Work time pressure, work–family conflict, sleep quality, and burnout among intensive care nurses: a cross-sectional study using structural equation modeling

Background: Burnout is highly prevalent among intensive care unit (ICU) nurses and poses a serious threat to workforce stability, nurses' well-being, and patient safety. Work time pressure has been identified as a key occupational stressor in critical care settings; however, the mechanisms through which work time pressure contributes to burnout among ICU nurses remain insufficiently understood. Clarifying these mechanisms may help identify potential targets for burnout prevention in ICU settings. Objective: This study aimed to examine the association between work time pressure and burnout among ICU nurses and to explore the mediating roles of work-family conflict and sleep quality in this relationship. Methods: A cross-sectional survey was conducted among 545 ICU nurses from four hospitals in Chengdu, Lanzhou and Sanya, China. Data were collected using validated self-report questionnaires measuring time pressure, work-family conflict, sleep quality, and burnout. Structural equation modeling (SEM) was employed to test the hypothesized mediation model. Indirect effects were examined using a bootstrapping procedure with 5,000 resamples. Results: Work time pressure was positively associated with burnout among ICU nurses. Work-family conflict and sleep quality each independently mediated the relationship between work time pressure and burnout. In addition, a significant serial mediating effect was observed, indicating that higher time pressure was associated with increased work-family conflict, which in turn was related to poorer sleep quality and subsequently higher levels of burnout. Conclusion: Work time pressure is an important risk factor for burnout among ICU nurses. Work-family conflict and sleep quality play both independent and sequential mediating roles in this relationship. These findings suggest that reducing work-related time pressure, supporting work-family balance, and promoting healthy sleep may contribute to burnout prevention among ICU nurses.