Psychological resilience and burnout in nursing interns versus registered nurses: a systematic review and meta-analysis

Abstract

Background Burnout is a common, serious occupational mental-health problem in nursing, and psychological resilience is a modifiable factor that may be associated with lower burnout. Whether this association holds equally across the education-to-practice transition, from interns to registered nurses, is unclear, and the most comparable prior meta-analysis excluded nursing students and the Chinese-language literature. Objective We aimed to pool the resilience–burnout association in nurses and nursing interns. Two coprimary outcomes were prespecified: the resilience–emotional-exhaustion (EE) correlation, and a concept-matched intern-versus-registered-nurse comparison on total burnout. Secondary outcomes were depersonalization and personal accomplishment. Methods Nine databases, five English-language and four Chinese-language, were searched from inception to 2026 with no language filter applied inside any database; eligibility was limited to reports published in English or Chinese. Eligible studies were cross-sectional and reported a correlation between a validated resilience measure and burnout in nurses or nursing interns. Two reviewers independently screened, extracted data, and appraised quality (AHRQ 11-item). Correlations were pooled via Fisher’s z under random-effects models (REML; metafor), with subgroup, sensitivity, and small-study analyses. Results Seventy-eight occupational-burnout studies were analyzed (29,292 participants); five academic-burnout studies were out of scope. Resilience was inversely associated with emotional exhaustion ( r = − 0.36, 95% CI = − 0.42 to − 0.31; k = 49; I 2 = 95%), total burnout (− 0.44), and depersonalization (− 0.30), and positively associated with personal accomplishment (+ 0.43). On the concept-matched comparison (total burnout), registered nurses showed a numerically stronger association than interns ( r = − 0.46 vs. − 0.28; Q _between p = 0.025); with only five intern studies and instability in sensitivity analyses, this difference is preliminary. Estimates were stable across leave-one-out, model-choice, and PET-PEESE analyses, and no weaker in the nine studies scoring AHRQ ≥ 8 ( r = − 0.43, − 0.59 to − 0.24); no funnel-plot asymmetry was detected (Egger’s p = 0.49). Conclusions Psychological resilience is a moderate, consistent protective correlate of nurse burnout, but a wide prediction interval reflecting high heterogeneity means its practical benefit likely varies across settings. Resilience-building should complement, not replace, organizational measures. Whether the correlate is stronger in registered nurses than in interns remains preliminary. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261427008 , identifier CRD420261427008.