Barriers and Coping Strategies for Work-Life Balance Among Nurses: A Sequential Exploratory Mixed Methods Study

Abstract

Background

Nurses working in intensive care units (ICUs) experience high work demands that pose significant challenges to maintaining work–life balance.

Aim

This study aimed to explore barriers to, and coping strategies for, achieving work–life balance among ICU nurses.

Methods

A sequential exploratory mixed methods design was employed. In Phase I, a descriptive exploratory qualitative approach was used, and in Phase II, a descriptive cross-sectional design was adopted. Integration of qualitative and quantitative findings was conducted during the interpretation stage.

Results

Both qualitative and quantitative findings consistently indicate that caregiving responsibilities substantially increase work–life conflict. Achieving work–life balance among nurses was particularly challenging, with most reporting difficulties managing professional and family responsibilities. These challenges led to stress and reduced personal time, whereas strong support systems, including workplace flexibility and family support, were essential for improving work–life balance. Significant associations with medium effect sizes were identified for age (p = 0.01), gender (p = 0.02), and income (p = 0.04), indicating that personal characteristics influence how ICU nurses manage work and family demands. Unresolved emotional stress directly affected work engagement and motivation. Organizational constraints emerged as key structural barriers to work–life balance, with financial factors further intensifying stress and limiting nurses’ ability to manage competing demands. Social and organizational support systems acted as protective factors, mitigating stress and enhancing nurses’ ability to sustain demanding ICU roles.

Conclusion

ICU nurses face substantial barriers to achieving work–life balance. Organizational support is crucial for promoting nurses’ well-being and sustaining quality patient care. The generalizability of these findings is limited due to the use of non-probability sampling and data collection from a single tertiary care center; therefore, results should be interpreted with caution when applied to other settings or populations.

Keywords

nurses intensive care units work–life balance coping behavior social support

Introduction

Nursing, historically considered a vocation, has long been associated with an image of selflessness and caring, often exemplified by Florence Nightingale in the nineteenth century (Currie & Carr-Hill, 2013Currie & Carr‐Hill, 2013). Traditionally, nurses were viewed as trained caregivers and continue to constitute the largest segment of the workforce in healthcare systems (Currie & Carr-Hill, 2013Currie & Carr‐Hill, 2013). Over time, the profession has evolved significantly; however, nurses continue to face numerous challenges, including heavy workloads, long working hours, sleep disturbances, limited autonomy, staff shortages, and mental stress resulting from the continuous care of sick and dying patients (Saedpanah et al., 2022). These factors negatively impact physical and mental health, ultimately affecting nurses’ overall performance (Labrague, Nwafor, & Tsaras, 2020Labrague et al., 2020). Previous studies have reported that 30% to 70% of nurses experience work-related stress (Feleke et al., 2025).

Nurses working in intensive care units (ICUs) encounter a range of stressors that are patient-related, interpersonal, or organizational (Hao et al., 2020). ICU nurses experience higher levels of continuous stress than those in general wards due to frequent exposure to critically ill patients and complex procedures (Hao et al., 2020; Saravanan et al., 2023). Interactions with patients’ families and witnessing their suffering further contribute to the emotional burden (Kaushik et al., 2021; Şanlıtürk et al., 2021). In ICU settings, heavy workloads, long shifts, and high patient-to-nurse ratios are consistently associated with perceived stress (Şanlıtürk et al., 2021). Inadequate salaries and limited resources further contribute to strain and dissatisfaction (Kaushik et al., 2021; Şanlıtürk et al., 2021). These stressors can result in adverse outcomes, including physical health issues such as musculoskeletal, gastrointestinal, and cardiovascular disorders, as well as psychological distress and challenges in personal and family life (Saedpanah et al., 2022). Collectively, these factors negatively affect overall nursing performance (Khamisa et al., 2015).

Nurses with better work–life balance experience lower mental strain, reduced burnout, and greater job satisfaction (Widayana, Agustina, & Mediawati, 2025Widayana et al., 2025). Evidence shows that nurses who maintain a healthy balance between professional and personal roles report higher well-being, improved mental health, and greater overall job satisfaction (Zhang et al., 2024). A scoping review across 12 countries noted that 24-hour shift systems for nurses were associated with lower quality of life, reduced job satisfaction, and increased mental exhaustion (Widayana, Agustina, & Mediawati, 2025Widayana et al., 2025). Given that nurses comprise over half of the global healthcare workforce, improving work–life balance is a key strategy for protecting nurses’ well-being, stabilizing the workforce, and maintaining high-quality patient care (AbdELhay et al., 2025).

Review of Literature

Nurses face numerous challenges in maintaining work–life balance. Emphasizing self-care without addressing organizational issues such as staffing shortages, overtime work, and unsafe workloads limits nurses’ capacity to achieve sustainable work–life balance (Mullen, 2015). Conversely, factors such as adequate income, family support, supportive organizational policies, and manageable working hours play a crucial role in maintaining this balance (Widayana, Agustina, & Mediawati, 2025Widayana et al., 2025; Sarla and Sandhu, 2024). Married female nurses, especially in low- or middle-income settings, experience additional barriers, including difficulties in time management due to multitasking between household and clinical responsibilities, childcare, and persistent gendered expectations. These factors result in a “double burden” of paid and unpaid work (Sellahewa & Arachchi, 2023).

Work–life balance is also strongly associated with employee dissatisfaction and the reciprocal negative effects of work on family and family on work (Rony, Numan, & Alamgir, 2023). A strong culture of self-sacrifice and loyalty to patients and families often normalizes long working hours and missed family time as indicators of being a “good nurse” frequently at the expense of personal well-being (Ong et al., 2024). A cross-sectional study of nurses in Jordan found that demographic and occupational factors significantly influenced work–life balance, job satisfaction, and burnout. Higher education was associated with better work–life balance; however, many nurses reported that job demands negatively affected family life. Notably, nurses working more than 50 hours per week reported higher work–life balance, but job satisfaction remained moderate, and work-related burnout was prevalent, highlighting the need for strategies to improve nurses’ well-being and professional engagement (Abuhammad et al., 2025).

Additional research has examined the relationship between work environment factors and professional quality of life among ICU nurses, focusing on burnout, compassion satisfaction, and secondary traumatic stress. The study found that most nurses reported average levels of compassion satisfaction, burnout, and secondary traumatic stress. A moderately positive practice environment was significantly associated with lower burnout and higher compassion satisfaction. Overall, ICU nurses viewed their work environment positively; however, targeted interventions are needed to reduce burnout and enhance professional well-being (Ayed et al., 2024).

Similarly, a study of 233 NICU nurses in the West Bank found that most reported average compassion satisfaction, burnout, and secondary traumatic stress, with a moderately favorable practice environment. Positive work environments were strongly associated with higher compassion satisfaction and lower burnout and secondary traumatic stress. Enhancing staffing, resources, nurse–physician collaboration, and emotional support was deemed essential for improving professional quality of life (Batran et al., 2025). Maintaining nurses’ work–life balance is also essential for improving organizational productivity, quality of care, and positive clinical outcomes (Rony, Numan, & Alamgir, 2023).

Nurses employ a range of coping strategies to protect their well-being and maintain work–life balance. These strategies include setting clear boundaries between work and home, seeking support from colleagues, engaging in open communication, and participating in restorative activities (Poku et al., 2023). Evidence consistently identifies social support from family, friends, colleagues, and supervisors as a key factor in helping nurses cope with stress and maintain a better quality of life (Kowitlawkul et al., 2019). Cross-sectional studies and scoping reviews have also identified physical exercise, self-care practices, and mindfulness-based stress reduction techniques as effective strategies for sustaining resilience in high-stress nursing roles (Setiawan & Susanto, 2025; Widayana, Agustina, & Mediawati, 2025Widayana et al., 2025). Addressing stressors and regulating emotions constructively has been associated with lower burnout, whereas avoidant coping strategies are linked to poorer outcomes (Eysa et al., 2025).

Work–life balance remains a widespread concern among nurses, contributing to high levels of stress, burnout, and reduced job satisfaction, ultimately affecting the quality of patient care (Feleke et al., 2025; Smith & Lee, 2022). Although previous studies have predominantly focused on work-related stress or burnout, few have examined organizational barriers and coping strategies among ICU nurses, particularly in low- and middle-income countries. Furthermore, most studies rely solely on quantitative or qualitative methods, limiting a comprehensive understanding of how organizational, personal, and social factors interact to influence work–life balance. To address this gap, the present sequential exploratory mixed methods study aims to comprehensively examine work–life balance among ICU staff nurses in a tertiary care center. By integrating qualitative insights with quantitative findings, this study seeks to provide a nuanced understanding of work–life balance among nurses and inform nursing administration, hospital management, and policymakers about specific strategies to improve nurses’ well-being, promote a sustainable work environment, and ultimately support high-quality patient care. The study adopts the Job Demands–Resources (JD–R) model (Bakker & Demerouti, 2007) to interpret barriers and coping strategies.

Methods

The reporting of this study followed the Good Reporting of a Mixed Methods Study (GRAMMS) checklist, which provides guidance for the transparent and rigorous reporting of mixed methods research, including the integration of qualitative and quantitative findings.

Research Approach and Design

A sequential exploratory mixed methods research design was used. In Phase I, a descriptive exploratory qualitative approach was employed to collect in-depth information about the barriers to, and coping strategies for, maintaining work–life balance among ICU nurses. In Phase II, a descriptive cross-sectional research design was used, with qualitative findings translated into a structured dichotomous questionnaire to assess work–life balance. Integration of qualitative and quantitative data occurred during the interpretation stage. The study was conducted from April 2025 to May 2025.

Study Setting

The study was conducted among staff nurses working in ICUs at a tertiary care center in Tamil Nadu, India. The hospital employs 725 nurses and provides advanced medical care for complex health conditions, including specialized surgeries, intensive care, and organ transplants. Equipped with expert specialists and advanced technology, the hospital offers a controlled environment suitable for conducting research due to its large nursing workforce, diverse departments, and adequate patient load.

Population

Qualitative Phase. The qualitative population comprised staff nurses working in ICUs at the tertiary care center in Tamil Nadu, India. These nurses were selected because they work directly with patients in high-intensity settings and are likely to face unique challenges related to work–life balance.

Quantitative Phase. The quantitative population comprised staff nurses working in the ICUs at the same tertiary care center in Tamil Nadu, India.

Sample Size and Sampling Technique

Qualitative Phase. Twenty-five nurses were purposively selected for in-depth interviews.

Quantitative Phase. A total of 104 nurses were recruited using convenience sampling.

Sample Size Calculation. Rony, Numan, & Alamgir, 2023 reported a 56.5% prevalence of work–life imbalance among nurses in a tertiary care setting. Given that ICU nurses are known to experience similar or higher levels of work–life imbalance, this proportion was considered appropriate for estimating the required sample size. The sample size was calculated using the single population proportion formula. Although this method assumes probability-based sampling, convenience sampling was used in this study for practical and feasibility considerations. Therefore, the calculated sample size should be interpreted as an approximate guide rather than a statistically rigorous requirement.

n = Z^{2} \times p \times q / d^{2}

Where:

n = required sample size

Z = 1.96 (standard normal deviate at 95% confidence level)

p = 0.565 (estimated prevalence of work–life imbalance)

q = 1 − p = 0.435

d = 0.10 (allowable error)

Substituting the values:

n = {(1.96)}^{2} \times 0.565 \times 0.435 / {(0.10)}^{2}

n = 3.84 \times 0.245 / 0.01

n = 94.1

Thus, the minimum required sample size was 94 ICU staff nurses. To account for a possible 10% non-response or incomplete data, the sample size was adjusted as follows:

Adjusted sample size = 94 + 10% of 94

Adjusted sample size = 94 + 9.4 ≈ 104

The final sample size for the quantitative component was therefore 104 ICU nurses.

Inclusion and Exclusion Criteria

The study included both male and female staff nurses working in the ICUs. Staff nurses with a minimum of six months of ICU experience who were willing to participate, provide informed consent, and communicate effectively in Tamil or English were included in the study. Nurses on long-term leave, maternity leave, or unwilling/unable to participate in interviews were excluded from the study.

Description and Interpretation of the Study Instrument

Part 1 . Demographic data such as age, gender, educational qualification, ICU work experience, working hours, marital status, family type, and monthly income were collected.

Part 2 . Nine semi-structured qualitative interview questions were used to explore the barriers and coping strategies used by nurses in relation to work–life balance. (Table 1)

Table 1.

Semi- Structured Interview Guide to Explore the Barriers and Coping Strategies Used by the Nurses in Maintaining Work-Life Balance

S. No	Questions
1.	What is your perception about the importance of Work-life Balance?
2.	How do you balance your work duties with your personal life?
3.	How do you manage stress arising from your work?
4.	How does your work–life balance affect your engagement and motivation at work?
5.	What will you do when you feel low?
6.	Can you describe a challenging time balancing work and life, and how you managed it?
7.	What strategies you employ to achieve work–life balance?
8.	What changes at work would improve your work–life balance and increase your engagement?
9.	What initiatives you suggest for individual to manage his work life?

Part 3 . A structured dichotomous (Yes/No) questionnaire was developed by translating the qualitative themes into measurable items. Each theme was examined to generate statements reflecting the frequency and impact participants’ experiences. Subject-matter experts reviewed the items for clarity, relevance, and alignment with qualitative findings. The questionnaire included eight multiple-choice items addressing emotional stress, career hindrance, lack of personal time, family involvement, and the perceived usefulness of flexible work arrangements. Each “Yes” or “No” response was scored based on the presence of a challenge or support factor. More “Yes” responses to negative statements indicated greater work–life conflict.

Reliability and Validity of the Tool

Content validity was established through review by eight nursing education experts. A pilot study, conducted with 11 ICU nurses (10% of the sample), assessed reliability. Cronbach’s alpha was 0.89, indicating strong internal consistency.

Data Collection Procedure

Qualitative Phase. In Phase I, comprehensive semi-structured interviews were conducted with 25 ICU nurses to explore barriers and coping strategies in managing their work–life balance. The interviews were held in a private, safe, and comfortable area of the hospital. Each interview consisted of nine questions, and lasted approximately 30 to 40 minutes. Data saturation was achieved after 25 participants, as no new themes or meaningful insights emerged. Therefore, recruitment was stopped once thematic redundancy was observed.

Quantitative Phase. Findings from the Qualitative Phase informed the development of the structured questionnaire used in Phase II of the study. A total of 104 ICU nurses who met the inclusion criteria were provided with the questionnaire, which included demographic items and a dichotomous tool measuring work–life balance. Data were collected face-to-face.

Ethical Considerations

The study adhered to the Declaration of Helsinki. Written permission was obtained from the Nursing Directorate. Participants were fully informed about study procedures, provided written consent, and could withdraw at any time without penalty. No identifying information was collected. Audio recording of the interviews was conducted with consent. Professional boundaries and culturally appropriate communication were maintained throughout the study. Reflexive journals were used to enhance transparency and credibility. The collected data were stored in a password-protected file under the custody of the principal investigator.

Data Analysis Procedure

Qualitative Phase. Interviews were transcribed verbatim and analyzed using Braun and Clarke’s thematic analysis. Codes were categorized and reviewed to identify patterns and generate themes.

Quantitative Phase. Descriptive statistics (mean, standard deviation (SD), frequency) and inferential analyses, including chi-square tests and Cramer’s V, were used to examine associations between work–life balance and demographic variables.

Effect Size Interpretation (Phi & Cramer’s V in Chi-square test):

0.10: Negligible/no association

0.10–0.20: Weak association

0.20–0.40: Moderate association

0.40–0.60: Relatively strong association

> 0.60: Strong association

Data Integrity and Trustworthiness

The study findings accurately represent the nurses’ experiences and are reported honestly. All data were entered, analyzed, and presented transparently, without manipulation to support desired outcomes.

Credibility. Credibility was established with member checking to validate interpretations. Participants’ verbatim statements were accurately represented.

Dependability. Step-by-step analytic procedures were documented and peer-reviewed by the supervisor.

Confirmability. Direct quotations were used to support the themes, and reflective journaling acknowledged the assumptions of the researcher.

Transferability. Detailed descriptions of participants, context, and research conditions were provided to enhance generalizability.

Results

Table 1 outlines the semi-structured interview guide used to explore nurses’ barriers to, and coping strategies related to, work–life balance.

Demographic Characteristics of the Participants

Table 2 presents the frequency and percentage distribution of the demographic variables for participants in both Phase I and Phase II. In the Qualitative Phase, nurses aged 21–30 years and 41–50 years constituted the largest groups, followed by those aged 31–40 years, allowing representation from both early-career and highly experienced nurses. In contrast, the Quantitative Phase was predominantly composed of nurses aged 21–30 years. Females comprised the majority of participants in both phases. Most participants were single, particularly in the Quantitative Phase, although a considerable proportion reported family responsibilities, including childcare.

Table 2.

Frequency and Percentage Distribution of Demographic Variables of Nurses

S. No	Demographic Variables	Qualitative data Phase I(n=25)		Quantitative data Phase II(n=104)
S. No	Demographic Variables	Frequency	Percentage	Frequency	Percentage
1.	Age
	a) 21–30 years	10	40	90	86.5
	b) 31–40 years	4	16	12	11.5
	c) 41–50 years	10	40	2	1.9
	d) Above 50 years	1	4	0	0
2.	Gender
	a) Male	1	4	12	11.5
	b) Female	24	96	92	88.5
3.	Marital Status:
	a) Single	8	32	84	80.8
	b) Married	16	64	20	19.2
	c) Divorced/Widowed	1	4	0	0
4.	Family Type:
	a) Nuclear Family	12	48	76	73
	b) Joint Family	13	52	27	26
	c) Extended Family	0	0	1	1
5.	Number of Children
	a) 0	15	60	72	69.2
	b) 1	5	20	15	14.4
	c) 2	5	20	17	16.3
6.	Educational Qualification:
	a) Diploma in Nursing	8	32	95	91.3
	b) Bachelor of Science in Nursing (B.Sc. Or P.B.B.Sc)	12	48	5	4.8
	c) Postgraduate (M.Sc. Nursing or higher)	5	20	4	3.8
7.	Years of Experience in Nursing
	a) Less than 1 year	11	44	95	91.3
	b) 1–5 years	1	4	5	4.8
	c) 6–10 years	1	4	2	1.9
	d) More than 10 years	12	48	2	1.9
8.	Number of Working Hours per Week
	a) Less than 40 hours	2	8	46	44.2
	b) 40–50 hours	3	12	47	45.2
	c) More than 50 hours	20	80	11	10.6

Participants primarily belonged to nuclear families, especially in Phase II, suggesting limited access to extended family support. Most nurses held a Bachelor of Science in Nursing degree, indicating a well-qualified sample. The Qualitative Phase included nurses with both minimal and extensive experience, whereas the Quantitative Phase largely consisted of nurses with less than one year of experience. Long working hours were commonly reported, particularly among qualitative participants, highlighting the demanding nature of ICU work.

Phase I: Qualitative Phase

Emergent Themes

Themes and subthemes related to barriers and coping strategies adopted by the nurses are presented below.

Theme 1: Challenges With Balancing Work and Life

Subtheme 1.1: Schedule strain. Previous studies have shown that long and rotating shifts disturb family routines and reduce time spent with family members (Sarla and Sandhu, 2024). Consistent with this evidence, participants in the present study reported similar challenges. One nurse stated: “Rotating shifts disturb our family routine. I often miss important events in my child’s daily life, like school events. It changes my connection with home.” (P1)

Subtheme 1.2: Emotional spillover. A longitudinal study in the United Kingdom reported that nurses often remain in “survival mode” and struggle to detach from ICU experiences after returning home (Maben et al., 2022). Similar experiences were described by participants: “After my shift in the ICU, I carry the emotional burden home with me. Even when I’m not working, I’m still contemplating patients, which doesn’t leave much time for family.” (P5)

Theme 2: Coping Strategies

Subtheme 2.1: Self-care practices. Previous research has identified yoga and physical activity, particularly when practiced after work, as common strategies for managing burnout among nurses (Hsu et al., 2024). Consistent with these findings, participants reported engaging in self-care activities to help cope with work-related stress: “I do yoga or go for a short run to relax after long shifts. It’s my way of getting away from the stress of being in the hospital.”

Subtheme 2.2: Social support. Social support from colleagues, leaders, or mentors has been identified as a protective factor against mental exhaustion (Piercy & Hamby, 2025). Participants emphasized the importance of team-based support in managing emotional strain: “When I feel like I can’t handle it, my team steps in. They understand my emotional burden and provide me space when I need the most.” (P7, P19)

Theme 3: Barriers in Institutions

Subtheme 3.1: Staffing shortages. Workforce shortages often lead to extended hours, double shifts, overtime, and ultimately physical and emotional exhaustion among nurses (Kunaviktikul et al., 2015). Similar experiences were reported by nurses in the present study, highlighting how workforce shortages affect family life: “I often have to work extra hours due to a shortage of staff. When I get home, I’m too worn out to even talk to my kids.” (P6)

Subtheme 3.2: Rigid scheduling. Inflexible scheduling has been associated with stress and poor work–life balance (Widayana, Agustina, & Mediawati, 2025Widayana et al., 2025). Consistent with this evidence, nurses who participated in the ongoing study described how rigid work schedules and last-minute work affect their personal lives: “Even when I try to set boundaries, I keep getting last-minute tasks; because my schedule is so strict, I can’t spend time with my family.” (P4, P20)

Theme 4: Effects of Work Engagement and Motivation

Subtheme 4.1: Motivation drain. Fatigue has been shown to reduce motivation and increase feelings of working under pressure (Austin et al., 2020). Likewise, emotional fatigue and reduced engagement with their work were noted among the participants of this study: “I love being a nurse, but I’m always tired. Some days I feel like a robot, just doing things without feeling anything.” (P3, P12)

Subtheme 4.2: Resilience strategies. Peer and social support has been shown to help nurses enhance their resilience, cope with stress, and adapt to difficult clinical situations (Wang et al., 2018). Similarly, nurses in the present study emphasized the motivational and emotional advantages of peer support: “Communicating with co-workers helps me get back. Peer support provides me a motivation to get up in the morning, especially on days when I’m feeling particularly down.” (P11, P19)

Theme 5: Proposed Solutions

Subtheme 5.1: Flexibility in scheduling. Self-scheduling has recently been suggested as a strategy to improve job satisfaction, work–life balance, and job retention of nurses (Kaushik, Kumar, & Prasad, 2025Kaushik et al., 2025). Consistent with these perspectives, nurses in the current study emphasized the need for more autonomy over their work schedules: “Self-scheduling, or my own meetings, or even having fewer of them would help a lot. To keep ourselves safe, we need more control over our shifts.” (P22, P23)

Subtheme 5.2: Programs for health and wellness. According to a cohort study conducted in the United Kingdom, access to psychological support is most helpful for maintaining good mental health (Siddiqui et al., 2023). Consistent with this evidence, nurses in the current study underscored the importance of mental health support in mitigating burnout: “Having days off for mental health or counselling on-site would help with burnout. A brief respite can help rejuvenate a healthcare worker’s energy, allowing them to engage with patients more effectively.”

Phase II: Quantitative Phase

Outcome Measures

Table 3 shows that 73.1% of nurses with children or elderly family members reported difficulty balancing work and home responsibilities. Additionally, 69.2% indicated that work interfered with time spent on family, social activities, and household responsibilities. Furthermore, 59.6% reported that family responsibilities caused stress at work and reduced time for personal relationships. Support systems were highlighted as critical, with 78.8% indicating that flexible work hours and workplace childcare or eldercare would improve work–life balance. Family support was also substantial, with 79.8% of individuals reporting assistance in managing work and home responsibilities. Notably, 42.3% reported prioritizing family over work when conflicts arose between their professional and personal lives.

Table 3.

Work-Life Balance Among Nurses N=104

S. No	Statements	Yes		No
S. No	Statements	F	%	F	%
1	During working hours, feel more pressurized due to family responsibilities	62	59.6	42	40.4
2	My personal responsibilities, sometimes slow down my career development.	54	51.9	50	48.1
3	My job leaves me with less time for personal or family relationships.	62	59.6	42	40.4
4	Because of my job, I don’t have enough time for housework or to be with family and friends.	72	69.2	32	30.8
5	Nurses who take care of children or elderly family members find it harder to balance their job and home life.	76	73.1	28	26.9
6	In case of conflict between household work and office work, preference is given to household work	44	42.3	60	57.7
7	Does your family help you manage both your job and home duties?	83	79.8	21	20.2
8	Do you think flexible work hours and childcare at work can help you manage home and job better?	82	78.8	22	21.2

Table 4 indicates several statistically significant correlations (p < .05), with medium effect sizes. Age was significantly associated with difficulties in balancing professional and family obligations (p = .01). Gender was also significantly related to the impact of family duties on career progression (p = .02). Income was significantly associated with multiple dimensions of work–life balance, including feeling stressed at work due to family responsibilities (p = .03), insufficient time for personal and family interactions because of work (p = .04), difficulty managing both household and professional duties (p = .04), and prioritizing household responsibilities over work during conflicts (p = .04). These results suggest that demographic variables play a substantial role in shaping how ICU nurses manage their work–life balance.

Table 4.

Association Between Work–Life Balance Among Nurses and Demographic Variables N = 104

Work–Life balance among ICU staff nurses and demographic variables	Chi square value	df	P Value	Cramer’s V	Effect size
Age Nurses who take care of children or elderly family members find it harder to balance their job and home life.	8.092	2	(p=0.017)	0.279	Medium
Gender slowing down of career development due to family responsibilities	5.361	1	(p=0.021)	0.227	Medium
Income • pressurized at work due to family responsibility	6.594	2	(p=0.037)	0.252	Medium
• job leaves less time for personal and family responsibilities	6.434	2	(p=0.040)	0.249	Medium
• nurses with family responsibilities found it difficult to manage their house and office work	6.458	2	(p=0.040)	0.249	Medium
• in case of conflict between household work and office work, preference is given to household work	6.212	2	(p=0.045)	0.244	Medium

Integrated Mixed Methods Results

Joint displays of the mixed methods results are presented in Table 5. Qualitative findings revealed themes of schedule strain and emotional spillover, particularly among nurses with children or elderly dependents. Rotating shifts and prolonged working hours disrupted family routines and intensified feelings of guilt and emotional exhaustion. Quantitative findings supported these results, with 73.1% of participants reporting difficulty balancing work and home responsibilities when caring for children or elderly family members. Age was significantly associated with these challenges, indicating that caregiving responsibilities substantially increase work–life conflict, particularly among nurses in certain age groups.

Table 5.

Joint Displays of Mixed Methods Results

Qualitative findings	Quantitative findings	Integrated interpretation
Nurses described schedule strain and emotional spillover, particularly among those with children or elderly dependents. Rotating shifts and prolonged working hours disrupted family routines and intensified guilt and emotional exhaustion.	73.1% reported difficulty in balancing work and home when caring for children or elderly family members. Age showed a significant association with difficulty balancing work and family life	Both findings consistently indicate that caregiving responsibilities substantially increase work–life conflict, particularly among nurses in specific age groups.
Themes of emotional spillover and motivation drain highlighted how ICU stress carried into personal life, reducing emotional energy, engagement, and intrinsic motivation at work.	59.6% felt pressurized at work due to family responsibilities, 59.6% reported that their job interfered with personal and family relationships.	Qualitative experiences clarify the quantitative trends, showing that unresolved emotional stress directly affects work engagement and motivation, often leaving nurses functioning in a state of emotional exhaustion rather than professional fulfillment.
Themes of staffing shortage and rigid scheduling showed how organizational constraints forced overtime, reduced autonomy, and limited recovery time.	69.2% lacked time for family or household responsibilities due to work. Income was significantly associated with multiple work- life balance challenges, including stress, time scarcity, and prioritizing household work over professional duties (p < .05).	Organizational constraints emerge as key structural barriers to work–life balance, with financial factors further intensifying stress and limiting nurses’ ability to manage competing demands.
Nurses reported self-care practices (yoga, exercise) and social support from family and colleagues as key coping strategies that enhanced resilience.	79.8% received family support in managing work and home duties. 78.8% believed flexible work hours and workplace childcare would improve work-life balance.	The findings complement each other, indicating that social and organizational support systems are protective factors that mitigate stress and enhance nurses’ ability to sustain demanding ICU roles.
Nurses expressed strong family orientation, often prioritizing household responsibilities during emotional or physical exhaustion.	42.3 % preferred household work over office work during conflicts. Income significantly influenced this prioritization (p = .045).	This pattern reflects a value-based coping approach, where nurses consciously prioritize family well-being when faced with competing professional and personal demands.

Themes of emotional spillover and motivation drain further illustrated how ICU-related stress extends into personal life, reducing emotional energy, work engagement, and intrinsic motivation. Correspondingly, 59.6% of participants reported experiencing stress at work due to family responsibilities, and an equal proportion indicated that work interfered with personal and family relationships. These findings clarify the quantitative trends, suggesting that unresolved emotional stress negatively affects work engagement and motivation, often resulting in emotional exhaustion rather than professional fulfillment.

Institutional barriers, including staffing shortages and rigid scheduling, emerged as significant challenges. These constraints contribute to overtime work, reduced autonomy, and limited recovery time. Consistent with these findings, 69.2% of participants reported insufficient time for family or household responsibilities due to work demands. Income was significantly associated with multiple work–life balance challenges (p < .05), including stress, time constraints, and prioritization of household responsibilities over professional duties. These results highlight organizational constraints as key structural barriers, with financial factors further exacerbating stress and limiting nurses’ ability to manage competing demands.

Key coping strategies identified in the Qualitative Phase, such as self-care practices (such as yoga and exercise) and social support from family and colleagues, were reinforced by quantitative findings. A total of 79.8% of participants reported receiving family support, and 78.8% indicated that flexible work hours and workplace childcare would improve work–life balance. Together, these findings suggest that social and organizational support systems function as protective factors that mitigate stress and enhance nurses’ capacity to sustain demanding ICU roles.

Finally, nurses demonstrated a strong orientation toward family responsibilities, often prioritizing household needs during periods of emotional or physical exhaustion. A total of 42.3 % reported prioritizing family over work during conflicts. Income significantly influenced this prioritization (p = .045), reflecting a value-based coping approach in which nurses consciously prioritize family well-being when faced with competing professional and personal demands.

Discussion

This sequential exploratory mixed methods study provides a comprehensive understanding of the barriers, coping strategies, and work engagement outcomes related to work–life balance among ICU nurses in a tertiary care setting. By integrating qualitative and quantitative findings, the study highlights how individual, organizational, and sociocultural factors collectively influence nurses’ ability to balance professional and personal responsibilities in high-intensity clinical environments.

The findings consistently indicate that caregiving responsibilities substantially increase work–life conflict, particularly among nurses in specific age groups. Qualitative insights further explain these quantitative trends, demonstrating that unresolved emotional stress negatively affects work engagement and motivation, often leaving nurses in a state of emotional exhaustion rather than professional fulfillment. Organizational constraints emerged as key structural barriers to work–life balance, with financial factors further intensifying stress and limiting nurses’ ability to manage competing demands. In contrast, social and organizational support systems were identified as protective factors that mitigate stress and enhance nurses’ capacity to sustain demanding ICU roles.

Previous studies support these findings, indicating that nurses with dependent children and greater family responsibilities report poorer work–life balance (Gribben & Semple, 2021). Similarly, studies among Spanish nurses have shown that having children increases work–family conflict, particularly when combined with rotating shifts (Jover et al., 2025). Limited access to childcare further exacerbates this burden (Alazzam et al., 2017). Additionally, rotating shifts have been associated with higher emotional exhaustion, poor sleep quality, and increased burnout compared with fixed schedules (Al-Hammouri et al., 2025; Dhaini et al., 2018). Consistent with these findings, the present study demonstrates that caregiving responsibilities and rotating shifts contribute significantly to emotional exhaustion and work–life imbalance. These findings can be interpreted with JD–R model, where caregiving responsibilities and rotating shifts act as job demands that increase strain and emotional exhaustion. In contrast, limited resources such as childcare support and stable scheduling reduce coping capacity, thereby intensifying work-life imbalance and burnout.

The study also revealed that ICU nurses experience substantial emotional spillover from work into their personal lives. Previous studies have similarly reported that ICU and NICU nurses often feel emotionally drained, with limited energy for family and personal activities after work (Hagen et al., 2025; Wudarczyk et al., 2025). Compassion fatigue has been shown to affect both personal and professional domains, leaving nurses functioning in a state of exhaustion rather than fulfillment (Hagen et al., 2025). In line with this evidence, participants in the current study described emotional exhaustion, reduced motivation, and difficulty in engaging in family life, all of which contribute to poor work–life balance. Additionally, work–life conflict has been associated with lower job satisfaction, increased stress, and higher turnover intentions (Rhéaume, 2022; Labrague et al., 2020). These findings align with the JD–R model, where high emotional demands in ICU settings deplete nurses’ energy, leading to exhaustion and impaired work-life balance. The lack of sufficient resources, such as psychological support and recovery time, further intensifies strain, contributing to reduced job satisfaction and increased turnover intentions.

Organizational constraints, such as understaffing, rigid scheduling, overtime, limited autonomy, insufficient recovery time, and low income, were identified as major barriers to nurses’ work–life balance. Notably, 69.2% of participants reported insufficient time for household responsibilities. These findings are consistent with existing literature, which highlights staffing shortages, irregular shifts, and heavy workloads as key contributors to burnout and poor work–life balance (Akter et al., 2019; Hujová et al., 2025; Mathebula et al., 2025; Widayana, Agustina, & Mediawati, 2025Widayana et al., 2025). Additionally, income and work schedules have been shown to significantly influence work–life balance in a Turkish study by Aslan et al. (2023), while financial stress among nurses is linked to reduced well-being and poorer mental health (Smith et al., 2026). The need for adequate rest and recovery has also been emphasized, as compressed schedules and insufficient time between shifts can exacerbate fatigue and negatively affect life outside work (Barker et al., 2025). These findings align with the JD–R model, where organizational constraints such as understaffing, heavy workload, and rigid scheduling function as high job demands that drive fatigue and work-life imbalance. Simultaneously, inadequate resources-such as fair income, autonomy, and sufficient recovery time –limit coping capacity, thereby intensifying burnout and negatively affecting well-being.

Nurses in the current study reported using various coping strategies, primarily self-care practices (such as exercise and yoga) and social support from friends, family, and colleagues. A substantial proportion (79.8%) reported receiving family support in managing work and personal responsibilities. These findings align with prior research identifying social support as a key coping mechanism (Badu et al., 2020; Cooper et al., 2020). Likewise, integrative reviews conducted among Australian nurses have identified strategies such as exercise, meditation, mindfulness, relaxation, and maintaining work–life balance as effective approaches to reducing stress and enhancing resilience (Badu et al., 2020; Li et al., 2024; Wei et al., 2025). Organizational interventions, such as flexible scheduling, adequate staffing, and family-supportive policies, have also been identified as critical for enhancing work–life balance (Widayana, Agustina, & Mediawati, 2025Widayana et al., 2025), consistent with the present study’s finding that 78.8% of nurses perceived flexible work arrangements and workplace childcare as beneficial in enhancing work–life balance. These findings are supported by JD–R model, where personal resources and job resources help buffer the impact of job demands. Such resources enhance resilience, reduce stress, and promote better work-life balance among nurses.

Financial factors also played a significant role in shaping work–life balance. Lower income was associated with higher mental workload and stress, indicating that financial difficulties influence how nurses prioritize work and family roles under pressure (Jin et al., 2024). This finding is consistent with the present study, which found that income significantly influenced the prioritization of work versus family responsibilities. Furthermore, previous research suggests that work–life balance among professionals is not uniform but is shaped by key demographic factors such as age, experience, and marital status (Ali et al., 2025). This aligns with the current study population, in which the majority of participants were novice nurses aged 21–30 years, unmarried, and with less than one year of ICU experience. These findings suggest that nurses at different life and career stages face distinct challenges. For example, early-career nurses may struggle primarily with job demands, whereas married or more experienced nurses may experience increased family responsibilities, affecting their work–life balance differently (Ali et al., 2025). Additionally, resilience has been shown to vary by gender, highlighting the need for targeted strategies to manage stress and support nurses’ well-being and quality of patient care (Aqtam et al., 2023). These findings can be interpreted through JD-R model, where financial strain and life-stage responsibilities act as contextual job demands that elevate stress and influence work-family prioritization. At the same time, individual factors such as experience and resilience function as personal resources, shaping how effectively nurses cope with demands and maintain work-life balance across different career stages.

A study of 500 Jordanian nurses found that higher education levels were associated with better work–life balance, although work demands continued to negatively affect family life (Abuhammad et al., 2025). Evidence from diverse global contexts, including Indonesia, Japan, Uganda, Bangladesh, Turkey, Malaysia, Jordan, South Korea, and Australia, shows that cultural and healthcare system differences significantly influence nurses’ work–life balance (Widayana, Agustina, & Mediawati, 2025Widayana et al., 2025). For example, a Japanese cohort study found that nurses may prioritize career advancement over family responsibilities to secure future stability (Tan et al., 2025). In contrast, the present study found that 42.3% of nurses prioritized family responsibilities over work during conflicts. These findings suggest that prioritization choices, whether career-focused or family-focused, are influenced by financial pressure and cultural expectations, which vary across different settings. These cross-cultural differences can be explained using JD-R model, where varying cultural expectations, financial pressures, and work demands act as context-specific job demands shaping prioritization between work and family roles. At the same time, resources such as education, career opportunities, and social support differ across settings, influencing how nurses balance demands and maintain work-life equilibrium.

Research conducted in Tamil Nadu, India, further supports these findings, indicating that nurses (particularly women) experience considerable challenges due to demanding work conditions, shift duties, and family responsibilities. Studies in this region have shown that age, income, and the nature of work significantly influence nurses’ ability to maintain work–life balance, with irregular shifts and heavy workloads contributing to imbalance (Jayarani & Mahalakshmi, 2020). Broader hospital-based studies in Tamil Nadu also emphasize that poor working conditions, long working hours, and inadequate staffing negatively affect work–life balance and well-being, particularly among married women (Sushil Shankar et al., 2020).

In Phase II, the sample predominantly comprised young, single, and novice nurses, which may limit the generalizability of the findings to ICU nurses with established family responsibilities. Consequently, the findings primarily reflect the experiences of nurses in the early stages of their careers rather than the broader ICU nursing workforce. Some interpretations of work–family conflict may therefore reflect adjustment-related stress associated with early professional roles rather than long-term work–life imbalance.

Strengths and Limitations

The sequential exploratory mixed methods design is a major strength of this study, as it facilitated a comprehensive understanding through the integration of qualitative and quantitative results. The development of the quantitative tool based on qualitative data increased the contextual relevance. The trustworthiness of the qualitative findings was strengthened through rigorous methods, such as data saturation, thematic analysis, and member checking. Additionally, the study considered both individual and organizational factors within the framework of the Job Demands–Resources model, providing a strong theoretical foundation. The use of joint displays further improved interpretive depth, and the study contributes valuable context-specific evidence from a tertiary care setting in India, where mixed-methods research remains limited.

Despite these strengths, several limitations warrant consideration. First, voluntary participation and informed consent may have introduced selection bias, as nurses with a particular interest in or experience of work–life balance issues may have been more likely to participate. Second, the study was conducted in a single tertiary care center, limiting the generalizability of the findings to other healthcare settings, such as primary care facilities, private hospitals, or different cultural and organizational contexts. The use of non-probability convenience sampling further restricts generalizability; therefore, the results should be interpreted with caution when applied to other settings or populations.

In Phase II, 91.3% of participants had less than one year of ICU experience. This disproportionate representation limits the inclusion of more experienced ICU nurses. Therefore, the findings are likely to primarily reflect the perspectives and challenges of novice nurses in their early transition period rather than those of the wider ICU nursing workforce. The cross-sectional design of the study also precludes causal inferences, as the observed associations between demographic factors, work–life balance, and related outcomes do not establish directionality or temporality.

In addition, the study may be subject to social desirability bias, as participants might have provided responses they perceived as favorable or acceptable, particularly when discussing sensitive topics such as work–family conflict, organizational support, and coping strategies. The dichotomous questionnaire, developed from themes identified in the Qualitative Phase, has not undergone formal psychometric validation. Although items were reviewed for clarity and content relevance by subject-matter experts, the dichotomous format may have limited sensitivity in capturing nuanced experiences of work–life balance. Furthermore, reliance on self-reported data introduces the potential for recall and response biases. The use of a sample size calculation based on probability sampling assumptions, in conjunction with convenience sampling, may also limit the statistical representativeness of the findings.

Implications for Practice

The results highlight the importance of strengthening organizational support to help ICU nurses achieve work–life balance. Offering childcare facilities alone may be insufficient; these services should be made accessible, flexible, and responsive to nurses’ needs.

Hospitals should ensure adequate staffing levels and offer flexible work schedules to lighten the workloads of nurses and support the effective management of professional and family responsibilities. Nurse managers play a critical role in fostering a positive work environment by encouraging teamwork, promoting open communication, and providing emotional support to reduce stress and burnout.

Additionally, integrating wellness programs, stress management interventions, and self-care initiatives can enhance nurses’ coping capacity and resilience. Overall, optimizing organizational resources and support systems is essential for improving nurses’ well-being and maintaining high-quality patient care.

Future research should include multi-center studies with larger and more diverse samples, as well as longitudinal designs to examine the long-term effects of organizational interventions on nurses’ work–life balance, retention, and patient care outcomes.

Conclusion

This sequential exploratory mixed methods study provides a comprehensive understanding of the barriers, coping strategies, and work engagement outcomes related to work–life balance among ICU nurses in a tertiary care setting. Key barriers identified include staff shortages, rigid scheduling, overtime work, limited autonomy, low income, and insufficient recovery time. These factors contribute to emotional spillover, reduced motivation, stress, and exhaustion.

At the same time, nurses adopt coping strategies such as engaging in physical activities (e.g., exercise and yoga) and relying on social support from family, peers, and colleagues to manage work-related stress. The integrated findings indicate that flexible work arrangements and strong family support are essential for maintaining work–life balance, while financial strain further increases mental workload and stress.

Overall, these findings underscore the need for policies that prioritize adequate staffing, flexible scheduling, and fair compensation to promote nurses’ well-being, sustain work engagement, and ensure high-quality patient care in ICU settings. Furthermore, strengthening nursing education and research through collaborative efforts among policymakers, educators, and nursing leaders is essential to enhance workforce capacity and professional development (Nashwan et al., 2024).

Footnotes

Acknowledgement

The authors acknowledge the study participants.

ORCID iD

Kalaiyarasi Balakrishnan

Ethical Consideration

Ethical clearance was given by the Institutional Ethics Committee- (Approval Number: 8954/IEC/2024).Written informed consent was obtained from all participants prior to data collection. Ethical approval for the study was obtained from the Institutional Review Board (IRB) of SRM to Medical College Hospital and Research Centre (ECR/8869/INST/TN/2013/RR-19, dated 23/07/2024).

Author Contributions

KB: Conceived the idea, conducted the study and wrote the original version of the manuscript.

HSJC: Supervised the project and reviewed and edited the manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The data supporting this study are not publicly available due to confidentiality restrictions and cannot be shared.

Roles and responsibilities

The funders had no role in the study design; data collection, management, analysis, or interpretation; or in the writing or publication of the report.

References

AbdELhay

E. S.

Taha

S. M.

El-Sayed

M. M.

Helaly

S. H.

AbdELhay

I. S.

(2025). Nurses retention: the impact of transformational leadership, career growth, work well-being, and work-life balance. BMC nursing, 24(1), 148. https://doi.org/10.1186/s12912-025-02762-1

Abuhammad

Alzoubi

K. H.

Al-Azzam

Karasneh

Masadeh

M. M.

Alameddine

(2025). Work-life balance, job satisfaction, and burnout among nurses in Jordan: A cross-sectional study. Plos one, 20(10), e0334603. https://doi.org/10.1371/journal.pone.0334603

Akter

M. K.

Turale

S. O. U. T. H.

(2019). Barriers to quality of work life among Bangladeshi nurses: a qualitative study. International nursing review, 66(3), 396–403. https://doi.org/10.1111/inr.12540

AlAzzam

AbuAlRub

R. F.

Nazzal

A. H.

(2017). The relationship between work–family conflict and job satisfaction among hospital nurses. Nursing forum, 52(4), 278–288. https://doi.org/10.1111/nuf.12199

Al‐Hammouri

M. M.

Rababah

AL‐Jdeetawey

N. A. A.

(2025). How shift schedules shape nurses’ sleep and compassion: A Comparative study. International Nursing Review, 72(3), e70085. https://doi.org/10.1111/inr.70085

Ali

Ishrat

Barthwal

Ali

Singh

R. R.

Singh

(2025). Unveiling the nexus: Exploring how demographic factors shape work-life balance for women professionals. International Review of Management and Marketing, 15(2), 390–394. https://doi.org/10.32479/irmm.17486

Aqtam

Ayed

Toqan

Salameh

Abd Elhay

E. S.

Zaben

Mohammad Shouli

(2023). The relationship between stress and resilience of nurses in intensive care units during the COVID-19 pandemic. INQUIRY. The Journal of Health Care Organization, Provision, and Financing, 60, 00469580231179876. https://doi.org/10.1177/00469580231179876

Austin

Fernet

Trépanier

S. G.

Lavoie‐Tremblay

(2020). Fatigue in new registered nurses: A 12‐month cross‐lagged analysis of its association with work motivation, engagement, sickness absence and turnover intention. Journal of nursing management, 28(3), 606–614. https://doi.org/10.1111/jonm.12962

Ayed

Abu Ejheisheh

Aqtam

Batran

Farajallah

(2024). The relationship between professional quality of life and work environment among nurses in intensive care units. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 61, 00469580241297974. https://doi.org/10.1177/00469580241297974

10.

Badu

O’Brien

A. P.

Mitchell

Rubin

James

McNeil

Nguyen

Giles

(2020). Workplace stress and resilience in the Australian nursing workforce: A comprehensive integrative review. International journal of mental health nursing, 29(1), 5–34. https://doi.org/10.1111/inm.12662

11.

Bakker

A. B.

Demerouti

(2007). The job demands‐resources model: State of the art. Journal of managerial psychology, 22(3), 309–328. https://doi.org/10.1108/02683940710733115

12.

Barker

H. R.

Griffiths

Dall’ora

(2025). Balancing preferences and constraints around nurses shift scheduling across healthcare organizations: a qualitative study. medRxiv, 2025-02. https://doi.org/10.1101/2025.02.18.25322227

13.

Batran

Aqtam

Ayed

Ejheisheh

M. A.

(2025). The relationship between professional quality of life and work environment among nurses in neonate care units. PLoS One, 20(4), e0322023. https://doi.org/10.1371/journal.pone.0322023

14.

Cooper

A. L.

Brown

J. A.

Rees

C. S.

Leslie

G. D.

(2020). Nurse resilience: A concept analysis. International journal of mental health nursing, 29(4), 553–575. https://doi.org/10.1111/inm.12721

15.

Currie

E. J.

Carr‐Hill

R. A.

(2013). What is a nurse? Is there an international consensus? International nursing review, 60(1), 67–74. https://doi.org/10.1111/j.1466-7657.2012.00997.x

16.

Dhaini

S. R.

Denhaerynck

Bachnick

Schwendimann

Schubert

De Geest

Simon

Match RN study group . (2018). Work schedule flexibility is associated with emotional exhaustion among registered nurses in Swiss hospitals: A cross-sectional study. International journal of nursing studies, 82, 99–105. https://doi.org/10.1016/j.ijnurstu.2018.03.019

17.

Eysa

I. M.

Shehada

Rulloda-Agoncillo

Hassan

N. P.

AlAtey

A. M.

Singh

(2025). Professional quality of life and coping strategy of trauma nurses-a cross-sectional study. European Journal of Trauma and Emergency Surgery, 51(1), 302. https://doi.org/10.1007/s00068-025-02975-8

18.

Feleke

M. G.

Ayalew

T. L.

Ashager

Beyene

H. A.

Abate

M. W.

Tibebu

N. S.

(2025). Prevalence and determinants of work-related stress among nurses in Ethiopia: a systematic review and meta-analysis. BMC nursing, 24(1), 1344. https://doi.org/10.1186/s12912-025-03980-3

19.

Gribben

Semple

C. J.

(2021). Prevalence and predictors of burnout and work-life balance within the haematology cancer nursing workforce. European Journal of Oncology Nursing, 52, 101973. https://doi.org/10.1016/j.ejon.2021.101973

20.

Hagen

L. W.

Rød

Kynø

N. M.

Tandberg

B. S.

(2025). Compassion fatigue among nurses in neonatal intensive care units. BMC nursing, 24(1), 817. https://doi.org/10.1186/s12912-025-03385-2

21.

Hao

Zhu

Zhang

Rong

Zhang

Yang

(2020). Serial multiple mediation of professional identity, and psychological capital in the relationship between work-related stress and work-related well-being of ICU nurses in China: a cross-sectional questionnaire survey. Frontiers in psychology, 11, 535634. https://doi.org/10.3389/fpsyg.2020.535634

22.

Hsu

H. C.

Lee

H. F.

Hung

H. M.

Chen

Y. L.

Yen

Chiang

H. Y.

Chow

L. H.

Fetzer

S. J.

P. F.

(2024). Effectiveness of individual‐based strategies to reduce nurse burnout: an umbrella review. Journal of nursing management, 2024(1), 8544725. https://doi.org/10.1155/2024/8544725

23.

Hujová

Zemanová

Stupková

Vostrý

(2025). Exploring the Determinants Impacting Work–Life Balance for General Nurses in Diverse Healthcare Settings: A Cross‐Sectional Study. Journal of Nursing Management, 2025(1), 8856776. https://doi.org/10.1155/jonm/8856776

24.

Jayarani

Mahalakshmi

(2020). A study on nurse’s work life balance intercept with personal’s factors. International Journal of Management, 11(11), 3621–3627. https://doi.org/10.34218/IJM.11.11.2020.353

25.

Jin

Qian

Wang

Long

Yuan

Zeng

Liao

Liu

Tang

Huang

(2024). Influencing factors associated with mental workload among nurses: A latent profile analysis. International journal of nursing sciences, 11(3), 330–337. https://doi.org/10.1016/j.ijnss.2024.04.002

26.

Kaushik

Kumar

Prasad

(2025). The Role of Flexible Work Arrangements in Retaining Gen Y And Gen Z Nurses: Evidence From India:Lex Localis (23, pp. 7250–7265). Journal of Local Self-Government. https://doi.org/10.52152/8z5p0271. S6.

27.

Kaushik

Ravikiran

S. R.

Suprasanna

Nayak

M. G.

Baliga

Acharya

S. D.

(2021). Depression, anxiety, stress and workplace stressors among nurses in tertiary health care settings. Indian Journal of Occupational and Environmental Medicine, 25(1), 27–32. https://doi.org/10.4103/ijoem.ijoem_123_20

28.

Khamisa

Oldenburg

Peltzer

Ilic

. Work related stress, burnout, job satisfaction and general health of nurses. International journal of environmental research and public health, 12(1), 652–666.

29.

Kowitlawkul

Yap

S. F.

Makabe

Chan

Takagai

Tam

W. W. S.

Nurumal

M. S.

(2019). Investigating nurses’ quality of life and work‐life balance statuses in Singapore. International nursing review, 66(1), 61–69. https://doi.org/10.1111/inr.12457

30.

Kunaviktikul

Wichaikhum

Nantsupawat

Chontawan

Klunklin

Roongruangsri

Nantachaipan

Supamanee

Chitpakdee

Akkadechanunt

Sirakamon

(2015). Nurses' extended work hours: Patient, nurse and organizational outcomes. International nursing review, 62(3), 386–393. https://doi.org/10.1111/inr.12195

31.

Labrague

L. J.

Nwafor

C. E.

Tsaras

(2020). Influence of toxic and transformational leadership practices on nurses' job satisfaction, job stress, absenteeism and turnover intention: A cross‐sectional study. Journal of nursing management, 28(5), 1104–1113. https://doi.org/10.1111/jonm.13053

32.

Wei

Yang

Tian

Han

Jia

De Ala

Song

Wei

(2024). Relationships among perceived social support, mindful self-care, and resilience among a sample of nurses in three provinces in China: a cross-sectional study. Frontiers in Public Health, 12, 1334699. https://doi.org/10.3389/fpubh.2024.1334699

33.

Maben

Conolly

Abrams

Rowland

Harris

Kelly

Kent

Couper

(2022). You can't walk through water without getting wet’UK nurses’ distress and psychological health needs during the Covid-19 pandemic: A longitudinal interview study. International journal of nursing studies, 131, 104242. https://doi.org/10.1016/j.ijnurstu.2022.104242

34.

Mathebula

Mathevula

R. F.

Ramalepa

T. N.

(2025). A scoping review of the factors affecting work–life balance among nurse educators. Health SA Gesondheid, 30, 2910. https://doi.org/10.4102/hsag.v30i0.2910

35.

Mullen

(2015). Barriers to work–life balance for hospital nurses. Workplace health & safety, 63(3), 96–99. https://doi.org/10.1177/2165079914565355

36.

Nashwan

A. J.

Abou Hashish

E. A.

Mohamed

A. S.

Alrimawi

Aqtam

Al Obeisat

Alhalaiqa

Alzaatreh

Al Hadidi

Al-Fayyadh

Faleh

J. N.

Shaban

Mirzaei

Vakilabad

Arabloo

Siddique

Shdefat

Atout

Alharbi

H. F.

, …, & Shaban

(2024). Exploring the National nursing research priorities in the Eastern mediterranean region and overcoming the associated challenges: an expert opinion. Cureus, 16(7), e64540. https://doi.org/10.7759/cureus.64540

37.

Ong

Cong

Yeo

Shorey

(2024). Experiences of nurses managing parenthood and career: A systematic review and meta‐synthesis. International nursing review, 71(3), 610–625. https://doi.org/10.1111/inr.12885

38.

Piercy

Hamby

(2025). A scoping review of resilience among intensive care nurses: Exploring strengths that mitigate secondary trauma. Psychological Trauma: Theory, Research, Practice, and Policy, https://doi.org/10.1037/tra0002017

39.

Poku

C. A.

Bayuo

Mensah

Bam

(2023). Quality of work‐life and coping strategies of nurse educators and clinicians in COVID‐19: A cross‐sectional study. Nursing Open, 10(7), 4336–4345. https://doi.org/10.1002/nop2.1676

40.

Rhéaume

Breau

(2022). Antecedents of burnout and turnover intentions during the COVID-19 pandemic in critical care nurses: A mediation study. Canadian journal of critical care nursing, 33(3), 548–556. https://doi.org/10.1177/01939459211005712

41.

Rony

M. K. K.

Numan

S. M.

Alamgir

H. M.

(2023). The association between work-life imbalance, employees' unhappiness, work's impact on family, and family impacts on work among nurses: A Cross-sectional Study. Informatics in Medicine Unlocked, 38, 101226.

42.

Şanlıtürk

(2021). Perceived and sources of occupational stress in intensive care nurses during the COVID-19 pandemic. Intensive and Critical Care Nursing, 67, 103107. https://doi.org/10.1016/j.iccn.2021.103107

43.

Saedpanah

Ghasemi

Akbari

Adibzadeh

Akbari

(2022). Effects of workload and job stress on the shift work disorders among nurses: PLS SEM modeling. European Journal of Translational Myology, 33(1), 10909. https://doi.org/10.4081/ejtm.2022.10909

44.

Saravanan

Nisar

Zhang

Masud

Sasangohar

(2023). Occupational stress and burnout among intensive care unit nurses during the pandemic: A prospective longitudinal study of nurses in COVID and non-COVID units. Frontiers in psychiatry, 14, 1129268. https://doi.org/10.3389/fpsyt.2023.1129268

45.

Sarla

G. S.

Sandhu

(2024). Work life balance in nurses. International Journal of Biomedical and Clinical Research, 1(1), 1–5. https://doi.org/10.14744/ejma.2024.55375

46.

Sellahewa

W. N.

Arachchi

R. S. S. W.

(2023). Exploring the Challenges for Work-Life Balance among Married Female Nurses. Kelaniya Journal of Human Resource Management, 18(2), 36–52. https://doi.org/10.4038/kjhrm.v18i2.128

47.

Setiawan

Susanto

D. Y.

(2025). Analisis Strategi Coping Stres pada Perawat di RSI Aisyiyah Malang. Jurnal Ekonomi dan Manajemen, 26(3), 26–41. https://doi.org/10.62951/jem.v26i3.72

48.

Siddiqui

Gupta

Collett

McIntosh

Komodromos

Godec

Maniero

Antoniou

Khan

Kapil

Khanji

M. Y.

Gupta

A. K.

(2023). Perceived workplace support and mental health, well-being and burnout among health care professionals during the COVID-19 pandemic: a cohort analysis. Canadian Medical Association Open Access Journal, 11(1), E191–E200. https://doi.org/10.9778/cmajo.20220191

49.

Smith

Fisher

Ramprogus

. (2022). Adding University to work and life: the work–life balance and well-being experiences of women who combine employment, HE learning and care of the family. Community, Work & Family, 25(5), 583–602.

50.

Smith

B. W.

Maneze

Ramjan

L. M.

Stephen

C. M.

Montayre

Salamonson

(2026). Impacts of financial stress on mental health and wellbeing of nursing students: A systematic integrative review. Journal of Advanced Nursing, 82(4), 2766–2789. https://doi.org/10.1111/jan.70043

51.

Sushil Shankar

T. K.

Nisha

Harsha Vardhini

(2020). Working condition and work-life balance of working women in a tertiary care hospital in a metropolitan city of Tamil Nadu: a cross sectional study. International Journal of Community Medicine and Public Health, 7(3), 1134–1138. https://doi.org/10.18203/2394-6040.ijcmph20200980

52.

Tan

Zhou

Zhang

Lan

Chen

Zhong

Zhu

Gao

(2025). Effects of effort-reward imbalance on emergency nurses’ health: a mediating and moderating role of emotional exhaustion and work-family conflict. Frontiers in Public Health, 13, 1580501. https://doi.org/10.3389/fpubh.2025.1580501

53.

Wang

Tao

Bowers

B. J.

Brown

Zhang

(2018). Influence of social support and self-efficacy on resilience of early career registered nurses. Western journal of nursing research, 40(5), 648–664. https://doi.org/10.1177/0193945916685712

54.

Wei

Yun

Zhang

Liang

Gao

Tang

Liu

(2025). Mindful Self‐Care and Compassion Fatigue in Nurses: The Chain Mediating Roles of Resilience and Professional Identity. Journal of Nursing Management, 2025(1), 8572654. https://doi.org/10.1155/jonm/8572654

55.

Widayana

I. G. A. A.

Agustina

H. R.

Mediawati

A. S.

(2025). Factors associated with work life balance among nurses in hospitals: a socio-ecological scoping review. Journal of Multidisciplinary Healthcare, 18, 4511–4521. https://doi.org/10.2147/JMDH.S534729

56.

Wudarczyk

Krupa-Nurcek

Czapla

Uchmanowicz

(2025). Factors influencing burnout, stress levels, and coping strategies among nursing staff in intensive care units. Frontiers in public health, 13, 1530353. https://doi.org/10.3389/fpubh.2025.1530353

57.

Zhang

Rehman

Addas

Ahmad

(2024). Influence of work-life balance on mental health among nurses: The mediating role of psychological capital and job satisfaction. Psychology Research and Behavior Management, 17, 4249–4262. https://doi.org/10.2147/prbm.s497305