In recent years, nurses have played a crucial role in the ongoing COVID-19 pandemic. Faced with the constant threat of COVID-19 infection, nurses endure significant psychological stress, making them vulnerable to burnout and other adverse outcomes (Galanis et al., 2021; Çağış and Yıldırım, 2023; Rizzo et al., 2023). A meta-analysis has revealed that one in ten nurses worldwide has reported experiencing burnout (Woo et al., 2020). High levels of burnout could lead to decreased job satisfaction, reduced worker productivity, lower levels of care, higher absenteeism and increased turnover (Borritz et al., 2006; Kakemam et al., 2021; Stewart et al., 2023), which could further exacerbate staffing shortages in healthcare organizations (Fasih Far et al., 2022). Therefore, it is necessary to address nurse burnout to maintain a stable healthcare workforce in times of crisis (Karimi et al., 2022). Specifically, it is vital to understand the impact of burnout on nurses’ occupational mental health and well-being, as well as its effects on patient care.

Burnout is a psychological response to prolonged workplace stress, characterized by emotional exhaustion, depersonalization, and diminished personal accomplishment (Maslach and Jackson, 1981; Chen et al., 2023; Chirico et al., 2023). Cross-sectional studies have connected burnout to psychological symptoms such as hopelessness (Civilotti et al., 2022) and depression (Chen et al., 2021). This suggested that burnout might be associated with the abnormality of future thinking. Future thinking refers to the capacity to envision or simulate experiences that might occur in one’s future (Schacter et al., 2008, 2017). Simulating future scenarios provides crucial functional benefits such as visionary decision-making (Sze et al., 2017), emotional regulation (Hallford et al., 2022), and the formation of intentions and plans (Schacter et al., 2017). Thus, future thinking is critical for the human well-being (Schacter and Addis, 2007; Ward, 2016).

Hopelessness, a key element of burnout, often involves anticipating a bleak future (Marchetti, 2019). As a positive psychological capital, hope is closely related to an individual’s expectations and plans for future goals, as well as the actions needed to achieve those goals (Snyder, 2002). Several studies have reported that hope and resilience is the dominant positive force in confronting the future and is linked negatively with job burnout (Pharris et al., 2022; Yıldırım et al., 2023; Yıldırım and Ashraf, 2023). In addition, burnout has a close connection with depression, and is sometimes referred to as job depression (Firth et al., 1987). Previous research has demonstrated that individuals with depression, schizophrenia, bipolar disorder, and Parkinson’s disease often exhibit abnormalities in future thinking (de Vito et al., 2012; Hallford et al., 2018). Notably, many studies have found that individuals with depression lack depth and vividness in their future thinking (Stöber, 2000; King et al., 2011). Finally, positive or negative expectations about the future significantly influence one’s behaviors. Negative expectations about the future can lead to negative reactions and contribute to the development of burnout (Koc and Bozkurt, 2017; Ahlstedt et al., 2019). All the mentioned evidences seem to indicate that job burnout might have an important influence on future thinking. Exploring the characteristics of future thinking in nurses with burnout might contribute to uncover the mechanism by which burnout occurs and develops.

Despite the importance of future thinking in understanding burnout, most studies on job burnout have focused on past and present situations. To the best of our knowledge, no study has investigated future thinking in nurses with burnout. Therefore, the present study attempts to fill this gap. We adopted the Sentence Completion for Events in the Future Test (SCEFT) to evaluate the content of future thinking, which has been used to assess future thinking in people with schizophrenia (Gan et al., 2015) and autism spectrum disorder (Crane et al., 2013). Specifically, we aim to examine whether the future thinking in nurses with burnout is impaired and to identify any specific characteristics in the content of their future thinking. Additionally, we aim to determine if these manifestations worsen as burnout progresses. We hypothesize that nurses with burnout will exhibit impaired future thinking with negatively biased imaginative content. Furthermore, we anticipate that these manifestations will intensify with the severity of burnout.

Most previous studies addressing nurses with burnout have primarily explored the associated negative manifestations using scales (e.g., Barello et al., 2020; Levi et al., 2021). In the present study, we examined the features of future thinking content in nurses with burnout using a novel methodology, the SCEFT. We found that, compared to nurses without burnout, nurses with burnout had impaired imaginations of future events. Specifically, they expected less specific future events, positive events and events on relationships and achievement. With the burnout level increased, their impairment in the future thinking also worsened, as demonstrated by the results in the future thinking in nurses with mild, moderate and severe burnout. Furthermore, our study found significant correlations between the scores of emotional exhaustion, depersonalization, and personal accomplishment, and the proportions of positive events, as well as events related to relationships and achievement/mastery in nurses’ future thinking content. These results support our hypothesis that nurses’ ability of future thinking was impaired. When thinking about events in the future, nurses with burnout performed differently from nurses without burnout. They imagined a vague, less positive, or even omitted future. Similar results have been found in studies on future thinking in depressed people (Stöber, 2000; King et al., 2011). The current results provide empirical evidence that nurses with burnout experience deficits in future thinking, similar to individuals with depressive symptoms.

We found that nurses with burnout produced significantly fewer specific events than nurses without burnout. This suggested that nurses experiencing burnout demonstrated a significant impairment in constructing vivid future scenarios. This may be attributed to the influence of negative emotions on the subjective quality of individual scenes in future thinking, as negative emotions potentially hinder the process of generating expectations (Hepburn et al., 2009). Meanwhile, personality disintegration, a state in which individuals perceive themselves as insignificant, can lead to feelings of despair and indifference toward the past, present, and future, and thus disrupt the complex metacognitive judgments necessary for making decisions about the future (Kinley et al., 2021). Since there is a close relationship between achieving accomplishments and realizing future goals (Lee et al., 2010), lacking personal accomplishment in nurses with burnout might lead to less specific future imagination.

Additionally, we found that nurses with burnout envisioned significantly fewer positive future events than nurses without burnout. This is further validated by the findings that nurses with burnout envisioned fewer happy events and events associated with relationships and achievement/mastery in their future, as well as the significant correlations between the scores of burnout and proportions of positive events, happy events and events on relationships and achievement/mastery. This observation could be attributed to the challenges that nurses with burnout encounter (e.g., serious emotional exhaustion and depersonalization, and decreased personal accomplishment), which making it difficult for them to envision positive scenarios during the chronic stress (Pines and Kanner, 1982). Given the evident significance of interpersonal relationships in nursing practice (D'Antonio et al., 2014), nurses are often required to manage complex interpersonal conflicts, which may contribute to job burnout (Duddle and Boughton, 2007; Carod-Artal and Vázquez-Cabrera, 2013). These findings suggest that nursing managers should focus on promoting positive emotional experiences and interpersonal relationships among nurses to prevent and alleviate job burnout (Lee and Jang, 2019).

However, no group difference was found concerning the negative future events between the nurses with burnout and without burnout. Previous studies showed that depressed people have decreased positive future expectations and increased negative expectations (Beck et al., 2006; Szőllősi et al., 2015). This is in line with our results of the deficits of positive envisioning, but does not agree with the absence of the enhancement of negative expectation. This inconsistent manifestations might be explained by the different features between depression and burnout (Brenninkmeyer et al., 2001). The core problem of burnout is the exhaustion of positive emotions, but depression is also accompanied by an increase in negative thinking. These findings suggested that interventions for burnout may require a different strategy from that for depression. Specifically, interventions for burnout should prioritize fostering positive thinking.

Few previous studies have addressed the problem of omission. We found that future thinking omission was severer among nurses with burnout than nurses without burnout. This result was further consolidated by the results concerning the levels of burnout, i.e., nurses with severe burnout were linked with more omissions than nurses with mild and moderate burnout. This suggested that nurses with burnout had difficulty when envisioning future events. Nurses with burnout generally experience chronic stress, which manifests as a low spirit and perceived dim prospects (Taormina and Law, 2000). They are often busy and struggle to balance work and family life. Over time, their image of the future becomes increasingly blurred, and their ability to imagine the future gradually diminishes. Therefore, in nursing practice, managers should prioritize training nurses in future thinking to alleviate burnout.

Furthermore, we found that the impairment of nurses’ future thinking became more serious as the levels of burnout increased. Nurses experiencing severe burnout face a dual challenge compared to nurses with mild or moderate burnout, they not only display greater ambiguity and omissions in their future thinking but also tend to perceive future events as less positive. These results suggested that when alleviating nurse burnout, it is essential to treat nurses suffering from different levels of burnout with various ways (Maslach and Leiter, 2016). Specifically, there is a critical need to focus on nurses experiencing severe burnout and provide targeted training to enhance their future thinking abilities (Szpunar and Schacter, 2013).

In our study, we observed that nurses experiencing burnout demonstrated a significant impairment in constructing future scenarios and had difficulty envisioning future events, especially positive future events. These findings have vital implications for nursing managers. Studies have demonstrated that repeated mental simulations of future events can enhance an individual’s ability to vividly imagine the future with more details (Szpunar and Schacter, 2013). Nursing managers can utilize future thinking intervention to alleviate nurses’ burnout, such as future-oriented interventions (e.g., solution-focused brief therapy; Luo H. et al., 2019), future-oriented therapy (FOT) (Landkroon et al., 2022), and future-oriented occupational health services and workplace health promotion programs (Nucera et al., 2023). This intervention may help nurses with burnout develop a positive and hopeful future (Salmela-aro et al., 2004), which, in turn, can alleviate burnout, improve work efficiency, and enhance overall work quality. Furthermore, nursing managers can use positive psychological interventions, such as gratitude journal writing (Camero and Carrico, 2022), cultivating resilience (Alonazi et al., 2023), and focusing on personal strengths and values, to create a positive work environment that fosters positive emotions in nurses (Giorgi et al., 2016; Luo Y. H. et al., 2019).

Several limitations should be acknowledged in this study. First, the nurses in the present study were all female, whether the findings could be extended in male nurses remains to be investigated in future studies. Second, the nurses in our study came from a single hospital in eastern China, which might have its unique organizational culture and stressors that could potentially affect the nurses’ burnout and future thinking. Therefore, future research on the future thinking of nurses with job burnout can be conducted in a multi-center setting with a larger sample from different hospitals and even diverse countries with multi-culture. This will contribute to the generalizability of the findings. Third, we did not set a time limit for completing the SCEFT task, which might have influenced participants’ responses (Anderson and Dewhurst, 2009; Crane et al., 2013). Future research could consider implementing time constraints on future thinking to explore the effect.

The current study found that nurses with burnout had impaired ability of future thinking. They could envision less specific and positive future events. In addition, as their symptoms of burnout progresses, the deficit in future thinking becomes worsen. The results of the present study indicated that burnout among nurses not only disturbs their present life but also have negative influence on their future thinking. Thus, our findings advocate effective interventions of positive future thinking to mitigate nurses’ burnout.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving humans were approved by the Ethics Committee of the School of Nursing Hangzhou Normal University (Approval no. 2022002). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.

BX, ZH, and HL contributed to conception and design of the study. BX, YF, YiZ, XL, and XY organized the database. BX, JZ, YZ, and SW performed the statistical analysis. BX wrote the first draft of the manuscript. YF and JZ wrote sections of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.