System Efficiency and Workforce Well-being of Self-Managed Nursing Teams: A Systematic Review

Background: The global healthcare landscape is currently facing a dual crisis of economic sustainability and organizational burnout, largely stemming from rigid, fragmented delivery models. Objectives: To evaluate the global organizational and economic outcomes of self-managed nursing teams (SMNTs) using the Relational and Organizational Efficiency Model (ROEM), focusing on system efficiency and workforce well-being. Design: A comparative systematic review following PRISMA guidelines. Data Sources: A systematic search was conducted across PubMed, Scopus, Web of Science and CINAHL for peer-reviewed articles published between 1990 and 2025. Review Methods: The methodological quality of the 32 included studies was appraised using the Mixed Methods Appraisal Tool (MMAT). Data were synthesized across the macro, meso and micro levels of the ROEM framework. Results: SMNT models foster relational efficiency, yielding high patient satisfaction, stronger continuity of care, and up to a 40% reduction in care hours in fully integrated models. However, the ROEM analysis reveals an "autonomy-strain paradox" at the micro-level: without adequate macro-level funding shifts (e.g., transitioning away from Fee-For-Service) and structural support, increased operational autonomy leads to high psychological distress and cognitive overload among nurses. Conclusions: Transitioning to SMNTs is a viable strategy to mitigate professional burnout and improve system efficiency. Successful scaling requires dismantling traditional hierarchies, shifting managers to coaching roles, and implementing value-based health policies.