# Perceived Stress and Burnout Among Nurses in Acute and Critical Care Settings: The Mediating Role of Self‐Efficacy

## TL;DR

This study shows that self-efficacy reduces the impact of stress on burnout in nurses working in high-pressure hospital settings.

## Contribution

The study demonstrates that self-efficacy mediates the stress-burnout relationship, especially in older and day-shift nurses.

## Key findings

- Higher perceived stress was significantly linked to lower self-efficacy and increased burnout.
- Self-efficacy significantly mediated the stress-burnout pathway.
- The mediating effect was stronger among nurses over 40 and those working day shifts.

## Abstract

Nurses working in acute and critical care settings, including general wards, intensive care units and emergency departments, are exposed to high job demands that increase the risk of stress and burnout. Self‐efficacy has been identified as an important psychological resource that may buffer these effects; yet limited evidence has explored its mediating role in clinical nursing practice.

To examine the association relationships between perceived stress, self‐efficacy, and burnout among hospital nurses and to test the mediating role of self‐efficacy, with subgroup analysis across demographic and work‐related factors.

A cross‐sectional design was conducted through quota sampling to recruit registered nurses from a medical centre in Taiwan between July and October 2020. Data were collected using a self‐report questionnaire including demographic and work‐related characteristics, the Perceived Stress Scale, the General Self‐Efficacy Scale and the Burnout Scale. Descriptive analyses and mediation with bootstrapping were used to test the indirect effect of self‐efficacy, with stratified analyses for subgroups.

Of the 395 nurses invited, 380 completed the survey, yielding a response rate of 96.2%. Higher perceived stress was significantly associated with lower self‐efficacy, which in turn increased burnout. Mediation analysis confirmed that self‐efficacy played a significant indirect role in the stress–burnout pathway. The mediating effect was particularly evident among nurses aged over 40 years and those working day shifts, groups often holding leadership or supervisory responsibilities in acute and critical care environments.

Self‐efficacy is a key psychological mechanism linking stress to burnout among nurses in acute and critical care settings. This study adds evidence that reinforcing self‐efficacy may reduce vulnerability to burnout, particularly among senior and supervisory nurses.

Interventions designed to reduce perceived stress while enhancing self‐efficacy, such as resilience training, simulation‐based education and mentorship programmes may help mitigate burnout, improve nurse retention and support well‐being in high‐intensity clinical settings.

What is known about this topic?
○Nurses in acute and critical care settings are at high risk of stress and burnout due to demanding workloads and complex patient care.○Burnout negatively affects nurse well‐being, retention, and patient outcomes.○Self‐efficacy has been identified as a protective factor, but its mediating role in the stress–burnout relationship remains unclear.
What this paper adds?
○Demonstrates that self‐efficacy significantly mediates the association between perceived stress and burnout among nurses.○Identifies nurses over 40 years and those working day shifts, as particularly vulnerable.○Highlights the need for targeted interventions that enhance self‐efficacy to reduce burnout and support workforce sustainability in acute and critical care environments.

What is known about this topic?
○Nurses in acute and critical care settings are at high risk of stress and burnout due to demanding workloads and complex patient care.○Burnout negatively affects nurse well‐being, retention, and patient outcomes.○Self‐efficacy has been identified as a protective factor, but its mediating role in the stress–burnout relationship remains unclear.

Nurses in acute and critical care settings are at high risk of stress and burnout due to demanding workloads and complex patient care.

Burnout negatively affects nurse well‐being, retention, and patient outcomes.

Self‐efficacy has been identified as a protective factor, but its mediating role in the stress–burnout relationship remains unclear.

What this paper adds?
○Demonstrates that self‐efficacy significantly mediates the association between perceived stress and burnout among nurses.○Identifies nurses over 40 years and those working day shifts, as particularly vulnerable.○Highlights the need for targeted interventions that enhance self‐efficacy to reduce burnout and support workforce sustainability in acute and critical care environments.

Demonstrates that self‐efficacy significantly mediates the association between perceived stress and burnout among nurses.

Identifies nurses over 40 years and those working day shifts, as particularly vulnerable.

Highlights the need for targeted interventions that enhance self‐efficacy to reduce burnout and support workforce sustainability in acute and critical care environments.