HealthMarch 02, 2022

What nurse leaders should know about PTSD in nurses during COVID-19

By: Sarah Handzel, BSN, RN
In early 2020, the COVID-19 pandemic caused major disruptions to the global healthcare industry. Two years later, nurses and healthcare workers continue to face tremendous pressure and stress to effectively treat patients diagnosed with the virus, resulting in increased rates of mental health disorders, including post-traumatic stress disorder (PTSD), among frontline healthcare workers.

According to the National Institute of Mental Health1, PTSD develops only after a person experiences a shocking, scary, or dangerous event. Symptoms may include flashbacks, bad dreams, avoidance of places or events, feeling tense, having angry outbursts, loss of interest in enjoyable activities, and distorted feelings like guilt or blame.

Many people who experience traumatic events eventually recover. But repeated exposure to such sources of stress may result in PTSD. Many studies already point to first responders having higher PTSD rates compared to the general population. Some research indicates that several work-related factors, such as unsupportive management, poorly staffed nursing units, increased nursing responsibilities, and high nurse-to-patient ratios may lead to symptoms of emotional exhaustion and PTSD.

The Journal of Nursing Administration2 recently published a study aiming to explore the connection between nurses’ practice environment, PTSD, and intent to leave among nurses working during the pandemic. The results can be used by nurse leaders to inform future mental health strategies and stress management interventions that support nursing staff members working during COVID-19.

One third of nurses report PTSD symptoms

The study authors collected data from nurses using an anonymous, confidential, Web-based, cross-sectional survey of nurses in the northeastern and midwestern regions of the country. Ultimately, data was used from 56 nurses. Participants completed:

  • A demographic questionnaire
  • The Practice Environment Scale of the Nursing Work Index (PES-NWI)
  • The PTSD Checklist Specific for DSM-IV (PCL-S)
  • The 6-teim Turnover Intention Scale (TIS-6)

Each nurse was also asked whether he or she worked during the COVID-19 pandemic and whether or not direct patient care was provided to COVID-19 patients.

Based on the scoring system for the PCL-S scale, 33% of survey respondents reported some degree of PTSD symptoms. Approximately 82% reported a favorable practice environment; 91.1% indicated that the nurse manager’s ability, leadership, and support of nurses greatly contributed to a “good” practice environment. Most nurses surveyed also reported collegial nurse-physician relationships as favorable as well as nursing foundations for quality of care. However, 18% still reported a work environment that was not ideal.

On the basis of the study findings, 44.5% of respondents indicated they thought about leaving their position. An unfavorable nurses’ practice environment accounted for 20.3% of nurse’ intent to leave.

What can nurse leaders to do support staff?

This study found a relationship between the practice environment and nurses’ intent to leave their position. Unfavorable practice environments are associated with negative consequences such as PTSD symptoms and intent to leave a nursing position.

Nurse leaders should work with others to develop meaningful mental health management strategies, including stress management techniques. Doing so helps provide support and promote effective coping among direct care providers. Nurse leaders can advocate for staff members by recommending strategies to address practice issues through shared governance.

It is also essential for leaders to be aware of and educated regarding factors that increase the risk of PTSD in the workplace. Interventions can improve the recognition of psychological symptoms among nurses exposed to traumatic events. Other techniques, such as mindfulness and resilience training, may help mitigate the effects of PTSD.

The long-term impact of the COVID-19 pandemic on the mental health of nurses is not yet fully known. However, based on this and other studies, it is important for nurse leaders to advocate for tools and resources to help staff members support and improve their mental health.

  1. “Post-Traumatic Stress Disorder.” National Institute of Mental Health, U.S. Department of Health and Human Services,
  2. JONA: The Journal of Nursing Administration: February 2022 - Volume 52 - Issue 2 - p E3-E8 doi: 10.1097/NNA.0000000000001112
Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
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