Burnout among intensive care unit (ICU) nurses is a growing concern worldwide (Ramírez-Elvira et al., 2021), with significant implications for healthcare systems, patient safety and quality of care (Li et al., 2024). Characterised by emotional exhaustion, depersonalisation and reduced personal accomplishment, burnout has been widely recognised as a critical issue affecting healthcare professionals, particularly among those working in high-stress environments such as ICUs (Maslach & Leiter, 2016). Nurses in ICUs face excessive workloads, prolonged shifts, high patient acuity and frequent exposure to traumatic events, all of which contribute to an increased risk of burnout (Ramírez-Elvira et al., 2021). The consequences of burnout extend beyond the individual, as studies have linked it to increased medical errors, reduced quality of care, higher absenteeism and nurse turnover (Garcia et al., 2019; Lee et al., 2023).

Globally, the prevalence of high burnout symptoms among nurses has been estimated at 14.36 %, with the highest rates reported in Southeast Asia and the Pacific region (13.68 %), followed by Latin America (10.51 %) and North America (10.27 %) (Woo et al., 2020). In Indonesia, where nurses frequently contend with high patient loads, inadequate staffing and limited organisational support, burnout prevalence among general nurses has reached 49.2 % (Juanamasta et al., 2024; Nursalam et al., 2020). However, despite these statistics, there remains a notable gap in research focusing specifically on ICU nurses in Indonesia, a population at particularly high risk due to the demanding nature of their work. Addressing burnout in this group is essential for ensuring nurse retention, safeguarding patient safety and maintaining healthcare system efficiency.

Previous studies have identified a range of contributors to burnout, including sociodemographic factors (e.g., age, marital status, educational level) and work-related variables (e.g., staffing ratios, shift length, workload) (Ramírez-Elvira et al., 2021; Yestiana et al., 2019). Nevertheless, despite global efforts to mitigate burnout, research remains limited in examining protective factors, especially in Indonesia's ICU settings. Among the potential protective factors, spirituality and self-efficacy have, however, received increasing attention.

Spirituality, defined as a sense of purpose, connection and inner strength, has been identified as a buffer against occupational stress (De Diego-Cordero et al., 2022). It has been found that nurses with higher levels of spirituality report lower burnout, as spirituality helps them cope with workplace stress by fostering resilience and inner strength. Evidence from South Korea (Kim & Yeom, 2018), Greece (Ntantana et al., 2017) and Indonesia (Putri et al., 2022) has demonstrated a negative correlation between spirituality and burnout. However, this relationship has not been fully explored in Indonesian ICU nurses, whose stress levels and work environments differ significantly from those of other nursing populations.

Another key psychological factor influencing burnout is self-efficacy, defined as the belief in one's ability to manage challenges (Bandura, 1997). In this study, self-efficacy specifically refers to ICU nurses' confidence in handling work-related stressors and patient care demands in high-pressure critical care environments. High self-efficacy is associated with greater adaptability, stronger coping mechanisms and lower emotional exhaustion in demanding work environments (de la Fuente et al., 2023) and several studies have confirmed a negative relationship between self-efficacy and burnout (Hussien et al., 2025; Xie et al., 2024), suggesting that nurses with higher self-efficacy are better equipped to handle stress and maintain job satisfaction (Morales-García et al., 2024). Nevertheless, inconsistencies remain regarding the extent to which self-efficacy directly influences burnout, particularly across different cultural and healthcare contexts (Alidosti et al., 2016).

Emerging evidence suggests that spirituality may also enhance self-efficacy, as individuals with a strong sense of meaning and purpose develop greater confidence in handling workplace stress (Jun & Lee, 2016; Kasapoğlu, 2022; Kown & Oh, 2019). Self-efficacy, in turn, is a critical psychological resource for ICU nurses, who routinely face complex clinical situations, emotional exhaustion and moral distress (Hussien et al., 2025). Thus, it is plausible that spirituality reduces burnout both directly and indirectly by reinforcing self-efficacy (Kasapoğlu, 2022; Kown & Oh, 2019; Xie et al., 2024). Despite theoretical support for this pathway, the mediating role of self-efficacy in the relationship between spirituality and burnout has, however, not been systematically tested in ICU settings, particularly in Indonesia, where cultural and religious values strongly influence coping mechanisms (Putri et al., 2022).

This study addresses that gap by examining the influence of spirituality and self-efficacy on burnout and testing whether self-efficacy mediates this relationship among ICU nurses in Indonesia. By clarifying this mechanism, the study contributes to a deeper understanding of the psychological determinants of burnout and provides practical guidance for nurse leaders and educators seeking to promote resilience and reduce burnout in high-stress ICU environments.