(PS4-A20) Understanding the Role of Covid-related Workplace Stress and Institutional Betrayal on Mental Health in Nurses: Some Heroes Wear Scrubs

The SARS-CoV-2 virus (COVID) has caused considerable strain on the healthcare system due to the influx of critically ill patients. Research has shown that healthcare professionals, particularly nurses, have exhibited increased rates of posttraumatic stress disorder (PTSD), depression, and anxiety. Specifically, COVID-related stressors have been highlighted as increasing negative mental health outcomes. Institutional betrayal has gained attention as a potentially moderating variable of the relationship between COVID-related stressors and mental health. The current study investigated three specific COVID-related workplace stressors (percentage of nursing work with COVID+ patients, number of COVID-related patient deaths, and living separately from family for safety) and their association with symptoms of three mental health conditions (PTSD, depression, and generalized anxiety disorder [GAD]) in a sample of nurses. Institutional betrayal was examined as a moderator of these associations.

The sample consisted of 391 nurses practicing in Massachusetts during the first year of the COVID pandemic. Participants ranged in age from 23 to 69 years old (M = 43.6; SD = 12.7) with the majority of the sample being White (93.6%) and identifying as female (93.4%). COVID-related workplace stress was measured by three separate questions, and institutional betrayal was measured using the Institutional Betrayal Questionnaire (modified for the current study). Mental health symptoms of PTSD, depression, and anxiety were measured using the Posttraumatic Checklist for the DSM-5, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder Assessment, respectively.

Three separate moderation analyses were run using Mplus for each workplace stress variable. Significant main effects were noted for institutional betrayal on PTSD, depression, and GAD (b’s = .22 to .71, p < .001), wherein higher levels of institutional betrayal were associated with higher levels of each mental health condition. Percentage of nursing work with COVID+ patients was also significantly associated with higher levels of PTSD (b = .18, p < .001 ), depression (b = .03, p = .003), and GAD (b = .02, p = .007). Living away from family was significantly associated with higher levels of PTSD (b = 8.18, p < .001) and depression (b = 2.07, p = .015). Number of patient deaths held a significant association with PTSD alone (b = .27, p = .027). No significant interactions were noted.

Results from the current study suggest that perceptions of institutional betrayal were impactful among nurses during the early stages of the COVID pandemic, with many nurses perceiving that their workplace failed to protect them or fulfill its obligation to them. These findings suggest that it would be beneficial for healthcare systems to be receptive to nurses’ perceptions of institutional betrayal, as feelings of betrayal may be a contributing factor to reasons for quitting their employment. As well, results imply that healthcare systems should prioritize the mental health of nursing staff, as moderate levels of PTSD, depression, and GAD were observed in the study sample.