Nurses Struggle to Name Their Feelings, Massive Analysis of 9,135 Finds

There is a quiet, paradoxical crisis unfolding at the bedsides of hospitals around the world, and it has nothing to do with staffing shortages or equipment failures. It is a crisis of emotional vocabulary — the inability of the very people tasked with the most emotionally demanding work in medicine to identify, understand, and describe what they themselves are feeling. A sweeping new analysis published in BMC Nursing has put hard numbers on the problem for the first time, and the figures are striking enough that hospital administrators, nursing educators, and mental health researchers should all be paying attention.

The condition in question is alexithymia, a term coined in the 1970s that literally translates from Greek as “no words for emotions.” People with alexithymia are not unfeeling — far from it. They experience emotions fully, but the signals those emotions send remain scrambled, difficult to decode, and nearly impossible to articulate. A person with high alexithymia may feel their chest tighten and their stomach churn without recognizing that what they are experiencing is anxiety. They may withdraw from colleagues without understanding that they are overwhelmed. In a profession built on continuous, intimate, emotionally charged interaction with patients and families, this perceptual blind spot is not a trivial quirk. It is a structural vulnerability.

The new study, led by Xiaoyan Gong and Lingli Jiang of the General Hospital of Western Theater Command PLA in Chengdu, China, is a systematic review and meta-analysis — the most rigorous form of evidence synthesis in medical research. The team searched nine major databases, including PubMed, Web of Science, Embase, CINAHL, the Cochrane Library, and four Chinese-language databases, casting a net from the earliest records through October 31, 2024. After screening, they assembled 22 observational studies covering a combined 9,135 clinical nurses, every one of which measured alexithymia using the same instrument: the 20-item Toronto Alexithymia Scale, or TAS-20, the international gold standard for quantifying this trait.

The methodology matters here, because meta-analyses live or die on the quality of what goes into them. The researchers assessed each included study using the Agency for Healthcare Research and Quality tool, and the average quality score came in at a respectable 7.8. Because the individual studies showed substantial statistical heterogeneity — meaning their results varied more than chance alone would explain — the team pooled the data using a random-effects model, the statistically appropriate choice when combining studies conducted in different settings, countries, and nursing cultures. All computations were performed in Stata version 15.1, and the resulting estimate carries a tight confidence interval, which is exactly what you want to see in a pooled finding of this scale.

The headline number: clinical nurses scored a pooled mean of 54.50 on the TAS-20, with a 95 percent confidence interval of 53.56 to 55.44. To understand why that figure is alarming, you need to know how the scale works. The TAS-20 ranges from 20 to 100, and scores of 61 or above conventionally indicate clinical alexithymia, while scores between roughly 52 and 60 fall into a gray zone often described as moderate alexithymia. A pooled mean of 54.50 means the average clinical nurse in these studies sits squarely in that moderate band — close enough to the clinical threshold that a meaningful fraction of the workforce likely crosses it entirely. This is not a fringe phenomenon affecting a few emotionally burnt-out individuals. It describes the center of the distribution.

Just as revealing are the subgroup analyses, which map exactly where the emotional blind spot runs deepest. Male nurses scored higher than their female colleagues, a finding consistent with broader psychosocial research suggesting that gendered norms around emotional expression may compound the underlying trait. Unmarried nurses scored higher than married ones, hinting that intimate partnership may provide a kind of daily emotional decoding practice that buffers the trait. Nurses working in intensive care units — the highest-acuity, highest-mortality environments in the hospital — scored higher than those elsewhere, which will surprise no one who has spent a night in an ICU but is sobering to see quantified. Nurses with an associate degree or lower education, and those with fewer than five years of experience, also showed elevated scores, suggesting that both professional maturity and deeper training may offer partial protection.

One subgroup finding deserves particular scrutiny: studies published after 2020 reported higher alexithymia scores than earlier ones. The timing is impossible to ignore. The COVID-19 pandemic subjected nursing staff to unprecedented mortality exposure, moral injury, and chronic psychological strain, and this analysis adds to a growing body of evidence that the emotional toll was not transient. Whether the post-2020 elevation reflects a genuine worsening of the trait, a shift in the populations studied, or a change in how honestly nurses report their inner states, the signal aligns with what frontline clinicians have been saying for years — that the pandemic left a durable mark on the psychological architecture of the nursing workforce.

The clinical consequences of widespread alexithymia among nurses are anything but abstract. Decades of research have linked the trait to impaired empathic communication, poorer detection of patient distress, reduced job satisfaction, elevated burnout, and increased susceptibility to anxiety and depression. A nurse who cannot accurately read her own emotional state is, in a very real sense, operating with a degraded internal dashboard — and that same difficulty often extends to reading the emotional states of others. In a profession where a single misread cue can mean a missed warning sign from a frightened patient, the downstream risks compound quickly. The authors of the analysis are explicit on this point: alexithymia among nurses may impair effective nurse–patient communication and interaction, compromising the quality of clinical care while imposing considerable physical and psychological burdens on the nurses themselves.

What makes this study valuable is not that it discovers something wholly new — alexithymia has been studied in healthcare workers for decades — but that it consolidates the evidence into a single, defensible estimate at unprecedented scale. Nine thousand nurses across 22 studies, measured with one validated instrument, quality-assessed with a standardized tool, and pooled with appropriate statistical methods, produce a number that can no longer be dismissed as an artifact of any single hospital, country, or survey. The moderately high level of alexithymia among clinical nurses is now an evidence-backed characteristic of the profession itself, and the authors argue that greater awareness of it as an important psychosocial concern is warranted across the healthcare sector.

The practical implications follow directly from the data. The elevated scores among junior nurses point to a clear intervention window: emotional awareness training embedded early in nursing education, before maladaptive coping patterns harden into career-long habits. The ICU finding argues for targeted psychological support in high-acuity units rather than one-size-fits-all wellness programs. The gender and marital-status patterns suggest that interventions should account for the social contexts in which nurses process emotion, not just the hospital environment. And the post-2020 signal is a warning that the profession’s emotional reserves have not fully recovered from the pandemic era. The researchers call on healthcare institutions and nursing managers to implement targeted strategies to reduce alexithymia and promote nurses’ psychological well-being — a recommendation that, given the numbers, looks less like a wellness nicety and more like patient-safety infrastructure. The people who spend their careers tending to the feelings of others, it turns out, may need help finding words for their own.

Subject of Research: Alexithymia prevalence among clinical nurses

Article Title: Occurrence levels of alexithymia in clinical nurses: a systematic review and meta-analysis

Article References: Gong, X., Ma, Y., Hu, X., Xiao, C., Zhang, H., Guo, H., & Jiang, L. (2026). Occurrence levels of alexithymia in clinical nurses: a systematic review and meta-analysis. BMC Nursing. https://doi.org/10.1186/s12912-026-05297-1

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05297-1

Keywords: alexithymia, clinical nurses, meta-analysis, TAS-20, mental health, nursing, burnout, ICU, systematic review, emotional intelligence, healthcare workers, psychometrics