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AIMS AND OBJECTIVES This integrative review aimed to synthesise current evidence on the factors that precede and contribute to the occupational distress of emergency nurses. BACKGROUND Emergency nurses practice within an environment challenged by demand exceeding capacity, an inability of staffing to meet this demand in addition to limited resources which contribute to form a unique risk to clinician and patient safety. The risk of occupational distress, while demonstrated across specialties, is noted to be highest in emergency nurses with subsequent impacts for clinicians, organisations and patients being explored. While previous studies have examined singular outcomes or elements, a comprehensive review that considers the factors and components of the overarching occupational distress is not evident in the current published literature. DESIGN Whittemore and Knafl's integrative review methodology enabled a structured format for synthesis and analysis of literature. METHODS A review of CINAHL, MEDLINE, Psych INFO, Embase, Australian Digital Thesis Network, University Microfilm International and Google Scholar between 2014 and 2021 was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Search terms explored the contributions of compassion fatigue, burnout, acute and post-traumatic stress disorder, and secondary traumatic stress/vicarious trauma to occupational distress. This search resulted in sixteen publications included for synthesis. RESULTS Literature for inclusion was identified as quantitative (seven), qualitative (six) and mixed-methods (three) studies. Factors identified as contributing to the development of occupational distress arise from the characteristics and situations of individual nurses, local organisational governance and the inherent nature of the emergency nurse role. Consequentially, there are negative impacts on patients, clinicians and healthcare organisations. CONCLUSION Emergency nurses experience exposure to several unique factors contributing to occupational distress which may originate from individual, organisational, occupational sources or a combination of these. Future research and strategies to address these factors could strengthen clinicians and organisations in the delivery of safe, holistic, high-quality nursing care. RELEVANCE TO CLINICAL PRACTICE Emergency nurses practice in unique and challenging environments which place them at higher risk of occupational distress with subsequent negative impacts for the clinician, healthcare organisation and patients. Through the investigation and development of strategies such as the facilitation of knowledge of patient disposition, emergency nurses may experience an increase in their well-being, retention, job satisfaction and resiliency.