Factors which contribute to how ICU nurses experience ‘meaning’ in their work

AIMS: Intensive care units (ICUs) face a persistent shortage of nurses worldwide. While the stressors that drive turnover are well documented, less is known about what makes ICU nurses stay. Meaning in work has recently been identified as an overarching factor to remain in the profession. In this study we aim explore how ICU nurses experience meaning in work, identifying themes that contribute to this experience. METHODS: Semi-structured interviews were held with 10 ICU nurses in an academic hospital. The interviews were analysed thematically and findings were interpreted through the dimensions of self-determination theory and beneficence and integrated into the framework of meaning in life. FINDINGS: Many respondents found the complex cases of the ICU deeply meaningful. They valued ongoing challenges to their technical expertise and social skills both individually and as a team. Furthermore, nurses found meaning in making a difference, whether that means to save someone's life or to shave a patient before visiting hours. Work in which their unique skillset and potential was either not required, recognized or appreciated was experienced as draining. That disconnect was most prominent when nurses were not sure if their patient truly wanted to start or continue with a treatment, or when medical efforts felt hopeless. CONCLUSION: The findings indicate that ICU nurses' experiences are best understood not only through self-determination theory's emphasis on autonomy, competence, and relatedness, but also through beneficence. Integrating these perspectives into a framework of meaning in life helps explain how nurses experience their work as coherent, purposeful, and significant. IMPLICATIONS FOR CLINICAL PRACTICE: ICU organizations should create conditions that support nurses' autonomy, competence, relatedness, and beneficence, for example through ethical dialogue and recognition of expertise. Aligning protocols and HR policies with these dimensions may help sustain nurses' sense of meaning.