The Psychosocial Impact of COVID‐19 on Registered Nurses

RESEARCH OBJECTIVE: Central the COVID‐19 pandemic response are registered nurses (nurses), making life and death decisions amidst personal protective equipment (PPE) shortages and scarcity in other resources (e.g., ventilators, medications, staff). Emerging international evidence suggests nurses are at higher risk for detrimental psychosocial outcomes related to the pandemic, such as anxiety, depression, and sleep problems, compared to other clinician groups. The objective of this research is to describe the psychosocial impact of the COVID‐19 pandemic on nurses currently practicing in the U.S. STUDY DESIGN: We conducted a concurrent mixed methods study from May‐August 2020. Participants were recruited through email listservs from regional professional nursing organizations, NIOSH‐funded Education and Research Centers nationwide, and through social media. Through REDCap, participants completed researcher‐developed sociodemographic and work characteristic questions (e.g., unit type, staffing levels, availability of PPE), and several validated instruments to measure depressive symptoms (Patient Health Questionnaire; PHQ‐9), anxiety (Generalized Anxiety Disorder; GAD‐7), insomnia (Insomnia Severity Index; ISI), and resilience (Connor Davidson Resilience Scale; CD‐RISC‐10). A subset of participants was purposefully selected for semi‐structured individual phone interviews to achieve maximum variation. Following data collection, we randomly drew 10 participants to receive a $50 Amazon giftcard. POPULATION STUDIED: We recruited a sample of nurses from 36 states and the District of Columbia. The analytic sample included N=629 for the survey and N=34 for the interviews. We report only survey findings herein. PRINCIPAL FINDINGS: Participants were on average 43 years old (SD 13), 92% female, and 80% White; 92% were non‐Hispanic. Three‐quarters (76%) worked in inpatient hospital settings; 20% worked in intensive care or step‐down units. Approximately 70% of the sample worked day shifts and 59% worked 12‐hour shifts. Out of a list of 13 common PPE items, 91% of the sample reported at least one PPE shortage since the pandemic began, and 24% reported bringing or making their own PPE for use at work. Over one in four (28%) nurses reported being unsure or planned to leave their employer in the next year. About 18% of the sample scored ≥ 15 on the ISI, suggesting insomnia symptoms significant enough to warrant evaluation and treatment. A third of participants (34%) had scores reflecting mild anxiety, a quarter (24%) had scores reflecting moderate anxiety, and 9% scored in the range reflecting severe anxiety on the GAD‐7. Reports on the PHQ‐9 showed 9% of the sample with scores consistent with major depressive disorder while another 7% scored in the range consistent with other depressive disorder. Finally, the average CD‐RISC score was 29, with lower scores indicating lower resilience (range 0‐40). CONCLUSIONS: As with other countries, U.S. nurses are facing highly stressful working conditions, with warning signals indicated in the psychosocial domains of anxiety, depression, and insomnia. Overall, resilience levels are worse than pre‐pandemic levels from previously published literature. IMPLICATIONS FOR POLICY OR PRACTICE: As healthcare organizations adapt and respond to the pandemic, priority should be given to assessing and treating the psychosocial harm to nurses. Evidence‐based treatments and development of novel interventions to support this vital healthcare sector are warranted. PRIMARY FUNDING SOURCE: intramural university funds