<b>Unseen Struggles: Nurse Shortages and Workplace Violence Driving Burnout in Abbottabad’s Healthcare Sector</b>

Background: Workplace violence (WPV) is a major occupational hazard for nurses worldwide, leading to psychological distress, burnout, and attrition. In Pakistan, WPV remains underreported, and staffing shortages exacerbate nurses’ vulnerability, particularly in overcrowded government hospitals. Limited empirical evidence exists on how these systemic factors interact to affect nurse well-being in Abbottabad. Objective: To explore the relationship between nurse shortages, workplace violence, and burnout among nurses in government and private hospitals in Abbottabad, and to assess the adequacy of existing institutional support mechanisms. Methods: A qualitative descriptive phenomenological study was conducted between January and March 2023. Eighteen registered nurses with at least one year of experience and direct exposure to WPV participated in semi-structured interviews. Transcripts were analyzed using thematic analysis, supported by reflexive journaling to enhance credibility and minimize bias. Results: WPV was highly prevalent, with 91.7% of government nurses and 66.7% of private nurses reporting verbal abuse. Physical abuse was more frequent in government hospitals (66.7% vs 33.3%). Burnout affected 66.7% of participants, with emotional exhaustion reported by 75.0% of government nurses compared to 50.0% of private nurses. Nurse–patient ratios exceeding 1:8 was significantly associated with higher WPV exposure (p=0.03). Administrative support was markedly limited in government hospitals (16.7% vs 66.7%). Conclusion: WPV and burnout are pervasive among nurses in Abbottabad, disproportionately affecting government hospital staff due to chronic staffing shortages and weak institutional support. Addressing nurse–patient ratios, enforcing WPV prevention policies, and strengthening leadership engagement are critical to protect nurse well-being and sustain healthcare delivery.