Psychological distress in registered nurses and the role of the workplace: A cross-sectional study
Authors: Tabakakis Costantinos , McAllister Margaret , Bradshaw Julie , Sahay Ashlyn 
Published: September 2024

Objective: To investigate the impact of workplace factors on psychological distress in New Zealand registered nurses.
Background: Nurses are often faced with challenging work environments, with long work hours, high patient ratios, and emotionally charged situations that cause stress. Despite the well-established links between the nurse work environment and well-being, there remains a gap in the literature around the role of workplace factors on psychological distress in nurses.
Study design and methods: A cross-sectional survey was conducted with registered nurses in New Zealand. Depression, anxiety, and stress were self-reported using the DASS-21, while difficult practice environments and negative workplace acts were self-reported using PES-NWI and NAQ-R. Descriptive and inferential statistics were undertaken using SPSS. STROBE guidelines were used to report the study.
Results: 480 RNs completed the survey. On average, depression, anxiety, and stress scores were 6.08 (SD=7.06, Normal), 4.87 (SD=6.05, Normal), and 9.50 (SD=7.30, Normal), respectively. The Average PES-NWI score was 2.70 (SD=0.54), while the average total NAQ-R score was 34.27 (SD=12.67). Depression, anxiety, and stress scores were positively associated with NAQ-R scores, and negatively associated with PES-NWI scores (p-values <0.05). PES-NWI score was negatively associated with NAQ-R score (p<0.05). PES-NWI and NAQ-R explained 28.8%, 15.6%, and 26.1% of the variation in depression, anxiety, and stress, respectively. Depression, anxiety, and stress were significantly associated with intention to leave (p-values <0.05). Depression and anxiety were significantly associated with ethnicity (p-values <0.05). Age was negatively associated with anxiety and stress (p-values <0.05). Years employed as a nurse were also negatively associated with anxiety (p<0.05).
Discussion: This study addresses a knowledge gap by demonstrating that workplace factors are associated with psychological distress in nurses.
Conclusion: Psychological distress in nurses is significantly associated with the work environment and with intention to leave the profession. Given that most countries are facing nurse shortages and are actively recruiting nurses from diverse countries and ethnic backgrounds, targeted and individualised support needs to be provided to preserve nurses’ mental health and subsequent retention in the workforce.
Implications for research, policy, and practice: Healthcare providers must prioritise modifying the work environment to address the factors contributing to nurses’ psychological distress. This includes providing culturally tailored mental health resources and support for nurses with diverse backgrounds and experiences. Future research should examine how organisational-level strategies can reduce psychological distress in nurses.
What is already known about the topic?

Psychological distress is common in nurses.
Indicators of psychological distress include non-specific symptoms of stress, anxiety, and depression.
Psychological distress is associated with challenging working conditions.

What this paper adds:

Vulnerable groups, such as nurses from specific ethnic backgrounds and less experience, report higher levels of psychological distress, such as anxiety and depression.
The quality of the practice environment is associated with psychological distress in registered nurses.
Negative acts in the workplace (i.e., bullying and harassment) are positively associated with psychological distress in registered nurses.