Burnout among Pakistani nurses: a systematic review and meta-analysis

BACKGROUND: Burnout among nurses is a psychological syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, typically arising from chronic workplace stress. Given the nursing shortage, high workload, and structural constraints within Pakistan’s healthcare system, an accurate estimate of burnout prevalence in this workforce is essential. This study aimed to estimate the pooled prevalence of burnout and explore sources of heterogeneity among Pakistani nurses. METHODS: This systematic review and meta-analysis was registered in PROSPERO (CRD420251251405) and conducted in accordance with PRISMA 2020 guidelines. A comprehensive search was performed in PubMed, Web of Science, Embase, Scopus, APA PsycINFO, Google Scholar, and Pakistan-specific sources up to 21 October 2025. Quantitative observational studies reporting burnout prevalence using validated instruments (primarily the Maslach Burnout Inventory [MBI], Oldenburg Burnout Inventory [OLBI], Copenhagen Burnout Inventory [CBI], and Professional Quality of Life scale [ProQOL]) were eligible. Study quality was appraised using the Joanna Briggs Institute (JBI) checklist for prevalence studies. Meta-analysis was conducted using a random-effects model (REML) in STATA 17, and heterogeneity was assessed using the I² statistic. RESULTS: Twenty-three studies were included in the systematic review, and 17 studies (n = 3164 nurses) met criteria for quantitative synthesis. The pooled prevalence of occupational burnout among Pakistani nurses was 68%. Heterogeneity was extremely high. Leave-one-out sensitivity analysis demonstrated the stability of the pooled estimate. Meta-regression showed no significant association between publication year and burnout prevalence (p=0.896). Subgroup analyses by measurement tool and geographic region revealed no significant between-group differences. Egger’s test indicated publication bias; however, the Trim-and-Fill method did not change the pooled estimate. CONCLUSION: Burnout is highly prevalent among nurses in Pakistan. This high prevalence may reflect underlying structural challenges such as workforce shortages, heavy workloads, and limited organizational support. System-level reforms are urgently needed to improve working conditions and strengthen nurse retention policies. CLINICAL TRIAL NUMBER: Not applicable.