Teresa McIntyre, Ph.D., University of Houston College of Nursing (Corresponding author); Lisa Welty, MSN, RN, LCCE, HCA Houston Healthcare Clear Lake; Pinky Shani, Ph.D., MSN, RN, University of Houston College of Nursing; Mary Love, Ph.D., RN, University of Houston College of Nursing; Pat Taylor, Ph.D, Texas Institute for Measurement, Evaluation and Statistics, University of Houston; Scott McIntyre, Ph.D., University of Houston Clear Lake
This study examines COVID-19 factors associated with the health and well-being of nurses in hospital setting during a heightened wave of the pandemic. Study examines: (a) the sources of nurse’s stress during the January-April 2021 wave of COVID-19, (b) nurses’ perceived stress, clinical stress (anxiety, depression, burnout), COVID-19 anxiety and physical symptoms, and (c) work and personal factors associated with stress and well-being outcomes.
The COVID-19 pandemic has placed unprecedented demand on hospitals and health professionals. International reports (e.g. from China, Europe), highlight the heavy toll of these demands on health professionals, including nurses (e.g. Chen et al., 2020; Lai et al., 2020, Ruiz-Fernandez et al., 2020). Long shifts, physical and emotional exhaustion, dealing with death and grief, anxiety about personal infection or infection of others, disruption of normal lifestyle routines (e.g. sleep, diet), are some of these challenges (Leng et al., 2020; Wu et al., 2020). A systematic review (Bohlken et al., 2020) concluded that extensive strain, anxiety and depression are reported by health professionals indicating a heavy mental health toll of caring for COVID-19 patients. Nurses carry a significant part of this burden as they are in close proximity to patients over long periods of time, and are intermediaries to family members. Few studies in the US have documented the impact of the pandemic on frontline nurses and associated factors.
Design – This is a cross-sectional and correlational study. Sample – Of the 1,266 nurses contacted via email (total population from lists provided by the two enrolled hospitals), 314 participated in the study (≈25% response rate).
Measures – Measures were collected via an online survey (REDCap platform), after IRB approval and informed consent. The survey included a socio-demographic and professional form (e.g. gender, employment status), and a compilation of standardized scales: COVID-19 Sources of Stress Scale – Adapted from Park et al, 2020 by McIntyre et al., 2020; The Perceived Stress Scale – Cohen et al, 1983; Coronavirus Anxiety Scale – Lee, 2020; Patient Health Questionnaire-9 – 1999 Pfizer Inc.; Somatization Scale (Hopkins Symptom Checklist – 12; Derogatis et al., 1974) and Copenhagen Burnout Inventory (Kristensen et al., 2015).
Analyses – Data analyses include descriptive statistics (e.g. M and SD) to characterize nurses in terms of sources of stress, and stress and well-being outcomes. We will use regression analyses to explore the relations among personal and professional factors, and outcomes (completed August 2021).
Participant nurses are predominantly female (92%, 88) and white (73.8%, 231), 67.8% (213) are married and with an average age of 40.45 years (SD = 11.51). Regarding work characteristics, 27.2% are nurse leaders, the majority being employed full-time (89.8%), their average daily workload is 11.08 hrs. (SD = 1.90), they work an average 2.51 consecutive shifts/week (SD = 1.11), and 59.1% (185) provide direct patient care. In terms of COVID-19 work experience, 45.2% (141) work in a unit designated to receive COVID-19 patients, 59.1% (185) provide direct care to COVID-19 patients, 56.7% (177) indicate that their overtime hrs. have increased due to the pandemic, and 61% (192) report no experience in epidemic, ICU, infectious disease or emergency work prior to COVID-19. Twenty percent had suspected or confirmed COVID-19 and 68.6% (214) had been vaccinated, and 33.5% (105) have had an immediate family member with suspected or confirmed infection.
Regarding perceived stress, nurses scored an average 18.17 total (SD = 6.80; range 2-37), nurses endorsed on average 18.35 (SD = 5.22) of 24 stressors related to work with COVID-19 patients, with a mean degree of perceived stress of 63.46 (SD = 21.20; range: 24-120). Stressors related to infection (e.g. risk of infection or infecting others) were endorsed by 70-90% of nurses, as were activity-related (e.g. personal care and social routines), and resource-related stressors (e.g. shortage of staff or PPE). Regarding work and well-being outcomes, 49.3% (147) experienced COVID-19 related anxiety, 23.9% (68) reported moderate to severe depression, 8.5% (25) indicating suicidal thoughts, and 70.9% (200) reported moderate (47.1%) to high/severe (23.8%) burnout. Preliminary analyses indicated that nurses with more children at home reported higher stress associated with COVID-19 and more burnout. Work factors were caring for COVID-19 patients, weekly workload (higher burnout), and seniority (lower burnout, and lower endorsement of COVID-19 stressors).
A significant percentage of nurses reported high level of stressors associated with COVID-19 experience at work and in their personal lives, significant COVID-19 related anxiety, depression, and high levels of burnout. Nurses with children at home, caring for COVID-19 patients, with higher workload and less seniority, reported worse mental health and well-being outcomes.
Findings suggest that this sample of U.S. nurses involved in hospital COVID-19 care experience high levels of stress and seem to be likely to develop worse mental health and well-being outcomes. The results indicate the need for interventions to support nurses during and post-pandemic.