Cross-sectional survey of COVID-19-related impacts on mental health of nurses: occupational disruption, organisational preparedness, psychological harm, and moral distress

Abstract

Background: The COVID-19 pandemic has presented unprecedented levels of prolonged strain on healthcare systems and healthcare workers (HCWs) globally, with nurses at the forefront.

Objectives: To describe types and prevalence of occupational disruptions and exposure to COVID-19, and their impacts on mental health, moral distress, coping strategies, and help-seeking behaviours of Australian nurses.

Design: A cross-sectional online anonymous survey distributed amongst Australian HCWs between 27 August and 23 October 2020.

Methods: Data was collected on demographics, workplace disruption, personal relationships, and mental health. Predictors of mental health impacts and coping strategies were identified through multivariate regression analyses.

Results: 7845 complete responses were returned, of which 3082 (39.3%) were from nurses and 4763 (60.7%) were from all other professions (‘other HCWs’). Occupational disruption was common, with nurses specifically reporting additional paid hours (p < 0.001). Nurses were exposed to, and infected with, COVID-19 more frequently than other HCWs (p < 0.001) and were more likely to report concerns around stigmatisation from the broader community (p < 0.001). Symptoms of mental illness (anxiety, depression, PTSD and burnout) were significantly more prevalent in nurses than other HCWs, despite both groups scoring high on resilience. Common predictors of mental health symptoms included exposure to COVID-19 and worsening of personal relationships. Nurses reported a variety of coping strategies and were more likely than other HCWs to increase alcohol consumption. Engagement with formal support services was low for both groups. Personal and professional predictors for coping strategy use were identified.

Conclusions: Urgent action is needed to address staff shortages and burnout which have been exacerbated by COVID-19. Initiatives that recognise the importance of nursing staff and incentivise current and future nurses to join and remain in the workforce are essential.

KEYWORDS:

• COVID-19
• mental health
• Nursing staff
• workforce
• Cross-sectional studies
• regression analysis

Acknowledgements

The authors gratefully acknowledge and thank the Royal Melbourne Hospital Foundation and the Lord Mayor’s Charitable Foundation for financial support for this study. The authors acknowledge the following people who helped plan and disseminate the survey: A/Prof Leila Karimi, A/Prof Mark Putland, A/Prof Douglas Johnson, A/Prof Marie Bismark, Prof Shyamali Dharmage, Dr Elizabeth Barson, Dr Nicola Atkin, Dr Clare Long, Dr Irene Ng, Prof Anne Holland, Assoc Prof Jane Munro, Dr Irani Thevarajan, Dr Cara Moore, Assoc Prof Anthony McGillion and Ms Debra Sandford. They wish to thank the numerous health organisations, universities, professional societies, associations and colleges, and many supportive individuals who assisted in disseminating the survey. We thank the Royal Melbourne Hospital Business Intelligence Unit who provided and hosted the REDCap electronic data capture tools.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data are available upon reasonable request to the corresponding author.

Additional information

Funding

This work was supported by Royal Melbourne Hospital Foundation and the Lord Mayor’s Charitable Foundation. Funding bodies had no role in the research activity. All authors were independent from the funders and had access to the study data.