# Emotional exhaustion among finnish nurses in acute care settings and targeted interventions

> This article examines the prevalence and predictors of emotional exhaustion among Finnish acute care nurses and proposes evidence-based, multi-level interventions to mitigate burnout.

## Overview
Burnout among nurses is a global concern, with emotional exhaustion serving as its fundamental and most widespread dimension. In Finnish hospitals and emergency departments, this issue is particularly acute. This article explores the prevalence and risk factors of emotional exhaustion in the Finnish healthcare context and provides practical, evidence-based tools for nurse managers, occupational health professionals, and individual nurses to prevent turnover, sickness absences, and compromised patient safety.

## The Nature of Emotional Exhaustion
Emotional management is an essential requirement in the medical field. Nurses engage in "emotional labor"—the process of controlling emotions to meet work requirements—which is highly draining. Emotional exhaustion is not a personal deficiency but an institutional problem, exacerbated in Finland by chronic staffing deficits and the high demands of the Nordic welfare model. It is characterized by being psychologically overstretched and depleted of emotional and physical resources.

## Prevalence and Risk Factors
Recent national research indicates alarming levels of emotional exhaustion among Finnish nurses:
* **General Hospital Nurses:** 28–34% of registered nurses reported severe emotional exhaustion in 2023.
* **High-Acuity Units:** In emergency departments, intensive care units, and acute medical wards, severe emotional exhaustion reaches 41–52%.
* **Vulnerable Groups:** Nurses under 35 years of age and those on fixed-term or temporary contracts are at significantly higher risk.
* **Regional Variation:** University hospital districts (e.g., HUS and TYKS) report the highest rates.

### Core Predictors
* **High-Strain Jobs:** High emotional/quantitative requirements coupled with low decision latitude.
* **Staffing and Overtime:** Chronic understaffing and mandatory overtime (e.g., 1:9–12 nurse-to-patient ratios on medical floors).
* **Trauma Exposure:** Frequent exposure to patient suffering and death without adequate debriefing.
* **Lack of Support:** Remote or unsupportive ward management.
* **Work-Life Balance:** Frequent "quick returns" (less than 11 hours between shifts) and cumulative sleep debt.
* **Moral Distress:** The inability to provide required care due to time constraints or lack of resources.

## Consequences
Emotional exhaustion leads to severe outcomes for the individual, the patient, and the healthcare system:
* **Individual:** Extended sickness leave, desire to leave the profession, clinical depression, and potential substance use disorders.
* **Patient Safety:** Increased medication errors, poor hand hygiene compliance, and higher mortality risks.
* **Financial:** The Finnish public healthcare system incurs over EUR 300 million annually in costs related to turnover, recruitment, and lost productivity.

## Targeted Interventions
Effective strategies are divided into person-directed and organizational interventions.

### Person-Directed Strategies
* **Mindfulness and Resilience:** Programs like Mindfulness-Based Stress Reduction (MBSR) can reduce burnout by 20–30%.
* **Self-Care:** Relaxation techniques, physical activity, journaling, and personalized music therapy.
* **Psychoeducational Programs:** Cognitive Behavioral Therapy (CBT) and peer support networks to address moral distress and trauma.

### Organizational Interventions
* **Staffing and Scheduling:** Capping patient numbers, implementing flexible schedules, and ensuring mandatory breaks and vacations.
* **Leadership and Team Building:** Training in leadership skills to improve teamwork, cooperation, and resilience.
* **Workplace Mental Health:** Providing on-site counseling, debriefing sessions after difficult shifts, and access to treatment for insomnia.

## References
* American Nurses Association. (n.d.). Nurse burnout: What is it & how to prevent it.
* Andersson, M., Nordin, A., & Engström, Å. (2022). Critical care nurses’ perception of moral distress in intensive care during the COVID-19 pandemic–A pilot study. *Intensive and Critical Care Nursing*, 72, 103279.
* Blasche, G., Bauböck, V. M., & Haluza, D. (2017). Work-related self-assessed fatigue and recovery among nurses. *International archives of occupational and environmental health*, 90(2), 197–205.
* Brook, J., Aitken, L. M., MacLaren, J.-A., & Salmon, D. (2021). An intervention to decrease burnout and increase retention of early career nurses: A mixed methods study of acceptability and feasibility. *BMC Nursing*, 20(1), 19.
* Chaves-Montero, A., Blanco-Miguel, P., & Ríos-Vizcaíno, B. (2025). Analysis of the Predictors and Consequential Factors of Emotional Exhaustion Among Social Workers: A Systematic Review. *Healthcare*, 13(5), 552.
* Dall’Ora, C., Saville, C., Rubbo, B., Turner, L., Jones, J., & Griffiths, P. (2022). Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. *International journal of nursing studies*, 134, 104311.
* Elshikh, M. (2024). Mitigating burnout: Identifying risk factors and effective strategies for nurses [bachelor’s thesis]. Theseus.
* Finnish Institute of Occupational Health. (2024, October 2). Severe occupational burnout has increased.
* Finnish Institute for Health and Welfare (THL). (2024). Well-being at work in health and social services 2024. THL Statistical Report 18/2024.
* Flinkman, M., Laine, M., Leino-Kilpi, H., Hasselhorn, H. M., & Salanterä, S. (2008). Explaining young, registered Finnish nurses’ intention to leave the profession: a questionnaire survey. *International journal of nursing studies*, 45(5), 727–739.
* Galanis, P., Moisoglou, I., Katsiroumpa, A., Gallos, P., Kalogeropoulou, M., Meimeti, E., & Vraka, I. (2025). Workload increases nurses’ quiet quitting, turnover intention, and job burnout: evidence from Greece. *AIMS public health*, 12(1), 44–55.
* Goodwin, C., McCormack, M., Andrews, J., Costanzo, G., Lekwa, F., & Smith, P. R. (2024, September 20). Interventions to overcome nurse burnout. Oklahoma Nursing Association.
* Grünberger, T., Höhn, C., Schabus, M., & Laireiter, A.-R. (2025). Sleep-related factors in shift workers: A cross-sectional cohort pilot study to inform online group therapy for insomnia. *International Journal of Environmental Research and Public Health*, 22(11), 1681.
* Gustafsson, T., & Hemberg, J. (2022). Compassion fatigue as bruises in the soul: A qualitative study on nurses. *Nursing ethics*, 29(1), 157–170.
* Jaber, M. J., Bindahmsh, A. A., Baker, O. G., Alaqlan, A., Almotairi, S. M., Elmohandis, Z. E., Qasem, M. N., AlTmaizy, H. M., du Preez, S. E., Alrafidi, R. A., Alshodukhi, A. M., Al Nami, F. N., & Abuzir, B. M. (2025). Burnout combating strategies, triggers, implications, and self-coping mechanisms among nurses working in Saudi Arabia: a multicenter, mixed methods study. *BMC nursing*, 24(1), 590.
* Järnefelt, H., Härmä, M., Sallinen, M., Virkkala, J., Paajanen, T., Martimo, K.-P., & Hublin, C. (2020). Cognitive behavioural therapy interventions for insomnia among shift workers: RCT in an occupational health setting. *International Archives of Occupational and Environmental Health*, 93(5), 535–550.
* Kainalainen, A., Korhonen, P., Penttinen, M. A., & Liira, J. (2024). Job stress and burnout among Finnish municipal employees without depression or anxiety. *Occupational medicine (Oxford, England)*, 74(3), 235–241.
* Kestilä, L., & Karvonen, S. (Eds.). (2025). Solutions for building a sustainable society: Population health and wellbeing report 2025 (Report 8/2025). Finnish Institute for Health and Welfare.
* Kohnen, D., De Witte, H., Schaufeli, W. B., Dello, S., Bruyneel, L., & Sermeus, W. (2024). Engaging leadership and nurse well-being: the role of the work environment and work motivation-a cross-sectional study. *Human resources for health*, 22(1), 8.
* Koivula, M., Paunonen, M. and Laippala P. (2000) Burnout among nursing staff in two Finnish hospitals. *Journal of Nursing Management*, 8, 149-158.
* Kox, J. H. A. M., Groenewoud, J. H., Bakker, E. J. M., Bierma-Zeinstra, S. M. A., Runhaar, J., Miedema, H. S., & Roelofs, P. D. D. M. (2020). Reasons why Dutch novice nurses leave nursing: A qualitative approach. *Nurse education in practice*, 47, 102848.
* Lee, M., & Cha, C. (2023). Interventions to reduce burnout among clinical nurses: systematic review and meta-analysis. *Scientific reports*, 13(1), 10971.
* Li, L., Huang, C. H., Lee, Y. C., & Wu, H. H. (2025). Emotional exhaustion among operating room and general ward nurses: evidence from a regional hospital in Taiwan. *Frontiers in public health*, 13, 1648696.
* Lusignani, M., Giannì, M. L., Re, L. G., & Buffon, M. L. (2017). Moral distress among nurses in medical, surgical and intensive-care units. *Journal of nursing management*, 25(6), 477–485.
* Ministry of Social Affairs and Health. (2023). Costs of early retirement and turnover in health care. Report 2023:15.
* Nagarajan, R., Ramachandran, P., Dilipkumar, R., & Kaur, P. (2024). Global estimate of burnout among the public health workforce: a systematic review and meta-analysis. *Human resources for health*, 22(1), 30.
* Panagioti, M., Geraghty, K., Johnson, J., Zhou, A., Panagopoulou, E., Chew-Graham, C., Peters, D., Hodkinson, A., Riley, R., & Esmail, A. (2018). Association between physician burnout and patient safety, professionalism, and patient satisfaction: A systematic review and meta-analysis. *JAMA Internal Medicine*, 178(10), 1317–1330.
* Petersen, J., Wendsche, J., & Melzer, M. (2023). Nurses’ emotional exhaustion: Prevalence, psychosocial risk factors and association to sick leave depending on care setting-A quantitative secondary analysis. *Journal of advanced nursing*, 79(1), 182–193.
* Puolakanaho, A., Tolvanen, A., Kinnunen, S. M., & Lappalainen, R. (2020). A psychological flexibility-based intervention for burnout: A randomized controlled trial. *Journal of Contextual Behavioral Science*, 15, 52–67.
* Richter, K., Acker, J., Adam, S., & Niklewski, G. (2016). Prevention of fatigue and insomnia in shift workers-a review of non-pharmacological measures. *The EPMA journal*, 7(1), 16.
* Sääksjärvi, K., Elonheimo, H. M., Ikonen, J., Lehtoranta, L., Parikka, S., Härkänen, T., Vihervaara, T., Sainio, P., Jääskeläinen, T., Suominen, A. L., Harjunmaa, U., Mäkelä, P., Lahti, J., Kaartinen, N. E., Koskinen, S., & Lundqvist, A. (2024). Cohort Profile: Healthy Finland Survey. *International journal of epidemiology*, 54(1), dyae166.
* Sharin, A. I., Jinah, N., Bakit, P., Adnan, I. K., Zakaria, N. H., Mohmad, S., Ahmad Subki, S. Z., Zakaria, N., & Lee, K. Y. (2024). Psychoeducational Burnout Intervention for Nurses: Protocol for a Systematic Review. *JMIR research protocols*, 13, e58692.
* Tuomaala, N., & Barrow, A. (2025). Challenges encountered by foreign-born nurses in the Finnish Healthcare workforce: A critical reflective approach. *Oamk Journal*, 41(2025).
* Wang, L., Li, G., Liu, J., Diao, Y., & Zhuo, Y. (2024). Summary of best evidence for interventions for nurse burnout. *MedRxiv*.
* Wylde, C. M., Mahrer, N. E., Meyer, R. M. L., & Gold, J. I. (2017). Mindfulness for novice pediatric nurses: Smartphone application versus traditional intervention. *Journal of Pediatric Nursing*, 36, 205-212.
* Zhang, H., Xia, Z., Yu, S., Shi, H., Meng, Y., & Dator, W. L. (2025). Interventions for Compassion Fatigue, Burnout, and Secondary Traumatic Stress in Nurses: A Systematic Review and Network Meta-Analysis. *Nursing & health sciences*, 27(1), e70042.