Burnout and moral distress among school nurses during the COVID-19 pandemic: a brief report

Introduction School nurses play a critical role in supporting student health but faced unprecedented burdens during the COVID-19 pandemic, including increased workloads, rapidly changing guidelines, and heightened risk of exposure. These pressures contributed to burnout and moral distress (MD) threatening workforce stability. This study aimed to quantify burnout among school nurses during the pandemic and examine its relationship with moral distress. Methods A cross-sectional, mixed-methods survey was administered in December 2022 to school nurses in a large, diverse region of California. The survey utilized the Mini-Z to measure burnout, Moral Distress Thermometer to measure moral distress, and school nurse moral dilemmas. The survey also included open-ended questions about school nurses' biggest challenges, supports for their practice, and sources of hope. Quantitative data were analyzed using t -tests and correlations, and qualitative data were analyzed through content analysis. Results Forty percent of school nurses reported burnout. Burned-out nurses had significantly higher moral distress scores ( p < 0.01), and burnout severity correlated with higher moral distress ( r s = 0.26, p = 0.045). Burnout was most strongly associated with systemic barriers, such as the inability to provide preventive care. Qualitative findings further highlighted overwhelming workloads and systemic challenges as primary stressors, while peer support was identified as an important source of hope. Conclusion The pandemic was associated with significant burnout and moral distress among school nurses, largely driven by systemic constraints. Sustaining this essential workforce and protecting student health will require systemic solutions including increased staffing, improved resource allocation, and robust organizational support to enhance nurse wellbeing and resilience.