# Psychological Safety and Burnout in Nurses: A Scoping Review

## TL;DR

This review explores how psychological safety can reduce burnout in nurses, highlighting the need for supportive leadership and workplace conditions.

## Contribution

The study is the first scoping review to systematically examine the relationship between psychological safety and burnout in nurses.

## Key findings

- Three studies found a consistent inverse relationship between psychological safety and burnout.
- Leadership style, especially servant leadership, significantly influences both psychological safety and burnout.
- Workplace conditions like patient acuity and team dynamics are key contextual factors affecting these constructs.

## Abstract

Burnout among nurses has become a global problem, with prevalence rates exceeding 40% in high-intensity clinical settings. Psychological safety represents a shared belief about team interpersonal risk-taking safety. These constructs have emerged as potential protective factors in recent research. However, studies that simultaneously examine both constructs remain limited, thereby hindering the development of evidence-based interventions aimed at promoting psychological safety and preventing burnout.Therefore, we conducted a scoping review to evaluate and synthesize existing literature that investigates the direct relationship between psychological safety and burnout among nurses, with emphasis on the conceptualization, measurement, and contextual association of these constructs within the nursing profession. This scoping review was conducted in accordance with the Joanna Briggs Institute methodology and complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive literature search was conducted across Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Excerpta Medica Database, International Clinical Trials Registry Platform, and ClinicalTrials.gov. The search was conducted using terms related to psychological safety, burnout, and nurses. Studies were deemed eligible if they involved nurses employed in hospital-based settings and simultaneously examined the concepts of psychological safety and burnout. All published studies that examined psychological safety and burnout among nurses were included, with data extracted on study design, setting, country of origin, publication year, definitions used, measurement instruments, reported scores, and associated factors. Of 1,021 initially identified studies, six met the inclusion criteria, comprising 4,984 nurses across the United States, China, Pakistan, Japan, and South Korea, published between 2021 and 2025. Study designs included four cross-sectional studies, one longitudinal study, and one non-randomized controlled trial, conducted across diverse healthcare settings, including coronavirus disease 2019 wards, emergency departments, and psychiatric units. Three studies reported a consistent inverse relationship between psychological safety and burnout. Psychological safety was consistently defined in accordance with Edmondson's framework, while burnout was assessed based on Maslach's three-dimensional conceptualization. Leadership style, particularly servant leadership, emerged as a key factor potentially influencing both constructs. Workplace conditions, including patient acuity, exposure to workplace violence, and team dynamics, were identified as significant contextual factors.This review provides evidence of a consistent inverse relationship between psychological safety and burnout among nurses, with Edmondson's and Maslach's frameworks offering appropriate conceptual foundations for future research. These findings suggest that promoting psychological safety serves as a protective organizational strategy in high-intensity clinical settings. They also underscore the need for comprehensive, multi-level interventions focused on leadership development, structured communication protocols, and robust organizational support systems to enhance psychological safety and mitigate the risk of burnout.