Table 1.

Articles on nurse burnout during the COVID-19 pandemic

Article Citation	Measurement	Sample Size Nurses	Country	Setting	Findings
Lasalvia et al,2 2021	MBI-GS	687	NE Italy	Tertiary hospital nurses	They found that 49% of nurses displayed emotional exhaustion and were at a higher risk of burnout than other health care workers.
Huo et al,32 2021	MBI-GS	526	China	Frontline nurses	Researchers found that 42.5% of nurses in their study had burnout in China. Young and less experienced should receive more attention.
Wan et al,33 2020	MBI-GS	1011	Wuhan, China	Tertiary hospital	Found anxiety is serious but only mild to medium burnout. Note that Wuhan saw COVID-19 pneumonia patients starting in December 2019 and this study was done in February 2020 (only 2 mo later).
Lasater et al,34 2020	MBI-HSS	4298	US-NY and Ill	Med-Surg compared with ICU	Higher burnout in med-surg nurses (53.1%) than intensive care nurses (ICU) (46.9%). Lasater et al. pointed out that nurses working in understaffed conditions before the pandemic and understaffing conditions only worsened with the pandemic.
Bruyneel et al,35 2021	MBI-HSS	1135	Belgium	ICU	More than 68% were at risk of burnout during the first wave of COVID-19. Interestingly, this study also showed that those who perceived having a higher workload had a higher risk of burnout in all dimensions of the MBI.
Hu et al,36 2020	MBI-HSS	2014	Wuhan, China	Frontline nurses	Chinese version of the entire MBI-HSS was used and found that about half of the nurses reported moderate and high work burnout.
Wu et al,37 2020	MBI-HSS	190	Wuhan, China	Frontline compared oncology unit ward nurses	Interestingly, burnout was significantly lower in the nurses working frontline (13%) when compared with the nurses working on the unit ward (38%). The reasoning given was that perhaps frontline nurses felt more prepared with information, whereas the nurses working on the unit ward were less informed.
Guixia et al,38 2020	MBI-HSS	92	China	ICU compared with general ward nurses	A third study done in China found the opposite results as Wu et al. when looking at the prevalence of burnout compared with frontline ICU nurses working on general wards. An almost double number of ICU nurses (89.57%) compared general ward nurses (49.15%) with moderate to high burnout. The difference may be due to the first group working with highly vulnerable oncology patients.
Jose et al,39 2020	MBI-HSS	120	North India	ED	54% had moderate to severe levels of burnout. The researchers also found a negative correlation between burnout and resilience, in that as resilience scores were higher, burnout scores were lower.
Kakeman et al,40 2021	MBI-HSS	1004	Iran	Nurses who work FT in hospitals >1 y	31.5% reported "high" burnout. A positive correlation was found between emotional exhaustion and depersonalization scores and patient care quality, whereas a negative correlation was found between personal accomplishment scores and all poor care item scores. Personal accomplishment reduced the risk of occurrence of “medication errors” (OR = 0.99) and the onset of “patient and their family verbal abuse” (OR = 0.97).
Jalili et al,41 2021	MBI-HSS	300	Tehran, Iran	Nurses in contact with COVID-19 patients	55% experiencing high levels of burnout.
Murat et al,42 2021	MBI-HSS	705	Istanbul, Turkey	Front-line nurses at hospitals	High burnout was found. “…nurses who did not feel sufficient about the nursing care experienced personal accomplishment burnout, those who worked in public hospitals and tested positive for COVID-19 experienced depersonalization burnout, and also male nurses who worked in public hospitals and tested positive for COVID-19 experienced emotional exhaustion burnout. However, it was observed that Bachelor’s graduates, those who had worked for between 1 and 10 y, and nurses who did not want to work voluntarily during the pandemic had higher scores from the sub dimensions of the MBI (personal accomplishment, emotional exhaustion, depersonalization); in other words, they were more negatively affected.”
Galanis et al,43 2021	MBI-HSS	18,935	Systematic review of 16 articles China, Turkey, Italy, Singapore, Puerto Rico, UK, India, Iran, Spain, Japan, USA, Spain	Nurses working during COVID-19 pandemic	Overall, the study reported emotional exhaustion was 34.1%, depersonalization was 12.6%, and lack of personal accomplishment was 15.2%. High scores on emotional exhaustion (>20) and depersonalization (>10) and low scores on personal accomplishment (<25) indicate burnout. (Maslach et al., 1996). These findings would be in agreement with most of the conclusions of the articles reviewed here.
Prasad et al,44 2021	MBI-one question	5027	US	Nurses working during COVID-19 pandemic	A national survey only asked one question from the MBI about burnout and found 53.87% had burnout
Garcia et al,45 2021	Spanish Burnout Inventory	771	Spain	Nurses working in hospitals during COVID-19 pandemic	“The perceived threat of COVID-19 positively correlates with burnout (0.68; P < .01). This correlation is the highest between burnout and the variables used to explain it”
Chor et al,53 2020	Copenhagen Burnout Inventory	210	Singapore	ED and urgent care nurses	53.3% were experiencing burnout during the pandemic.
Hoseinabadi et al,46 2020	OBI	245	Iran	151 frontline nurses compared with 94 nurses not exposed to COVID-19 patients	Frontline nurses scored 2.57 out of 5 and nonexposed nurses scored 2.51
Horta et al,47 2021	OBI	123	Brazil	Frontline nurse	60% were exhausted, with 41% experiencing burnout.
Bellanti et al,48 2021	MBI OBI	293	Italy	Frontline nurses	This study compared the MBI scores with OBI scores. The MBI reported moderate/high emotional exhaustion in 76.5%, depersonalization in 50.2%, and personal gratification in 54.6% of participants. Compared with the OBI, which resulted in medium/high burnout in 89.1% of participants.48 Pearson's correlations of the MBI and OBI and the sub-dimensions found exhaustion detected by MBI or OBI showed 50% agreement, with 197 (67.2%) of participants with a high level of exhaustion on both tools.

Abbreviations: GS, General Survey; HSS, Human Services Survey; MBI, Maslach Burnout Inventory; OBI, Oldenburg Burnout Inventory.