Background

Burnout is a widespread and persistent issue in the nursing profession, affecting nurses across settings and specialties worldwide. Defined as a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment resulting from chronic work stress [1], burnout has reached concerning levels among nurses. Based on a comprehensive systematic review and meta-analysis of 85 studies involving 288,581 nurses across 32 countries, the mean prevalence rate of burnout was 30.7% (SD 9.7%) among nurses, with study-specific ascertainments [2]. The mean age of affected nurses was 33.9 years (SD 2.1), with 82.7% being female [2]. Other systematic reviews have estimated nurse burnout prevalence ranging from 11% to 56% [3, 4], with the highest rates observed in critical care, emergency, and oncology settings [5, 6]. Risk factors include younger age [7], male sex [8], single or divorced marital status [8], not having children [8], low staffing levels [9], and workplace violence [10]. The wide prevalence range reflects the diversity of measurement tools, cut-off criteria, and practice environments, but underscores the pervasiveness of the problem.

Burnout takes a heavy toll on nurses’ physical, mental, and occupational well-being. Emotionally exhausted and disengaged nurses are at elevated risk for depression, anxiety, sleep disturbances, substance abuse, and suicidal ideation [11,12]. Burnout is associated with poorer physical health, including higher rates of musculoskeletal disorders, respiratory infections, and cardiovascular disease [13]. These health consequences often compel nurses to reduce work hours or leave the profession entirely. Nurse burnout is a strong predictor of job dissatisfaction, absenteeism, and turnover [14], exacerbating staffing shortages and increasing healthcare costs.

Beyond harming nurses themselves, burnout poses a major threat to patient safety and care quality. Robust evidence links nurse burnout to higher rates of medical errors, healthcare-associated infections, and patient mortality [15,16]. Burned-out nurses are less attentive to patients’ needs, provide lower-quality teaching and discharge planning, and have poorer communication with patients and colleagues [17]. Patients cared for by burned-out nurses report lower satisfaction, less trust in providers, and more frequent adverse events [18]. As burnout drives experienced nurses out of the bedside, it erodes the overall competency of the nursing workforce.

Healthcare organizations are grappling with the burnout crisis, recognizing its impact on quality of care, patient experience, and financial performance. Burnout-related turnover is estimated to cost the average hospital $4.4 to $6.9 million annually [19]. Initiatives to improve the practice environment, such as adequate staffing, supportive leadership, and meaningful recognition, are essential but often constrained by resource limitations [20]. Individually-focused interventions are also needed to enhance nurses’ resilience and coping capacities.

Stress management programs have shown promise in reducing burnout among nurses [21]. Mindfulness-based interventions, cognitive-behavioral training, and relaxation techniques can alleviate emotional exhaustion and increase personal accomplishment [22–24]. However, traditional programs are often time- and location-dependent, posing barriers for participation. The de-stressing effects may also diminish quickly if not reinforced by regular practice. Digital mental health tools, such as web-based and smartphone apps, offer more flexibility but are often limited in engagement and adherence [25].

Virtual reality (VR) has emerged as a novel and immersive platform for delivering mental health interventions. VR refers to computer-generated simulations of three-dimensional environments that can be interacted with in a seemingly real or physical way using specialized equipment like head-mounted displays [26]. By providing multisensory stimuli and rich user engagement, VR can induce potent and lasting therapeutic effects. Accumulating research demonstrates the efficacy of VR in treating anxiety disorders, depression, phobias, and posttraumatic stress [27,28].

Several features of VR make it particularly well-suited for stress management and burnout prevention. First, the immersive and engaging nature of VR can provide a sense of presence and psychological detachment from real-world stressors, allowing for mental restoration [29]. Second, VR environments can be specifically designed to promote relaxation, mindfulness, and self-regulation through calming visual imagery, soothing sounds, and guided meditation [30]. Third, VR simulations of natural environments, such as forests, beaches, and mountains, can provide restorative effects on stress and cognitive fatigue [31]. Fourth, VR interventions can be conveniently delivered in workplace settings and accessed on demand, overcoming participation barriers [32].

A growing body of research has explored the application of VR for stress management in various populations, with promising results. For example, a meta-analysis of 30 studies found that VR-based interventions were effective in reducing stress and anxiety in healthy adults, with a medium effect size [33]. Another systematic review concluded that VR relaxation training was efficacious in reducing stress-related symptoms in young adults [34]. Recent studies have also demonstrated the feasibility and acceptability of VR interventions for occupational stress in healthcare workers [35–38].

Preliminary evidence suggests that VR may be a valuable tool for mitigating stress and burnout among nurses specifically. A study demonstrated that a 10-minute VR relaxation intervention reduced perceived stress by 39.9% among ICU nurses during the COVID-19 pandemic, with 62% of participants reporting the intervention as helpful for stress reduction [39]. Another study showed that a VR mindfulness program resulted in improved relaxation and reduced burnout symptoms in nursing students [40]. However, the literature on VR interventions for nurse burnout is still nascent and scattered. To date, no systematic review has comprehensively synthesized and critically appraised the evidence on this topic.

Given the pressing need for effective and scalable interventions to mitigate the burnout crisis in nursing, it is timely to systematically review the evidence on VR-based approaches. A comprehensive synthesis of the literature will provide valuable insights into the feasibility, acceptability, and efficacy of VR interventions for managing stress and reducing burnout among nurses. By identifying the most promising VR intervention designs and delivery methods, the review will inform the development of evidence-based programs to support nurse well-being. The review will also elucidate gaps and limitations in the current research and guide future studies to optimize the implementation and impact of VR interventions.

Objectives

The overarching aim of this systematic review is to synthesize and appraise the evidence on VR interventions for stress management and burnout reduction in nursing. The specific objectives are:

1. To identify, describe, and critically evaluate studies that have examined the effects of VR interventions on stress, burnout, and related outcomes among nurses.
2. To characterize the types of VR interventions that have been studied, including the VR content, delivery format, dose, and theoretical basis.
3. To quantify the effects of VR interventions on stress, burnout, and associated outcomes in nurses, and explore potential moderators of effectiveness.
4. To assess the certainty of the evidence and identify sources of bias, inconsistency, and imprecision in the literature.
5. To generate recommendations for future research and practice to optimize the design, implementation, and evaluation of VR interventions for nurse stress and burnout.

By addressing these objectives, the systematic review will provide a rigorous and comprehensive evidence synthesis to guide research, policy, and practice efforts to address the critical issue of burnout in nursing.

Methods

This systematic review protocol has been developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement [41] (S1 Checklist). The protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42024604179).

Data extraction

Data extraction will be conducted using a standardized form in Covidence software, following a pilot testing phase to refine the extraction process. Two independent reviewers will systematically extract data, with any disagreements resolved through consensus or consultation with a third reviewer. The extraction protocol will capture comprehensive information across five key domains: study characteristics (including authorship, publication details, funding, and conflicts of interest), participant demographics (encompassing sample size, age, gender distribution, ethnicity, nursing specialization, work setting, and professional experience), intervention specifics (detailing VR implementation, delivery methods, dosage, duration, theoretical framework, and control conditions), outcome measurements (including assessment tools, timing, statistical results, and adverse events), and methodological considerations (covering randomization procedures, blinding methods, participant retention, data handling, and statistical power) (S1 File). If data are unclear or missing, we will contact the study authors for clarification or additional information. If studies report results for multiple follow-up time points, we will extract data for the longest duration of follow-up. If studies include both nurses and other healthcare professionals, we will only extract data for the nurse subgroup. If subgroup data are not reported, we will contact authors to request this information.

Data synthesis

Discussion

This systematic review will comprehensively synthesize and critically appraise the evidence on VR interventions for stress management and burnout reduction in nurses. To our knowledge, this will be the first systematic review to focus specifically on VR-based approaches for this population and purpose. Previous reviews have examined the effectiveness of VR interventions for stress and anxiety in general populations [33,56] or healthcare workers broadly [57], but have not targeted nurses or assessed burnout outcomes. Given the unique stressors and challenges faced by nurses, and the urgent need to mitigate the growing burnout crisis, a focused review is warranted.

The review will have several strengths. First, the broad eligibility criteria will allow for a comprehensive mapping of the VR intervention landscape, including diverse VR modalities, therapeutic approaches, and delivery formats. Second, the inclusion of both published and grey literature will minimize the risk of publication bias. Third, the use of validated tools to assess risk of bias and grade the certainty of the evidence will provide a rigorous and transparent appraisal of the literature. Finally, the involvement of multiple reviewers in screening, data extraction, and quality assessment will enhance the reliability of the findings.

However, we anticipate some limitations. First, the inconsistency in how stress and burnout are defined and measured across studies may hinder comparisons and synthesis. We will use validated instruments as a reference standard and carefully examine the conceptual and psychometric properties of outcome measures. Second, the heterogeneity in VR intervention types and study designs may limit the feasibility and interpretability of meta-analysis. We will follow best-practice guidelines for conducting narrative synthesis and exploring sources of heterogeneity [50]. Third, the generalizability of the findings may be restricted by the inclusion of only English-language studies. However, we do not expect language bias to substantially alter the conclusions, as most VR research is published in English.

The review findings will have important implications for nursing practice, education, and research. By identifying the most promising VR intervention approaches and delivery formats, the review will inform the development and implementation of evidence-based programs to support nurse well-being. The integration of effective VR tools into nursing education and professional development may help build resilience and coping skills. VR stress management may be particularly valuable for high-risk nursing specialties such as critical care, emergency, and oncology. The portability and flexibility of VR may also extend access to nurses in rural and underserved areas.

The review will also guide future research on VR interventions for nurse stress and burnout. By identifying gaps and limitations in the current evidence base, the review will highlight priority areas for investigation. For example, research is needed to optimize the design features and dose-response of VR interventions, evaluate implementation barriers and facilitators, and assess the long-term sustainability of effects. Economic evaluations are also needed to establish the cost-effectiveness of VR programs compared to traditional stress management approaches.

Supporting information