Global Stressors Among Nurses: A Systematic Review and Meta-Analysis Stratified by Income Tier and Region

Background: Nurses worldwide face escalating stressors that compromise well-being, patient safety, and workforce sustainability. While burnout, emotional labour, and techno-stress are well documented, comparative evidence across income tiers and regions remains fragmented. This review addresses the urgent need for stratified synthesis to inform global health policy and nursing reform. Objectives: To systematically review and meta-analyse the prevalence, sources, and impact of stressors among nurses, stratified by income tier (LIC, MIC, HIC) and geographic region, and to assess evidence quality using GRADE and ROBIS. Methods: Following PRISMA 2020 guidelines, five databases were searched for systematic reviews and meta-analyses published between 2010 and 2025. Eligible studies reported nurse-specific stressors, including burnout, workplace violence, shift fatigue, emotional labour, techno-stress, and COVID-19 distress. Data were extracted into a modular matrix and stratified by region and income tier. Quality of evidence was appraised using GRADE and ROBIS, with inter-rater reliability checks. Results: Ten meta-analyses (n ≈ 330,000 nurses) met inclusion criteria. Burnout prevalence ranged from 25–33%, with ICU and trauma nurses most affected. LIC nurses reported stress linked to resource scarcity, while HIC nurses experienced bureaucratic overload and techno-stress. COVID-19 amplified moral distress globally. Organisational factors—such as poor leadership and limited autonomy—and emotional labour were consistent predictors of stress. Overall certainty of evidence ranged from moderate to high. Conclusions: Nurse stressors are pervasive yet shaped by structural and regional contexts. Stratified synthesis reveals policy gaps in LIC support systems and HIC digital overload. Findings highlight the urgency of SDG-aligned reforms, formal recognition of emotional labour, and modular interventions tailored to income tier and specialty. This review provides an evidence base for global nursing advocacy and systems redesign.