Healing The Healer: A Systematic Review and Meta-Analysis of the "Battle Buddy" Peer-Support Framework in U.S. Acute Care Settings

Nurse burnout, characterized by emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA), is a major challenge in U.S. acute care settings and is closely associated with poor patient safety outcomes. Structured peer-support interventions, such as the “Battle Buddy” model, have emerged as potential strategies to address this issue. A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Electronic databases including MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library were searched from 2000 to 2026. Eligible studies included randomized controlled trials, quasi-experimental, and cohort studies evaluating structured peer-support interventions among nurses in U.S. hospitals. Data extraction and quality assessment were performed independently by two reviewers. Pooled standardized mean differences (SMDs) were calculated using a random-effects model. A total of 35 studies involving approximately 12,500 nurses were included. Peer-support interventions were associated with significant reductions in emotional exhaustion (SMD = −0.48; 95% CI: −0.62 to −0.34) and depersonalization (SMD = −0.35; 95% CI: −0.50 to −0.20), and a modest increase in personal accomplishment (SMD = 0.22; 95% CI: 0.10 to 0.34). Improvements in patient safety outcomes were also observed, including enhanced safety climate (SMD = 0.55) and reductions in medication errors and infection rates. Leadership style was identified as a significant moderator (P < 0.01). Structured peer-support interventions are effective in reducing burnout and improving patient safety among nurses. Integration of these programs, supported by strong leadership, is recommended to enhance workforce well-being and clinical outcomes. KEYWORDS: Nurse burnout; Peer support; Battle Buddy; Patient safety; Systematic review; Meta-analysis DOI: 10.7176/JHMN/120-03 Publication date: March 30th 2026