healthcare organisations and wider health systems. It also considers why conventional financial and workforce dashboards may underestimate these costs and identifies practical approaches for integrating burnout prevention into organisational investment and workforce planning.

Methods

A structured narrative review was conducted using PubMed/MEDLINE-indexed literature and reports from the World Health Organization and the Agency for Healthcare Research and Quality. Searches prioritised systematic reviews, meta-analyses, economic evaluations, longitudinal or multi-hospital studies, and major workforce reports published between 2002 and July 2026. Search concepts included nurse burnout, turnover, presenteeism, absenteeism, patient safety, nurse staffing, economic cost, cost-effectiveness, work environment and retention. Because this was a narrative rather than a systematic review, formal risk-of-bias scoring and meta-analysis were not undertaken.

Results

The evidence indicates that burnout-related costs are distributed across multiple budgets and time periods. Turnover produces immediate expenditure on recruitment, vacancy coverage, onboarding and orientation. Presenteeism can reduce effective nursing capacity even when scheduled positions appear filled. Burnout is also associated with poorer safety climate, medication errors, falls, healthcare-associated infections, adverse events, lower patient satisfaction and lower nurse-assessed quality of care. Economic evaluations suggest that reducing burnout-attributed turnover, improving registered nurse staffing and providing structured staff support can generate substantial organisational value, although estimates remain context-specific.

Conclusion

Burnout should not be treated solely as an individual resilience problem or an employee-wellness concern. It is a form of operational and economic risk. Healthcare organisations that measure only headcount, payroll and vacancy rates may miss the financial consequences of depleted human capacity. A more accurate economic approach should connect nurse well-being with staffing adequacy, retention, productivity, patient outcomes and long-term workforce sustainability.

Keywords: nursing burnout; health economics; nurse retention; turnover; presenteeism; patient safety; nurse staffing; workforce sustainability; healthcare costs

A hospital may appear financially efficient while quietly consuming its nursing workforce.

The roster is filled. The beds are occupied. Payroll remains within target. Shifts continue, discharges proceed and the organisation appears to be functioning.

Yet beneath this visible activity, nurses may be working without adequate recovery, carrying unsafe or unpredictable workloads, missing breaks, staying beyond scheduled hours, returning while unwell, or considering leaving the organisation entirely.

From a conventional accounting perspective, much of this may remain invisible until a nurse resigns, sickness absence rises, agency expenditure increases or patient outcomes deteriorate. By that point, the cost has already accumulated.

The World Health Organization defines burnout as an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed. It is characterised by exhaustion, increased mental distance or cynicism towards work, and reduced professional efficacy. Burnout is not classified as a medical condition in ICD-11, but its occupational definition is important: it directs attention towards the relationship between the worker and the conditions under which work is performed, rather than locating the entire problem within the individual nurse (World Health Organization, 2019).

This distinction has economic significance. When burnout is understood primarily as an individual inability to cope, organisational responses tend to focus on resilience training, mindfulness, counselling or self-care. These interventions may be valuable, but they cannot independently compensate for persistent understaffing, excessive workload, inadequate schedule control, poor leadership support, repeated moral conflict or insufficient recovery time.

Burnout research consistently identifies adverse job characteristics—including high workload, inadequate staffing, long shifts, low control, limited autonomy, poor support and unfavourable work environments—as important predictors. Reported consequences include sickness absence, reduced performance, intention to leave, adverse events and poorer patient experience (Dall’Ora et al., 2020).

The issue is increasingly important in a global labour market already facing maldistribution and shortages. The State of the World’s Nursing 2025 report estimated that the global nursing workforce reached approximately 29.8 million in 2023, while the estimated shortage remained 5.8 million. WHO projected that the shortage could decline to 4.1 million by 2030, but emphasised that global progress conceals major regional inequalities and continuing difficulties in educating, employing and retaining nurses (World Health Organization, 2025).

In this environment, losing experienced nurses to preventable burnout is not only a human or professional loss. It is the destruction of scarce productive capacity.

The total economic burden of nursing burnout can be conceptualised as:

Burnout-related cost = turnover cost + absence cost + presenteeism cost + temporary staffing cost + safety and quality cost + lost organisational capacity + future workforce cost

These components rarely appear together in one budget.

Recruitment expenditure may sit within human resources. Overtime may be reported in nursing operations. agency staffing may be managed through procurement. Adverse events may appear under quality or risk. Longer hospital stays may be absorbed within service-line performance. Education and preceptorship costs may be recorded separately. Reduced team learning, poorer continuity and loss of institutional knowledge may not be assigned a financial value at all.

This fragmentation creates the hidden economics of burnout.

A hospital may therefore conclude that a staffing investment is “too expensive” because its cost is visible and immediate, while the avoided costs of turnover, absence, adverse outcomes and depleted capacity are dispersed, delayed or unmeasured.

Turnover is the clearest economic pathway connecting burnout to organisational expenditure.

When an experienced nurse leaves, the organisation does not lose only one employee. It may incur costs associated with advertising, recruitment, interviewing, occupational screening, onboarding, orientation, preceptorship and reduced productivity during transition. Existing staff may cover vacancies through overtime, additional shifts, internal redeployment or temporary staffing.

The remaining team also absorbs non-financial workload. Nurses may orient replacements, supervise less experienced colleagues and compensate for lost local knowledge while continuing to manage their own patient assignments.

Kelly, Gee and Butler found that emotional exhaustion was significantly associated with nurses leaving their organisation. In their study, each one-unit increase in emotional exhaustion was associated with a 12% increase in the likelihood of organisational turnover, although it was not significantly associated with movement to another position within the same organisation (Kelly, Gee and Butler, 2021).

An economic modelling study by Muir et al. examined burnout-attributed nurse turnover in hypothetical United States hospital scenarios. Under the status quo scenario, the model estimated an expected cost of US$16,736 per nurse employed per year. Under a scenario incorporating a burnout-reduction programme, the expected cost fell to US$11,592 per nurse per year—a difference of US$5,144, or approximately 30.7% (Muir et al., 2022).

These figures should not be treated as universal prices. They were derived from a model using specific US assumptions about turnover, employment duration, intervention effects and replacement costs. Their value lies in demonstrating the mechanism: even an intervention requiring upfront investment may create net value when reduced turnover is incorporated into the analysis.

Turnover also produces a reinforcing cycle:

1. Burnout contributes to resignation.

2. Resignation increases vacancies and workload.

3. Increased workload raises burnout among remaining staff.

4. Further resignations become more likely.

5. Recruitment becomes increasingly difficult because the work environment itself is unstable.

The economic consequences are therefore not linear. One departure may increase the probability and cost of subsequent departures.

Absence is visible because an employee is not at work. Presenteeism is more difficult to measure because the employee is present but unable to work at normal capacity because of physical illness, psychological strain, exhaustion or other health limitations.

In nursing, presenteeism may arise from professional commitment, staffing shortages, financial need, limited sick-leave access, concern about burdening colleagues or a workplace culture that rewards attendance regardless of health.

A cross-sectional study involving nurses and chief nurses in five Chinese hospitals found high reported levels of presenteeism. Using a human-capital approach, the authors estimated annual monetary losses of ¥4.38 billion based on nurses’ reports and ¥2.88 billion based on chief nurses’ reports. Workload, leave arrangements and conscientiousness were identified as major contributing factors, while financial need was more strongly recognised by nurses than by chief nurses (Shan et al., 2021).

These estimates were context-specific and involved extrapolation; they should not be directly transferred to other healthcare systems. Nevertheless, the study illustrates an important economic problem: scheduled nursing hours are not necessarily equivalent to effective nursing capacity.

Research has also linked nurse health and work environment with presenteeism and patient-safety outcomes. Rainbow, Drake and Steege argued that an unhealthy nurse working in a poor environment may be physically present while functioning with impaired capacity, creating implications for both productivity and safety (Rainbow, Drake and Steege, 2020).

This creates a critical distinction:

Headcount measures physical presence. It does not measure usable clinical capacity.

A unit can therefore be covered on paper while operating below its real cognitive, emotional and clinical capacity.

Burnout may also affect expenditure through sickness absence and the operational responses required to cover it.

When a nurse is absent, the organisation may use overtime, internal float staff, agency staff or reduced staffing. Each option carries a potential cost.

Overtime creates an immediate wage cost and may reduce recovery time for the same workforce already experiencing high demands. Agency or temporary staffing may increase direct labour expenditure and can require additional local orientation. Operating short may reduce direct payroll expenditure in the moment, but shifts risk towards missed care, delayed work, staff exhaustion and patient outcomes.

The theoretical review by Dall’Ora et al. found relationships between burnout and sickness absence, while also identifying inadequate staffing, long shifts, time pressure, limited schedule flexibility and inadequate breaks as relevant occupational factors (Dall’Ora et al., 2020). A later survey in the United Kingdom and Ireland found that perceived inadequate staffing was associated with higher odds of burnout, while rarely or never taking breaks was associated with exhaustion. Greater choice over shift length was associated with lower burnout (Dall’Ora et al., 2023).

These findings suggest that absence should not be analysed only as an individual attendance problem. It may also be a delayed signal of workload design, insufficient recovery or declining workforce health.

The economic effects of burnout extend beyond labour expenditure.

Nurses continuously detect deterioration, coordinate care, administer medication, prevent complications, educate patients, communicate changes and compensate for failures elsewhere in the system. When nursing capacity is depleted, the effects may appear in patient outcomes rather than workforce accounts.

A 2024 systematic review and meta-analysis included 85 studies and 288,581 nurses. Burnout was associated with poorer patient-safety climate and safety ratings, more medication errors, patient falls, healthcare-associated infections and adverse events, lower patient satisfaction, and lower nurse-reported quality of care. These associations were broadly consistent across nurse and study characteristics (Li et al., 2024).

The review demonstrates association rather than proving that burnout independently caused every outcome. Many studies were observational, and burnout may coexist with understaffing, poor work environments and organisational dysfunction. However, this does not weaken the system-level argument. It suggests that burnout may function both as an outcome of unsafe conditions and as a marker of environments in which quality and safety are at risk.

Earlier evidence also linked staffing, nurse outcomes and patient outcomes. Aiken et al. found that each additional patient added to a nurse’s workload was associated with a 23% increase in the odds of burnout and a 15% increase in the odds of job dissatisfaction. The same study found increased risk-adjusted mortality and failure-to-rescue among surgical patients in hospitals with higher patient-to-nurse workloads (Aiken et al., 2002).

The economic consequences of adverse outcomes can include additional treatment, investigations, extended length of stay, readmission, complaints, litigation exposure, reputational harm and the opportunity cost of beds remaining occupied for longer.

Not all these costs can be attributed directly to burnout. Yet excluding them entirely from workforce decisions produces an equally misleading conclusion.

Traditional workforce budgeting often treats registered nurse staffing primarily as expenditure. Economic evidence suggests that this approach may understate the value generated by nursing care.

A systematic review of economic studies by Griffiths et al. concluded that increasing the absolute or relative number of registered nurses in general medical and surgical wards has the potential to be highly cost-effective. The review found no economic support for addressing shortages primarily through dilution of registered nurse skill mix. Although uncertainty remains and not every staffing increase becomes cost-saving, the evidence supports evaluating nursing investment against patient outcomes and avoided costs rather than payroll alone (Griffiths et al., 2023).

Evidence from Queensland, Australia, provides a practical example. Following the introduction of minimum nurse-to-patient ratio legislation in selected hospitals, improved staffing was associated with reductions in mortality, readmissions and length of stay. The authors concluded that minimum ratios were a feasible policy with a favourable return on investment (McHugh et al., 2021).

This does not mean that ratios alone solve burnout. Safe staffing also depends on acuity, admissions, discharges, transfers, deterioration, skill mix, experience, supervision requirements, interruptions, documentation and the availability of support services.

It does mean that apparent savings achieved by maintaining inadequate registered nurse staffing may be offset by turnover, poorer outcomes and reduced organisational capacity.

Some economic consequences of burnout are difficult to quantify because they involve capabilities rather than transactions.

An experienced nurse carries knowledge about:

• how deterioration presents before it becomes obvious;

• how to navigate local systems during emergencies;

• which workflows repeatedly fail;

• how to coordinate across departments;

• how to prioritise under pressure;

• how to mentor new nurses;

• how to communicate with specific teams;

• and how to recognise when an apparently stable situation is becoming unsafe.

When experienced nurses leave, these capabilities are not immediately replaced by filling the vacancy.

A newly recruited nurse may be clinically competent but still require time to understand the organisation, build relationships and develop local pattern recognition. During this period, senior nurses may carry additional supervisory and educational work.

This labour is often absent from workload measurement. A preceptor may be counted as one full nurse while simultaneously managing patient care, teaching, monitoring another practitioner and protecting patients from errors during transition.

The organisation therefore loses more than hours. It loses accumulated clinical intelligence.

Because conventional accounting systems rarely assign value to continuity, mentorship and institutional memory, these losses can appear financially neutral even when operational resilience is deteriorating.

Many hospital dashboards monitor:

• budgeted and actual full-time equivalents;

• vacancy rates;

• turnover;

• overtime;

• sickness absence;

• agency expenditure;

• patient volume;

• occupancy;

• length of stay;

• incidents and complaints.

The problem is not that these measures are unimportant. The problem is that they are frequently interpreted separately.

A rise in overtime may be viewed as a scheduling problem. Turnover may be attributed to labour-market competition. Falls or medication errors may be managed as isolated safety events. Increased length of stay may be assigned to medical complexity. Burnout survey results may be sent to a well-being committee.

The economic connection between these outcomes remains unexamined.

A more useful dashboard would ask:

• Does burnout rise before turnover increases?

• Are units with inadequate breaks also using more overtime?

• Is vacancy coverage increasing the workload of experienced nurses?

• Are agency costs concentrated in units with poor work-environment scores?

• Does loss of experienced nurses increase orientation and preceptor demand?

• Are units reporting high burnout also reporting more missed care, interruptions or adverse events?

• What proportion of apparent staffing coverage is lost through sickness absence and presenteeism?

• How much does replacing nurses cost compared with improving the conditions that influence retention?

Without these connections, organisations measure symptoms but not the economic system producing them.

Burnout interventions are often divided into person-directed and organisation-directed approaches.

Person-directed approaches may include mindfulness, coping education, stress-management programmes, psychological support and resilience training. Organisation-directed approaches may involve workload reduction, staffing improvement, schedule redesign, leadership development, increased autonomy, better teamwork and reduced administrative burden.

Systematic reviews indicate that interventions can reduce burnout, but effects vary and long-term evidence remains limited. Many evaluated interventions focus on individuals, while organisational interventions are more difficult to design and study (Yildirim et al., 2023; Lee and Cha, 2023).

The correct conclusion is not that individual support is unimportant.

A cost-benefit evaluation of the Resilience In Stressful Events peer-support programme at a 1,000-bed private US hospital estimated a net monetary benefit of US$22,576.05 per nurse who initiated a support call and potential annual hospital savings of US$1.81 million. The model included programme costs, turnover and time away from work (Moran et al., 2020).

However, peer support after a stressful event is not a substitute for adequate staffing, manageable workload or psychologically safe leadership.

The most credible approach is layered:

1. Prevent avoidable occupational stressors.

2. Detect declining workforce capacity early.

3. Provide rapid and confidential support.

4. Redesign recurrent system failures.

5. Measure whether the intervention improves retention, capacity and patient outcomes.

In a study of physicians and nurses across 60 US Magnet hospitals, clinicians ranked management and care-delivery interventions above interventions focused only on individual mental health. Improving nurse staffing was the highest-ranked well-being intervention among nurses (Aiken et al., 2023).

This finding reflects an essential principle: nurses do not need only help coping with the system. They need the system to stop producing avoidable harm.

11.1 Treat retention as protection of organisational capital

Experienced nurses should be understood as holders of scarce clinical, relational and organisational knowledge. Retention investment should therefore be compared with the full cost of replacement, transition, supervision and lost productivity—not recruitment expenditure alone.

11.2 Build a burnout economics dashboard

Organisations should connect burnout and work-environment data with turnover, absence, overtime, temporary staffing, safety indicators, patient experience and length of stay.

Data should be analysed at unit level because organisation-wide averages can conceal high-risk environments.

11.3 Measure workload beyond patient numbers

Workload models should include acuity, dependency, admissions, discharges, transfers, deterioration, isolation requirements, documentation, interruptions, supervision, mentoring and the availability of support staff.

A physically occupied bed does not describe the nursing work required to care for the patient in it.

11.4 Measure effective capacity, not only scheduled capacity

A roster may be numerically complete while the workforce is exhausted, inexperienced, frequently interrupted or unable to take breaks.

Measures of staffing adequacy should therefore consider skill mix, experience, missed care, overtime, break completion, sickness absence, presenteeism and recovery opportunities.

11.5 Protect schedule control and recovery

Predictable scheduling, meaningful participation in roster decisions, adequate breaks, limits on excessive overtime and sufficient recovery between shifts should be treated as operational controls rather than optional benefits.

11.6 Reduce administrative and technological friction

Technology should reduce duplicate documentation, improve information access, reveal hidden workload and return nursing time to patient care.

Digital systems that add clicks, alerts, workarounds or parallel documentation may increase labour cost while appearing to improve standardisation.

11.7 Combine support with structural redesign

Confidential counselling, peer support and mental-health services should be available without stigma. However, repeated patterns of distress should trigger investigation of staffing, workload, leadership, workflow and safety conditions.

11.8 Include nursing outcomes in financial decisions

Business cases for staffing or work-environment improvement should include plausible avoided costs related to turnover, vacancy coverage, absence, agency use, adverse outcomes, readmissions and length of stay.

The objective is not to claim that every nursing investment automatically saves money. It is to prevent decisions based on an incomplete cost model.

The economics of nursing burnout remain hidden because healthcare organisations often separate workforce well-being from operational performance.

Burnout is recorded in surveys. Turnover is recorded in human-resources systems. Overtime appears in payroll. Adverse events appear in safety systems. Length of stay appears in performance reports. Patient dissatisfaction appears in experience data.

Yet the same underlying conditions—insufficient staffing, high workload, limited control, poor support, repeated interruptions and inadequate recovery—may influence all of them.

This fragmentation allows organisations to underestimate both the cost of burnout and the value of prevention.

The available evidence does not support reducing burnout to a single financial figure. Burnout instruments differ, healthcare labour markets vary and most patient-outcome studies are observational. Replacement costs and intervention costs are highly dependent on country, profession, setting and methodology.

Nevertheless, the direction of the evidence is consistent. Burnout is associated with turnover, sickness absence, reduced productivity and poorer organisational and patient outcomes. Registered nurse staffing and supportive work environments may require visible expenditure, but their benefits extend beyond staff satisfaction.

The correct economic question is therefore not:

“How much does it cost to support nurses?”

It is:

“What does the system lose when it repeatedly exhausts, disables or drives away the people on whom safe care depends?”

This article is a structured narrative review rather than a systematic review. It did not include exhaustive database searching, duplicate screening, formal risk-of-bias assessment or meta-analysis.

Much of the evidence is observational, making causal interpretation difficult. Burnout may contribute to poor outcomes, but it may also reflect underlying organisational conditions that independently affect those outcomes.

Economic estimates were derived from different countries, healthcare systems, price years and modelling assumptions. Monetary figures should therefore not be transferred directly between settings without local adaptation.

Burnout was also measured using different instruments and thresholds. The economic burden cannot be calculated reliably from prevalence alone.

Future studies should combine longitudinal workforce data, validated burnout measures, staffing and workload information, patient outcomes and detailed organisational cost data. Economic evaluations should also examine which interventions produce sustainable improvement and whether benefits are distributed equitably across units and workforce groups.

Nursing burnout is not only what happens to a nurse after prolonged exposure to unsustainable work.

It is also what happens to a healthcare organisation when human capacity is treated as unlimited.

The costs appear in resignation letters, vacant shifts, overtime, agency expenditure, sickness absence, reduced productivity, lost experience, delayed care and avoidable harm. Some are visible immediately. Others emerge months later in budgets that are never connected back to workforce conditions.

A hospital can reduce staffing expenditure and still increase the total cost of care.

It can fill every shift and still lack safe nursing capacity.

It can meet a financial target while weakening the workforce on which future performance depends.

Burnout prevention should therefore be understood as an investment in patient safety, operational reliability and workforce sustainability—not simply as an employee benefit.

Exhaustion should never become the staffing model.

Strengthening nursing capacity strengthens the economic and clinical foundations of healthcare itself.

1. Which burnout-related costs are currently measured in your organisation, and which remain invisible?

2. Does your staffing system measure real nursing workload and human capacity, or mainly headcount and patient numbers?

3. How should healthcare leaders include retention, patient safety and lost experience when evaluating the cost of nursing investment?

4. Which organisational change would most reduce avoidable burnout in your setting: staffing, scheduling, workflow, leadership, documentation or psychological support?

1. Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J. and Silber, J.H. (2002) ‘Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction’, JAMA, 288(16), pp. 1987–1993. doi: 10.1001/jama.288.16.1987.

2. Aiken, L.H., Lasater, K.B., Sloane, D.M., Pogue, C.A., Fitzpatrick Rosenbaum, K.E., Muir, K.J. and McHugh, M.D. (2023) ‘Physician and nurse well-being and preferred interventions to address burnout in hospital practice: Factors associated with turnover, outcomes, and patient safety’, JAMA Health Forum, 4(7), e231809. doi: 10.1001/jamahealthforum.2023.1809.

3. Dall’Ora, C., Ball, J., Reinius, M. and Griffiths, P. (2020) ‘Burnout in nursing: A theoretical review’, Human Resources for Health, 18, article 41. doi: 10.1186/s12960-020-00469-9.

4. Dall’Ora, C., Ejebu, O-Z., Ball, J. and Griffiths, P. (2023) ‘Shift work characteristics and burnout among nurses: Cross-sectional survey’, Occupational Medicine, 73(4), pp. 199–204. doi: 10.1093/occmed/kqad046.

5. Griffiths, P., Saville, C., Ball, J., Dall’Ora, C., Meredith, P., Turner, L. and Jones, J. (2023) ‘Costs and cost-effectiveness of improved nurse staffing levels and skill mix in acute hospitals: A systematic review’, International Journal of Nursing Studies, 147, 104601. doi: 10.1016/j.ijnurstu.2023.104601.

6. Jun, J., Ojemeni, M.M., Kalamani, R., Tong, J. and Crecelius, M.L. (2021) ‘Relationship between nurse burnout, patient and organizational outcomes: Systematic review’, International Journal of Nursing Studies, 119, 103933. doi: 10.1016/j.ijnurstu.2021.103933.

7. Kelly, L.A., Gee, P.M. and Butler, R.J. (2021) ‘Impact of nurse burnout on organizational and position turnover’, Nursing Outlook, 69(1), pp. 96–102. doi: 10.1016/j.outlook.2020.06.008.

8. Lee, M. and Cha, C. (2023) ‘Interventions to reduce burnout among clinical nurses: Systematic review and meta-analysis’, Scientific Reports, 13, article 10971. doi: 10.1038/s41598-023-38169-8.

9. Li, L.Z., Yang, P., Singer, S.J., Pfeffer, J., Mathur, M.B. and Shanafelt, T.D. (2024) ‘Nurse burnout and patient safety, satisfaction, and quality of care: A systematic review and meta-analysis’, JAMA Network Open, 7(11), e2443059. doi: 10.1001/jamanetworkopen.2024.43059.

10. McHugh, M.D., Aiken, L.H., Sloane, D.M., Windsor, C., Douglas, C. and Yates, P. (2021) ‘Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: A prospective study in a panel of hospitals’, The Lancet, 397(10288), pp. 1905–1913. doi: 10.1016/S0140-6736(21)00768-6.

11. Moran, D., Wu, A.W., Connors, C., Chappidi, M.R., Sreedhara, S.K., Selter, J.H. and Padula, W.V. (2020) ‘Cost-benefit analysis of a support program for nursing staff’, Journal of Patient Safety, 16(4), pp. e250–e254. doi: 10.1097/PTS.0000000000000376.

12. Muir, K.J., Wanchek, T.N., Lobo, J.M. and Keim-Malpass, J. (2022) ‘Evaluating the costs of nurse burnout-attributed turnover: A Markov modeling approach’, Journal of Patient Safety, 18(4), pp. 351–357. doi: 10.1097/PTS.0000000000000920.

13. Rainbow, J.G., Drake, D.A. and Steege, L.M. (2020) ‘Nurse health, work environment, presenteeism and patient safety’, Western Journal of Nursing Research, 42(5), pp. 332–339. doi: 10.1177/0193945919863409.

14. Shan, G., Wang, S., Wang, W., Guo, S. and Li, Y. (2021) ‘Presenteeism in nurses: Prevalence, consequences, and causes from the perspectives of nurses and chief nurses’, Frontiers in Psychiatry, 11, 584040. doi: 10.3389/fpsyt.2020.584040.

15. World Health Organization (2019) Burn-out an “occupational phenomenon”: International Classification of Diseases. Geneva: World Health Organization. Published 28 May 2019. Accessed 27 July 2026.

16. World Health Organization (2025) State of the World’s Nursing Report 2025. Geneva: World Health Organization. Published 12 May 2025. Accessed 27 July 2026.