The study, led by Dikshya Adhikari and colleagues, was conducted as a hospital-based cross-sectional observational survey over a single month, from September to October 2024. The team recruited 242 health workers from selected hospitals in Pokhara, located in the Kaski district of Nepal. Participants completed a self-administered questionnaire designed to capture both the prevalence of burnout and a wide range of personal, job-related, and work-life balance characteristics. Rather than relying on a single generic measure, the researchers used the Oldenburg Burnout Inventory, a validated instrument that assesses burnout along two distinct dimensions: exhaustion, the physical and emotional depletion that builds up over time, and disengagement, the cynical distancing from the job that often follows.

The headline number was stark. Overall, 61.6 percent of the health workers screened positive for burnout. When the researchers examined the two subscales separately, the picture became even more alarming. Slightly more than three-quarters of participants, 76.4 percent, scored high on disengagement, while 71.9 percent showed high exhaustion. In other words, the majority of the hospital workforce in this Nepali city was not merely tired at the end of a long shift; they were simultaneously worn down and psychologically pulling away from the very work that defines their professional lives. That combination matters, because burnout in health workers has been linked in prior research to compromised patient safety and reduced patient satisfaction, in addition to the direct harm it does to the workers themselves.

To understand what was driving these numbers, the team first used chi-square tests to identify factors associated with burnout in simple comparisons, and then applied multivariate logistic regression to isolate the independent predictors while controlling for other variables. This statistical approach, which produces adjusted odds ratios with 95 percent confidence intervals, allows researchers to estimate how strongly each factor predicts burnout when everything else is held constant. Three factors emerged as significant. Health workers who reported insufficient sleeping hours at night had more than twice the odds of burnout compared with those who slept adequately, with an adjusted odds ratio of 2.292 and a confidence interval of 1.193 to 4.404.

The second significant predictor was job satisfaction. Workers who described their satisfaction with the job as poor had roughly three and a half times the odds of being burned out, with an adjusted odds ratio of 3.391 and a confidence interval of 1.286 to 8.943. This finding aligns with a broad international literature showing that burnout is not simply a matter of individual resilience or personal weakness; it is deeply tied to how people experience the conditions of their employment, including workload, recognition, autonomy, and the sense that their work has meaning. When satisfaction collapses, disengagement tends to follow, and the Oldenburg inventory’s high disengagement scores in this sample suggest exactly that trajectory.

The strongest single predictor, however, was work-life balance. Health workers who rated their balance between professional demands and personal life as poor had more than five times the odds of burnout, with an adjusted odds ratio of 5.187 and a confidence interval of 2.600 to 10.350. That effect size is striking even by the standards of occupational health research, and it suggests that in Pokhara’s hospitals, the erosion of any boundary between work and home life may be the central mechanism through which burnout takes hold. Long shifts, unpredictable rosters, and the chronic understaffing that characterizes many hospitals in low- and middle-income countries can leave workers with little protected time for rest, family, or recovery, and the sleep findings in this study fit neatly into that pattern.

The connection between insufficient sleep and burnout deserves particular attention because it points to a vicious cycle. Sleep deprivation impairs emotional regulation, cognitive performance, and physical health, all of which make the demands of clinical work harder to meet. As performance suffers and fatigue accumulates, exhaustion deepens and disengagement grows, which in turn can make it harder to rest and recover even when the opportunity arises. The fact that inadequate night-time sleep roughly doubled the odds of burnout in this sample, even after adjusting for job satisfaction and work-life balance, indicates that sleep is not merely a byproduct of a demanding schedule but an independent lever that interventions could target.

Burnout syndrome has attracted growing attention over the last three decades, and high levels have been reported among health workers globally, from emergency departments in Europe to rural clinics in sub-Saharan Africa. Nepal, the study’s authors note, is no exception, with hospital settings in particular showing concerning levels. Yet the researchers argue that burnout in the country has not received sufficient attention in the literature, and their study was designed to fill that gap by providing prevalence estimates and associated factors from a specific, well-defined hospital population. Cross-sectional designs like this one cannot prove that insufficient sleep or poor work-life balance cause burnout, since the data capture a single moment in time and the relationships could run in either direction, but the strength and consistency of the associations make a compelling case for action.

The practical implications are clear, and the authors are direct about them. Hospital administrators, policymakers, and health system leaders, they conclude, should prioritize interventions targeting burnout among health workers, with a particular focus on protecting work-life balance and improving job satisfaction. In practice, that could mean enforcing limits on consecutive working hours, building rosters that allow for genuine recovery time, creating channels through which staff can raise concerns about workload and recognition, and treating adequate sleep as a system-level safety issue rather than a private matter for individual workers. Given that burnout undermines patient safety and satisfaction as well as the health of the workforce itself, such investments would protect not only the roughly 242 health workers studied here but the patients who depend on them every day.

What makes the Pokhara study resonate beyond Nepal is its reminder that burnout is a global phenomenon with local textures. The same two dimensions, exhaustion and disengagement, appear wherever health systems are strained, but the specific drivers differ: in some settings it is administrative burden, in others it is violence in the workplace or inadequate pay. In this Nepali hospital sample, the dominant drivers were the most fundamental ones, sleep, satisfaction, and the space to live a life outside work. Nearly two-thirds of the health workers who keep Pokhara’s hospitals running are burning out, and the study’s message to health leaders everywhere is that the factors determining that outcome are measurable, identifiable, and, with deliberate policy effort, changeable.

Subject of Research: Burnout prevalence and associated factors among hospital health workers in Pokhara, Nepal

Article Title: Burnout and its’ associated factors among health workers: A hospital-based cross-sectional study from Pokhara, Nepal

Article References: Adhikari, D., Kaphle, H. P., Ojha, R., & Adhikari, C. (2026). Burnout and its’ associated factors among health workers: A hospital-based cross-sectional study from Pokhara, Nepal. PLOS One, 21(10), e0360067. https://doi.org/10.1371/journal.pone.0360067

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360067

Keywords: burnout, health workers, Nepal, Pokhara, Oldenburg Burnout Inventory, cross-sectional study, job satisfaction, work-life balance, sleep deprivation, hospital settings, occupational health, PLOS One