The hospital, established in 1964, is a key facility in western Jamaica. As a type B hospital, it provides 5 basic specialties: general surgery, internal medicine, obstetrics and gynecology, orthopedics, and pediatrics, ensuring comprehensive care for its diverse population. Although its capacity is 190 patients, it currently houses up to 300, leading to significant overcrowding and challenges for the health care system and medical staff [16].

This was a qualitative study that used purposive sampling to identify research participants, grounded in a constructivist epistemological approach. This perspective recognized the coconstruction of knowledge between the researcher and participants, aligning with the study’s aim to explore the subjective experiences of nurses [17].

The principal researcher acknowledged their potential influence on the research process, particularly given prior acquaintance with 2 participants. Efforts were made to remain self-aware and neutral during interviews and analysis, to minimize bias and enhance the credibility of the findings.

Permission was obtained from the Director of Nursing Services at the hospital on April 8, 2024, after discussing the research’s objectives, methodology, and potential impacts. A formal written request outlining the research aims, methodology, ethical considerations, and data management was submitted on April 11, 2024. Following approval, a signed permission letter was issued. The hospital administration assisted in ethically disseminating recruitment emails to 15 potential participants (see Table 1 for inclusion/exclusion criteria). While all 15 acknowledged receipt, only 12 participated: 1 did not sign the consent form, and 2 failed to respond after signing.

An interview guide was developed with open-ended questions exploring nurses’ practices in managing rest, perceptions of rest’s impact on satisfaction and burnout, and the role of hospital policies in promoting well-being. It also included recommendations for improving rest in the medical and emergency units at the hospital (see Multimedia Appendix 1).

Prior to the interview, participants were emailed the participant information sheet and subsequently the consent form and were asked to sign them via DocuSign. Interviews, averaging 45 minutes, were all conducted via Zoom using a semistructured guide with only the participants and the principal researcher present. Each session was audio recorded for accuracy, with no photos or videos taken. Data from interviews were transcribed, coded, and analyzed thematically following the 6-step framework of Braun and Clarke [18], which involved familiarization with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and writing up. An inductive approach was used, allowing themes to emerge from the data without being driven by preexisting theories or frameworks [18].

The trustworthiness of the data was reinforced through transparency in the research process and ongoing critical reflection. While one researcher led the initial coding, all authors reviewed the coding framework and contributed to the interpretation of findings. This collaborative process helped ensure consistency, reliability, and analytical depth, supported by clear documentation maintained throughout. Feedback from all authors further shaped the development of the analysis and structure of the paper, enhancing its overall rigor and quality.

The research was conducted in adherence to ethical guidelines outlined by the Declaration of Helsinki and followed institutional protocols to ensure quality, integrity, and ethical responsibility [19]. The methodology was rigorously designed to ensure reliability, validity, and participant protection, following best practices for qualitative research [20].

Ethical approval was granted by the Research Governance and Integrity Team at Imperial College London (ethics application ID 7069331).

Data management was robust, with clear documentation and secure storage. Paper forms were scanned into the primary author’s OneDrive space and then securely shredded. The data were securely stored. Any sensitive data archived were encrypted and access was restricted to authorized personnel only. Risks were managed by transparent communication, voluntary participation, and anonymization of data. To anonymize the data, personal identifiers such as names were removed and replaced with pseudonyms. Unique codes were assigned to each participant, and any identifying information was stored separately from the research data to maintain confidentiality.

All participants received a Participant Information Sheet prior to recruitment and provided written informed consent electronically before taking part in the study. Participation was voluntary, and participants were informed of their right to withdraw at any time without consequence. No financial or material compensation was provided for participation.

Twelve RNs participated in the study (see Table 2). The mean age of the participants was 28 (SD 2.2; range 25‐33) years. All nurses held a Bachelor of Science in Nursing degree, with 1 nurse also possessing a critical care certificate.

Participants had a mean of 3.6 (SD 1.8; range 1.2‐6) years of experience working at the hospital. The sample was evenly distributed across clinical units, with 50% (6/12) of participants assigned to the Accident and Emergency (A&E) unit and 50% (6/12) to the Medical unit.

To further contextualize these findings, differences based on gender, unit type, and experience level were also observed among participants, offering deeper insight into how individual and situational factors shape nurses’ experiences with rest policy compliance.

This study examined the role of adequate rest in nurse satisfaction, burnout prevention, and physical well-being in medical and emergency units. It uncovered systemic challenges that hinder nurses from obtaining sufficient rest. High patient-to-nurse ratios, staffing shortages, and lack of managerial support were identified as key contributors to fatigue and burnout. Nurses’ personal responsibilities, such as caregiving at home, also affected their ability to prioritize rest. These findings show how both institutional and personal factors compromise nurses’ well-being and, in turn, patient care.

Demographic differences reflect social, cultural, and professional dynamics shaping nurses’ experiences. Female nurses often balance work and caregiving roles, heightening stress and burnout risk [23]. A&E nurses reported higher fatigue levels than those in Medical units, due to the unpredictable nature of emergency care. Experienced nurses highlighted systemic issues, while newer nurses focused on the immediate physical and emotional toll, reflecting their frontline pressures [24].

The study reaffirms the link between rest and well-being. Nurses with more rest reported better physical and mental health, supporting global research on this topic [25]. Challenges at this hospital, such as high workloads and weak managerial support, mirror trends in other resource-limited settings [26]. For example, a Namibian study also found burnout tied to understaffing and lack of rest infrastructure [27]. Nurses at the hospital in Western Jamaica frequently reported physical exhaustion and long-term health concerns, echoing global findings on rest-related health risks, including musculoskeletal pain and emotional exhaustion, key components of burnout [7,25,28].

Jamaica faces a severe brain drain, with 80% of skilled workers emigrating, including health care professionals [29]. Ranking second globally on the brain drain index [30], Jamaica’s workforce shortages worsen burnout. Similar trends are noted in Guyana and Trinidad and Tobago [31]. Cultural and economic pressures often lead nurses to work extended hours without adequate compensation or rest. In contrast, high-income countries enforce stricter work hour regulations. At Spanish Town Hospital in Southeast-Central Jamaica, the nurse-patient ratio is 1:10, far above ratios in wealthier nations, contributing to burnout and absenteeism [32-34]. The Maslach Burnout Inventory indicated “very high” burnout among nurses, especially in emotional exhaustion [22,35]. The International Council of Nurses [36] highlights the negative outcomes that occur from high-income countries attempting to address their nursing shortages through “inequitable international recruitment.” Through recruiting via migration, it leaves nursing workforces in low- and middle-income countries without adequate care, masks the underlying issues leading to high turnover, and costs low- and middle-income countries lost training expenses after public investment in education.

Nurses struggle to maintain work-life balance in these settings. Overcrowding and understaffing lead to long hours and little time for self-care [37,22]. The State of the World’s Nursing Report 2025 [38] illustrated that only 55% of countries had regulations on working hours and conditions, whereas the remaining 45% had partial or no regulations. Care packages for mental well-being of nurses were implemented in 42% of countries, whereas 64% only implemented partial or no care packages. A study in Iceland showed higher satisfaction among nurses working standard hours versus those on overtime [39]. However, extended shifts remain necessary at this hospital in Western Jamaica, negatively affecting health and morale. These findings call for urgent action to support nurses and improve patient care through systemic reform. This is supported by the International Council of Nurses 2025 report [36], which states that solutions such as “ensuring adequate staffing and a balanced skill mix and workforce capacity aligned with patients demands” need to be implemented.

This study’s strength lies in its qualitative design, which captured rich personal narratives often missed in quantitative research [17]. Familiarity between the researcher and some participants may have encouraged openness. However, it may also have introduced bias. The lead researcher’s nursing background may have shaped interpretations. Additionally, excluding non-English-speaking nurses, such as Cuban staff [1], limited the diversity of views. With only 12 participants from 2 units, generalizability is limited. Self-reported data also carry risks of under- or over-reporting.

Future studies should explore strategies for staff recruitment and retention to reduce burnout. Research is needed on how managerial practices affect rest and well-being. Peer support systems and cultural change around rest and self-care should be evaluated. Post-COVID recovery efforts should prioritize mental health support and enforceable rest policies [40].

The hospital should address high nurse-to-patient ratios by increasing staff, ensuring breaks without compromising care. California’s Nurse-to-Patient Ratios Law (1:2 in intensive care units; 1:4 in medical-surgical) reduced burnout and improved outcomes [4]. Structured break policies and cross-unit support systems are vital. UK hospitals implementing scheduled breaks reported reduced stress and higher job satisfaction [41]. Australia’s cross-unit model ensures continuity of care and relieves pressure during breaks [39,42,43].

Hospital leadership should prioritize nurse well-being. Programs in Australia train managers to promote self-care and regular breaks, leading to greater satisfaction and lower turnover [44]. At Cleveland Clinic in the United States, managerial training on rest and mental health improved morale and retention [45,46]. Wellness programs like Johns Hopkins’ Resilience in Stressful Events provide peer support and counseling, significantly reducing burnout and emotional exhaustion among nurses [47].

This study underscores the role of adequate rest in preventing burnout and enhancing job satisfaction among nurses in medical and emergency units. The findings reveal that systemic barriers, such as high workloads, inadequate staffing, and chaotic work environments, significantly hinder nurses’ ability to achieve sufficient rest. Nurses in the emergency unit, in particular, face higher stress levels due to the demanding nature of their work, which worsens fatigue and burnout. The lack of localized studies focusing on the physical and mental well-being of Jamaican nurses, particularly in high-pressure emergency units, creates a significant academic gap.

Addressing these issues can enhance the global understanding of burnout in various contexts while providing region-specific strategies to improve nurse retention, job satisfaction, and overall health care quality in Jamaica. A multifaceted approach is required to tackle these challenges, incorporating policy changes, management training, and the creation of supportive work environments. By prioritizing the well-being of nurses through adequate rest, health care institutions can not only improve nurse satisfaction but also ensure better patient care outcomes.