Objectives This study aimed to assess the associations of pre-pandemic perceived work stressors and work satisfaction among nurses, including nurse assistants, with burnout profiles and their transitions in response to the pandemic.

Methods Three hundred and thirty-seven nurses working in an Italian University hospital participated in a longitudinal study including a survey in August 2019 investigating perceived work stressors (assessed using the HSE Indicator Tool), work satisfaction (Work Satisfaction Scale), and burnout (Maslach Burnout Inventory), and a second survey in December 2020 assessing burnout. Using latent transition analysis, we identified burnout profiles and then estimated the associations between work stressors and satisfaction on profiles and transitions.

Results We identified three pre-pandemic profiles, namely engaged (67%), ineffective (15%), and burnout (18%); and three pandemic profiles, namely engaged (37%), exhausted (51%), and severe burnout (12%). The severe burnout profile consisted of 70% nurses classified in the burnout profile before the pandemic. Overall, work stressors and satisfaction were associated with both pre-pandemic and pandemic burnout profiles. Among nurses not in the burnout profile prior to COVID-19, pre-pandemic hostile relationships increased [odds ratio (OR) 1.19, 95% confidence interval (CI) 1.05–1.34] and work satisfaction decreased (OR 0.82, 95% CI 0.68–0.98) the probability to transition to exhausted. Moreover, work satisfaction (OR 0.54, 95% CI 0.32–0.91) and participation in work organization (OR 0.69, 95% CI 0.51–0.93) protected from transitioning to severe burnout. The association between peer support and the transition to exhausted needs further investigation.

Conclusions Pre-pandemic work stressors and satisfaction were associated with pandemic burnout and burnout transitions. To enhance preparedness for future crises, healthcare managers should carefully assess and tackle work-related constraints affecting nurses.

Key terms burnout; COVID-19; health care worker; healthcare organization; hospital management; mental health; nurse; organizational stressor; pandemic; prospective longitudinal study; transition; work stressor

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