Neonatal Intensive Care Unit Nurses' perspectives, staffing workload, and burnout in the transition toward family-integrated care models: A structured literature review

Background: The transition toward Family-Integrated Care (FICare) and Family-Centered Care (FCC) models in the Neonatal Intensive Care Unit (NICU) is highly advocated to optimize infant developmental outcomes. However, executing this paradigm shift at the bedside creates deep institutional friction, profoundly reshaping the operational realities and psychological burdens placed on the neonatal nursing workforce. 
Objective: This structured literature review aims to evaluate the comprehensive impact of the FCC/FICare transition on NICU nurses' occupational, psychological, and operational dimensions, specifically focusing on staff readiness, workload changes, and systemic triggers of burnout or missed care. 
Methods: A systematic search was performed across PubMed, ScienceDirect, and Google Scholar for peer-reviewed primary studies, health economic evaluations, clinical audits, and rapid reviews published between 2021 and 2026. Applying strict eligibility criteria, 15 studies were selected for final analysis. Due to methodological heterogeneity, a narrative thematic synthesis was executed across three core domains: nurse perspectives, objective vs. subjective workloads, and predictors of professional burnout. 
Results: The synthesis revealed a statistically significant gap between ideal FCC philosophies and real bedside capacities, imposing an unmeasured cognitive load on nurses. Objective physical workloads escalated rapidly when infant-to-nurse staffing ratios exceeded the critical threshold of 2:1, particularly in resource-limited countries. Crucially, subjective workload (mental and emotional stress) served as a much more consistent driver of workforce failure than objective metrics, showing a direct correlation with missed nursing care across all 17 clinical neonatal performance indicators. Severe nurse burnout was strongly driven by systemic failures, with mandatory extra duties increasing burnout risk 5.28-fold (p=0.001) and a lack of specialized transition training increasing it 4.28-fold (p=0.003). Conversely, when properly managed, family integration yielded clear clinical dividends, reducing high-dependency care duration from 13 to 10 days, invasive ventilation by 12%, and CPAP support by 26%. 
Conclusion: Successful family-integrated neonatology cannot survive on romanticized textbook assumptions; it functions as a delicate ecosystem where staff well-being directly dictates patient safety. Hospital administrations must move beyond simplistic task delegation checklists toward an integrated, risk-stratified framework. Protecting workforce sustainability requires immediate structural interventions, including maintaining strict staffing controls (≤2:1), implementing experience-stratified training for complex family dynamics, and allocating dedicated nurse educators.