Experiences of U.S. Nurses Compared With Nonnurses in the First Year of COVID-19: Findings From a National Registry

Mei Lin Chen-Lim, Margaret A McCabe, Haolin Xu, Laine E Thomas, Christopher B Forrest, Shira Birnbaum, Laura E Webb, Emily C O'Brien, Mei Lin Chen-Lim, Margaret A McCabe, Haolin Xu, Laine E Thomas, Christopher B Forrest, Shira Birnbaum, Laura E Webb, Emily C O'Brien

Abstract

Background: Nursing professional organizations and media sources indicated early in the pandemic that the physical and psychological effects of COVID-19 might be distinct and possibly greater in nurses than in other types of healthcare workers (HCWs).

Objectives: Based on survey data collected in Healthcare Worker Exposure Response and Outcomes (HERO), a national registry of U.S. HCWs, this study compared the self-reported experiences of nurses with other HCWs during the first 13 months of the pandemic.

Methods: Nurse responses were compared to responses of nonnurse HCWs in terms of viral exposure, testing and infection, access to personal protective equipment (PPE), burnout, and well-being. Logistic regression models were used to examine associations between nurse and nonnurse roles for the binary end points of viral testing and test positivity for COVID-19. We also examined differences by race/ethnicity and high-risk versus low-risk practice settings.

Results: Of 24,343 HCWs in the registry, one third self-identified as nurses. Nurses were more likely than other HCWs to report exposure to SARS-CoV-2, problems accessing PPE, and decreased personal well-being, including burnout, feeling tired, stress, trouble sleeping, and worry. In adjusted models, nurses were more likely than nonnurse HCWs to report viral testing and test positivity for COVID-19 infection. Nurses in high-risk settings were more likely to report viral exposure and symptoms related to well-being; nurses in low-risk settings were more likely to report viral testing and test positivity. Black or Hispanic nurses were most likely to report test positivity.

Discussion: Differences were identified between nurses and nonnurse HCWs in access to PPE, physical and mental well-being measures, and likelihood of reporting exposure and infection. Among nurses, testing and infection differed based on race and ethnicity, and type of work setting. Our findings suggest further research and policy are needed to elucidate and address social and occupational disparities.

Trial registration: ClinicalTrials.gov NCT04342806.

Conflict of interest statement

Drs. Thomas, O’Brien, and Forrest report grants from PCORI, during the conduct of the study. Dr. O’Brien also reports grant from Pfizer. The remaining authors have no conflicts of interest to report.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Figures

FIGURE 1
FIGURE 1
State of residence for 8,606 nurses based on individuals reported five-digit zip codes of residence.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/9640262/bin/nres-71-421-g002.jpg

References

    1. Aiyer A. Surani S. Ratnani I., & Surani S. (2020). Mental health impact of COVID-19 on healthcare workers in the USA: A cross-sectional web-based survey. Journal of Depression and Anxiety, 9, 1–8.
    1. Akinbami L. J. Chan P. A. Vuong N. Sami S. Lewis D. Sheridan P. E. Lukacs S. L. Mackey L. Grohskopf L. A. Patel A., & Petersen L. R. (2021). Severe acute respiratory syndrome coronavirus 2 seropositivity among healthcare personnel in hospitals and nursing homes, Rhode Island, USA, July–August 2020. Emerging Infectious Diseases, 27, 823–834. 10.3201/eid2703.204508
    1. American Nurses Association . (2021, September 1). ANA urges U.S. Department of Health and Human Services to declare nurse staffing shortage a national crisis [Press release].
    1. Cabarkapa S. Nadjidai S. E. Murgier J., & Ng C. H. (2020). The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: A rapid systematic review. Brain, Behavior, & Immunity–Health, 8, 100144. 10.1016/j.bbih.2020.100144
    1. Castro-Sánchez E. Russell A. M. Dolman L., & Wells M. (2021). What place does nurse-led research have in the COVID-19 pandemic? International Nursing Review, 68, 214–218. 10.1111/inr.12660
    1. Cohen J., & van der Meulen Rodgers Y. (2020). Contributing factors to personal protective equipment shortages during the COVID-19 pandemic. Preventive Medicine, 141, 106263. 10.1016/j.ypmed.2020.106263
    1. Czeisler M. É. Lane R. I. Petrosky E. Wiley J. F. Christensen A. Njai R. Weaver M. D. Robbins R. Facer-Childs E. R. Barger L. K. Czeisler C. A. Howard M. E., & Rajaratnam S. M. W. (2020). Mental health, substance use, and suicidal ideation during the COVID-19 pandemic—United States, June 24–30, 2020. Morbidity and Mortality Weekly Report, 69, 1049–1057. 10.15585/mmwr.mm6932a1
    1. Dean A. Venkataramani A., & Kimmel S. (2020). Mortality rates from COVID-19 are lower in unionized nursing homes. Health Affairs, 39, 1993–2001. 10.1377/hlthaff.2020.01011
    1. Dolan E. D. Mohr D. Lempa M. Joos S. Fihn S. D. Nelson K. M., & Helfrich C. D. (2015). Using a single item to measure burnout in primary care staff: A psychometric evaluation. Journal of General Internal Medicine, 30, 582–587. 10.1007/s11606-014-3112-6
    1. Forrest C. B. Xu H. Thomas L. E. Webb L. E. Cohen L. W. Carey T. S. Chuang C. H. Daraiseh N. M. Kaushal R. McClay J. C. Modave F. Nauman E. Todd J. V. Wallia A. Bruno C. Hernandez A. F., & O’Brien E. C., HERO Registry Research Group (2021). Impact of the early phase of the COVID-19 pandemic on U.S. healthcare workers: Results from the HERO Registry. Journal of General Internal Medicine, 36, 1319–1326. 10.1007/s11606-020-06529-z
    1. Friedland A. Hernandez A. F. Anstrom K. J. Chen-Lim M. L. Cohen L. W. Currier J. S. Forrest C. B. Fraser R. Fraulo E. George A. Handberg E. Jackman J. Koellhoffer J. Lawrence D. Leverty R. McAdams P. McCourt B. Mickley B., & Naqvi S. H., HERO Research Program (2021). Design of the Healthcare Worker Exposure Response and Outcomes (HERO) research platform. Contemporary Clinical Trials, 109, 106525. 10.1016/j.cct.2021.106525
    1. Gallup . (2019). Gallup 2019 global emotions report.
    1. Goldman J., & Xyrichis A. (2020). Interprofessional working during the COVID-19 pandemic: Sociological insights. Journal of Interprofessional Care, 34, 580–582. 10.1080/13561820.2020.1806220
    1. Goldman N. Pebley A. R. Lee K. Andrasfay T., & Pratt B. (2021). Racial and ethnic differentials in COVID-19-related job exposures by occupational standing in the U.S. PLOS ONE, 16, e0256085. 10.1371/journal.pone.0256085
    1. Gómez-Ochoa S. A. Franco O. H. Rojas L. Z. Raguindin P. F. Roa-Díaz Z. M. Wyssmann B. M. Guevara S. L. R. Echeverría L. E. Glisic M., & Muka T. (2021). COVID-19 in health-care workers: A living systematic review and meta-analysis of prevalence, risk factors, clinical characteristics, and outcomes. American Journal of Epidemiology, 190, 161–175. 10.1093/aje/kwaa191
    1. Handfield R. Finkenstadt D. J. Schneller E. S. Godfrey A. B., & Guinto P. (2020). A commons for a supply chain in the post-COVID-19 era: The case for a reformed strategic national stockpile. Milbank Quarterly, 98, 1058–1090. 10.1111/1468-0009.12485
    1. Hatef E. Chang H.-Y. Kitchen C. Weiner J. P., & Kharrazi H. (2020). Assessing the impact of neighborhood socioeconomic characteristics on COVID-19 prevalence across seven states in the United States. Frontiers in Public Health, 8, 571808. 10.3389/fpubh.2020.571808
    1. Hughes M. M. Groenewold M. R. Lessem S. E. Xu K. Ussery E. N. Wiegand R. E. Qin X. Do T. Thomas D. Tsai S. Davidson A. Latash J. Eckel S. Collins J. Ojo M. McHugh L. Li W. Chen J. Chan J., … Stuckey M. J. (2020). Update: Characteristics of health care personnel with COVID-19—United States, February 12–July 16, 2020. Morbidity and Mortality Weekly Report, 69, 1364–1368. 10.15585/mmwr.mm6938a3
    1. Ibiebele J. Silkaitis C. Dolgin G. Bolon M. Cullen J., & Zembower T. (2021). Occupational COVID-19 exposures and secondary cases among healthcare personnel. American Journal of Infection Control, 49, 1334–1336. 10.1016/j.ajic.2021.07.021
    1. Khajuria A. Tomaszewski W. Liu Z. Chen J.-H. Mehdian R. Fleming S. Vig S., & Crawford M. J. (2021). Workplace factors associated with mental health of healthcare workers during the COVID-19 pandemic: An international cross-sectional study. BMC Health Services Research, 21, 262. 10.1186/s12913-021-06279-6
    1. Kim H. Hegde S. LaFiura C. Raghavan M. Sun N. Cheng S. Rebholz C. M., & Seidelmann S. B. (2021). Access to personal protective equipment in exposed healthcare workers and COVID-19 illness, severity, symptoms and duration: A population-based case-control study in six countries. BMJ Global Health, 6, e004611. 10.1136/bmjgh-2020-004611
    1. Lasater K. B. Aiken L. H. Sloane D. M. French R. Martin B. Reneau K. Alexander M., & McHugh M. D. (2020). Chronic hospital nurse understaffing meets COVID-19: An observational study. BMJ Quality & Safety, 30, 639–647. 10.1136/bmjqs-2020-011512
    1. National Nurses United . (2020, September). Sins of omission: How government failures to track COVID-19 data have led to more than 1,700 health care worker deaths and jeopardize public health [Report].
    1. Nguyen L. H. Drew D. A. Graham M. S. Joshi A. D. Guo C.-G. Ma W. Mehta R. S. Warner E. T. Sikavi D. R. Lo C.-H. Kwon S. Song M. Mucci L. A. Stampfer M. J. Willett W. C. Eliassen A. H. Hart J. E. Chavarro J. E. Rich-Edwards J. W., … Chan A. T. (2020). Risk of COVID-19 among front-line health-care workers and the general community: A prospective cohort study. The Lancet Public Health, 5, e475–e483. 10.1016/s2468-2667(20)30164-x
    1. Norman S. B. Feingold J. H. Kaye-Kauderer H. Kaplan C. A. Hurtado A. Kachadourian L. Feder A. Murrough J. W. Charney D. Southwick S. M. Ripp J. Peccoralo L., & Pietrzak R. H. (2021). Moral distress in frontline healthcare workers in the initial epicenter of the COVID-19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning. Depression & Anxiety, 38, 1007–1017. 10.1002/da.23205
    1. NurseGrid . (2021). A pandemic’s toll on nursing: January 2021 [Report].
    1. Piccoli L. Ferrari P. Piumatti G. Jovic S. Rodriguez B. F. Mele F. Giacchetto-Sasselli I. Terrot T. Silacci-Fregni C. Cameroni E. Jaconi S. Sprugasci N. Bartha I. Corti D. Uguccioni M. Lanzavecchia A. Garzoni C. Giannini O. Bernasconi E., … Ceschi A. (2021). Risk assessment and seroprevalence of SARS-CoV-2 infection in healthcare workers of COVID-19 and non-COVID-19 hospitals in Southern Switzerland. The Lancet Regional Health–Europe, 1, 100013. 10.1016/j.lanepe.2020.100013
    1. Pilkonis P. A. Choi S. W. Reise S. P. Stover A. M. Riley W. T. Cella D., PROMIS Cooperative Group . (2011). Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): Depression, anxiety, and anger. Assessment, 18, 263–283. 10.1177/1073191111411667
    1. Prasad K. McLoughlin C. Stillman M. Poplau S. Goelz E. Taylor S. Nankivil N. Brown R. Linzer M. Cappelucci K. Barbouche M., & Sinsky C. A. (2021). Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study. EClinicalMedicine, 35, 100879. 10.1016/j.eclinm.2021.100879
    1. Rich-Edwards J. W. Ding M. Rocheleau C. M. Boiano J. M. Kang J. H. Becene I. Nguyen L. H. Chan A. T. Hart J. E. Chavarro J. E., & Lawson C. C. (2021). American frontline healthcare personnel’s access to and use of personal protective equipment early in the COVID-19 pandemic. Journal of Occupational and Environmental Medicine, 63, 913–920. 10.1097/jom.0000000000002308
    1. Romano S. D. Blackstock A. J. Taylor E. V. El Burai Felix S. Adjei S. Singleton C.-M. Fuld J. Bruce B. B., & Boehmer T. K. (2021). Trends in racial and ethnic disparities in COVID-19 hospitalizations, by region—United States, March–December 2020. Morbidity and Mortality Weekly Report, 70, 560–565. 10.15585/mmwr.mm7015e2
    1. Rushton C. H. Turner K. Brock R. N., & Braxton J. M. (2021). Invisible moral wounds of the COVID-19 pandemic: Are we experiencing moral injury? AACN Advanced Critical Care, 32, 119–125. 10.4037/aacnacc2021686
    1. Shah A. S. V. Wood R. Gribben C. Caldwell D. Bishop J. Weir A. Kennedy S. Reid M. Smith-Palmer A. Goldberg D. McMenamin J. Fischbacher C. Robertson C. Hutchinson S. McKeigue P. Colhoun H., & McAllister D. A. (2020). Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: Nationwide linkage cohort study. BMJ, 371, m3582. 10.1136/bmj.m3582
    1. Shaukat N. Ali D. M., & Razzak J. (2020). Physical and mental health impacts of COVID-19 on healthcare workers: A scoping review. International Journal of Emergency Medicine, 13, 40. 10.1186/s12245-020-00299-5
    1. Stefan N. Birkenfeld A. L., & Schulze M. B. (2021). Global pandemics interconnected—Obesity, impaired metabolic health and COVID-19. Nature Reviews. Endocrinology, 17, 135–149. 10.1038/s41574-020-00462-1
    1. Tai D. B. G. Shah A. Doubeni C. A. Sia I. G., & Wieland M. L. (2021). The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States. Clinical Infectious Diseases, 72, 703–706. 10.1093/cid/ciaa815
    1. Valdes A. M. Moon J. C. Vijay A. Chaturvedi N. Norrish A. Ikram A. Craxford S. Cusin L. M. L. Nightingale J. Semper A. Brooks T. McKnight A. Kurdi H. Menni C. Tighe P. Noursadeghi M. Aithal G. Treibel T. A. Ollivere B. J., & Manisty C. (2021). Longitudinal assessment of symptoms and risk of SARS-CoV-2 infection in healthcare workers across 5 hospitals to understand ethnic differences in infection risk. EClinicalMedicine, 34, 100835. 10.1016/j.eclinm.2021.100835
    1. Wolff D. Nee S. Hickey N. S., & Marschollek M. (2021). Risk factors for COVID-19 severity and fatality: A structured literature review. Infection, 49, 15–28. 10.1007/s15010-020-01509-1

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel