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Exploring the Relation Between Nursing Workload and Moral Distress, Burnout, and Turnover in Latvian Intensive Care Units: An Ecological Analysis of Parallel Data

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  • Olga Cerela-Boltunova

    (Department of Nursing and Midwifery, Riga Stradiņš University, LV-1067 Riga, Latvia)

  • Inga Millere

    (Department of Nursing and Midwifery, Riga Stradiņš University, LV-1067 Riga, Latvia)

Abstract

Latvia faces one of the lowest nurse-to-population ratios in the EU, resulting in critical staff shortages in intensive care units (ICUs). Nurses frequently care for more patients than recommended, which not only compromises patient safety but also places heavy psycho-emotional burdens on staff. The aim of this study was to examine organizational-level relationships between objectively measured ICU nursing workload and subjectively reported psycho-emotional outcomes, including moral distress, burnout, and intention to leave one’s job. A secondary analysis combined data from two cross-sectional studies conducted in 2025. Workload was measured using 3420 Nursing Activities Score (NAS) protocols from three hospitals, while 155 ICU nurses from 16 units completed validated instruments assessing moral distress, burnout, and turnover intentions. The findings revealed persistent nurse shortages, with one ICU showing deficits exceeding 70% and mean NASs above 100 points per nurse per shift. Nurses reported moderate moral distress, particularly in situations of unsafe patient ratios and aggressive treatment, while burnout levels were moderate to high, especially in personal and work-related dimensions. About one-quarter of respondents were actively considering leaving their jobs. Moral distress significantly correlated with burnout (r = 0.357, p < 0.001), and organizational-level comparison indicated that higher workload was associated with greater emotional strain. These results not only highlight urgent national challenges but also resonate with international evidence on the link between unsafe staffing, moral distress, and workforce sustainability. Implementing systematic workload monitoring, safe staffing ratios, and structured support mechanisms is essential to safeguard ICU nurses’ well-being, reduce turnover, and protect patient safety in both Latvian and global contexts.

Suggested Citation

  • Olga Cerela-Boltunova & Inga Millere, 2025. "Exploring the Relation Between Nursing Workload and Moral Distress, Burnout, and Turnover in Latvian Intensive Care Units: An Ecological Analysis of Parallel Data," IJERPH, MDPI, vol. 22(9), pages 1-19, September.
    • Handle: RePEc:gam:jijerp:v:22:y:2025:i:9:p:1442-:d:1751536
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    References listed on IDEAS

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    1. Olga Cerela-Boltunova & Inga Millere & Ingrida Trups-Kalne, 2024. "Adaptation of the Nursing Activities Score in Latvia," IJERPH, MDPI, vol. 21(10), pages 1-18, September.
    2. Olga Cerela-Boltunova & Inga Millere & Ingrida Trups-Kalne, 2025. "Adaptation of the Copenhagen Burnout Inventory in Latvia: Psychometric Data and Factor Analysis," IJERPH, MDPI, vol. 22(5), pages 1-23, May.
    3. Yun-Seok Hwang & Byung-Jik Kim, 2021. "“The Power of a Firm’s Benevolent Act”: The Influence of Work Overload on Turnover Intention, the Mediating Role of Meaningfulness of Work and the Moderating Effect of CSR Activities," IJERPH, MDPI, vol. 18(7), pages 1-15, April.
    4. Olga Cerela-Boltunova & Inga Millere & Evija Nagle, 2025. "Moral Distress, Professional Burnout, and Potential Staff Turnover in Intensive Care Nursing Practice in Latvia—Phase 1," IJERPH, MDPI, vol. 22(8), pages 1-25, August.
    5. Santiago Ramírez-Elvira & José L. Romero-Béjar & Nora Suleiman-Martos & José L. Gómez-Urquiza & Carolina Monsalve-Reyes & Guillermo A. Cañadas-De la Fuente & Luis Albendín-García, 2021. "Prevalence, Risk Factors and Burnout Levels in Intensive Care Unit Nurses: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 18(21), pages 1-12, October.
    6. Sergio Edú-Valsania & Ana Laguía & Juan A. Moriano, 2022. "Burnout: A Review of Theory and Measurement," IJERPH, MDPI, vol. 19(3), pages 1-27, February.
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