Funding: This work was supported by São Paulo Research Foundation (FAPESP# # 2017/19645-2), and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Code 001.

Fernanda Carini Da Silva and Juliana Nery Souza-Talarico contributed equally to the manuscript and shared the first authorship.

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ABSTRACT

Aim

To determine the relationship between stress mindset, work-related stress and burnout in nursing professionals. We hypothesised that a stress-is-debilitating mindset is associated with higher work-related stress and burnout levels.

Design

Cross-sectional study.

Methods

Data from 119 nursing professionals recruited from oncology hospitals were evaluated. We used the Stress Mindset Scale for general and specific stressor conditions, the Work-Stress Scale and the Maslach Burnout Inventory. Regression analysis adjusted for covariates was applied to assess the association between stress mindset, work stress and burnout.

Results

A stress-is-debilitating mindset in general and specific stressful contexts was linked to higher levels of work-related stress. However, no significant associations were found with burnout outcomes such as emotional exhaustion, depersonalisation or personal accomplishment.

Conclusion

These findings suggest that while stress mindsets are related to work-related stress, their connection to burnout outcomes requires further exploration. Future studies should consider a longitudinal design with a diverse sample of nursing professionals at various career stages.

Implications for the Profession

The findings highlight the potential value of stress management training tailored to nurses' individual stress mindsets and workplace challenges. Future longitudinal studies and clinical trials are needed to assess whether enhancing stress mindset can reduce work-related stress and burnout, guiding the development of more effective and personalised interventions to support nurses' mental health and job satisfaction.

Impact

This study addressed the problem of work-related stress and burnout among nursing professionals, focusing on how stress mindsets are associated with these outcomes. The main findings revealed that a stress-is-debilitating mindset is linked to higher levels of work-related stress but does not significantly correlate with burnout. By highlighting the importance of stress mindsets, the study suggests that tailored stress management training and clinical trials to enhance stress mindsets could improve mental health and job satisfaction among nurses, ultimately contributing to healthier work environments and better patient care.

Reporting Method

This article adheres to the STROBE Statement guidelines for reporting cross-sectional studies, ensuring clarity, transparency and reproducibility of the research findings.

Patient or Public Contribution

No patient or public contribution.

1 Introduction

Work-related stress in nurses arises from excessive demands that exceed their personal and work environment resources, potentially leading to burnout (Hetzel-Riggin et al. 2020; World Health Organization [WHO] 2019). Approximately 60% of nurses report moderate stress levels, while 40% experience burnout due to chronic stress exposure (Gayol and Lookingbill 2022; Vega et al. 2023). Burnout, which both individual and workplace factors can influence, negatively affects physical and psychological health and compromises care safety (Andolhe et al. 2015; Borges et al. 2021; Coelho et al. 2024; Dall'Ora et al. 2020; Maslach and Jackson 1982; Soares et al. 2022; Waddill-Goad 2019).

An individual's beliefs about stress can significantly influence how stress responses manifest, leading to either positive or negative outcomes (Crum et al. 2013; Keller et al. 2012). A stress-is-debilitating mindset, where individuals view stress negatively, predisposes them to perceive situations as threats and focus on their lack of resources to cope (Crum et al. 2020; Jamieson et al. 2018). Studies have shown a relationship between burnout and stress mindset (Hahm 2016; Klussman et al. 2021; Shipherd et al. 2024).

Investigating the relationship between a stress-is-debilitating mindset and burnout in nursing is crucial due to the unique challenges nurses face. Nurses work in high-stress environments that require technical proficiency, emotional resilience and constant vigilance to avoid medical errors. These demands can intensify the effects of stress and burnout more than in other professions, potentially leading nurses to believe that stress is always negative. This can create a vicious cycle, where the anticipation of negative outcomes further exacerbates stress and increases the risk of burnout. Importantly, stress mindset can be shifted toward a positive one (Crum et al. 2013, 2020). This shift is linked to better health outcomes, including reduced emotional symptoms and increased resilience in non-nursing workers (Crum et al. 2013, 2020). However, the relationship between stress mindset, work-related stress and burnout among nursing professionals remains inconclusive. Understanding how a stress-is-debilitating mindset contributes to nurses' burnout can help develop targeted interventions to strengthen their stress mindset, elevate the positive aspects of stress and shift the perception of threats to challenges, consequently improving nurses' well-being.

This study aimed to explore the relationship between stress mindset, work-related stress and burnout among nurses.

2 Background

Burnout is a psychological syndrome resulting from chronic workplace stress that has not been successfully managed, characterised by emotional exhaustion, depersonalization and a reduced sense of personal accomplishment (Maslach and Jackson 1981). In the nursing profession, the implications of burnout are particularly severe. It contributes to diminished job satisfaction, reduced quality of patient care and increased rates of absenteeism and staff turnover (Adriaenssens et al. 2015). Beyond these organisational consequences, burnout significantly undermines nurses' ability to engage meaningfully with patients, restricting their capacity to provide holistic care, which depends on emotional resilience, empathy and sustained interpersonal communication (Cañadas-De la Fuente et al. 2015).

Crucially, burnout among nurses is closely linked to prolonged exposure to work-related stress (Cañadas-De la Fuente et al. 2015; Dall'Ora et al. 2020). Work-related stress arises when professional demands exceed an individual's coping abilities, particularly when perceived control over the situation is low (Lazarus and Folkman 1984). In nursing, such stress is commonly triggered by excessive workloads, emotional strain, shift work and organisational deficiencies such as lack of managerial support and staffing shortages (Jennings 2008; Liu et al. 2018). Interestingly, recent evidence suggests that individuals' beliefs about stress, rather than the intensity of stress itself, may significantly influence health and well-being (Crum et al. 2013; Keller et al. 2012). For example, Keller et al. (2012) found that among approximately 29,000 Americans, high stress levels were associated with a 43% increased mortality risk, but only for those who believed stress was harmful. Participants who did not hold such beliefs exhibited no significant increase in mortality risk (Keller et al. 2012). These findings underscore that stress-related beliefs shape stress responses, influencing whether outcomes are negative or adaptive (Crum et al. 2013; Keller et al. 2012). While most studies have focused on the general population, this line of research highlights a critical and underexplored factor in occupational health: how stress beliefs may impact professional outcomes in healthcare settings.

Building on this, Crum et al. (2013) introduced the concept of stress mindset, which integrates stress appraisal theory with the broader mindset paradigm (Dweck 2008). Unlike cognitive appraisal, which assesses the severity of a stressor, stress mindset refers to an individual's beliefs about the nature and consequences of stress, whether it is viewed as enhancing or debilitating (Crum et al. 2013). This distinction helps explain how beliefs about stress can shape not only immediate reactions but also long-term physiological and psychological responses through secondary appraisals or reappraisals (Crum et al. 2020; Jamieson et al. 2018).

For instance, a stress-is-enhancing mindset, the belief that stress can promote learning, growth or performance, may lead individuals to perceive stressful situations as challenges and to interpret available resources as sufficient (Crum et al. 2020; Jamieson et al. 2018). In contrast, a stress-is-debilitating mindset predisposes individuals to interpret the same situations as threats, focusing on perceived resource deficits and fostering avoidance or emotional distress. Thus, even when stressors are objectively similar, stress mindset can shape vastly different subjective experiences and health outcomes (Crum et al. 2013).

To frame these concepts within the nursing context, this study draws on the Biopsychosocial Model of Challenge and Threat (BPSM), which explains how individuals assess stress based on the perceived balance between demands and resources (Blascovich et al. 2003). According to the BPSM, a challenge state arises when perceived resources meet or exceed demands, facilitating engagement and positive performance. A threat state, by contrast, emerges when demands are perceived to outweigh resources, leading to anxiety, physiological dysregulation and impaired functioning (Blascovich 2013; Jamieson and Elliot 2018). Several individual and contextual factors, such as self-esteem, social support and past experiences, shape this appraisal process, potentially including stress mindset as a modifiable psychological factor (Crum et al. 2020).

Although research in this area is still emerging, a few studies have examined the link between stress mindset and burnout. For example, Hahm (2016) found that employees with a stress-is-debilitating mindset reported higher levels of job stress. Similarly, studies involving college athletes and business students found that a stress-is-debilitating mindset was associated with greater burnout (Klussman et al. 2021; Shipherd et al. 2024). However, findings remain mixed; for instance, Shipherd et al. (2024) reported no significant relationship between stress mindset and the emotional exhaustion subdomain of burnout Shipherd et al. (2024).

Despite these inconsistencies, there is growing evidence that stress mindset can be modified through targeted interventions (Crum et al. 2013). Shifting from a stress-is-debilitating to a stress-is-enhancing mindset has been associated with behavioural, cognitive, biological and emotional outcomes (Crum et al. 2013, 2015, 2017; Keech et al. 2021; Kaluza et al. 2022). Yet few studies have examined this mechanism among healthcare professionals. Establishing a clear relationship between stress mindset, work-related stress and burnout in high-stress occupations such as nursing could inform future psychological interventions to foster healthier, more adaptive stress responses. Specifically, modifying stress mindset may help nurses reframe stressors as challenges rather than threats, resulting in more effective coping and better patient outcomes.

Thus, based on the BPSM theoretical framework, the current study proposes that a stress-is-debilitating mindset is associated with higher levels of work-related stress and that the interaction between these variables contributes to symptoms of burnout, particularly across subdomains such as emotional exhaustion, depersonalization and reduced personal accomplishment.

This framework underpins the hypotheses tested in this study, which seeks to clarify how stress mindset and work-related stress interact to shape burnout symptoms in nurses. By exploring these relationships, this research offers valuable insights for developing future interventions that enhance professional well-being and patient care quality.

3 Methods

3.1 Study Design

Aligned with the exploratory nature of the study aims, which do not involve causal analysis, this study is a secondary analysis of cross-sectional data from two primary studies: ‘Effectiveness of Chinese Herbal Medicine Gan Mai Da Zao to Improve Chronic Stress in the Oncology Nursing Team: Randomized Clinical Trial’ and ‘Effect of Quick Massage on Cortisol and Melatonin Levels on Chronic Stress of Nursing Staff: Randomized Control Trial’. The institutional ethics committee approved the current study (# 6.835.088). This article follows the STROBE Statement guidelines for reporting cross-sectional studies, ensuring clarity, transparency and reproducibility of the research findings.

3.2 Study Setting, Recruitment and Sampling

In the original studies, nursing professionals (registered nurses and nursing technicians/assistants) were recruited from oncology units in two hospitals in Brazil. These professionals worked shifts of 6–12 h daily, totaling 32 h per week. Recruitment methods included email invitations, in-person requests and support from unit heads. A total of 140 female nursing professionals met the inclusion criteria: they worked day shifts, had been employed at the institution for at least 1 year, reported moderate to high stress levels (Stress Symptoms List score ≥ 29, Vasconcellos 1984) and voluntarily agreed to participate. Exclusion criteria included individuals experiencing menopause, hysterectomy, smoking habits, pregnancy, scheduled vacations during data collection, gluten intolerance, use of integrative practices (e.g., acupuncture, massage, herbal medicine, reiki, floral therapy), or use of glucocorticoids, beta-blockers, or psychoactive medications in the past 3 months. For the present study, data on stress mindset and work-related stress were available for 119 participants.

3.3 Measurements

3.3.1 Stress Mindset

Stress mindset was assessed using the adapted version of the Stress Mindset Measure (SMM) (Crum et al. 2013; Peixoto et al. 2019). This measure evaluates participants' beliefs about the consequences of stress, either as ‘stress-is-debilitating’ or ‘stress-is-enhancing’. Participants rated their agreement with eight statements about stress consequences (e.g., ‘experiencing stress improves my health and vitality’) on a scale from 0 (strongly disagree) to 4 (strongly agree) for both general (SMM-G) and specific stressor conditions (SMM-S). Scores were calculated by reversing the negative items and averaging the responses across all eight items. Total scores for each condition ranged from 0 to 4, with scores ≤ 2 indicating a stress-is-debilitating mindset (Kilby 2016). Reliability estimates for SMM-G (α = 0.81; ω = 0.83) and SMM-S (α = 0.75; ω = 0.76) were satisfactory (Campo-Arias and Oviedo 2008; Cunha et al. 2016).

3.3.2 Burnout

Burnout was assessed using the Maslach Burnout Inventory Human Services Survey (MBI-HSS) (Lautert 1995; Maslach and Jackson 1986), a 22-item questionnaire that evaluates three dimensions of occupational burnout: emotional exhaustion (9 items), depersonalization (5 items) and personal accomplishment (8 items). Respondents indicated the frequency of each feeling (from 0 = never to 6 = every day). Scores for each dimension range from: emotional exhaustion (0–54), depersonalization (0–30) and personal accomplishment (0–48). High scores in emotional exhaustion and depersonalization indicate greater burnout, while low scores in personal accomplishment reflect reduced feelings of efficacy. Internal consistency for each dimension was satisfactory (α = 0.71–0.90).

3.3.3 Work-Related Stress

Work-related stress was measured using the reduced Work Stress Scale (WSS) (Paschoal and Tamayo 2004). This scale includes 13 items rated on a five-point Likert scale (1 = totally disagree; 5 = totally agree). Total scores ranged from 13 to 65, with higher scores indicating greater work-related stress. The WSS demonstrated satisfactory reliability (α = 0.85).

3.4 Statistical Analysis

Descriptive statistics were used to summarise quantitative variables, including means and standard deviations, while categorical variables were presented as relative frequencies. Normality assumptions were checked for all dependent variables using the Kolmogorov–Smirnov test. Multiple regression analyses were conducted, following recommended sample size prerequisites (N > 100) and ensuring sufficient predictors (number of predictors × 10 <N), independent residuals and variance inflation factors (VIF between 1.02 and 1.20) (Hair et al. 2014). Multivariate linear regression models were used to investigate: (i) the association between general stress mindset (SMM-G scores) as the independent variable and work-related stress (WSS scores) and burnout (MBI domains) as dependent variables, and (ii) the association between specific stress mindset (SMM-S scores) and the same outcomes. Moderation analysis was conducted using the PROCESS macro in SPSS (Hayes 2013), estimating the interaction effect between stress mindset (SMM-G or SMM-S) and work-related stress (WSS scores) on burnout outcomes, adjusting for age and work shift. All variables were centred around the mean to facilitate interpretation and reduce multicollinearity. Using R² from the full model and R² from the nested models, with an alpha level of less than 0.05, we obtained a power of 0.735 for the association between SMM-S and WSS, 0.703 for SMM-S and emotional exhaustion, 0.134 for SMM-S and depersonalization and 0.070 for SMM-S and personal achievement. Although there is moderate power to evaluate the association between stress mindset and work-related stress, this was not true for the burnout subdomains. Statistical analyses were performed using SPSS (version 29.0, IBM Corporation, Armonk, NY, USA). Statistical significance was set at p < 0.05, with a 95% confidence interval.

4 Results

4.1 Sample Characteristics

The participants were predominantly young, highly educated nursing professionals, mostly married and working part-time shifts. The sample had a low prevalence of chronic diseases, including diabetes, dyslipidaemia, sleep disorders, pain, hypothyroidism, migraine, endometriosis and respiratory issues (Table 1). Notably, the upper quartile (Q3) indicated that 75% of participants scored low on the Stress Mindset Measure (SMM) for both general (SMM-G) and specific (SMM-S) contexts. These scores, along with low personal achievement, suggested a prevalent stress-is-debilitating mindset (Table 1).

TABLE 1. Sample characteristics.

	N	Mean	SD	Min	Q1	Median	Q3	Max	Lower CI	Upper CI
	N	Mean	SD	Min	Q1	Median	Q3	Max	95% CI
Age	119	33.76	5.29	21	30.50	33.00	37.50	49.00	32.84	34.73
SMM-G	118	0.74	0.61	0	0.25	0.63	1.13	2.88	0.64	0.86
SMM-S	118	0.76	0.62	0	0.25	0.75	1.09	2.50	0.65	0.87
WSS	117	34.50	8.22	18	29.00	34.00	40.00	60.00	33.05	36.02
MBI emotional exhaustion	60	19.20	6.72	2	15.00	18.50	23.00	36.00	17.51	20.88
MBI depersonalization	60	4.68	3.12	0	3.00	4.00	6.00	15.00	3.97	5.54
MBI personal accomplishment	60	20.78	5.18	8	17.75	22.00	24.00	30.00	19.43	22.03

	N	Percent	Lower CI	Upper CI
Education level (%)
≥ 15 years	56	47.06	38.32	55.98
≤ 14 years	63	52.94	44.02	61.68
Chronic disease (%)^a
No	94	78.99	70.77	85.40
Yes	25	21.01	14.60	29.23
Work shift (%)
Full-time shift	37	31.09	23.46	39.91
Partial-time shift	82	68.91	60.09	76.54
Maritual status (%)
Single	41	34.45	26.51	43.37
Married	57	47.90	39.13	56.80
Divorced	10	8.40	4.47	14.94
Stable union	11	9.24	5.09	15.94

Abbreviations: CI, confidence interval; Max., maximum; MBI, Maslach Burnout Inventory; Min., minimum; SMM-G, Stress Mindset Measure General; SMM-S, Stress Mindset Measure Specific; WSS, work-stress scale.
^a Diabetes, dyslipidemia, sleep disorder, pain, hypothyroidism, migraine, endometriosis and/or respiratory problem.

4.2 Association Between Stress Mindset, Work-Related Stress and Burnout

After adjusting for age and work shift, regression models examining work-related stress revealed that lower scores on both SMM-G (B = −3.15, p = 0.009) and SMM-S (B = −3.05, p = 0.012) were associated with higher scores on the WSS. This indicates that a stress-is-debilitating mindset was linked to greater work-related stress (Table 2). Specifically, each one-point decrease in SMM-G and SMM-S scores corresponded to a 3.2- and 3.0-point increase in WSS scores, respectively (Table 2).

TABLE 2. Multiple regression models for work-related stress (WSS).

Effect	WSS^a				95% CI
Effect	Β	t	β	p	Lower	Upper CI
Model 1
Intercept	46.19	8.59		< 0.001	35.55	56.84
Age	−0.34	−2.49	−0.22	0.014	−0.61	−0.07
Work shift^b	1.28	0.81	0.07	0.417	−1.83	4.40
SMM-G	−3.15	−2.64	−0.23	0.009	−5.51	−0.79
Model 2
Intercept	44.958	8.33		< 0.001	34.26	55.65
Age	−0.324	−2.31	−0.207	0.023	−0.60	−0.04
Work shift^b	1.636	1.03	0.092	0.307	−1.52	4.79
SMM-S	−3.053	−2.54	−0.229	0.012	−5.43	−0.67

Note: Bold means p-values < 0.05.
Abbreviations: CI, confidence interval; SMM-G, stress mindset measure general; SMM-S, stress mindset measure specific; WSS, Work Stress Scale.
^a N = 119.
^b Work shift: full-time (1) versus part-time (0).

Regarding burnout, regression models adjusting for age and work shift did not reveal significant associations between SMM scores and emotional exhaustion, depersonalization or personal accomplishment (Table 3). However, higher WSS scores were associated with increased emotional exhaustion (B = 0.33, p = 0.004), but no significant associations were found with depersonalization or personal accomplishment (Table 3). Specifically, each one-point increase in WSS scores was linked to a 0.33-point increase in emotional exhaustion scores (Table 3).

TABLE 3. Multiple regression models of the main effect and interaction of stress mindset (SMM) and work-related stress (WSS) on burnout domains.

	Β	t	p	95% CI		Β	t	p	95% CI		Β	t	p	95% CI
	Emotional exhaustion					Depersonalization					Personal achievement
	Β	t	p	Min	Max	Β	t	p	Min	Max	Β	t	p	Min	Max
Model 1
Intercept	11.54	1.76	0.083	−1.57	24.65	4.78	1.38	0.170	−2.12	11.68	24.75	4.40	0.001	13.47	36.03
WSS	0.33	2.95	0.004	0.10	0.56	0.08	1.49	0.141	−0.03	0.20	0.05	0.52	0.599	−0.14	0.24
SMM-G	0.10	0.07	0.934	−0.252	2.73	0.69	1.00	0.319	−0.69	0.21	−1.60	−1.42	0.160	0.16	0.65
WSS × SMM-G	−0.14	−0.82	0.415	−0.20	0.21	−0.02	−0.25	0.796	−0.21	0.16	0.29	1.90	0.067	−0.01	0.60
Age	−0.03	−0.20	0.839	−0.35	0.28	−0.01	−0.10	0.915	−0.17	0.15	−0.08	−0.63	0.531	−0.36	0.19
Work shift^a	4.61	2.20	0.031	0.41	8.81	0.09	0.08	0.928	−2.11	2.30	−0.49	−0.27	0.785	−4.10	3.11
Model 2
Intercept	11.50	1.78	0.080	−1.43	24.45	5.77	1.68	0.097	−1.07	12.62	23.05	3.99	0.002	11.49	34.61
WSS	0.35	3.16	0.002	0.12	0.57	0.08	1.47	0.146	−0.03	0.20	0.04	0.40	0.686	−0.15	0.23
SMM-S	0.25	0.21	0.833	−2.20	2.72	0.22	0.34	0.728	−1.07	1.53	−0.30	−0.27	0.782	−2.50	1.89
WSS × SMM-S	−0.14	−0.88	0.379	−0.47	0.18	0.05	0.66	0.507	−0.11	0.23	0.14	0.99	0.323	−0.14	0.44
Age	−0.02	−0.14	0.889	−0.33	0.29	−0.04	−0.51	0.606	−0.20	0.12	−0.03	−0.25	0.797	−0.31	0.24
Work shift^a	4.38	2.05	0.044	0.10	8.67	0.21	0.18	0.850	−2.05	2.47	−0.47	−0.24	0.804	−4.29	3.34

Note: N = 60. Bold means p-values < 0.05.
Abbreviations: CI, confidence interval; SMM-G, stress mindset measure general; SMM-S, stress mindset measure specific; WSS, Work Stress Scale.
^a Work shift: full-time (1) versus part-time (0).

Moderation analysis did not find a significant interaction effect between SMM (both general and specific) and WSS scores on personal accomplishment, emotional exhaustion or depersonalisation (Table 3).

5 Discussion

Our study explored the relationship between stress mindset, work-related stress and burnout among nurses. We hypothesized that a stress-is-debilitating mindset would be linked to higher work-related stress, and that the interaction between these factors would contribute to burnout, particularly in emotional exhaustion, depersonalization and reduced personal accomplishment. The results partially supported this hypothesis, showing that a stress-is-debilitating mindset, both in general and specific stressful contexts, was associated with higher levels of work-related stress. However, no significant associations were found with burnout outcomes such as emotional exhaustion, depersonalization or personal accomplishment. These findings suggest that while stress mindsets are related to work-related stress, their connection to burnout outcomes requires further exploration.

These results are consistent with other studies that have found a stress-is-enhancing mindset to be associated with reduced job stress, particularly among female preschool and college teachers (Kim et al. 2020; Yu et al. 2022). Conversely, a stress-is-debilitating mindset was linked to higher job stress in male employees (Hahm 2016). These findings support theoretical and empirical evidence that stress mindset is a key component of the BPSM (Crum et al. 2013, 2017, 2020; Jamieson et al. 2018; Jamieson and Elliot 2018; Yeager et al. 2022). In our study, a stress-is-debilitating mindset, as indicated by low SMM scores, may lead individuals to perceive workplace stressors as threats, which influences their secondary appraisals (such as perceiving a lack of resources to cope), resulting in heightened psychological responses as indicated by elevated work-related stress (high WSS scores). However, it is important to note that these assumptions are speculative, as no causal interpretations can be made with cross-sectional data. Further research using longitudinal designs is needed to better understand the directionality and mechanisms of these relationships.

Regarding burnout, our study found no significant association between SMM-G and SMM-S scores and the MBI domains. Although a trend toward a significant interaction between stress mindset and work-related stress on low personal accomplishment was observed, it did not reach the threshold for statistical significance, suggesting only a potential association that warrants further investigation. Corroborating these findings, Shipherd et al. (2024) also found no relationship between stress mindsets, emotional exhaustion and depersonalization among young, predominantly female college students, but a stress-is-debilitating mindset was linked to lower personal efficacy. In contrast, other studies have found significant associations between a stress-is-debilitating mindset and burnout in employees, college students and athletes (Belza and Gatchlian 2023; Hahm 2016; Klussman et al. 2021). Moreover, a stress-is-enhancing mindset has been associated with lower emotional exhaustion in employees and college teachers (Ben-Avi et al. 2018; Kaluza et al. 2022; Yu et al. 2022). Methodological factors may help explain the inconsistencies between findings. These include differences in participants' age (e.g., teenagers/young adults vs. middle-aged individuals), sex (e.g., male or mixed samples vs. female-only) and burnout measurement (different scales vs. MBI). Research has shown that female nurses are particularly vulnerable to burnout due to gender-specific expectations and roles (Maslach and Jackson 1982; Soares et al. 2022). Additionally, variations in mindset scale scoring (e.g., negative items scored separately vs. total score) may account for discrepancies across studies.

As widely discussed in the literature, burnout is a stress-related outcome resulting from prolonged exposure to chronic workplace stressors (Hetzel-Riggin et al. 2020; Gayol and Lookingbill 2022; WHO 2019). The absence of significant associations between stress mindset and burnout in our study may be due to the low levels of burnout observed in our sample, as the participants were relatively young and early in their careers. These individuals had low scores on emotional exhaustion and depersonalisation, suggesting they were not experiencing burnout. Although they reported low personal accomplishment, this was not linked to a stress-is-debilitating mindset. Moreover, the direct impact of stress beliefs on long-term outcomes such as burnout remains uncertain, raising questions about the temporal influence of stress mindset on health outcomes.

Contextual factors might also play a crucial role. For example, in healthcare settings, where social environment, workload and constant exposure to human suffering (especially in oncology units) are prevalent, the impact of stress mindset on long-term stress outcomes may be diminished. This highlights the importance of considering context-specific factors within the stress mindset model, as the influence of stress beliefs may vary depending on the characteristics of the stressors and demands in the environment.

5.1 Study Limitations and Future Directions

Interpreting our findings requires consideration of certain limitations. Firstly, our cross-sectional data from a sample of women in two healthcare settings, specifically those experiencing menopause and not undergoing stress-management therapies, limits causal interpretation and generalisation. Although these exclusion criteria were essential to control for potential confounders in the primary study, they limit the generalisability of our secondary analysis results. On the other hand, focusing on females allowed us to explore stress mindset and work-related stress among individuals of the same sex. Secondly, the non-significant findings between stress mindset and burnout may be influenced by the participants' age and career stage, as the sample was predominantly young and in the early stages of their professional careers. This likely contributed to a lower risk of burnout, potentially limiting the variability necessary to detect significant associations. Moreover, due to sample size constraints, a factor analysis for the WSS was not conducted. Nonetheless, this instrument has been previously validated in a large Brazilian worker sample and has demonstrated consistent reliability and construct validity across various nursing populations (Paschoal and Tamayo 2004; Cazassa et al. 2023). Its reliability was also confirmed in the present study, supporting its suitability for use in this context. Lastly, the small sample size increases the likelihood of Type II error, reducing the statistical power to identify significant effects and heightening the risk of false negatives. Future research should adopt longitudinal designs with larger and more diverse samples to improve both validity and generalisability. In particular, examining potential moderator variables such as career stage and including resilience-related factors such as job satisfaction, workplace social support and self-compassion may help clarify the complex ways in which stress mindset interacts with work-related stress to influence specific dimensions of burnout.

5.2 Contribution to the Literature

Despite these limitations, our study contributes to the literature by offering insights into the potential temporal and contextual factors that may influence the relationship between stress mindset and stress-related outcomes. Our findings suggest that while a stress-is-debilitating mindset may be linked to short- and intermediate-term psychological stress responses, its direct association with long-term outcomes like burnout remains unclear. By highlighting the connection between stress mindsets and work-related stress, we inform future intervention studies aimed at modifying stress mindsets to improve health outcomes among nursing professionals.

6 Conclusion

A stress-is-debilitating mindset, both in general and specific stressful contexts, was associated with higher levels of work-related stress. However, no significant associations were found with burnout outcomes such as emotional exhaustion, depersonalization or personal accomplishment. Our findings emphasise the importance of considering time and contextual factors when examining the association of stress mindset on health outcomes. Future longitudinal studies should further explore the moderator and mediator roles of stress mindsets in shaping the relationship between work-related stress and burnout.

Author Contributions

Fernanda Carini Da Silva: conceptualization (supporting), validation and visualisation (equal), writing original draft (lead); Juliana Nery Souza-Talarico: conceptualization (lead), supervision (lead), funding acquisition (equal), methodology (lead), writing review and editing (equal), formal analysis (equal); Talita Pavarini Borges and Gisele Kuba: data curation (lead), investigation (equal); writing review and editing (equal); Ruth Natalia Teresa Turrini: writing review and editing (equal); supervision (equal); funding acquisition (lead).

Acknowledgements

This work was supported by São Paulo State Research Support Foundation (FAPESP# # 2017/19645-2), and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Code 001. We gratefully acknowledge Bernardo dos Santos, a statistician, for his invaluable contribution to the statistical analysis in this study.

Disclosure

Statistics Statements: The statistics were checked prior to submission by an expert statistician (Bernardo dos Santos, email address: [email protected]). The author(s) affirm that the methods used in the data analyses are suitably applied to their data within their study design and context, and the statistical findings have been implemented and interpreted correctly. The author(s) agrees to take responsibility for ensuring that the choice of statistical approach is appropriate and is conducted and interpreted correctly as a condition to submit to the Journal.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Data Availability Statement

Data from this study are available upon request to the corresponding author.

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Volume12, Issue7

July 2025

e70268

Association Between Stress Mindset, Work-Related Stress and Burnout in Nursing Professionals: Empirical Research Quantitative

ABSTRACT

Aim

Design

Methods

Results

Conclusion

Implications for the Profession

Impact

Reporting Method

Patient or Public Contribution

1 Introduction

2 Background

3 Methods

3.1 Study Design

3.2 Study Setting, Recruitment and Sampling

3.3 Measurements

3.3.1 Stress Mindset

3.3.2 Burnout

3.3.3 Work-Related Stress

3.4 Statistical Analysis

4 Results

4.1 Sample Characteristics

4.2 Association Between Stress Mindset, Work-Related Stress and Burnout

5 Discussion

5.1 Study Limitations and Future Directions

5.2 Contribution to the Literature

6 Conclusion

Author Contributions

Acknowledgements

Disclosure

Conflicts of Interest

Open Research

Data Availability Statement

References

References

Related

Information