This study investigated the influence of fear of COVID–19 on frontline nurses’ job satisfaction, psychological distress, organisational turnover intention and professional turnover intention. To our knowledge, this is the first study to investigate such a relationship, thus contributing key results from this career area in the field of nursing management and leadership. Overall, the obtained mean scale score for the fear of COVID–19 measure in the present study was 19.92 (SD: 6.15), which was above the midpoint. Due to the lack of studies involving the nurse population, comparison was not possible. However, when the study results were compared to studies of the general population, it was revealed that the mean score in the present study was higher than those reported in Russia (17.4) (Gritsenko et al.,, 2020), Belarus (16.6) (Reznik et al.,, 2020), Turkey (19.44) (Bakioglu et al.,, 2020) and Japan (18.71) (Masuyama, Shinkawa & Kubo, 2020). Since frontline nurses are directly involved in patient care, their risk of contracting COVID–19 is higher than the general population. This could contribute to their feelings of apprehension or fear of being infected or unknowingly infecting others, including their family members or friends. Further, pandemic-related concerns such as increased patient volume and patient load, provision of coronavirus-related precautions (Maben 2020), social distancing and community quarantine can intensify fears among nurses, affecting their psychological and emotional well-being and their work performance.
Healthcare institutions such as hospitals are frontline institutions during any disaster or disease outbreak. A well-planned workplace protocol should be in place, containing sets of actions relevant to disaster or disease outbreak, such as guidelines for caring for affected patients, safety practices when handling patients, relevant training, response plans and collaboration with other agencies at the local and national level (Hirshouer et al.,, 2020). As nurses are frontline health workers, it is essential that they are oriented and familiar with the content of workplace protocol; they should be knowledgeable on and skilful in carrying it out (Ben Natan et al.,, 2014; Labrague et al.,, 2018). In this study, a significant proportion of nurses (95.8%) reported being aware of the existence of workplace protocol related to COVID–19. This result contrasts with results in previous research, in which many nurses (> 50%) working in hospitals were unaware of the existing workplace protocol related to disaster, emergency and disease outbreak (Labrague et al.,, 2016). Higher awareness of workplace protocol related to COVID–19 may be attributed to the extensive campaign carried out by the Philippine Health Agencies to adequately prepare hospitals in the country for the COVID–19 pandemic. Hospitals were encouraged to develop COVID–19 protocols based on the standards set by the World Health Organization.
Training is a critical component of nurses’ readiness and competence in any disaster or disease outbreak response. During a disease outbreak, nurses are often given new roles and are compelled to carry out added tasks, which, in some instances, may be beyond the scope of their usual nursing role (Gebbie & Qureshi, 2002). In this study, attendance of COVID–19-related training was identified as a significant predictor of fear of COVID–19: nurses who reported having attended such training experienced decreased levels of fear of coronavirus than those who did not. This result supports previous studies highlighting the role played by training, drills and exercises related to emergency and disaster situations (including disease outbreak) in preparing nurses for disaster and infection outbreak response and management (Labrague et al.,, 2018; Labrague et al.,, 2016). This result coincides with that of Wu et al. (2020), where nurses who received COVID–19 epidemic training reported a significant reduction in apprehension about the disease and increased mental health functioning compared with those nurses who had not received training related to the management of COVID–19. However, despite this relationship, only 40.6% of nurses reported having attended relevant training related to COVID–19.
Job role significantly predicted fear of COVID–19, with part-time nurses reporting increased levels of fear. Considering the lower number of part-time nurses involved in this study, caution should be observed when interpreting this finding. Nevertheless, a higher level of fear of COVID–19 among part-time nurses could be explained by the fact that these nurses are usually used to “fill in” for regular staff and may be unfamiliar with the routines of the wards or units, their daily operations and processes, including care management processes for COVID–19 patients. Such instances may ultimately amplify fear of COVID–19 in this group of nurses.
Regression analyses revealed a significant association between fear of COVID–19 and psychological distress among nurses. Although there is a lack of similar studies of the nursing population, this relationship is in accordance with previous studies involving the general population. For instance, in a study involving 1 304 Turkish individuals, increased levels of fear of COVID–19 were strongly linked to negative emotional states including anxiety, depression and stress (Satici et al.,, 2020). A study by Bakioglu et al. (2020) showed a similar pattern: fear of COVID–19 had a significant positive relationship with anxiety, depression and stress. While fear is considered helpful in motivating individuals to respond effectively to a given threat or stimuli, extreme and persistent fear may result in negative psychological reactions such as stress, depression and anxiety (Gorman, 2008).
Finally, the results of this study demonstrated significant direct effects of fear of COVID–19 on nurses’ job satisfaction, organisational turnover intention and professional turnover intention beyond the influence on their personal characteristics. To the author’s knowledge, this study is the first to empirically test the association between fear of COVID–19 and nurses’ job outcomes, contributing original knowledge on nursing science, particularly in the area of nursing administration. As a psychological reaction to a threatening situation or stimuli (Gross & Canteras, 2012), fear associated with coronavirus may interfere with work performance in nurses, leading to higher levels of job dissatisfaction and increased intentions to leave the profession and the organisation. This result coincides with earlier studies in other sectors, in which workers who demonstrated high fear or anxiety found job-related events more stressful, affecting their overall performance and work satisfaction (McCarthy, Trougakos & Cheng, 2016; Jones, Latreille & Sloane, 2016). By addressing fear of coronavirus among nurses, nurse outcomes will be improved, with increased job satisfaction, decreased psychological distress and lower turnover intention.
Implications for Nursing Management
The findings of the study highlight the vital role of hospital and nurse administrators in supporting nurses during the pandemic through evidence-based education, training or interventions, and policy. As nonattendance of COVID–19 training was linked with increased fear of coronavirus, it is imperative that hospitals formulate or develop COVID–19 training plans to improve the capacity of nurses to effectively care for and manage coronavirus patients. This can be facilitated by using alternative platforms such as webinars, social media platforms or other video technologies in order to maintain social distancing. As job role predicted fear of COVID–19, with part-time nurses reporting increased fear of the disease, the provision of adequate peer and organisational support is vital to enhance this group of nurses’ preparedness for and familiarity with the care of coronavirus patients and ward or organisational processes related to COVID–19. A buddy system where a part-time nurse is paired with a more seasoned colleague can help support part-time nurses during the pandemic crisis (Maunder et al.,, 2006).
As excessive fear may intensify pre-existing mental health issues or provoke anxiety (Colizzi et al.,, 2020) and eventually affect nurses’ health and job outcomes (e.g., job satisfaction, turnover intention), supporting the mental, psychological and emotional health of nurses should be prioritised by nursing and hospital administrators. These measures may ultimately improve work satisfaction, enhance perceived health, reduce psychological distress and decrease turnover intention among frontline nurses. This can be accomplished by implementing measures to preserve and maintain the mental health of nurses. Mental health professionals during pandemic situations are instrumental in effectively supporting the mental health of frontline nurses.
Psychotherapy and psychological treatment may provide nurses with appropriate support (Sucala et al.,, 2012). Due to certain limitations regarding access to in-person mental health services, a novel approach such as telepsychiatry could provide psychotherapeutic management or interventions (Canady, 2020). Further, the provision of psychological materials (e.g., books, journals on mental health), psychological resources and counselling or psychotherapy (Kang et al.,, 2020) may improve frontline nurses’ mental health during COVID–19. Nursing staff should be oriented on how and where to access these psychosocial and mental health services, and access to these services should be facilitated.
Ensuring that nurses are always kept updated with the latest and most accurate information related to coronavirus reduces the fear and negative emotions associated with the disease. This information should include the nature of the causative virus, precautions to prevent transmission of the virus to the self and others, how to effectively use hospital resources and new trends in the management of coronavirus patients. Equally important is ensuring that the members of the nursing team are given the same information related to the disease, as well as the hospital protocols when handling or managing patents afflicted with the diseases. Frontline nurses should be provided with adequate break time to allow them to take care of themselves. Collectively, these measures could curtail the negative impacts of this crisis and reduce fear among nurses.
Support from peers, colleagues, families and friends may improve the sense of safety and help alleviate fear in nurses. Sharing their work experiences with others may be helpful in attaining adequate psychological or other support and improving their morale amid the pandemic (Maben & Bridges, 2020). Support from top management through the provision of a safe work environment, adequate PPE and other infection control supplies is vital to support nurses in their daily practices. Further, professional nursing organisations should provide COVID–19-related resources to nurses, including information on mental and psychological well-being, and the provision of resilience, coping and stress management programmes.