Management strategies to mitigate burnout and turnover intention while enhancing patient safety in neonatal intensive care: an integrative review.

Background: Globally, the nursing workforce shortage in Neonatal Intensive Care Units (NICUs) is evolving into a critical public health challenge. NICU nurses face a dual burden of high technical demands and intensive emotional labor, making them a high-risk group for professional burnout. The occupational wellbeing of nurses not only impacts individual health but also directly correlates with the clinical safety outcomes of preterm and ill neonates through the "health impairment process." Objective: This study aims to introduce the Job Demands-Resources (JD-R) model as a systemic management diagnostic framework to comprehensively evaluate organizational management interventions targeting burnout, turnover intention, and patient safety among NICU nurses. The ultimate goal is to identify public health pathways that safeguard healthcare workforce sustainability and enhance patient safety. Methods: Adopting Whittemore and Knafl's integrative review framework and strictly following the PRISMA 2020 guidelines, we systematically searched PubMed, CINAHL, Web of Science, and Embase for original studies published between 2015 and 2025. The Joanna Briggs Institute (JBI) checklists were utilized for quality appraisal. The JD-R model was applied for deductive categorization and narrative synthesis of the interventions. Results: Fourteen original studies were included, 11 of which provided high-quality evidence. The findings revealed: (1) Optimization of job demands: Implementing flexible scheduling and Developmental Care Partners (DCP) reduced cognitive and physical loads, significantly mitigating burnout. (2) Enhancement of job resources: Mentoring programs, institutionalized career advancement pathways (e.g., ENNP roles), and participatory management strategies (e.g., "World Café" workshops) were identified as core drivers for increasing retention intentions. (3) Public health outcome linkage: Nurse burnout was positively correlated with healthcare-associated infection (HAI) rates. Strengthening nurse resilience through organizational resource injection proved to be an effective strategy for improving safety outcomes in vulnerable infant populations. Conclusions: NICU nursing management must transition from "individual crisis response" to "public health system governance." Resource building based on the JD-R model, including institutionalized career paths and psychological resilience support, functions not merely as a management tool but as a critical defensive strategy for the sustainable development of the healthcare workforce and the safety of newborns.