Commentary: The effect of stress levels of nurses on performance during the COVID-19 pandemic: the mediating role of motivation.

As a researcher who has spent the last year focusing solely on nurse wellbeing in the UK during the context of the COVID-19 pandemic, the study immediately triggered my interest. The World Health Organization (WHO) declared a pandemic on 11 March 2020. Although the trajectory of the disease has varied in different countries, most have experienced high numbers of cases and mortality. In the UK, the large numbers of cases (currently over 18 million cases and 160,000 deaths linked to the disease (ONS, 2021)) posed a major challenge to healthcare staff working in hospitals, community services, care homes and other social care organisations who cared for individuals with COVID-19 symptoms. New stressors for healthcare staff included fears of contracting a highly infectious disease, concerns about staff shortages, insufficient personal protective equipment (PPE), navigating unfamiliar clinical settings or systems of care due to redeployment, and lack of organisational support (Greenberg et al., 2021). In the UK, these have placed both unexpected and unprecedented extra pressures on the healthcare workforce and on services already under intense strain (The British Academy, 2021). Therefore, it is appropriate to consider whether nurses’ higher levels of stress during the COVID-19 pandemic decrease their motivations and performance both in the UK and internationally.

This study sheds light on perceived stress levels of nurses based in one hospital in Turkey. The authors wished to examine the effect of perceived stress experienced by nurses on their motivation and performance. The authors used four scales (a perceived stress scale, a perceived work stress scale, a motivation at work scale and a performance scale) which all comprised a 5-point Likert scale design. Surprisingly, from the one hundred and fourteen nurses who completed the questionnaires, this study found that the participants’ perceived stress and job stress levels were at a medium level. The participants’ perceived motivation levels were also at a medium level, whilst their perceived performance levels were at a high level. This data is perhaps surprising and contrasts significantly with the longitudinal, qualitative, interview-based work I am involved in, which is ongoing and has now involved over 50 participants from a wide range of nursing settings (Conolly and Maben, 2021). The impact of COVID-19 on nurses (ICON) study based in the UK has found nurses’ stress levels have been significantly raised during the COVID-19 outbreak and continue to be so as measured by Depression Anxiety Stress Scales (DASS) scores which were taken from participants’ responses in the ICON survey from which the qualitative sample was drawn (Couper et al., 2021). Our data suggest the nurses’ increased stress has affected their motivation and their commitment to the profession, with many reporting plans to leave. Therefore, the difference between the two studies is striking. The authors of the reviewed study did attempt to gather data from a wide range of nurses who worked within different settings, albeit within one hospital in Turkey. Fourteen of the nurses who completed questionnaires in the reviewed study were based in the emergency department, 10 were based in the operating rooms, 30 were based in the intensive care unit and 60 were based in the inpatient services. It should be noted that the survey was conducted over 1 month from the end of May 2020. Turkey’s reported rates of incidence of COVID-19, which although had increased during April 2020, were relatively low, especially when compared to other countries. Turkey’s highest rates of COVID-19 incidence were seen during April 2021, so it can be argued that the results of the questionnaire may have differed if it had been conducted shortly after this later period.

Although the reviewed study is only generalisable for the hospital where the survey was conducted and therefore its scope is limited, the authors’ conclusions are worthy as they emphasise the literature that correlates the increasing stress levels of nurses to their performance and motivation negatively. The authors therefore recommend that supportive interventions such as psychological support and flexible working hours may improve nurses’ wellbeing. I would argue that the impacts of the COVID-19 pandemic continue to be felt, with infection rates at the time of writing increasing across Europe and hospitals seeing increasing numbers of patients with COVID-19 and other aliments as well as a high prevalence of staff shortages. Consequently, pressures upon healthcare systems are continuing to amass which can increase the stress experienced by many nurses. Therefore, continued and further research into nurses’ levels of stress, performance and motivation is essential in order to ensure the wellbeing of healthcare staff and the ongoing provision of compassionate care for their patients.