Focus on Nurses’ Mental Health
Canadian Journal of Nursing
Nurses’ Mental Health and Well-Being:
COVID-19 Impacts
Andrea M. Stelnicki1 , R. Nicholas Carleton2, and Carol Reichert3
Abstract
The editorial will introduce a special section on nurses’ mental health and well-being that will showcase results from a
groundbreaking pan-Canadian study of nurses’ occupational stress. The article series highlights research efforts toward
better supporting nurses’ mental health. In this editorial, we discuss the importance of this research in light of the COVID-19
pandemic. We review the current stressors faced by nurses and anticipate how nurses’ mental health and well-being will be
impacted by COVID-19.
Keywords
Mental health, COVID-19, nurses, well-being
Canadian nurses regularly encounter high workload,
violence in the workplace, burnout, and exposure to
potentially psychologically traumatic events (PPTEs),
each of which has been empirically associated with
increased symptoms of mental disorders (Carleton
et al., 2018; McFarlane & Bryant, 2007). The cumulative
effects of repeated exposure to stressors may result in
poorer mental health and functioning (Cavanaugh
et al., 2014). Nurses experience symptoms of posttrau-
matic stress disorder (PTSD), depression, and anxiety
more frequently than the general population (Mealer
et al., 2009), yet up-to-date and large sample data are
missing.
From May to September 2019, we deployed a survey
collaboratively designed with the Canadian Federation
of Nurses Unions (CFNU) to clarify the experiences of
occupational stress in health-care settings. We sought to
identify associated factors that may contribute to posi-
tive screens for mental disorders, including burnout,
exposures to PPTEs, workplace considerations (e.g.,
location, overtime, support from leadership), and socio-
demographic characteristics. Many have argued that
nurses represent an important component of the public
safety continuum; accordingly, the project intentionally
paralleled work completed between 2016 and 2017 with
Canadian public safety personnel (e.g., corrections
workers, firefighters, paramedics, police; Carleton
et al., 2018) to allow for unique comparisons across
occupational groups. In this special section and over
the next several issues, we will showcase results from
this groundbreaking pan-Canadian study of nurses’
Research
2020, Vol. 52(3) 237–239
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DOI: 10.1177/0844562120931623
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occupational stress and highlight research efforts
toward better supporting nurses’ mental health.
Having information from such a large sample of
Canadian nurses is extremely timely; baseline levels of
mental disorder symptoms may allow for inferences on
how the current COVID-19 pandemic is affecting nurses’
mental well-being. As health-care workers (HCWs) deal
with the novel coronavirus, nurses are managing addi-
tional increased sources of stress. Nurses are now faced
with concerns about sufficient supply and access to per-
sonal protective equipment (PPE); inadequate staffing
and long working hours; isolation from family and
friends; discrimination and negative treatment from
those in the community worried about nurses spreading
the virus; managing family responsibilities (e.g., child
care); concern for ill patients; and substantial risk of
contracting the virus (CFNU, 2020; Cullen, 2020;
Doolittle et al., 2020; Loeb et al., 2004; Shanafelt
et al., 2020). As of the end of April 2020, HCWs make
up a substantial portion of total cases, particularly in
British Columbia (21% of cases; Kotyk, 2020), Ontario
1
Canadian Institute for Public Safety Research and Treatment, University of
Regina, Regina, Saskatchewan, Canada
2
Anxiety and Illness Behaviour Lab, University of Regina, Regina,
Saskatchewan, Canada
3
Canadian Federation of Nurses Unions, Ottawa, Ontario, Canada
Corresponding Author:
Andrea M. Stelnicki, Canadian Institute for Public Safety Research and
Treatment, University of Regina, Regina, SK S4S 0A2, Canada.
Email: andrea.stelnicki@uregina.ca
238
(14.2% of cases; Rodrigues, 2020), and Quebec (18% of
cases; Laframboise, 2020). Canadian HCW infection
rates appear to have surpassed infection rates among
HCWs in China (4.4%; Zhan et al., 2020). We have
surpassed infection rates observed during the 2002–
2003 SARS outbreak, which was primarily contained
to hospitals and HCWs.
The psychological impacts of COVID-19 on global
HCWs are already apparent. Anecdotal accounts high-
light the increased frequency of unmanageable stress and
burnout among HCWs during the pandemic (Doolittle
et al., 2020). Between February and March 2020, during
the height of COVID-19 response, many HCWs surveyed
in two Singapore hospitals screened positive for clinically-
significant levels of anxiety (14.5%), depression (8.9%),
and PTSD (7.7%) (Tan et al., 2020). Nurses in China
are reporting high levels of depression and anxiety symp-
toms, insomnia, psychological distress, and vicarious trau-
matization related to COVID-19 (Lai et al., 2020; Li et al.,
2020). Preliminary survey results suggest that HCWs in
Canada will experience increased symptoms of anxiety
and depression, driven primarily by concerns about inad-
equate PPE supply (Oudyk & Smith, 2020).
Nurses’ mental health following the peak of the
COVID-19 pandemic will undoubtedly be impacted.
Large-scale disasters, including the previous H1N1 pan-
demic, have been accompanied by increased symptoms
of insomnia, depression, PTSD, and substance use, par-
ticularly in frontline workers (Goulia et al., 2010; Neria
et al., 2008). HCWs reported significantly high levels of
burnout, psychological distress, and PTSD symptoms
following the SARS outbreak in Toronto (Maunder
et al., 2006); however, psychiatric disorder incidence
rates were consistent with, or lower than, the communi-
ty, underscoring the resiliency of our HCWs (Lancee
et al., 2008). Psychological impacts may be more preva-
lent in settings with high risk of infection, without access
to psychiatric services, and without timely information
about the epidemic provided by leadership (Matsuishi
et al., 2012), suggesting that immediate and long-term
outcomes might be improved with properly implemented
proactive and progressive interventions.
Many provinces have already deployed psychosocial
supports specifically for health-care and frontline work-
ers. HCWs want to be supported by their organization
through open communication, transparency, compre-
hensive organizational risk assessments, sufficient and
appropriate staffing, access to appropriate PPE and
better information about the PPE supply, rapid virus
testing, prompt and extensive training, assisting with
physical needs (e.g., healthy meals while working, laun-
dering of uniforms, lodging for those in self-isolation),
and ongoing psychological support (Shanafelt et al.,
2020). Leaders and managers must provide opportuni-
ties to access counseling and other formal support
Canadian Journal of Nursing Research 52(3)
services and encourage peer support systems among col-
leagues. Researchers should be working collaboratively
with HCWs to track psychological stress throughout and
following the pandemic, evaluate organizational
responses over time (e.g., mental health training, post-
crisis debriefing and response), and prepare to inform
best practices going forward. The well-being of health-
care providers is a significant determinant of patient
care; as such, we need to support Canadian nurses as
they work to support us.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
ORCID iD
Andrea M. Stelnicki https://orcid.org/0000-0002-4519-0368
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Author Biographies
Andrea M. Stelnicki, PhD, is a postdoctoral fellow at the
Canadian Institute for Public Safety Research and
Treatment (CIPSRT) at the University of Regina. Dr.
Stelnicki’s research focuses on supporting the mental
health of public safety and military personnel and their
families.
R. Nicholas Carleton, PhD, is a Professor of Psychology
at the University of Regina who also serves as the
Scientific Director for CIPSRT. His interests including
the biopsychosocial measurement, assessment, and treat-
ments of trauma, anxiety, and somatic disorders, focus-
ing on transdiagnostics, fundamental cognitions (i.e.,
lower-order factors such as intolerance of uncertainty),
and shared emergent properties (i.e., higher-order fac-
tors such as extraversion).
Carol Reichert, MA, is a Policy and Research Specialist
at the Canadian Federation of Nurses Unions (CFNU).
Ms. Reichert coordinates, manages and contributes to
CFNU research projects and is responsible for the ongo-
ing work of CFNU’s three networks: Research,
Occupational Health & Safety and Professional Practice.