Lived Experiences of Occupational Burnout Among Newly Graduated Emergency Department Nurses Perceiving Insufficient Social Support: A Descriptive Phenomenological Study

Lived Experiences of Occupational Burnout Among Newly Graduated Emergency Department Nurses Perceiving Insufficient Social Support: A Descriptive Phenomenological Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Lived Experiences of Occupational Burnout Among Newly Graduated Emergency Department Nurses Perceiving Insufficient Social Support: A Descriptive Phenomenological Study Shui-xiu Huang, Wei Zhang, Yu Zhao, Li Liang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9324652/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Newly graduated nurses (NGNs) in emergency departments (EDs) face a high risk of occupational burnout. Although social support is known to be protective, NGNs’ reluctance to voice needs often results in perceived lack of support, potentially exacerbating burnout. The mechanisms through which this perception develops into chronic burnout remain unclear. This study explored the lived experiences of occupational burnout among ED NGNs who perceived insufficient social support. Methods A descriptive phenomenological design guided by Husserl's philosophy was adopted. Twenty NGNs were purposively recruited from the ED of a tertiary hospital in Shenzhen, China. Semi-structured in-depth interviews were conducted until data saturation was reached. Data were analyzed using Colaizzi's seven-step method. Trustworthiness was ensured through member checking and triangulation. Ethical approval was obtained from the hospital's Institutional Review Board (Approval No. 2025 − 279). Results Four interrelated themes emerged, illustrating a self-reinforcing cycle: (1) the shock of invisible isolation; (2) the silent spiral of emotional and physical exhaustion; (3) the erosion of professional identity; and (4) fragile seeds of resilience in silence. Perceived lack of support was experienced as contingent upon explicit help-seeking, transforming acute transition stress into chronic burnout. Conclusions Perceived insufficient social support acts as a critical catalyst in the development of occupational burnout among newly graduated emergency nurses, progressively undermining their professional identity and psychological well-being. Healthcare organizations should therefore transition from passive, request-based support to proactive, systematically embedded intervention frameworks that foster psychological safety and promote sustainable career development. Clinical trial number: Not applicable. Emergency department Newly graduated nurses Occupational burnout Social support Qualitative research Background The global nursing workforce faces a critical challenge in retaining newly graduated nurses (NGNs), particularly in high-intensity settings such as emergency departments (EDs). Characterized by unpredictable workloads, high patient acuity, and repeated exposure to trauma, the ED environment intensifies the stresses of transitioning from student to professional practitioner [ 1 – 3 ] . This period is frequently marked by “transition shock,” increasing vulnerability to occupational burnout [ 2 ] . Burnout-defined by emotional exhaustion, depersonalization, and reduced personal accomplishment-compromises nurses’ well-being and poses risks to patient safety and care quality [ 4 , 5 ] . Social support is a well-established protective factor against burnout [ 6 , 7 ] . According to Hobfoll's Conservation of Resources (COR) theory, social support acts as a key resource that buffers stress and prevents resource-loss spirals [ 8 , 9 ] . Quantitative studies consistently show an inverse relationship between perceived social support and burnout among nurses [ 5 , 10 ] . However, despite available support systems, burnout rates among ED NGNs remain high. This discrepancy highlights that perceived availability of support may matter more than its objective presence [ 11 , 12 ] . NGNs often hesitate to express needs during professional socialization, fearing they will appear incompetent or burden colleagues [ 13 ] . This reluctance can transform accessible support into perceived isolation. While quantitative evidence links low perceived support to burnout, it does not elucidate the subjective mechanisms: how the perception is constructed in daily interactions, how it amplifies over time, and how it culminates in chronic burnout [ 14 ] . Existing qualitative studies have focused mainly on general transition experiences, leaving the nuanced dynamics of perceived support deficits in the ED context underexplored [ 15 , 16 ] . This descriptive phenomenological study therefore aimed to explore the lived experiences of occupational burnout among ED NGNs who perceived insufficient social support. The objectives were to describe the essential structure of this experience, elucidate the mechanisms linking perceived lack of support to chronic burnout, and provide a phenomenological foundation for proactive intervention strategies. Methods Study design This study adopted a descriptive phenomenological design guided by Husserl's philosophy. Descriptive phenomenology was selected to bracket researchers' preconceptions and faithfully capture participants' lived experiences without imposing external theoretical frameworks. This approach is well-suited to uncovering the essence of how perceived lack of social support is experienced, amplified, and transformed into chronic burnout in everyday ED practice. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Setting and recruitment The study was conducted in the emergency department (ED) of a tertiary Grade-A general hospital in Shenzhen, Guangdong Province, China. This setting represents a typical high-volume urban healthcare environment where newly graduated nurses (NGNs) routinely undertake the transition from student to professional practitioner. Purposive sampling was employed to recruit participants who could provide rich descriptions of the phenomenon. Inclusion criteria were: (1) registered nurses within 12 months of graduation; (2) currently working full-time in the ED; and (3) willing to share their experiences. Exclusion criteria included visiting or trainee nurses and those on leave during the study period. Recruitment occurred between July and October 2025. Twenty NGNs participated. Data saturation was reached after the 17th interview; two additional interviews confirmed saturation. Participant demographics are presented in Table. Study design This study adopted a descriptive phenomenological design guided by Husserl's philosophy. Descriptive phenomenology was selected to bracket researchers' preconceptions and faithfully capture participants' lived experiences without imposing external theoretical frameworks. This approach is well-suited to uncovering the essence of how perceived lack of social support is experienced, amplified, and transformed into chronic burnout in everyday ED practice. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Setting and recruitment The study was conducted in the emergency department (ED) of a tertiary Grade-A general hospital in Shenzhen, Guangdong Province, China. This setting represents a typical high-volume urban healthcare environment where newly graduated nurses (NGNs) routinely undertake the transition from student to professional practitioner. Purposive sampling was employed to recruit participants who could provide rich descriptions of the phenomenon. Inclusion criteria were: (1) registered nurses within 12 months of graduation; (2) currently working full-time in the ED; and (3) willing to share their experiences. Exclusion criteria included visiting or trainee nurses and those on leave during the study period. Recruitment occurred between July and October 2025. Twenty NGNs participated. Data saturation was reached after the 17th interview; two additional interviews confirmed saturation. Participant demographics are presented in Table 1 . Interview guide A semi-structured interview guide was developed specifically for this study based on a review of the relevant literature and the research objectives. The guide was pilot-tested with two newly graduated nurses who were not included in the final sample and was refined accordingly. The final interview guide is provided as Supplementary File 1. The guide explored five key domains: critical incidents of exhaustion, subjective experiences of support deficits, emotional progression during shifts, impacts on professional identity, and coping strategies. Example questions included: “Can you describe a recent situation in which you felt most exhausted or unsupported?” Probing questions encouraged deeper reflection on bodily sensations, emotions, and thoughts. Data collection All interviews were conducted face-to-face in a private, quiet hospital room to ensure confidentiality. Each session lasted 35–45 minutes, was audio-recorded with consent, and included notes on non-verbal cues such as facial expressions, tone, and pauses. The first author (with eight years of ED nursing experience) led the interviews, supported by a second researcher trained in qualitative methods. Verbatim transcripts were prepared within 48 hours and returned to participants for member checking. In total, 20 interviews generated approximately 980 minutes of audio data. Data analysis Qualitative data were managed and analyzed using NVivo software (version 11.0, QSR International) to facilitate systematic coding, theme clustering, and retrieval of raw interview excerpts. Colaizzi’s seven-step phenomenological method was applied: [ 17 ] : (1) repeated reading of transcripts to grasp the overall sense; (2) extraction of significant statements; (3) formulation of meanings; (4) clustering of meanings into themes; (5) development of exhaustive descriptions; (6) integration into the fundamental structure; and (7) validation through member checking. Three researchers independently coded initial transcripts and reached consensus through iterative discussion, ensuring the analysis remained grounded in participants’ voices. Ethical considerations The study received ethical approval from the Institutional Review Board of Peking University Shenzhen Hospital (Approval No. 2025 − 279) and complied with the Declaration of Helsinki. Written informed consent was obtained from all participants, who were assured of their right to withdraw at any time without repercussions. Data were anonymized using codes (N1–N20) and stored securely. Trustworthiness and reflexivity Trustworthiness was established according to Lincoln and Guba’s criteria. Credibility was strengthened by prolonged engagement, member checking (accuracy > 92%), and peer debriefing. Transferability was supported by thick contextual descriptions. Dependability and confirmability were maintained through a detailed audit trail and reflexive journaling. The primary researcher actively bracketed her own ED nursing background to minimize bias and preserve participants’ perspectives. Results Four core themes with nine sub-themes emerged, illustrating how perceived lack of social support is experienced and progressively amplified into chronic burnout (Table 2 ). Table 2 Themes and sub-themes Theme Sub-themes 1. The shock of invisible isolation 1.1 Sudden abandonment in crises 1.2 Fear of "bothering" others 2. The silent spiral of emotional and physical exhaustion 2.1 Accumulation of unspoken fatigue 2.2 Sleep disruption and somatic complaints 3. The erosion of professional identity 3.1 Self-doubt and depersonalization 3.2 Diminished sense of accomplishment 4. Fragile seeds of resilience in silence 4.1 Self-protective internal strategies 4.2 Quiet hope for systemic change Theme 1: The shock of invisible isolation Participants frequently described an acute, visceral sense of isolation during high-stakes clinical events, even when colleagues were physically nearby. 1.1 Sudden abandonment in crises N3 (Female, 6 months): “During a cardiac arrest at 3 a.m., I was compressing alone for over 30 minutes while the senior nurse handled another case. I desperately wanted to call for help, but the thought ‘they are already overwhelmed-asking would make me a burden’ stopped me. The isolation hit like a wave; I felt completely invisible in a room full of people.” 1.2 Fear of "bothering" others N12 (Male, 4 months): “After managing a violent patient alone, no one came to check on me. I handled the documentation and decontamination by myself. The silence afterwards was deafening. I wanted debriefing but feared it would signal weakness.” These repeated experiences of being left to manage alone reinforced the conviction that support was available only upon explicit request - a request NGNs were often reluctant to make. Theme 2: The silent spiral of emotional and physical exhaustion The perceived absence of support created a self-perpetuating loop in which unvoiced fatigue accumulated rapidly across shifts. 2.1 Accumulation of unspoken fatigue N7 (Female, 9 months): “After night shifts, I would go home physically drained but mentally replaying every decision I made alone. No one ever asked how I was coping, so I stayed silent. Sleep became impossible—I’d lie awake worrying about the next shift, waking exhausted and even less able to handle the workload. The fatigue snowballed until my body simply refused to recover.” 2.2 Sleep disruption and somatic complaints N15 (Female, 11 months): “My shoulders and back ache constantly from tension. I know it’s stress-related, but admitting it feels like complaining. So I swallow painkillers and push on. Over weeks, the exhaustion moves from ‘tired after work’ to ‘permanently drained’, affecting concentration, empathy, and overall functioning.” Each unvoiced need deepened the perception of isolation, intensifying physiological stress responses and creating a pathway from acute episodes to chronic burnout. Theme 3: The erosion of professional identity As the cycle persisted, perceived support deficits gradually undermined participants’ sense of competence and professional purpose. 3.1 Self-doubt and depersonalization N9 (Male, 8 months): "In school I dreamed of saving lives in the ED. Now, after handling complex cases without validation or shared reflection, I question every action. Success feels hollow because no one acknowledges it; failure feels devastating because I bear it alone. I started feeling like an imposter pretending to be a real nurse." 3.2 Diminished sense of accomplishment N4 (Female, 3 months): "Patients still thank me, but inside I feel numb. The emotional weight of families in crisis used to motivate me; now I just go through motions. Without anyone to share the burden or affirm my efforts, nursing began to lose its meaning." Theme 4: Fragile seeds of resilience in silence Even amid the burnout trajectory, participants revealed subtle internal resources and quiet hopes. 4.1 Self-protective internal strategies N18 (Female, 10 months): “I started a private note on my phone listing ‘things I managed today without help’. No one sees it, but reviewing it reminds me of my strength and helps me get through bad days." 4.2 Quiet hope for systemic change N6 (Male, 7 months): “Deep down I hope the department will eventually notice that new nurses need quiet, proactive support. I’m holding on because I still believe things can improve—perhaps one day I can become the support someone else needs.” Fundamental Structure of the Phenomenon The lived experience of occupational burnout in this context constitutes a silent, self-amplifying cycle: invisible isolation → accumulation of unspoken fatigue → erosion of professional identity. This cycle is propelled by the deeply held perception that support is contingent upon active solicitation. Reinforced repeatedly during critical clinical moments (e.g., resuscitations, night shifts, violent incidents), the process is deeply embedded in professional norms that prize self-sufficiency, rendering burnout both insidious and culturally patterned. Discussion Interpretation of Findings This phenomenological study illuminates the micro-processes through which perceived lack of social support is subjectively experienced, amplified, and progressively transformed into chronic occupational burnout among ED NGNs. By focusing on lived daily clinical realities rather than aggregate scores, the findings extend previous quantitative association [ 10 , 18 ] and provide mechanistic depth regarding the process of burnout development. The theme "shock of invisible isolation" aligns with Duchscher's transition shock theory, which describes the initial stage of role adaptation as marked by anxiety, insecurity, and instability [ 19 ] . However, our participants' accounts reveal how this shock is powerfully mediated by perceived rather than actual support deficits. This is a phenomenon influenced by professional socialization norms that valorize self-sufficiency, where seeking assistance may be inadvertently perceived as a limitation in clinical competence [ 20 ] . Each unassisted critical event reinforces the internal narrative "support is not there for me unless I ask," rapidly depleting emotional resources in line with Hobfoll's Conservation of Resources (COR) theory [ 21 ] . Resource loss spirals ensue because silence prevents replenishment, turning isolated incidents into cumulative exhaustion. The "silent spiral of emotional and physical exhaustion " vividly demonstrates the somatic pathway often underemphasized in burnout literature. Repeated failure to receive unsolicited support leads to rumination, sleep disruption, and chronic fatigue - mechanisms that convert acute post-shift tiredness into persistent physiological burden [ 22 ] . This amplification occurs daily: night-shift solitude heightens vigilance, unprocessed emotions impair recovery sleep, and resulting daytime impairment further erodes confidence, creating a self-perpetuating loop. The theme "erosion of professional identity" represents the chronic phase of the burnout trajectory and extends current understanding of identity formation in NGNs. Earlier research has documented diminished personal accomplishment and depersonalization among new nurses [ 13 , 23 ] , but primarily as outcomes of heavy workload or inadequate orientation programs. Our analysis demonstrates that perceived lack of support functions as a pivotal mediator: without external validation or shared reflection, even successful clinical encounters lose meaning, gradually solidifying transient self-doubt into a stable negative professional self-concept. A distinctive contribution of this study lies in the theme "fragile seeds of resilience in silence." While most burnout research focuses on risk factors, our participants spontaneously described private coping strategies and latent hope for systemic change. These elements suggest that burnout is not inevitable and offer clear entry points for intervention. Implications for Practice and Research These mechanisms point toward a clear shift in organizational approaches- from passive, help-seeking-dependent models to proactive, low-threshold support systems. Practical strategies include scheduled non-intrusive check-ins, automated post-event debrief prompts, emotional intelligence training, sleep hygiene education, reflective journaling, and team-based psychological safety programs that normalize help-seeking as a professional strength rather than a weakness. Future multi-center, mixed-methods studies are warranted to evaluate the feasibility, scalability, and effectiveness of such interventions across diverse ED settings. Limitations The single-center design in one Chinese city may limit transferability to other regions or healthcare systems. Purposive sampling could have favored more reflective participants. As with all phenomenological research, findings represent co-constructed interpretations rather than absolute truths. Cross-cultural and multi-center studies would further strengthen generalizability. Conclusions This study reveals that perceived lack of social support among ED NGNs is a dynamic process leading to chronic burnout through invisible isolation and professional identity erosion. Findings advocate shifting from passive, help-seeking models to proactive, low-threshold support systems. Implementing such strategies promises to reduce burnout, support sustainable nursing workforces, and improve patient outcomes in demanding ED settings. Declarations Acknowledgements We sincerely thank the emergency department nurses at Peking University Shenzhen Hospital for their willingness to participate. We also acknowledge Editage (www.editage.cn) for professional English language editing. Author contributions SH, YZ, WZ, and LL conceptualized the study. SH, YZ, and LL were responsible for data collection. SH and YZ performed data analysis. SH acquired funding and managed the overall project. All authors contributed to methodology, validation, drafting and revising the manuscript, and approved the final version. Funding This study received no specific funding . Availability of Data and Materials The datasets generated and/or analyzed during the current study are not publicly available due to the sensitive nature of qualitative interview data but are available from the corresponding author on reasonable request. Ethics approval and consent to participate The study was approved by the Ethics Review Committee of Peking University Shenzhen Hospital (Approval No. 2025-279) and adhered to the principles of the Helsinki Declaration. All participants provided written informed consent. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details 1 Emergency Department, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China. References DUCHSCHER JE, PAINTER S. Proceed with caution: Integrating newly graduated nurses into an emergency department[J]. Adv Emerg Nurs J. 2021;43(1):53–70. HAN P, SUN Y, CHEN H, et al. The early career resilience experience of Generation Z newly graduated registered nurses in standardized training in the emergency department: A qualitative study in Shanghai[J]. BMC Nurs. 2024;23(1):391. YU C, JIANG J, ZHONG M, et al. Training load of newly recruited nurses in Grade-A tertiary hospitals in Shanghai, China: A qualitative study[J]. BMC Nurs. 2023;22(1):9. ZHANG R, SHAO D, HUANG H, et al. Dilemmas and strategies in the working experience of resident training nurses rotated in the intensive care unit: A qualitative study[J]. BMC Nurs. 2025;24(1):1302. AL-HELLO L, ERVASTI J, HAAPA T, et al. Interventions promoting work engagement and reducing turnover of newly graduated nurses: A systematic review[J]. Nurs Open. 2026;13(2):e70434. WHITEHEAD I O HANRATTYB. I clearly have some wiring that's not quite right: How general practitioners with lived experience of burnout describe personal factors related to their burnout: A qualitative study using in-depth interviews[J]. Fam Pract, 2026, 43(2). COGAN N, SMITH M. DEAKIN K. Psychological safety as a predictor of acute stress, well-being and burnout in health and social care workers: A predictive correlational study[J]. Behav Sci (Basel), 2026, 16(3). NEVEU JP. Measuring motivational patterns: A formal approach of Conservation of Resources Theory[J]. Nonlinear Dyn Psychol Life Sci. 2025;29(3):431–51. JIANG SF, WANG K N ZHANGS, et al. The mediating role of psychological resilience in the relationship between frailty and self-efficacy among dialysis patients[J]. Front Psychiatry. 2025;16:1542031. GONG S, LI J, TANG X, et al. Associations among professional quality of life dimensions, burnout, nursing practice environment, and turnover intention in newly graduated nurses[J]. Worldviews Evid Based Nurs. 2022;19(2):138–48. ISHIHARA I, ISHIBASHI Y, TAKAHASHI K, et al. Effect of organizational factors and work environments on newly graduated nurses' intention to leave[J]. Jpn J Nurs Sci. 2014;11(3):200–10. FORSMAN H, RUDMAN A, GUSTAVSSON P, et al. Nurses' research utilization two years after graduation: A national survey of associated individual, organizational, and educational factors[J]. Implement Sci. 2012;7:46. ZHANG Y, QIAN Y, WU J, et al. The effectiveness and implementation of mentoring programs for newly graduated nurses: A systematic review[J]. Nurse Educ Today. 2016;37:136–44. MASLACH C, LEITER M P. Understanding the burnout experience: Recent research and its implications for psychiatry[J]. World Psychiatry. 2016;15(2):103–11. ASSEIRI W, REIS J, OMURA M, et al. The experience of transition from student nurse to registered nurse among newly graduated nurses in the paediatric setting: An integrative literature review[J]. Nurse Educ Pract. 2025;83:104252. LINDFORS K, KAUNONEN M, HUHTALA H, et al. Newly graduated nurses' evaluation of the received orientation and their perceptions of the clinical environment: An intervention study[J]. Scand J Caring Sci. 2022;36(1):59–70. EDWARD K L, WELCH T. The extension of Colaizzi's method of phenomenological enquiry[J]. Contemp Nurse. 2011;39(2):163–71. JACOBS S, MOLONEY W. TERRY D, Creating organisational working conditions where nurses can thrive: An international action research study[J]. Nurs Rep, 2025, 15(3). CUSACK L, MADSEN L, DUCHSCHER JB et al. Growth and adaptation of newly graduated nurses based on Duchscher's stages of transition theory and transition shock model: A longitudinal quantitative study[J]. Nurs Rep, 2025, 15(12). DUCHSCHER JE. Transition shock: The initial stage of role adaptation for newly graduated registered nurses[J]. J Adv Nurs. 2009;65(5):1103–13. HOBFOLL S E. Conservation of resources: A new attempt at conceptualizing stress[J]. Am Psychol. 1989;44(3):513–24. SALVAGIONI D A J, MELANDA F N, MESAS A E, et al. Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies[J]. PLoS ONE. 2017;12(10):e0185781. RUSH K L, ADAMACK M. Best practices of formal new graduate nurse transition programs: An integrative review[J]. Int J Nurs Stud. 2013;50(3):345–56. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 07 May, 2026 Reviewers agreed at journal 06 May, 2026 Reviewers invited by journal 28 Apr, 2026 Editor assigned by journal 26 Apr, 2026 Editor invited by journal 09 Apr, 2026 Submission checks completed at journal 09 Apr, 2026 First submitted to journal 09 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9324652","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":634896196,"identity":"7bedcf90-ebc4-44e7-b358-7177c9fc3055","order_by":0,"name":"Shui-xiu Huang","email":"","orcid":"","institution":"Peking University Shenzhen Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shui-xiu","middleName":"","lastName":"Huang","suffix":""},{"id":634896197,"identity":"d0481ad5-ef30-40c2-9771-522340046bb3","order_by":1,"name":"Wei Zhang","email":"","orcid":"","institution":"Peking University Shenzhen Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zhang","suffix":""},{"id":634896198,"identity":"5b31e747-64e0-4767-b8cb-b59a61c68009","order_by":2,"name":"Yu Zhao","email":"","orcid":"","institution":"Peking University Shenzhen Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Zhao","suffix":""},{"id":634896199,"identity":"fe23df77-1db4-4de0-9773-83e9236645dd","order_by":3,"name":"Li Liang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBACefbmAwc+/pHg4WdvIFKLYc+xxIMzG2zkJHsOEGvNDR/jw5wNacYGNxKI1ME4g8fgMOOOw4kzZz7eeIOhxiaaoBZ26baCw4VnDif2S6cVWzAcS8ttIGjLnMMbDs9gA9oyO8dMgrHhMGEtDDcSDA7zALVsuHmGaC0pBod520De5yFSCzCQEw7OOAMKZKBfEojxCzAqD3/4UAGKysMbb3yosSHCYUjAQCKBFOUQLaTqGAWjYBSMgpEBABpGSV9BCggiAAAAAElFTkSuQmCC","orcid":"","institution":"Peking University Shenzhen Hospital","correspondingAuthor":true,"prefix":"","firstName":"Li","middleName":"","lastName":"Liang","suffix":""}],"badges":[],"createdAt":"2026-04-05 07:23:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9324652/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9324652/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108804701,"identity":"e50a1828-3448-4d76-bffd-dae724b70408","added_by":"auto","created_at":"2026-05-08 15:22:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":224773,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9324652/v1/a44c6c26-564e-4859-bbcb-e9486a9a160d.pdf"},{"id":108606029,"identity":"3c2b10c0-84d4-42b1-a7c1-572f57e60c1a","added_by":"auto","created_at":"2026-05-06 12:22:39","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16119,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-9324652/v1/8f53a11065c5f553c2985d42.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Lived Experiences of Occupational Burnout Among Newly Graduated Emergency Department Nurses Perceiving Insufficient Social Support: A Descriptive Phenomenological Study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe global nursing workforce faces a critical challenge in retaining newly graduated nurses (NGNs), particularly in high-intensity settings such as emergency departments (EDs). Characterized by unpredictable workloads, high patient acuity, and repeated exposure to trauma, the ED environment intensifies the stresses of transitioning from student to professional practitioner\u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. This period is frequently marked by \u0026ldquo;transition shock,\u0026rdquo; increasing vulnerability to occupational burnout\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Burnout-defined by emotional exhaustion, depersonalization, and reduced personal accomplishment-compromises nurses\u0026rsquo; well-being and poses risks to patient safety and care quality\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSocial support is a well-established protective factor against burnout\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. According to Hobfoll's Conservation of Resources (COR) theory, social support acts as a key resource that buffers stress and prevents resource-loss spirals\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Quantitative studies consistently show an inverse relationship between perceived social support and burnout among nurses\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. However, despite available support systems, burnout rates among ED NGNs remain high. This discrepancy highlights that perceived availability of support may matter more than its objective presence\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNGNs often hesitate to express needs during professional socialization, fearing they will appear incompetent or burden colleagues\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. This reluctance can transform accessible support into perceived isolation. While quantitative evidence links low perceived support to burnout, it does not elucidate the subjective mechanisms: how the perception is constructed in daily interactions, how it amplifies over time, and how it culminates in chronic burnout\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Existing qualitative studies have focused mainly on general transition experiences, leaving the nuanced dynamics of perceived support deficits in the ED context underexplored\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis descriptive phenomenological study therefore aimed to explore the lived experiences of occupational burnout among ED NGNs who perceived insufficient social support. The objectives were to describe the essential structure of this experience, elucidate the mechanisms linking perceived lack of support to chronic burnout, and provide a phenomenological foundation for proactive intervention strategies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003eStudy design\u003c/h2\u003e\n \u003cp\u003eThis study adopted a descriptive phenomenological design guided by Husserl\u0026apos;s philosophy. Descriptive phenomenology was selected to bracket researchers\u0026apos; preconceptions and faithfully capture participants\u0026apos; lived experiences without imposing external theoretical frameworks. This approach is well-suited to uncovering the essence of how perceived lack of social support is experienced, amplified, and transformed into chronic burnout in everyday ED practice. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eSetting and recruitment\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in the emergency department (ED) of a tertiary Grade-A general hospital in Shenzhen, Guangdong Province, China. This setting represents a typical high-volume urban healthcare environment where newly graduated nurses (NGNs) routinely undertake the transition from student to professional practitioner. Purposive sampling was employed to recruit participants who could provide rich descriptions of the phenomenon. Inclusion criteria were: (1) registered nurses within 12 months of graduation; (2) currently working full-time in the ED; and (3) willing to share their experiences. Exclusion criteria included visiting or trainee nurses and those on leave during the study period. Recruitment occurred between July and October 2025. Twenty NGNs participated. Data saturation was reached after the 17th interview; two additional interviews confirmed saturation. Participant demographics are presented in Table.\u003c/p\u003e\n\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003eStudy design\u003c/h2\u003e\n \u003cp\u003eThis study adopted a descriptive phenomenological design guided by Husserl\u0026apos;s philosophy. Descriptive phenomenology was selected to bracket researchers\u0026apos; preconceptions and faithfully capture participants\u0026apos; lived experiences without imposing external theoretical frameworks. This approach is well-suited to uncovering the essence of how perceived lack of social support is experienced, amplified, and transformed into chronic burnout in everyday ED practice. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eSetting and recruitment\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in the emergency department (ED) of a tertiary Grade-A general hospital in Shenzhen, Guangdong Province, China. This setting represents a typical high-volume urban healthcare environment where newly graduated nurses (NGNs) routinely undertake the transition from student to professional practitioner. Purposive sampling was employed to recruit participants who could provide rich descriptions of the phenomenon. Inclusion criteria were: (1) registered nurses within 12 months of graduation; (2) currently working full-time in the ED; and (3) willing to share their experiences. Exclusion criteria included visiting or trainee nurses and those on leave during the study period. Recruitment occurred between July and October 2025. Twenty NGNs participated. Data saturation was reached after the 17th interview; two additional interviews confirmed saturation. Participant demographics are presented in Table \u003cspan refid=\"Tab1\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" width=\"561\" height=\"703\"\u003e\u003c/p\u003e\n\u003ch3\u003eInterview guide\u003c/h3\u003e\n\u003cp\u003eA semi-structured interview guide was developed specifically for this study based on a review of the relevant literature and the research objectives. The guide was pilot-tested with two newly graduated nurses who were not included in the final sample and was refined accordingly. The final interview guide is provided as Supplementary File 1. The guide explored five key domains: critical incidents of exhaustion, subjective experiences of support deficits, emotional progression during shifts, impacts on professional identity, and coping strategies. Example questions included: \u0026ldquo;Can you describe a recent situation in which you felt most exhausted or unsupported?\u0026rdquo; Probing questions encouraged deeper reflection on bodily sensations, emotions, and thoughts.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eAll interviews were conducted face-to-face in a private, quiet hospital room to ensure confidentiality. Each session lasted 35\u0026ndash;45 minutes, was audio-recorded with consent, and included notes on non-verbal cues such as facial expressions, tone, and pauses. The first author (with eight years of ED nursing experience) led the interviews, supported by a second researcher trained in qualitative methods. Verbatim transcripts were prepared within 48 hours and returned to participants for member checking. In total, 20 interviews generated approximately 980 minutes of audio data.\u003c/p\u003e\n\u003cdiv id=\"Sec7\"\u003e\n \u003ch2\u003eData analysis\u003c/h2\u003e\n \u003cp\u003eQualitative data were managed and analyzed using NVivo software (version 11.0, QSR International) to facilitate systematic coding, theme clustering, and retrieval of raw interview excerpts. Colaizzi\u0026rsquo;s seven-step phenomenological method was applied:\u003csup\u003e[\u003cspan citationid=\"CR17\"\u003e17\u003c/span\u003e]\u003c/sup\u003e: (1) repeated reading of transcripts to grasp the overall sense; (2) extraction of significant statements; (3) formulation of meanings; (4) clustering of meanings into themes; (5) development of exhaustive descriptions; (6) integration into the fundamental structure; and (7) validation through member checking. Three researchers independently coded initial transcripts and reached consensus through iterative discussion, ensuring the analysis remained grounded in participants\u0026rsquo; voices.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\"\u003e\n \u003ch2\u003eEthical considerations\u003c/h2\u003e\n \u003cp\u003eThe study received ethical approval from the Institutional Review Board of Peking University Shenzhen Hospital (Approval No. 2025\u0026thinsp;\u0026minus;\u0026thinsp;279) and complied with the Declaration of Helsinki. Written informed consent was obtained from all participants, who were assured of their right to withdraw at any time without repercussions. Data were anonymized using codes (N1\u0026ndash;N20) and stored securely.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eTrustworthiness and reflexivity\u003c/h3\u003e\n\u003cp\u003eTrustworthiness was established according to Lincoln and Guba\u0026rsquo;s criteria. Credibility was strengthened by prolonged engagement, member checking (accuracy\u0026thinsp;\u0026gt;\u0026thinsp;92%), and peer debriefing. Transferability was supported by thick contextual descriptions. Dependability and confirmability were maintained through a detailed audit trail and reflexive journaling. The primary researcher actively bracketed her own ED nursing background to minimize bias and preserve participants\u0026rsquo; perspectives.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFour core themes with nine sub-themes emerged, illustrating how perceived lack of social support is experienced and progressively amplified into chronic burnout (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThemes and sub-themes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1. The shock of invisible isolation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1 Sudden abandonment in crises\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.2 Fear of \"bothering\" others\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2. The silent spiral of emotional and physical exhaustion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.1 Accumulation of unspoken fatigue\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.2 Sleep disruption and somatic complaints\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3. The erosion of professional identity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.1 Self-doubt and depersonalization\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.2 Diminished sense of accomplishment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4. Fragile seeds of resilience in silence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.1 Self-protective internal strategies\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.2 Quiet hope for systemic change\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: The shock of invisible isolation\u003c/h2\u003e \u003cp\u003e Participants frequently described an acute, visceral sense of isolation during high-stakes clinical events, even when colleagues were physically nearby.\u003c/p\u003e \u003cp\u003e \u003cb\u003e1.1 Sudden abandonment in crises\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN3 (Female, 6 months): \u0026ldquo;During a cardiac arrest at 3 a.m., I was compressing alone for over 30 minutes while the senior nurse handled another case. I desperately wanted to call for help, but the thought \u0026lsquo;they are already overwhelmed-asking would make me a burden\u0026rsquo; stopped me. The isolation hit like a wave; I felt completely invisible in a room full of people.\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e1.2 Fear of \"bothering\" others\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN12 (Male, 4 months): \u0026ldquo;After managing a violent patient alone, no one came to check on me. I handled the documentation and decontamination by myself. The silence afterwards was deafening. I wanted debriefing but feared it would signal weakness.\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThese repeated experiences of being left to manage alone reinforced the conviction that support was available only upon explicit request - a request NGNs were often reluctant to make.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: The silent spiral of emotional and physical exhaustion\u003c/h2\u003e \u003cp\u003eThe perceived absence of support created a self-perpetuating loop in which unvoiced fatigue accumulated rapidly across shifts.\u003c/p\u003e \u003cp\u003e \u003cb\u003e2.1 Accumulation of unspoken fatigue\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN7 (Female, 9 months): \u0026ldquo;After night shifts, I would go home physically drained but mentally replaying every decision I made alone. No one ever asked how I was coping, so I stayed silent. Sleep became impossible\u0026mdash;I\u0026rsquo;d lie awake worrying about the next shift, waking exhausted and even less able to handle the workload. The fatigue snowballed until my body simply refused to recover.\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e2.2 Sleep disruption and somatic complaints\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN15 (Female, 11 months): \u0026ldquo;My shoulders and back ache constantly from tension. I know it\u0026rsquo;s stress-related, but admitting it feels like complaining. So I swallow painkillers and push on. Over weeks, the exhaustion moves from \u0026lsquo;tired after work\u0026rsquo; to \u0026lsquo;permanently drained\u0026rsquo;, affecting concentration, empathy, and overall functioning.\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003cp\u003eEach unvoiced need deepened the perception of isolation, intensifying physiological stress responses and creating a pathway from acute episodes to chronic burnout.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: The erosion of professional identity\u003c/h2\u003e \u003cp\u003eAs the cycle persisted, perceived support deficits gradually undermined participants\u0026rsquo; sense of competence and professional purpose.\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.1 Self-doubt and depersonalization\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN9 (Male, 8 months): \"In school I dreamed of saving lives in the ED. Now, after handling complex cases without validation or shared reflection, I question every action. Success feels hollow because no one acknowledges it; failure feels devastating because I bear it alone. I started feeling like an imposter pretending to be a real nurse.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.2 Diminished sense of accomplishment\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN4 (Female, 3 months): \"Patients still thank me, but inside I feel numb. The emotional weight of families in crisis used to motivate me; now I just go through motions. Without anyone to share the burden or affirm my efforts, nursing began to lose its meaning.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4: Fragile seeds of resilience in silence\u003c/h2\u003e \u003cp\u003eEven amid the burnout trajectory, participants revealed subtle internal resources and quiet hopes.\u003c/p\u003e \u003cp\u003e \u003cb\u003e4.1 Self-protective internal strategies\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN18 (Female, 10 months): \u0026ldquo;I started a private note on my phone listing \u0026lsquo;things I managed today without help\u0026rsquo;. No one sees it, but reviewing it reminds me of my strength and helps me get through bad days.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e4.2 Quiet hope for systemic change\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN6 (Male, 7 months): \u0026ldquo;Deep down I hope the department will eventually notice that new nurses need quiet, proactive support. I\u0026rsquo;m holding on because I still believe things can improve\u0026mdash;perhaps one day I can become the support someone else needs.\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFundamental Structure of the Phenomenon\u003c/h2\u003e \u003cp\u003eThe lived experience of occupational burnout in this context constitutes a silent, self-amplifying cycle: invisible isolation \u0026rarr; accumulation of unspoken fatigue \u0026rarr; erosion of professional identity. This cycle is propelled by the deeply held perception that support is contingent upon active solicitation. Reinforced repeatedly during critical clinical moments (e.g., resuscitations, night shifts, violent incidents), the process is deeply embedded in professional norms that prize self-sufficiency, rendering burnout both insidious and culturally patterned.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eInterpretation of Findings\u003c/h2\u003e \u003cp\u003eThis phenomenological study illuminates the micro-processes through which perceived lack of social support is subjectively experienced, amplified, and progressively transformed into chronic occupational burnout among ED NGNs. By focusing on lived daily clinical realities rather than aggregate scores, the findings extend previous quantitative association\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e and provide mechanistic depth regarding the process of burnout development.\u003c/p\u003e \u003cp\u003eThe theme \"shock of invisible isolation\" aligns with Duchscher's transition shock theory, which describes the initial stage of role adaptation as marked by anxiety, insecurity, and instability\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. However, our participants' accounts reveal how this shock is powerfully mediated by perceived rather than actual support deficits. This is a phenomenon influenced by professional socialization norms that valorize self-sufficiency, where seeking assistance may be inadvertently perceived as a limitation in clinical competence\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Each unassisted critical event reinforces the internal narrative \"support is not there for me unless I ask,\" rapidly depleting emotional resources in line with Hobfoll's Conservation of Resources (COR) theory\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Resource loss spirals ensue because silence prevents replenishment, turning isolated incidents into cumulative exhaustion.\u003c/p\u003e \u003cp\u003eThe \"silent spiral of emotional and physical exhaustion \" vividly demonstrates the somatic pathway often underemphasized in burnout literature. Repeated failure to receive unsolicited support leads to rumination, sleep disruption, and chronic fatigue - mechanisms that convert acute post-shift tiredness into persistent physiological burden\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. This amplification occurs daily: night-shift solitude heightens vigilance, unprocessed emotions impair recovery sleep, and resulting daytime impairment further erodes confidence, creating a self-perpetuating loop.\u003c/p\u003e \u003cp\u003eThe theme \"erosion of professional identity\" represents the chronic phase of the burnout trajectory and extends current understanding of identity formation in NGNs. Earlier research has documented diminished personal accomplishment and depersonalization among new nurses\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, but primarily as outcomes of heavy workload or inadequate orientation programs. Our analysis demonstrates that perceived lack of support functions as a pivotal mediator: without external validation or shared reflection, even successful clinical encounters lose meaning, gradually solidifying transient self-doubt into a stable negative professional self-concept.\u003c/p\u003e \u003cp\u003eA distinctive contribution of this study lies in the theme \"fragile seeds of resilience in silence.\" While most burnout research focuses on risk factors, our participants spontaneously described private coping strategies and latent hope for systemic change. These elements suggest that burnout is not inevitable and offer clear entry points for intervention.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Practice and Research\u003c/h2\u003e \u003cp\u003eThese mechanisms point toward a clear shift in organizational approaches- from passive, help-seeking-dependent models to proactive, low-threshold support systems. Practical strategies include scheduled non-intrusive check-ins, automated post-event debrief prompts, emotional intelligence training, sleep hygiene education, reflective journaling, and team-based psychological safety programs that normalize help-seeking as a professional strength rather than a weakness. Future multi-center, mixed-methods studies are warranted to evaluate the feasibility, scalability, and effectiveness of such interventions across diverse ED settings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe single-center design in one Chinese city may limit transferability to other regions or healthcare systems. Purposive sampling could have favored more reflective participants. As with all phenomenological research, findings represent co-constructed interpretations rather than absolute truths. Cross-cultural and multi-center studies would further strengthen generalizability.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study reveals that perceived lack of social support among ED NGNs is a dynamic process leading to chronic burnout through invisible isolation and professional identity erosion. Findings advocate shifting from passive, help-seeking models to proactive, low-threshold support systems. Implementing such strategies promises to reduce burnout, support sustainable nursing workforces, and improve patient outcomes in demanding ED settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank the emergency department nurses at Peking University Shenzhen Hospital for their willingness to participate. We also acknowledge Editage \u003cu\u003e(www.editage.cn)\u003c/u\u003e for professional English language editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSH, YZ, WZ, and LL conceptualized the study. SH, YZ, and LL were responsible for data collection. SH and YZ performed data analysis. SH acquired funding and managed the overall project. All authors contributed to methodology, validation, drafting and revising the manuscript, and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no specific funding\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to the sensitive nature of qualitative interview data but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Review Committee of Peking University Shenzhen Hospital (Approval No. 2025-279) and adhered to the principles of the Helsinki Declaration. All participants provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Emergency Department, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDUCHSCHER JE, PAINTER S. Proceed with caution: Integrating newly graduated nurses into an emergency department[J]. Adv Emerg Nurs J. 2021;43(1):53\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHAN P, SUN Y, CHEN H, et al. The early career resilience experience of Generation Z newly graduated registered nurses in standardized training in the emergency department: A qualitative study in Shanghai[J]. BMC Nurs. 2024;23(1):391.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYU C, JIANG J, ZHONG M, et al. Training load of newly recruited nurses in Grade-A tertiary hospitals in Shanghai, China: A qualitative study[J]. BMC Nurs. 2023;22(1):9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZHANG R, SHAO D, HUANG H, et al. Dilemmas and strategies in the working experience of resident training nurses rotated in the intensive care unit: A qualitative study[J]. BMC Nurs. 2025;24(1):1302.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAL-HELLO L, ERVASTI J, HAAPA T, et al. Interventions promoting work engagement and reducing turnover of newly graduated nurses: A systematic review[J]. Nurs Open. 2026;13(2):e70434.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHITEHEAD I O HANRATTYB. I clearly have some wiring that's not quite right: How general practitioners with lived experience of burnout describe personal factors related to their burnout: A qualitative study using in-depth interviews[J]. Fam Pract, 2026, 43(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCOGAN N, SMITH M. DEAKIN K. Psychological safety as a predictor of acute stress, well-being and burnout in health and social care workers: A predictive correlational study[J]. Behav Sci (Basel), 2026, 16(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNEVEU JP. Measuring motivational patterns: A formal approach of Conservation of Resources Theory[J]. Nonlinear Dyn Psychol Life Sci. 2025;29(3):431\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJIANG SF, WANG K N ZHANGS, et al. The mediating role of psychological resilience in the relationship between frailty and self-efficacy among dialysis patients[J]. Front Psychiatry. 2025;16:1542031.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGONG S, LI J, TANG X, et al. Associations among professional quality of life dimensions, burnout, nursing practice environment, and turnover intention in newly graduated nurses[J]. Worldviews Evid Based Nurs. 2022;19(2):138\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eISHIHARA I, ISHIBASHI Y, TAKAHASHI K, et al. Effect of organizational factors and work environments on newly graduated nurses' intention to leave[J]. Jpn J Nurs Sci. 2014;11(3):200\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFORSMAN H, RUDMAN A, GUSTAVSSON P, et al. Nurses' research utilization two years after graduation: A national survey of associated individual, organizational, and educational factors[J]. Implement Sci. 2012;7:46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZHANG Y, QIAN Y, WU J, et al. The effectiveness and implementation of mentoring programs for newly graduated nurses: A systematic review[J]. Nurse Educ Today. 2016;37:136\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMASLACH C, LEITER M P. Understanding the burnout experience: Recent research and its implications for psychiatry[J]. World Psychiatry. 2016;15(2):103\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eASSEIRI W, REIS J, OMURA M, et al. The experience of transition from student nurse to registered nurse among newly graduated nurses in the paediatric setting: An integrative literature review[J]. Nurse Educ Pract. 2025;83:104252.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLINDFORS K, KAUNONEN M, HUHTALA H, et al. Newly graduated nurses' evaluation of the received orientation and their perceptions of the clinical environment: An intervention study[J]. Scand J Caring Sci. 2022;36(1):59\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEDWARD K L, WELCH T. The extension of Colaizzi's method of phenomenological enquiry[J]. Contemp Nurse. 2011;39(2):163\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJACOBS S, MOLONEY W. TERRY D, Creating organisational working conditions where nurses can thrive: An international action research study[J]. Nurs Rep, 2025, 15(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCUSACK L, MADSEN L, DUCHSCHER JB et al. Growth and adaptation of newly graduated nurses based on Duchscher's stages of transition theory and transition shock model: A longitudinal quantitative study[J]. Nurs Rep, 2025, 15(12).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDUCHSCHER JE. Transition shock: The initial stage of role adaptation for newly graduated registered nurses[J]. J Adv Nurs. 2009;65(5):1103\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHOBFOLL S E. Conservation of resources: A new attempt at conceptualizing stress[J]. Am Psychol. 1989;44(3):513\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSALVAGIONI D A J, MELANDA F N, MESAS A E, et al. Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies[J]. PLoS ONE. 2017;12(10):e0185781.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRUSH K L, ADAMACK M. Best practices of formal new graduate nurse transition programs: An integrative review[J]. Int J Nurs Stud. 2013;50(3):345\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Emergency department, Newly graduated nurses, Occupational burnout, Social support, Qualitative research","lastPublishedDoi":"10.21203/rs.3.rs-9324652/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9324652/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNewly graduated nurses (NGNs) in emergency departments (EDs) face a high risk of occupational burnout. Although social support is known to be protective, NGNs\u0026rsquo; reluctance to voice needs often results in perceived lack of support, potentially exacerbating burnout. The mechanisms through which this perception develops into chronic burnout remain unclear. This study explored the lived experiences of occupational burnout among ED NGNs who perceived insufficient social support.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA descriptive phenomenological design guided by Husserl's philosophy was adopted. Twenty NGNs were purposively recruited from the ED of a tertiary hospital in Shenzhen, China. Semi-structured in-depth interviews were conducted until data saturation was reached. Data were analyzed using Colaizzi's seven-step method. Trustworthiness was ensured through member checking and triangulation. Ethical approval was obtained from the hospital's Institutional Review Board (Approval No. 2025\u0026thinsp;\u0026minus;\u0026thinsp;279).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFour interrelated themes emerged, illustrating a self-reinforcing cycle: (1) the shock of invisible isolation; (2) the silent spiral of emotional and physical exhaustion; (3) the erosion of professional identity; and (4) fragile seeds of resilience in silence. Perceived lack of support was experienced as contingent upon explicit help-seeking, transforming acute transition stress into chronic burnout.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePerceived insufficient social support acts as a critical catalyst in the development of occupational burnout among newly graduated emergency nurses, progressively undermining their professional identity and psychological well-being. Healthcare organizations should therefore transition from passive, request-based support to proactive, systematically embedded intervention frameworks that foster psychological safety and promote sustainable career development.\u003c/p\u003e\u003ch2\u003eClinical trial number:\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Lived Experiences of Occupational Burnout Among Newly Graduated Emergency Department Nurses Perceiving Insufficient Social Support: A Descriptive Phenomenological Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-06 12:22:35","doi":"10.21203/rs.3.rs-9324652/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"296914477884157882288335305605582393739","date":"2026-05-07T10:04:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80630209339977569602024429758962717562","date":"2026-05-06T21:20:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-28T10:18:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-26T21:44:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-09T09:51:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-09T05:30:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-04-09T05:25:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d5ad9f6-9c84-4884-80bd-76b61653f6ae","owner":[],"postedDate":"May 6th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"296914477884157882288335305605582393739","date":"2026-05-07T10:04:40+00:00","index":60,"fulltext":""},{"type":"reviewerAgreed","content":"80630209339977569602024429758962717562","date":"2026-05-06T21:20:33+00:00","index":59,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T12:22:35+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-06 12:22:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9324652","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9324652","identity":"rs-9324652","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}