The U.S. deaths related to coronavirus disease 2019 (COVID-19) surpassed 100,000 just over a week ago.1 While much of the focus has been on those infected with the virus, there has also been widespread appreciation for the nurses and other healthcare workers who are courageously caring for those with the disease.

Importantly, the medical community has also begun to address the need for more support for these healthcare workers. Researchers, administrators, and policymakers – recognizing the psychological toll of caring for COVID-19 patients – are beginning to work together to develop strategies to help mitigate the negative effects that this and future outbreaks.

Researchers have identified specific psychological effects of outbreaks on nurses

Previous research has shown that caring for those in times of turmoil increases the risk for developing post-traumatic stress disorder (PTSD) and other types of anxiety and depression.28 More than 30% of the U.S. nurses who served in the Vietnam War suffered from symptoms of PTSD, and the symptoms persisted even when many of these nurses were evaluated 2 years after the war had ended.9,10 Similar results have been observed in response to outbreaks. It has been shown, for instance, that 1 in 5 of healthcare workers exposed to the avian flu has suffered symptoms of PTSD.11

The research on the psychological impact of infectious disease outbreaks on healthcare workers has shown that, compared to physicians, nurses tend to be more psychologically affected by these outbreaks.12 For instance, one study showed that while 30% of physicians had developed a fear of avian flu, 42% of nurses were afraid of this flu.13

COVID-19 has presented some unique stressors

While COVID-19 is leading to the same types of anxiety in frontline workers as has occurred with other unexpected stressful events and pandemics, including fear of contracting and spreading infection, the nature of COVID-19 is associated with additional psychological distress.14 Nurses are, for example, suffering from guilt from watching COVID-19 patients die alone and due to breaking bad news to loved ones through technology instead of through in-person interaction.15,16

Many nurses have also suffered from a sense of helplessness both in and out of work.  Many nurses have not had enough personal protective equipment (PPE) to protect themselves while working with COVID-19 patients, while almost all nurses have lost parts of their personal support system as social distancing policies have been put in place.14


Healthcare leaders are developing recommendations to support nurses

In response to the stress that COVID-19 has placed on nurses, the healthcare community has quickly begun to mobilize research findings to determine the best ways to mitigate the negative psychological impact.17,18 They have pointed, for instance, to the positive psychological effects of demonstrating support for healthcare workers through concrete protection efforts. These efforts include implementing measures to control the spread of infection in the workplace, minimizing work intensity by reducing work hours and arranging for sufficient PPE, and providing practical instructions and guidance on how to care for COVID-19 patients.19

Luckily, the commitment to nurse’s psychological well-being does not appear to stop at a theoretical discussion on how best to prevent or treat mental health issues in this population. Instead, researchers are now creating tools to support the mental health of healthcare workers who have cared for COVID-19 patients.20 The hope is that these tools will not only help the nurses who have cared for COVID-19 patients but will also provide a framework for providing much needed and deserved support for nurses going forward.




  1. United States coronavirus (COVID-19) death toll surpasses 100,000. CDC. https://www.cdc.gov/media/releases/2020/s0528-coronavirus-death-toll.html. Published 2020. Accessed June 7, 2020.
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  4. Lee SM, Kang WS, Cho A-R, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018;87:123-127. doi:10.1016/j.comppsych.2018.10.003
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  6. Mealer M, Burnham EL, Goode CJ, Rothbaum B, Moss M. The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses. Depress Anxiety. 2009;26(12):1118-1126. doi:10.1002/da.20631
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  8. Goulia P, Mantas C, Dimitroula D, Mantis D, Hyphantis T. General hospital staff worries, perceived sufficiency of information and associated psychological distress during the A/H1N1 influenza pandemic. BMC Infect Dis. 2010;10:322. doi:10.1186/1471-2334-10-322
  9. Paul EA. Wounded healers: a summary of the Vietnam Nurse Veteran Project. Mil Med. 1985;150(11):571-576.
  10. Abu-El-Noor NI, Aljeesh YI, Radwan AS, et al. Post-Traumatic Stress Disorder Among Health Care Providers Following the Israeli Attacks Against Gaza Strip in 2014: A Call for Immediate Policy Actions. Arch Psychiatr Nurs. 2016;30(2):185-191. doi:10.1016/j.apnu.2015.08.010
  11. Tang L, Pan L, Yuan L, Zha L. Prevalence and related factors of post-traumatic stress disorder among medical staff members exposed to H7N9 patients. Int J Nurs Sci. 2017;4(1):63-67. doi:10.1016/j.ijnss.2016.12.002
  12. Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. [Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2020;38(0):E001. doi:10.3760/cma.j.cn121094-20200219-00063
  13. Tzeng H-M, Yin C-Y. A crisis: fear toward a possible H5N1 pandemic. J Nurs Care Qual. 2008;23(2):177-183. doi:10.1097/01.NCQ.0000313768.17514.a3
  14. Santarone K, McKenney M, Elkbuli A. Preserving mental health and resilience in frontline healthcare workers during COVID-19. Am J Emerg Med. April 2020. doi:10.1016/j.ajem.2020.04.030
  15. Straus SE, Wilson K, Rambaldini G, et al. Severe acute respiratory syndrome and its impact on professionalism: qualitative study of physicians’ behaviour during an emerging healthcare crisis. BMJ. 2004;329(7457):83. doi:10.1136/bmj.38127.444838.63
  16. Styra R, Hawryluck L, Robinson S, Kasapinovic S, Fones C, Gold WL. Impact on health care workers employed in high-risk areas during the Toronto SARS outbreak. J Psychosom Res. 2008;64(2):177-183. doi:10.1016/j.jpsychores.2007.07.015
  17. Walton M, Murray E, Christian MD. Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Eur Hear journal Acute Cardiovasc care. April 2020:2048872620922795. doi:10.1177/2048872620922795
  18. Spoorthy MS. Mental health problems faced by healthcare workers due to the COVID-19 pandemic-A review. Asian J Psychiatr. 2020;51:102119. doi:10.1016/j.ajp.2020.102119
  19. Khalid I, Khalid TJ, Qabajah MR, Barnard AG, Qushmaq IA. Healthcare Workers Emotions, Perceived Stressors and Coping Strategies During a MERS-CoV Outbreak. Clin Med Res. 2016;14(1):7-14. doi:10.3121/cmr.2016.1303
  20. Blake H, Bermingham F, Johnson G, Tabner A. Mitigating the Psychological Impact of COVID-19 on Healthcare Workers: A Digital Learning Package. Int J Environ Res Public Health. 2020;17(9). doi:10.3390/ijerph17092997