Workplace environment and psychological distress of nurses and nursing assistants during COVID-19

Abstract

Registered nurses (RNs) and nursing assistants (NAs) play critical roles during crises. Understanding how the perceived work environment affects psychological distress among these healthcare workers is essential for developing interventions that support mental health and organizational outcomes. This study examined the association between perceived workplace environment and psychological distress, including stress, depressive, anxiety, and somatic symptoms, among inpatient RNs and NAs during the COVID-19 pandemic. A cross-sectional survey was conducted with 84 RNs and NAs employed at a large academic medical center between April and September 2021. The Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to measure the perceived workplace environment, while psychological distress symptoms were assessed using the Perceived Stress Scale, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7, and PHQ-15. Descriptive statistics and independent t-tests analyzed cohort characteristics. A stepwise approach with univariate and adjusted linear regression models assessed the relationship between workplace environment scores and psychological distress, incorporating demographic variables. Approximately one-third of participants reported moderate to severe psychological distress. No significant differences in distress symptoms were found between RNs and NAs; however, NAs rated Collegial Nurse-Physician Relations significantly lower than RNs (t = -3.84, 95% confidence interval [CI] [-1.15, -0.33], p = .001). Across all unadjusted models, higher PES-NWI total scores were associated with lower psychological distress. In adjusted models, unit-level Nurse Manager Leadership and Support subscale was significantly related to lower depressive (estimate: -2.03, 95% CI [-4.01, -0.04], p = .045) and somatic symptoms (estimate: -2.11, 95% CI [-4.16, -0.06], p = .044). These findings underscore the critical role of nurse managers in fostering supportive workplace environments and highlight the unique challenges faced by NAs. Targeted interventions at the unit and hospital levels can enhance RN and NA well-being, improve organizational outcomes, and build a resilient nursing workforce equipped to navigate future crises.