# The efficacy of an integrated empowerment and narrative nursing program on enhancing professional identity and alleviating burnout among neonatal nurses: a cluster randomized controlled trial

## TL;DR

A 6-month program combining empowerment and narrative nursing improved professional identity and reduced burnout in neonatal nurses, with benefits lasting 3 months after the program ended.

## Contribution

An integrated empowerment and narrative nursing program was tested and shown to effectively reduce burnout and strengthen professional identity in neonatal nurses.

## Key findings

- The I-ENP program significantly improved professional identity scores by 15.8 points compared to usual care.
- Burnout indicators like emotional exhaustion and depersonalization decreased significantly in the I-ENP group.
- Turnover intention was 18.1% lower in the I-ENP group at 9 months post-intervention.

## Abstract

Neonatal nurses frequently report lower professional identity and high levels of burnout owing to heavy workloads, emotional demands, and staffing pressures. This study evaluated an integrated empowerment and narrative nursing (I-ENP) program designed to enhance professional identity and reduce burnout among neonatal nurses.

We conducted a two-arm, parallel, cluster randomized controlled trial in four tertiary hospitals in Hebei Province, China, from January to October 2023. Hospital clusters were randomized to I-ENP or control (usual care). The I-ENP group received a structured 6-month program comprising four empowerment education modules and six narrative nursing sessions; the control group received no additional intervention. The primary outcome was change in the Professional Identity Scale for Nurses (PISN) from baseline to 6 months. Secondary outcomes were changes in the Maslach Burnout Inventory (MBI) subscales (emotional exhaustion, depersonalization, personal accomplishment) and nurse turnover intention, measured at baseline, 6 months (end of intervention), and 9 months (3-month follow-up).

One hundred seventy-two neonatal nurses completed the study (85 I-ENP, 87 control). At 6 months, the I-ENP group demonstrated greater improvement in PISN compared with control (mean difference 15.8 points; 95% CI: 12.5–19.1; P < 0.001). Emotional exhaustion and depersonalization declined significantly [mean differences −8.2 (95% CI: −10.5 to −5.9) and −4.1 (95% CI: −5.7 to −2.5), respectively; both P < 0.001], while personal accomplishment increased (mean difference 6.5; 95% CI: 4.8–8.2; P < 0.001). These benefits were largely sustained at 9 months, and turnover intention was lower in the I-ENP group than control (11.8 vs. 29.9%; P = 0.003).

This cluster randomized trial provides promising evidence that an integrated empowerment and narrative nursing program may be effective in enhancing professional identity and alleviating burnout among neonatal nurses, suggesting it is a potentially useful intervention strategy to support nurse wellbeing. The findings warrant further evaluation in diverse hospital settings and populations to determine broader applicability and sustainability.