Assessing sleep health dimensions in frontline registered nurses during the COVID-19 pandemic: implications for psychological health and wellbeing


 The COVID-19 pandemic altered work environments of nurses, yielding high rates of stress and burnout. Potential protective factors, including effective sleep, may influence psychological health and wellbeing. Evidence about sleep in nurses may help develop interventions that mitigate burnout and poor psychological outcomes. A cross-sectional survey was distributed across 3 hospitals to nurses in New York City (NYC). During the first wave of the pandemic (March-April 2020), NYC had the highest incidence of laboratory-confirmed COVID-19 cases (915/100,000) and half of all COVID-related deaths nationwide. Multivariable logistic regression was used to determine associations between Pittsburgh Sleep Quality Index (PSQI) global sleep score, PSQI sleep dimensions, and psychological health (burnout, depression, anxiety, compassion fatigue), unadjusted and then controlling for individual and professional characteristics. More than half of participants reported burnout (64%), depression, (67%) and anxiety (77%). Eighty percent of participants had PSQI global scores >5 (poor sleep) (mean 9.27, SD 4.14). Respondents reporting good sleep (PSQI≤5) had over 5 times the odds of no burnout (OR 5.65, 95%CI: 2.60, 12.27); increased odds of screening negative for depression (OR:6.91, 95%CI:3.24,14.72), anxiety (OR:10.75, 95%CI:4.22,27.42) and compassion fatigue (OR:7.88, 95%CI:1.97,31.51). Poor subjective sleep quality PSQI subcomponent was associated with burnout (OR:2.21, 95%CI:1.41,3.48) but sleep duration subcomponent was not (OR:0.84, 95%CI:0.59,1.19). Daytime dysfunction was significantly associated with all psychological outcomes. Sleep disturbances and medications yielded higher anxiety odds. Overall, sleep quality appears more strongly related to burnout than sleep duration in nurses working during the COVID-19 pandemic. Sleep interventions should target individual sleep dimensions in nurses.