Original Article

Occupational stress and coping strategies of the nursing staff of a Public University Hospital during the COVID-19 pandemic


Background & Aim: Nursing staff are exposed to high levels of stress daily due to the demanding work environment. This study aimed to examine nursing staff occupational stress and coping mechanisms during the COVID-19 pandemic.‎
Methods & Materials: A cross-sectional study with a sample of 108 nursing staff was carried out. The Expanded Nursing Stress Scale (ENSS), the Brief Coping Orientation to Problems Experienced (Brief COPE) Scale, and constructed questions were used for data collection. Data were analyzed using chi-square (χ2), Pearson methods, and Multiple linear regression analysis. Statistical significance was determined at p-value ≤ 0.05.
Results:  Overall Occupational stress was assessed with a mean score of 146.8 (SD±35.3). In Brief COPE Scale higher mean was assessed for “social support - information seeking” and lower for “substance use” or “withdrawal” (p<0.001). A significant difference in response distributions was observed regarding their degree of concern or fear about COVID-19 (p<0.01). Increased levels of Overall Occupational Stress (ENSS) were associated with higher levels of BCOPE. Emotional Focus and Venting and Diffusion of Emotions (β=5.15, p=0.026), younger age of the participants (β=-5.78, p=0.033), years of working in the healthcare sector (β=14.46, p=0.004) or the highest fear/concern about being infected and infecting their patients (β=6.22, p=0.032).
Conclusion: Nursing staff experienced moderate levels of occupational stress, while challenges raised by the pandemic were handled through seeking social support, positive reframing and acceptance, taking protective measures, and turning to religion. Developing meaningful administrative and educational strategies for staff empowerment and resilience may reduce anxiety and occupational stress for nurses.

1. Callaghan P, Tak-Ying SA, Wyatt PA. Factors related to stress and coping among Chinese nurses in Hong Kong. Journal of Advanced Nursing. 2000;31(6):1518–27. doi:10.1046/j.1365-2648.2000.01434.x
2. World Health Organization. 2020, Coronavirus disease (COVID-19) pandemic. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers? Accessed: December 21, 2022.
3. Shin H, Park YM, Ying JY, Kim B, Noh H, Lee SM. Relationships between coping strategies and burnout symptoms: A meta-analytic approach. Professional Psychology: Research and Practice. 2014 Feb;45(1):44-56. doi: 10.1037/a0035220
4. Kakemam E, Raeissi P, Raoofi S, Soltani A, Sokhanvar M, Visentin DC, Cleary M. Occupational stress and associated risk factors among nurses: A cross-sectional study. Contemporary Nurse. 2019 May 4;55(2-3):237-49. doi.org/10.1080/10376178.2019.1647791
Faremi FA, Olatubi MI, Adeniyi KG, Salau OR. Assessment of occupational related stress among nurses in two selected hospitals in a city southwestern Nigeria. International Journal of Africa Nursing Sciences. 2019 Jan 1;10:68-73.
5. Dar L, Akmal A, Naseem MA, Khan KU. Impact of stress on employees job performance in business sector of Pakistan. Global Journal of Management and Business research. 2011 May;11(6):1-4. doi:
6. Wu H, Chi TS, Chen LI, Wang L, Jin YP. Occupational stress among hospital nurses: cross‐sectional survey. Journal of Advanced Nursing. 2010 Mar;66(3):627-34. doi: 10.1111/j.1365-2648.2009.05203.x
7. Kaur MN, Gujral HK. Perceived Stress and Burnout in Nurses: A Conceptual Approach. International Journal of Psychosocial Rehabilitation. 2020 Jul 1;24(04). doi: 10.37200/IJPR/V24I4/PR201406
8. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, Qin M, Huang H. Work stress among Chinese nurses to support Wuhan in fighting against COVID‐19 epidemic. Journal of Nursing Management. 2020 Jul;28(5):1002-9. doi: 10.1111/jonm.13014
9. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, behavior, and immunity. 2020 Aug 1;88:901-7. doi: 10.1016/j.bbi.2020.05.026
10. Fernandez R, Lord H, Halcomb E, Moxham L, Middleton R,Alananzeh I, Ellwood L. Implications for COVID-19: A systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic. International Journal of Nursing Studies 2020, 111, 103637.
11. Chang EM, Daly JW, Hancock KM, Bidewell J, Johnson A, Lambert VA, Lambert CE. The relationships among workplace stressors, coping methods, demographic characteristics, and health in Australian nurses. Journal of Professional Nursing. 2006 Jan 1;22(1):30-8. doi: 0.1016/j.profnurs.2005.12.002
12. Chen S, Bonanno GA. Psychological adjustment during the global outbreak of COVID-19: A resilience perspective. Psychological Trauma: Theory, Research, Practice, and Policy. 2020 Aug;12(S1):S51-4. doi:10.1037/tra0000685
13. Stavropoulou A, Prasianaki M, Papageorgiou D, Kaba E, Misouridou E, Dafogianni C, Gerogianni G, Kelesi M. The Psychological and Professional Burden Experienced by Nurses Who Worked in COVID-19 Clinics during the Pandemic: A Content Analysis. Clinics and Practice. 2023 Mar 9;13(2):422-34. https://doi.org/10.3390/clinpract13020038
14. French SE, Lenton R, Walters V, Eyles J. An empirical evaluation of an expanded nursing stress scale. Journal of Nursing Measurement. 2000 Sep 1;8(2):161-78. doi: 10.1891/1061-3749.8.2.161
15. Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. Journal of Personality and Social Psychology. 1989 Feb;56(2):267. doi:10.1037/0022-3514.56.2.267
16. Apisarnthanarak A, Apisarnthanarak P, Siripraparat C, Saengaram P, Leeprechanon N, Weber DJ. Impact of anxiety and fear for COVID-19 toward infection control practices among Thai healthcare workers. Infection Control & Hospital Epidemiology. 2020 Sep;41(9):1093-4. doi: 10.1017/ice.2020.280
17. Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, Wan SW, Liu Z, Shen Q, Yang J, He HG. Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine. 2020 Jul 1;24: 100424. doi: 10.1016/j.eclinm.2020.100424
18. Chatzigianni D, Tsounis A, Markopoulos N, Sarafis P. Occupational stress experienced by nurses working in a Greek Regional Hospital: A cross-sectional study. Iranian journal of nursing and midwifery research. 2018 Nov;23(6):450-7. doi: 10.4103/ijnmr.IJNMR_120_17
19. Sarafis P, Rousaki E, Tsounis A, Malliarou M, Lahana L, Bamidis P, Niakas D, Papastavrou E. The impact of occupational stress on nurses’ caring behaviors and their health related quality of life. BMC Nursing. 2016 Dec;15:1-9. doi:10.1186/s12912-016-0178-y
20. Galdikienė N, Asikainen P, Balčiūnas S, Suominen T. Do nurses feel stressed? A perspective from primary health care. Nursing & Health Sciences. 2014 Sep;16(3):327-34. doi:10.1111/nhs.12108
21. Milutinović D, Golubović B, Brkić N, Prokeš B. Professional stress and health among critical care nurses in Serbia. Arhiv Za Higijenu Rada i Toksikologiju. 2012;63(2):171–80. doi:10.2478/10004-1254-63-2012-2140
22. Lee JK. Job stress, coping and health perceptions of Hong Kong primary care nurses. International Journal of Nursing Practice. 2003 Apr;9(2):86-91.
23. Costa B, Pinto IC. Stress, burnout and coping in health professionals: A literature review. Journal of Psychology and Brain Studies. 2017;1(1: 4):1-8.
24. Sadir MA, Bignotto MM, Lipp ME. Stress and quality of life: the influence of some personal variables. Paidéia (Ribeirão Preto). 2010;20:73-81.
25. Theodoratou Μ, Andreopoulou O, Bekos V, Pierrakeas C, Skiadopoulos S. Culture specific stress coping strategies used to alleviate occupational stress among Greek nursing personnel. Journal of Medical Psychology. 2009;1 (1):23-31.
26. Labrague LJ, De los Santos JA. COVID‐19 anxiety among front‐line nurses: Predictive role of organisational support, personal resilience and social support. Journal of Nursing Management. 2020 Oct;28(7):1653-61. doi:10.1111/jonm.13121
27. Liu Y, Aungsuroch Y. Work stress, perceived social support, self‐efficacy and burnout among Chinese registered nurses. Journal of Nursing Management. 2019 Oct;27(7):1445-53. doi: 10.1111/jonm.12828
28. Lau J, Tan DH, Wong GJ, Lew YJ, Chua YX, Low LL, Ho HK, Kwek TS, Toh SA, Tan KK. Prepared and highly committed despite the risk of COVID-19 infection: A cross-sectional survey of primary care physicians’ concerns and coping strategies in Singapore. BMC Family Practice. 2021 Dec;22(1):1-9. doi:10.1186/s12875-021-01370-7
29. Hernandez-Diaz Y, Genis-Mendoza AD, Fresan A, González-Castro TB, Tovilla-Zárate CA, Juárez-Rojop IE, López-Narváez ML, Martínez-Magaña JJ, Nicolini H. Knowledge, emotions and stressors in front-line healthcare workers during the COVID-19 outbreak in Mexico. International Journal of Environmental Research and Public Health. 2021 May 25;18(11):5622. doi:10.3390/ijerph18115622
IssueVol 10 No 3 (2023): Summer QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/npt.v10i3.13429
nursing staff; occupational stress; coping strategies; COVID-19 pandemic

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How to Cite
Dimitriadou Z, Kostagiolas P, Kritsotakis G, Rikos N, Stavropoulou A, Rovithis M. Occupational stress and coping strategies of the nursing staff of a Public University Hospital during the COVID-19 pandemic. NPT. 2023;10(3):198-207.