Mental health issues in nurses during the COVID-19 pandemic could be contributing to decreased quality of patient care, according to study findings published in Healthcare. Nurses with greater severity of mental health symptoms were more likely to rate the quality of care in their work units in hospitals, long-term care homes, and community health centers as poor during the pandemic compared with before the pandemic.

“When nurses reported high emotional exhaustion, their ratings of quality and safety of patient care delivery dropped eightfold,” said lead author Farinaz Havaei, RN, PhD, assistant professor in the School of Nursing at University of British Columbia.

The findings are based on cross-sectional data from surveys conducted in December 2019 (n=4729) and June to July 2020 (n=3585) among actively working registered nurses (RN) and/or registered psychiatric nurses (RPN) and licensed practical nurses (LPN) in British Columbia, Canada. Mental health was measured using standardized scales for anxiety, depression, post-traumatic stress disorder, and burnout.

Continue Reading

Nurses were also asked to provide the following information:

  • Rate the overall safety at their workplace on a 5-point scale ranging from failing to excellent
  • Rate the general quality of nursing care they delivered to patients on their unit using a 4-point response scale ranging from poor to excellent
  • Indicate their likelihood of recommending their unit to friends and family for care on a 4-point scale ranging from definitely no to definitely yes

Respondents reported significantly higher rates of anxiety, depression, PTSD, and emotional exhaustion during the COVID-19 pandemic compared with prepandemic levels (Table; P <.0001 for all comparisons). While respondents rated the overall safety of their workplace as higher during the pandemic and were more likely to recommend their unit to their friends, they rated the general quality of nursing care as significantly lower during the pandemic. For all mental health symptoms, higher ratings were associated with lower ratings of quality and safety both before and during the COVID-19 pandemic.

Table. Comparisons of Mental Health Symptoms and Quality Safety Ratings Before and During COVID-19

Table reprinted from Havaei et al.

The findings may not be generalizable to other samples, Dr. Havaei and colleagues noted. Other study limitations included relatively low response rates to the surveys and that the findings could be related to small differences in the sample demographics between the 2 survey cohorts. Also, the safety data are based on nurses’ reports and the findings do not imply a cause and effect relationship, the study authors noted. 

Clinical Implications

“Providing safe, quality patient care is impossible without a healthy nursing workforce,” Dr Havaei said. “We should pay close attention to work environment factors such as heavy workloads and inadequate staffing that are known risk factors to nurses’ mental health.”

“We also recommend that nurses’ mental health should be included as part of a comprehensive set of quality indicators in hospitals, tracked over time, and publicly reported in an aggregated format,” Dr Havaei said. “Patients and members of the public can then use the information to identify high-performing health care organizations.”


Havaei F, Tang X, Smith P, Boamah SA, Frankfurter C. The Association between mental health symptoms and quality and safety of patient care before and during covid-19 among Canadian nurses. Healthcare (Basel). 2022;10(2):314. doi:10.3390/healthcare10020314

The University of British Columbia. New COVID-19 study links nurses’ mental health to quality of care. February 16, 2022. Accessed February 25, 2022.