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Nurses' Mental Health during COVID-19

The Latest Research on Nurses’ Mental Health during COVID-19

Recent studies and review articles show the impact on frontline workers is not entirely negative, and offer advice for hospitals coping with the pandemic

Rachel Muenz

Rachel Muenz, managing editor for G2 Intelligence, can be reached at

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There is no doubt that COVID-19 has taken a toll on health care systems around the world. With National Nurses Day being celebrated today (May 6), we decided to take a look at some of the emerging research into how nurses and other frontline workers are coping with the pandemic so far.

Recent research on mental health of COVID-19 caregivers

With the mental and physical stress of treating patients during a pandemic, it’s not surprising that previous studies of health care workers dealing with earlier infectious disease outbreaks showed that many developed a number of mental health issues, including insomnia, depression, and anxiety, as well as fear for family, friends, and co-workers.

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This has been the case with those treating COVID-19 patients as well.

In a cross sectional study of 1,257 frontline staff from 34 hospitals in China, researchers found that “a considerable proportion of health care workers reported experiencing symptoms of depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and frontline health care workers directly engaged in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19.”

Not surprisingly, workers closer to Wuhan, the epicenter of the COVID-19 outbreak in China, were found to have more severe mental health issues than those further from the center of the outbreak. Female health workers, nearly 61 percent of them nurses, also reported more severe symptoms of distress, anxiety, and depression, the researchers said. 

The study noted that “frontline nurses treating patients with COVID-19 are likely exposed to the highest risk of infection because of their close, frequent contact with patients and working longer hours than usual.” The researchers added that many of these nurses were junior staff, likely with less work experience, noting that a study of health care workers during SARS also showed that, of the health care workers treating such patients, “nurses were more likely to develop distress and use behavioral disengagement than physicians.”

Another important point the scientists made is that, during SARS, nurses were less likely to be properly informed about the true exposure risk or “provided with adequate protections.” Similarly, with hospitals all over the world currently experiencing shortages of personal protective equipment, there have been many reported cases of nurses having to treat COVID-19 patients without adequate protection—a source of anxiety and fear for many.

The researchers concluded that health care workers dealing with COVID-19 are at a high risk of developing mental health issues and “may need psychological support or interventions.”

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Another recent study focused on health care workers dealing with COVID-19 in Singapore, however, found that non-medical workers scored higher for stress and anxiety than medical staff. They said their findings supported those of another study on health care workers in China that showed “that frontline nurses had significantly lower vicarious traumatization scores than non-frontline nurses and the general public.”

The authors theorized that those higher stress and anxiety scores for non-medical health staff could be due to fewer mental health supports as well as less training and education on COVID-19:

“Reasons for [the greater psychological impact on non-medical staff] may include reduced accessibility to formal psychological support, less first-hand medical information on the outbreak, less intensive training on personal protective equipment, and infection control measures,” they write.

In addition, other research shows that the psychological impact of COVID-19 on nurses and other care staff is not entirely negative.

In a study published Apr. 8 in the American Journal of Infection Control, researchers looked at the psychological experience of 20 nurses caring for COVID-19 patients in China’s First Affiliated Hospital of Henan University of Science and Technology from Jan. 20 to Feb. 10. Not surprisingly, negative emotions dominated the nurses in the early stages of the outbreak, but positive emotions eventually emerged, including “increased affection and gratefulness, development of professional responsibility, and self-reflection.”

The study also found that the nurses experienced “growth under pressure” and that key factors in maintaining their mental health were “self-coping styles and psychological growth.”

Though this research shows there is a positive side to handling a pandemic, many of the studies on frontline workers’ mental health during COVID-19 show the critical need for proper mental health supports for these workers “to ensure global recovery from the COVID-19 pandemic.”

Mental health support for health care workers

Recent papers outline strategies leaders and teams can follow to ensure nurses and other frontline staff maintain good mental health during the stress of a pandemic.

An Apr. 28 review article from researchers in the UK, published in the European Heart Journal: Acute Cardiovascular Care, outlines the challenges COVID-19 caregivers face, the common psychological effects, and how to manage them. The authors highlight the importance of preventing and mitigating mental health issues before they become major problems. They also include recommendations for what organizations can do for staff, what teams can do for members, and what individuals can do to help maintain their mental health.

For leaders, simply being a good leader and maintaining strong lines of communication are critical, the authors write.

“Although it may sound trite, the most important thing that leaders can do for their team in a crisis is be a good leader,” they say. “This is certainly far harder to do than it is to write down on a piece of paper. Leadership during a crisis is always a challenge; however, leading during the COVID-19 situation is even more difficult given that leaders themselves are ‘living’ in the crisis and are equally impacted by it as much as those who they are leading.”

Similar to the study in the American Journal of Infection Control, the UK-based researchers also discuss the positives of managing a pandemic, including stronger leadership skills and bonds among teams.“Although there are many negative aspects of the current situation, teams can grow stronger, individuals can develop, relationships can grow deeper as a result of this crisis,” the authors note.

Another article in the Annals of Internal Medicine gives advice on how hospitals can manage the stress of COVID-19. Published Apr. 21, author Joshua C. Morganstein, MD, outlines steps organizations can take to support frontline staff and maintain a high level of patient care as well as a self-care plan for individuals.

“A synergy of leadership and individual actions to preserve the well-being of our hospitalists and other health care workers is vital to this mission,” Morganstein writes. “These efforts will be facilitated by system-based approaches and individual behaviors that adapt lessons learned from previous outbreaks and exposure to mass trauma. It is imperative that the preservation of our hospitalists and other health care workers remain an essential priority. We cannot win this battle without them.”

Additional COVID-19 mental health resources

Most hospitals have their own specific mental health resources for workers, but the following are useful general resources for care workers, as well as the public:

In the US: 

In Canada: 

In the UK: