Lived Experiences of Quiet Quitting Among ICU Nurses: A Sequential Explanatory Mixed Methods Study
-
Walaa Yehya Abed Zead
,
Saleh Ali Abdulrasool
,
Ehab Al-Din Haider Saddam
,
Ali Alaa Al-hashimi
,
Rabab Khalil Ibrahim
Abstract
Objective: To examine the relationships among quality of work life (QWL), compassion fatigue, psychological resilience, and quiet quitting among intensive care unit (ICU) nurses, and to explore the lived experiences of nurses who exhibit quiet quitting behavior.
Method: A sequential explanatory mixed-methods design was employed. In the quantitative phase, 400 ICU nurses from six public teaching hospitals in Kerbala and Babylon, Iraq, completed the QWL Scale, Compassion Fatigue Short Scale, Connor-Davidson Resilience Scale (CD-RISC), and Quiet Quitting Scale. Data were analyzed using mediation analysis with PROCESS macro. In the qualitative phase, 30 nurses were purposively selected for in-depth semi-structured interviews based on their quiet quitting scores. Thematic analysis was used to identify key themes.
Results: QWL was negatively associated with quiet quitting (β = -0.38, P < 0.001) and compassion fatigue (β = -0.41, P < 0.001), while compassion fatigue was positively associated with quiet quitting (β = 0.42, P < 0.001). Compassion fatigue significantly mediated the relationship between QWL and quiet quitting (indirect effect = -0.14, 95% CI: -0.19 to -0.09), accounting for 43.8% of the total effect. Psychological resilience moderated the QWL-compassion fatigue relationship (interaction β = 0.18, P < 0.01). Qualitative analysis revealed three major themes: erosion of professional identity and meaning, surviving versus thriving in the ICU environment, and the paradox of resilience.
Conclusion: Poor QWL was associated with quiet quitting through increased compassion fatigue, while psychological resilience appeared to serve as a protective factor. The qualitative findings provide rich contextual understanding of the processes underlying quiet quitting. Organizational strategies that improve working conditions, foster resilience, and restore professional meaning may help sustain nurses' work engagement and reduce quiet quitting.
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6. Xie W, Chen L, Feng F, Okoli CTC, Tang P, Zeng L, et al. The prevalence of compassion satisfaction and compassion fatigue among nurses: A systematic review and meta-analysis. Int J Nurs Stud. 2021;120:103973.
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9. Al-Otaibi H, Kerari A. Quality of Nursing Work Life, Compassion Fatigue, and Self-Efficacy Among Primary Care Nurses in Saudi Arabia. Healthcare (Basel). 2025;13(15).
10. Chen X, Li J, Arber A, Qiao C, Wu J, Sun C, et al. The impact of the nursing work environment on compassion fatigue: The mediating role of general self-efficacy. Int Nurs Rev. 2025;72(2):e13044.
11. Koçak O, Boz C, Aksoy B, Aksan E, Özişli Ö, Solmaz U. The impact of quality of work life on quiet quitting in healthcare workers: The mediating and moderating effects of compassion fatigue and psychological resilience. Work. 2026;84(2):551-61.
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13. Chen SY, Yan SR, Zhao WW, Gao Y, Zong W, Bian C, et al. The mediating and moderating role of psychological resilience between occupational stress and mental health of psychiatric nurses: a multicenter cross-sectional study. BMC Psychiatry. 2022;22(1):823.
14. Mirzaei Dahka S, Maroufizadeh S, Pouralizadeh M, Zahedsefat T, Ghanbarpoor Ganjari M, Parsasalkisari E, et al. Mental Health and Resilience among Nurses in the COVID-19 Pandemic: A Web-Based Cross-Sectional Study. Iran J Psychiatry. 2022;17(1):35-43.
15. Fu C, Wang Y, Shi X, Wang Y, Liu W, Wang G. Influence of psychological resilience on compassion fatigue in nurses in the operating room: a cross-sectional study in China. BMC Nurs. 2025;24(1):90.
16. Chen M, Xie H, Liao X, Ni J. Workplace violence and turnover intention among Chinese nurses: the mediating role of compassion fatigue and the moderating role of psychological resilience. BMC Public Health. 2024;24(1):2437.
17. Prapanjaroensin A, Patrician PA, Vance DE. Conservation of resources theory in nurse burnout and patient safety. J Adv Nurs. 2017;73(11):2558-65.
18. Sorenson C, Bolick B, Wright K, Hamilton R. Understanding Compassion Fatigue in Healthcare Providers: A Review of Current Literature. J Nurs Scholarsh. 2016;48(5):456-65.
19. Yee A, Kauric-Klein Z. Managing Compassion Fatigue in Intensive Care Unit Nurses: A Systematic Review. Dimens Crit Care Nurs. 2025;44(3):145-58.
20. Yi L, Hu S, Liao M, Cheng L, Liu Y, Tian X, et al. Prevalence and related factors of compassion fatigue among registered nurses and nursing students during the internship: a systematic review and meta-analysis. BMC Nurs. 2024;23(1):956.
21. Venkatesh V, Brown SA, Sullivan YW. Guidelines for conducting mixed-methods research: An extension and illustration. Journal of the Association for Information systems. 2016;17(7):2.
22. Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs—principles and practices. Health Serv Res. 2013;48(6pt2):2134-56.
23. Liu Y. Paradigmatic compatibility matters: A critical review of qualitative-quantitative debate in mixed methods research. Sage Open. 2022;12(1):21582440221079922.
24. Jalali R, Fatahi S, Kolehjoubi AA. Quiet quitting in nursing: a concept analysis. BMC Nurs. 2026;25(1):163.
25. Liu Y. Paradigmatic compatibility matters: A critical review of qualitative-quantitative debate in mixed methods research. Sage Open. 2022;12(1):21582440221079922.
26. Hamzaa HG, Abdelaal MH, Hussein Ramadan Atta M, Abdelnaby HSM, Othman AA. Analysis of Compassion Fatigue Among Psychiatric Nurses and Its Effect on Spiritual and Competent Care. J Psychiatr Ment Health Nurs. 2025;32(4):986-97.
27. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76-82.
28. Alfuqaha OA. Validating the Arabic version of the Connor-Davidson resilience scale among university students. PLoS One. 2023;18(10):e0293384.
29. Bizri M, Ibrahim N, Beyrouthy C, Yamout D, Tamim H, Abiad J, et al. Psychometric properties of the Arabic version of Connor-Davidson Resilience Scale in a sample of Lebanese women. PLoS One. 2022;17(6):e0269700.
30. El-Sayed BKM, Asal MGR, El-Sayed AAI. Navigating Quiet Quitting Among Critical Care Nurses in the Digital Era: The Impact of Techno-Stress and Digital Resilience. Nurs Crit Care. 2026;31(1):e70273.
31. Alhammadi HY, Ban-Melhem S, Almazrouei S, Al-Hawari MA, Mohd-Shamsudin F, Saud J. Compassion at work: a catalyst for servant leadership and reducing employee quiet quitting behaviors. Management Research Review. 2026;49(4):448-67.
32. Danacı E, Arıca E, Erdoğan TK. The Relationship Between Stress of Conscience and Quiet Quitting in Nurses: The Mediating Role of Compassion Fatigue. Healthcare (Basel). 2026;14(3).
33. Moisoglou I, Katsiroumpa A, Katsapi A, Konstantakopoulou O, Galanis P. Poor Nurses' Work Environment Increases Quiet Quitting and Reduces Work Engagement: A Cross-Sectional Study in Greece. Nurs Rep. 2025;15(1).
34. Al Yahyaei A, Al Kindi Z, Al Sabei S, Al Hasni N, Al Jabri W, Muliira J. Moderating role of resilience on professional quality of life, stress and turnover intention among oncology nurses. BMC Nurs. 2025;24(1):692.
35. Lee HE, Kim H, Kim JS, Ryu E. Moral distress and quality of nursing work life: Mediating roles of compassion fatigue and resilience. Nurs Ethics. 2026:9697330261465731.
36. Fida R, Tramontano C, Paciello M, Kangasniemi M, Sili A, Bobbio A, et al. Nurse moral disengagement. Nurs Ethics. 2016;23(5):547-64.
37. Talebian F, Vejdani H, Sanagoo A, Jouybari L. Lived Experiences of Moral Disengagement Among Intensive Care and Emergency Department Nurses: A Phenomenological Study. SAGE Open Nurs. 2025;11:23779608251395004.
38. He J, Zhang Y, Zhang F, Yang X, Zhang X. Analysis of the current situation of ICU nurses' moral disengagement and influencing factors. BMC Med Ethics. 2025;26(1):80.
39. Juanfeng H, Ke K, Yalin Z, Pan L, Xi Z. The mediating role of ICU nurses' moral disengagement between moral resilience and moral distress. BMC Nurs. 2026;25(1).
40. Zhang X, Huang H, Du H, Li D. Mitigating the impact of emotional exhaustion among young intensive care unit nurses: A structural equation model based on the conservation of resources theory. Nurs Crit Care. 2025;30(5):e13266.
41. Sarwar A, Abdullah MI, Hafeez H, Chughtai MA. How Does Workplace Ostracism Lead to Service Sabotage Behavior in Nurses: A Conservation of Resources Perspective. Front Psychol. 2020;11:850.
42. Aljohani NHZ, Alotibi AM, Aldhabi AA, Alotibi NMH. Impact of resilience and wellbeing program in nursing: an integrative review. BMC Nurs. 2025;25(1):14.
43. Mohammadi MR, Khaleghi A, Mostafavi SA, Ahmadi N, Kamali K, Hooshyari Z, et al. Gender Determines the Pattern of Correlation between Body Mass Index and Major Depressive Disorder among Children and Adolescents: Results from Iranian Children and Adolescents' Psychiatric Disorders Study. Child Obes. 2019;15(5):331-7.
44. Mohammadi MR, Mostafavi SA, Hooshyari Z, Khaleghi A, Ahmadi N. Body Mass Index Status across Different Psychiatric Disorders in a National Survey amongst Children and Adolescents: To Identify the Role of Gender. Iran J Psychiatry. 2019;14(4):253-64.
2. Geng R, Geng X, Geng S. Identifying Key Antecedents of Quiet Quitting Among Nurses: A Cross-Profession Meta-Analytic Review. J Adv Nurs. 2026;82(1):913-33.
3. Galanis P, Katsiroumpa A, Vraka I, Siskou O, Konstantakopoulou O, Katsoulas T, et al. Nurses quietly quit their job more often than other healthcare workers: An alarming issue for healthcare services. Int Nurs Rev. 2024;71(4):850-9.
4. Galanis P, Katsiroumpa A, Vraka I, Siskou O, Konstantakopoulou O, Katsoulas T, et al. The Influence of Job Burnout on Quiet Quitting Among Nurses: The Mediating Effect of Job Satisfaction. Int J Nurs Pract. 2025;31(5):e70057.
5. Galanis P, Katsiroumpa A, Vraka I, Siskou O, Konstantakopoulou O, Katsoulas T, et al. The Influence of Job Burnout on Quiet Quitting Among Nurses: The Mediating Effect of Job Satisfaction. Int J Nurs Pract. 2025;31(5):e70057.
6. Xie W, Chen L, Feng F, Okoli CTC, Tang P, Zeng L, et al. The prevalence of compassion satisfaction and compassion fatigue among nurses: A systematic review and meta-analysis. Int J Nurs Stud. 2021;120:103973.
7. Xie W, Chen L, Feng F, Okoli CTC, Tang P, Zeng L, et al. The prevalence of compassion satisfaction and compassion fatigue among nurses: A systematic review and meta-analysis. Int J Nurs Stud. 2021;120:103973.
8. Özan A, Polat H. Determination of Compassion and Compassion Fatigue in Intensive Care Nurses. SAGE Open Nurs. 2024;10:23779608241247395.
9. Al-Otaibi H, Kerari A. Quality of Nursing Work Life, Compassion Fatigue, and Self-Efficacy Among Primary Care Nurses in Saudi Arabia. Healthcare (Basel). 2025;13(15).
10. Chen X, Li J, Arber A, Qiao C, Wu J, Sun C, et al. The impact of the nursing work environment on compassion fatigue: The mediating role of general self-efficacy. Int Nurs Rev. 2025;72(2):e13044.
11. Koçak O, Boz C, Aksoy B, Aksan E, Özişli Ö, Solmaz U. The impact of quality of work life on quiet quitting in healthcare workers: The mediating and moderating effects of compassion fatigue and psychological resilience. Work. 2026;84(2):551-61.
12. Stankovic M, Slavkovic M. Quality of Work Life Determinants of Healthcare Professionals' Quiet Quitting: Towards Individual Difference. Healthcare (Basel). 2025;13(13).
13. Chen SY, Yan SR, Zhao WW, Gao Y, Zong W, Bian C, et al. The mediating and moderating role of psychological resilience between occupational stress and mental health of psychiatric nurses: a multicenter cross-sectional study. BMC Psychiatry. 2022;22(1):823.
14. Mirzaei Dahka S, Maroufizadeh S, Pouralizadeh M, Zahedsefat T, Ghanbarpoor Ganjari M, Parsasalkisari E, et al. Mental Health and Resilience among Nurses in the COVID-19 Pandemic: A Web-Based Cross-Sectional Study. Iran J Psychiatry. 2022;17(1):35-43.
15. Fu C, Wang Y, Shi X, Wang Y, Liu W, Wang G. Influence of psychological resilience on compassion fatigue in nurses in the operating room: a cross-sectional study in China. BMC Nurs. 2025;24(1):90.
16. Chen M, Xie H, Liao X, Ni J. Workplace violence and turnover intention among Chinese nurses: the mediating role of compassion fatigue and the moderating role of psychological resilience. BMC Public Health. 2024;24(1):2437.
17. Prapanjaroensin A, Patrician PA, Vance DE. Conservation of resources theory in nurse burnout and patient safety. J Adv Nurs. 2017;73(11):2558-65.
18. Sorenson C, Bolick B, Wright K, Hamilton R. Understanding Compassion Fatigue in Healthcare Providers: A Review of Current Literature. J Nurs Scholarsh. 2016;48(5):456-65.
19. Yee A, Kauric-Klein Z. Managing Compassion Fatigue in Intensive Care Unit Nurses: A Systematic Review. Dimens Crit Care Nurs. 2025;44(3):145-58.
20. Yi L, Hu S, Liao M, Cheng L, Liu Y, Tian X, et al. Prevalence and related factors of compassion fatigue among registered nurses and nursing students during the internship: a systematic review and meta-analysis. BMC Nurs. 2024;23(1):956.
21. Venkatesh V, Brown SA, Sullivan YW. Guidelines for conducting mixed-methods research: An extension and illustration. Journal of the Association for Information systems. 2016;17(7):2.
22. Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs—principles and practices. Health Serv Res. 2013;48(6pt2):2134-56.
23. Liu Y. Paradigmatic compatibility matters: A critical review of qualitative-quantitative debate in mixed methods research. Sage Open. 2022;12(1):21582440221079922.
24. Jalali R, Fatahi S, Kolehjoubi AA. Quiet quitting in nursing: a concept analysis. BMC Nurs. 2026;25(1):163.
25. Liu Y. Paradigmatic compatibility matters: A critical review of qualitative-quantitative debate in mixed methods research. Sage Open. 2022;12(1):21582440221079922.
26. Hamzaa HG, Abdelaal MH, Hussein Ramadan Atta M, Abdelnaby HSM, Othman AA. Analysis of Compassion Fatigue Among Psychiatric Nurses and Its Effect on Spiritual and Competent Care. J Psychiatr Ment Health Nurs. 2025;32(4):986-97.
27. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76-82.
28. Alfuqaha OA. Validating the Arabic version of the Connor-Davidson resilience scale among university students. PLoS One. 2023;18(10):e0293384.
29. Bizri M, Ibrahim N, Beyrouthy C, Yamout D, Tamim H, Abiad J, et al. Psychometric properties of the Arabic version of Connor-Davidson Resilience Scale in a sample of Lebanese women. PLoS One. 2022;17(6):e0269700.
30. El-Sayed BKM, Asal MGR, El-Sayed AAI. Navigating Quiet Quitting Among Critical Care Nurses in the Digital Era: The Impact of Techno-Stress and Digital Resilience. Nurs Crit Care. 2026;31(1):e70273.
31. Alhammadi HY, Ban-Melhem S, Almazrouei S, Al-Hawari MA, Mohd-Shamsudin F, Saud J. Compassion at work: a catalyst for servant leadership and reducing employee quiet quitting behaviors. Management Research Review. 2026;49(4):448-67.
32. Danacı E, Arıca E, Erdoğan TK. The Relationship Between Stress of Conscience and Quiet Quitting in Nurses: The Mediating Role of Compassion Fatigue. Healthcare (Basel). 2026;14(3).
33. Moisoglou I, Katsiroumpa A, Katsapi A, Konstantakopoulou O, Galanis P. Poor Nurses' Work Environment Increases Quiet Quitting and Reduces Work Engagement: A Cross-Sectional Study in Greece. Nurs Rep. 2025;15(1).
34. Al Yahyaei A, Al Kindi Z, Al Sabei S, Al Hasni N, Al Jabri W, Muliira J. Moderating role of resilience on professional quality of life, stress and turnover intention among oncology nurses. BMC Nurs. 2025;24(1):692.
35. Lee HE, Kim H, Kim JS, Ryu E. Moral distress and quality of nursing work life: Mediating roles of compassion fatigue and resilience. Nurs Ethics. 2026:9697330261465731.
36. Fida R, Tramontano C, Paciello M, Kangasniemi M, Sili A, Bobbio A, et al. Nurse moral disengagement. Nurs Ethics. 2016;23(5):547-64.
37. Talebian F, Vejdani H, Sanagoo A, Jouybari L. Lived Experiences of Moral Disengagement Among Intensive Care and Emergency Department Nurses: A Phenomenological Study. SAGE Open Nurs. 2025;11:23779608251395004.
38. He J, Zhang Y, Zhang F, Yang X, Zhang X. Analysis of the current situation of ICU nurses' moral disengagement and influencing factors. BMC Med Ethics. 2025;26(1):80.
39. Juanfeng H, Ke K, Yalin Z, Pan L, Xi Z. The mediating role of ICU nurses' moral disengagement between moral resilience and moral distress. BMC Nurs. 2026;25(1).
40. Zhang X, Huang H, Du H, Li D. Mitigating the impact of emotional exhaustion among young intensive care unit nurses: A structural equation model based on the conservation of resources theory. Nurs Crit Care. 2025;30(5):e13266.
41. Sarwar A, Abdullah MI, Hafeez H, Chughtai MA. How Does Workplace Ostracism Lead to Service Sabotage Behavior in Nurses: A Conservation of Resources Perspective. Front Psychol. 2020;11:850.
42. Aljohani NHZ, Alotibi AM, Aldhabi AA, Alotibi NMH. Impact of resilience and wellbeing program in nursing: an integrative review. BMC Nurs. 2025;25(1):14.
43. Mohammadi MR, Khaleghi A, Mostafavi SA, Ahmadi N, Kamali K, Hooshyari Z, et al. Gender Determines the Pattern of Correlation between Body Mass Index and Major Depressive Disorder among Children and Adolescents: Results from Iranian Children and Adolescents' Psychiatric Disorders Study. Child Obes. 2019;15(5):331-7.
44. Mohammadi MR, Mostafavi SA, Hooshyari Z, Khaleghi A, Ahmadi N. Body Mass Index Status across Different Psychiatric Disorders in a National Survey amongst Children and Adolescents: To Identify the Role of Gender. Iran J Psychiatry. 2019;14(4):253-64.
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| Compassion Fatigue Intensive Care Units Nurses Occupational Stress Psychological Resilience | ||
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How to Cite
1.
Abed Zead WY, Abdulrasool SA, Haider Saddam EA-D, Al-hashimi AA, Khalil Ibrahim R. Lived Experiences of Quiet Quitting Among ICU Nurses: A Sequential Explanatory Mixed Methods Study. Iran J Psychiatry. 2026;:1-14.
