Nurse Staffing Factors, Fatigue, and Work-related Stress among Emergency Department Nurses During COVID-19 Pandemic


  • Ferdy Lainsamputty Universitas Klabat
  • Ailine Yoan Sanger Universitas Klabat
  • Ni Made Dewi Susanti STIKES Husada Mandiri Poso
  • Christanti Indriani Pontoh STIKES Husada Mandiri Poso



COVID-19 pandemic, emergency nurses, fatigue, staffing patterns, stress


Aims : This study aimed to examine the relationship between nurse staffing factors, fatigue, and stress among emergency department (ED) nurses during pandemic.

Design : Descriptive, correlation, and cross sectional approach.

Methods : Using cross-sectional design, a total of 113 ED nurses in Indonesia selected by convenience sampling completed the survey on the Fatigue Severity Scale (FSS) and the Expanded Nursing Stress Scale (ENSS). Data analysis included descriptive statistics and bivariate analysis.

Results : Nurse staffing factors were not significantly associated with stress (r = -0.07-0.16, p > 0.05). Fatigue correlated with the domain of death and dying (r = 0.19, p < 0.05), problems relating to supervisors (r = 0.19, p < 0.05), workload (r = 0.26, p < 0.01) and patients/families (r = 0.25, p < 0.01), and overall stress (r = 0.21, p < 0.05).

Conclusions : The more severe fatigue the emergency nurses suffered, the worse stress they experienced. The workload and rotation of nurses during pandemic should be readjusted in accordance with current hospital situation. Identification of basic needs during the pandemic such as ensuring the supply of personal protective equipment (PPE) may help to reduce stress and to maintain the service quality in ED. Organizing counseling programs and support group through online meetings can help nurses to share their difficulties and experiences and to prevent them from feeling isolated.


Hellebuyck M, Nguyen T, Halphern M, Fritze D, Kennedy J. Mind the workplace: Workplace mental health 2017 [Internet]. 2017. Available from:

Yuwanich N, Sandmark H, Akhavan S. Emergency department nurses’ experiences of occupational stress: A qualitative study from a public hospital in Bangkok, Thailand. Work. 2016;53(4):885–97.

Kibria MG. Prevalence of stress and coping mechanism among staff nurses of intensive care unit in a selected hospital. Int J Neurosurg. 2018;2(1):8.

Tao L, Guo H, Liu S, Li J. Work stress and job satisfaction of community health nurses in Southwest China. Biomed Res. 2018;29(3):510–8.

Yazdi Z, Javadi AHS, Afsari M, Abbasi M. Occupational stress and its relation to insomnia among nurses of educational hospitals in Qazvin. Sleep Hypn. 2019;21(2):140–6.

Khamisa N, Peltzer K, Ilic D, Oldenburg B. Effect of personal and work stress on burnout, job satisfaction and general health of hospital nurses in South Africa. Heal SA Gesondheid [Internet]. 2017;22: 252–8. Available from: http://dx.doi. org/10.1016/j.hsag.2016.10.001

Adriaenssens J, De Gucht V, Maes S. Causes and consequences of occupational stress in emergency nurses, a longitudinal study. J Nurs Manag. 2015;23(3):346–58.

Weigl M, Schneider A. Associations of work characteristics, employee strain and self-perceived quality of care in emergency departments: A cross-sectional study. Int Emerg Nurs [Internet]. 2017;30:20–4. Available from:

Healy S, Tyrrell M. Stress in emergency departments: Experiences of nurses and doctors. Emerg Nurse. 2011;19(4):31–7.

Gunawan J, Aungsuroch Y, Marzilli C, Fisher ML, Nazliansyah N, Sukarna A. A phenomenological study of the lived experience of nurses in the battle of COVID-19. Nurs Outlook. 2021;0:1–8.

Nespereira-Campuzano T, Vázquez-Campo M. Emotional intelligence and stress management in nursing professionals in a hospital emergency department. Enfermería Clínica (English Ed [Internet]. 2017;27(3):172–8. Available from:

Purcell SR, Kutash M, Cobb S. The relationship between nurses’ stress and nurse staffing factors in a hospital setting. J Nurs Manag. 2011;19(6):714–20.

Bae SH, Hwang SW, Lee G. Work hours, overtime, and break time of registered nurses working in medium-sized Korean hospitals. Work Heal Saf. 2018;66(12):588–96.

Alameddine M, Otterbach S, Rafii B, Sousa-Poza A. Work hour constraints in the German nursing workforce: A quarter of a century in review. Health Policy (New York) [Internet]. 2018;122(10):1101–8. Available from: healthpol.2018.07.023

Stimpfel AW, Fatehi F, Kovner C. Nurses’ sleep, work hours, and patient care quality, and safety. Sleep Heal [Internet]. 2020;6(3):314–20. Available from: 1016/j.sleh.2019.11.001

Buheji M, Buhaid N. Nursing human factor during COVID-19 pandemic. Int J Nurs Sci. 2020;10(1):12–24.

Linning S. Dedicated nurse killed himself after “struggling with stress and pressures of work.” 2014; Available from: https://www. html

Mahayu R. Tak kuat tanggung waktu kerjanya sebagai perawat, wanita ini bunuh diri dan tulis surat wasiat. 2019; Available from:

Boyle DA. Countering compassion fatigue: A requisite nursing agenda. Online J Issues Nurs. 2011;16(1):2.

Zhan Y, Zhao S yu, Yuan J, Liu H, Liu Y fang, Gui L li, et al. Prevalence and influencing factors on fatigue of first-line nurses combating with COVID-19 in China: A descriptive cross-sectional study. Curr Med Sci. 2020;40(4):625–35.

Juniartha IGN, Sardjono TW, Kartikawatiningsih D. A comparison of work-related fatigue and stress among emergency department nurses working in 7-7-10 and 12-12 shifts at the hospitals in Badung and Denpasar. Enfermería Clínica. 2020;30(Supplement 7):74–7.

Erdfelder E, FAul F, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–60.

Faul F, Buchner A, Erdfelder E, Mayr S. A short tutorial of GPower. Tutor Quant Methods Psychol. 2007;3(2):51–9.

Jones G, Hocine M, Salomon J, Dab W, Temime L. Demographic and occupational predictors of stress and fatigue in French intensive-care registered nurses and nurses’ aides: A cross-sectional study. Int J Nurs Stud. 2015;52(1):250–9.

Krupp LB, Larocca NG, Muir Nash J, Steinberg AD. The fatigue severity scale: Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46(10):1121–3.

French SE, Lenton R, Walters V, Eyles J. An empirical evaluation of an expanded nursing stress scale. J Nurs Meas. 2000;8(2):161–78.

Herqutanto, Harsono H, Damayanti M, Setiawati EP. Stres kerja pada perawat di rumah sakit dan fasilitas pelayanan kesehatan primer. eJournal Kedokt Indones. 2017;5(1):12–7.

Chappel SE, Aisbett B, Considine J, Ridgers ND. Emergency nurses’ activity levels across rotating shifts. Australas Emerg Care [Internet]. 2020;23(3):203–10. Available from:

Nasr-Esfahani M, Masoumi B, Mohamadirizi S, Mohamadirizi S. Job Stress and Work Ability Among Emergency Nurses in Isfahan, Iran. Nurs Midwifery Stud. 2016;inpress(inpress).

Sagherian K, Steege LM, Cobb SJ, Cho H. Insomnia, fatigue and psychosocial well-being during COVID-19 pandemic: A cross-sectional survey of hospital nursing staff in the United States. J Clin Nurs. 2020;

Windarwati HD, Ati NAL, Paraswati MD, Ilmy SK, Supianto AA, Rizzal AF, et al. Stressor, coping mechanism, and motivation among health care workers in dealing with stress due to the COVID-19 pandemic in Indonesia. Asian J Psychiatr. 2021;56 (November).

Chatzigianni D, Tsounis A, Markopoulos N, Sarafis P. Occupational stress experienced by nurses working in a Greek Regional Hospital: A cross-sectional study. Iran J Nurs Midwifery Res. 2018;23(6): 450–7.

Yuan N, Yang WX, Lu JL, Lv ZH. Investigation of adverse reactions in healthcare personnel working in level 3 barrier protection PPE to treat COVID-19. Postgrad Med J. 2020;1–4.

Cheung T, Yip PSF. Depression, anxiety and symptoms of stress among Hong Kong nurses: A cross-sectional study. Int J Environ Res Public Health. 2015;12(9):11072–100.

Kouta C, Kaite CP. Gender discrimination and nursing: A literature review. J Prof Nurs. 2011;27(1):59–63.

Adeyemi-Adelanwa O, Barton-Gooden A, Dawkins P, Lindo JLM. Attitudes of patients towards being cared for by male nurses in a Jamaican hospital. Appl Nurs Res [Internet]. 2016;29:140–3. Available from:

Rajacich D, Kane D, Williston C, Cameron S. If they do call you a nurse, it is always a “male nurse”: Experiences of men in the nursing profession. Nurs Forum. 2013;48(1):71–80.

Almazan JU, Albougami AS, Alamri MS. Exploring nurses’ work-related stress in an acute care hospital in KSA. J Taibah Univ Med Sci [Internet]. 2019;14(4):376–82. Available from:

Makabe S, Takagai J, Asanuma Y, Ohtomo K, Kimura Y. Impact of work-life imbalance on job satisfaction and quality of life among hospital nurses in Japan. Ind Health. 2015;53(2):152–9.

Kirana VDC, Dwiyanti E. Hubungan stres kerja dengan kelelahan pada perawat dengan metode pengukuran DASS 21 dan IFRC. J Ilm Kesehat Media Husada. 2017;6(1):133–40.

Zhan Y, Liu Y, Liu H, Li M, Shen Y, Gui L, et al. Factors associated with insomnia among Chinese front-line nurses fighting against COVID-19 in Wuhan: A cross-sectional survey. J Nurs Manag. 2020;28(7):1525–35.

Kim S-Y, Kwon I-S, Cho Y-C. Relationship between type A behavior pattern and fatigue symptoms among nurses in general hospitals. J Korea Acad Coop Soc. 2012;13(4):1759–68.




How to Cite

Lainsamputty, F., Sanger, A. Y., Susanti, N. M. D., & Pontoh, C. I. (2023). Nurse Staffing Factors, Fatigue, and Work-related Stress among Emergency Department Nurses During COVID-19 Pandemic . Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal), 9(1).