Pride and adversity among nurses and physicians during the pandemic in two US healthcare systems: a mixed methods analysis

Our aims were to examine themes of the most difficult or distressing events reported by healthcare workers during the first wave of COVID-19 pandemic in two US health care systems in order to identify common themes and to relate them to both behavioral theory and measures of anxiety and depression.

We conducted a cross-sectional survey during the early phases of the COIVD-19 pandemic in the US. We measured symptoms of anxiety and depression separately, captured demographics, and asked two open-ended questions regarding events that were the most difficult or stressful, and reinforced pride. The open-end questions were independently coded into themes developed by the authors and mapped to factors related to fostering well-being according to the Self-Determination Theory.

We recruited 874 nurses and 248 physicians. About a half shared their most distressing experiences as well as those experiences they were most proud of related to their professions. Themes that emerged from these narratives were congruent with prediction of Self-Determination theory that autonomy-supportive experiences will foster pride, while autonomy-thwarting experiences will cause distress. Those who reported distressful events were more anxious and depressed compared to those who did not. Among those who reported incidences that reinforced pride in the profession, depression was rarer compared to those who did not. These trends were evident after allowing for medical history and other covariates in logistic regressions.

Causal claims from our analysis should be made with caution due to the research design, a cross-sectional study design. Understanding of perceptions of the pandemic by nurses and physicians may help identify sources of distress and means of reinforcing pride in the professions, thereby helping nurses and physicians cope with disasters, and shape workplace policies during disasters that foster well-being among first responders.

No Patient or Public Contribution: We studied physicians and nurses themselves.