In recent years, the incidence of infectious disease has increased as new pathogens have been discovered, collectively creating enormous challenges for society regarding disease control (Esposito, 2016). Infectious diseases result in severe socioeconomic loss and a high mortality rate, effects especially associated with SARS (Zhong and Zeng, 2006), Ebola (Malvy et al., 2019), and the H7N9 virus, all of which emerged in the 21st century (Tanner et al., 2015). In December 2019, a novel coronavirus disease (coronavirus disease 2019, abbreviated as COVID-19) first emerged in Wuhan, became a large-scale epidemic in China, and subsequently became a global pandemic and the epicenter of public health concerns worldwide.

Public health emergencies require coordination among different personnel at a large scale, and participants, particularly medical personnel, are subjected to high stress levels that could easily lead to psychological disorders. A survey during the SARS pandemic suggested that the high level of stress, anxiety and depression faced by medical personnel may have caused a long-term psychological impact (Preti et al., 2020). The latest studies show that medical personnel exposed to COVID-19 have a higher incidence of depression and anxiety, and the symptoms are severe in particularly nurses (Lai et al., 2020). Mainly medical personnel, among whom nurses comprise the largest proportion, have been managing and containing COVID-19. The intense and highly controlled working environment has created extreme physical and psychological challenges for nurses. Variations in working intensity and the working environment while providing disaster assistance have made work more challenging for nurses. Previous research has focused on mainly the negative impact of the high volume of public health demands on nurses, with less attention given to the growth of nurses while providing disaster assistance (Preti et al., 2020; Feingold et al., 2022).

Post-traumatic growth (PTG) and post-traumatic stress disorder (PTSD) are the most common post-traumatic psychological reactions. PTSD refers to a group of characteristic and persistent symptoms that appear after an individual experiences an unusual threat or traumatic stress event (Iranmanesh et al., 2013). Compared with PTSD, PTG refers to the positive psychological changes that individuals experience after experiencing life crises (Silverstein et al., 2018). Several studies illustrate that medical personnel could acquire PTG from providing disaster assistance, and the extent of this growth seems to be positively correlated with the PTSD score (Nishi et al., 2016). Professional benefit is defined as the satisfaction and the sense of worth that one receives from one’s professional work (Rnn and Dolly Goldenberg, 2008). In China, nurses have a low social status. Chinese culture has improved the social status of nurses during the COVID-19 pandemic. Whether this improvement benefits the entire nurse population remains unclear.

In December 2019, COVID-19 emerged and spread in Hubei Province, China (Wang C. et al., 2020). To cope with the pandemic, thousands of nurses across China traveled to Hubei to provide medical assistance (Chen S. H. et al., 2021). Many studies have examined the mental health and PTG of nurses exposed to COVID-19 (Huang et al., 2020; Sheng et al., 2020; Peng et al., 2021), but few have compared the outcomes with nurses working outside Hubei Province. Therefore, the objectives of this research were to investigate and compare the difference of PTSD, professional benefits and PTG status among Chinese nurses working inside and outside Hubei in the context of the COVID-19 pandemic.

In this study, we discovered that during the COVID-19 pandemic, the prevalence of PTSD among Chinese nurses was high. The overall prevalence rate of PTSD among nurses was 54.6%. A total of 55.8% of nurses working outside Hubei Province had PTSD, and 48.3% of nurses working inside Hubei Province had PTSD. Our research indicated a high rate of PTSD, which could be attributed to the fact that COVID-19 first emerged in China. Additionally, nurses’ lack of experience with pandemics combined with their direct exposure to COVID-19 patients led to considerable physical and psychological stress. The reported incidence of PTSD in various populations has been high, with an incidence rate between 4 and 41% in the general population (Torales et al., 2020). The survey of Wang Y. X. et al. (2020) suggested that the incidence rate of PTSD among nurses was 16.83%. A Korean study stated that 36.7% of nurses were at risk of developing PTSD (Moon et al., 2021), which was significantly higher than our results. Most importantly, our study compared the prevalence of PTSD among nurses working within and outside Hubei during the early period of the COVID-19 pandemic. The prevalence of PTSD in our survey was higher than in other studies, possibly due to objective factors such as differences in measurement instruments and when the survey was distributed. Furthermore, the prevalence of PTSD among nurses working within Hubei Province was lower than that of nurses working outside Hubei Province. The reason may be that nurses who were involved in COVID-19 were carefully selected and trained rigorously; hence, their level of work engagement may have improved their ability to cope with stress.

Because of individuals’ scopes of knowledge and different work and social experiences, some nurses may tend to focus more on the negative reports of COVID-19. Specifically, married nurses may have been worrying about the safety of their family members while risking exposure to COVID-19; thus, their negative emotions could exacerbate their psychological stresses. As one of the essential personnel in containing pandemics, nurses offer assistance at the first instance of a crisis. As such, intense and repetitive exposure to traumatic events may lead nurses to worry about personal safety, which generates a sense of powerlessness, anxiety, depression or more severe mental disorders such as PTSD (Auxéméry, 2018).

Because of the political context, nurses who embarked to assist Hubei perceived their actions with a sense of obligation and responsibility, and their work caused feelings of honor and pride. In the past, nurses had a low social status (Feng et al., 2017); however, this situation has changed since the outbreak of COVID-19. Not only China but also all of society now perceive nurses more highly, which has affected nurses’ perceived professional benefits to a certain extent. Our findings suggested that the perceived professional benefits of nurses working outside Hubei Province were not significantly different from those of nurses working within Hubei Province (P > 0.05). Judging from the values of the results, however, the perceived professional benefits of nurses working inside Hubei Province were higher than those of nurses working outside Hubei Province (140.1 ± 21.3 vs. 138.6 ± 20.7). Few studies have investigated the effect of the COVID-19 pandemic on nurses’ perceived professional benefits, but our study showed that Chinese nurses’ perceived professional benefits improved during the COVID-19 pandemic.

Our results showed that nurses working inside Hubei Province had higher PTG scores than nurses working outside Hubei Province (P < 0.05), which implied that nurses inside Hubei Province attained more personal growth throughout their experiences in disease management and containment due to their proactive response. Our results were consistent with several studies that reported that nurses experienced PTG (Chen R. et al., 2021; Cui et al., 2021). However, the PTGI scores in our study were higher than those in other studies. In addition, our results suggested that nurses working inside Hubei Province obtained more growth. Contemporary research results have indicated that PTSD is correlated with PTG (Turner et al., 2018; Magid et al., 2019). However, there was less evidence to support correlation between PTSD and PTG for healthcare professionals (Hong et al., 2021; Feingold et al., 2022). Therefore, more research is needed to further investigate the relationship between PTSD and PTG.

Previous studies have identified multiple sources of PTSD, such as age, sex, job title, social support, exposure intensity and psychological factors (Shrestha, 2015; Šagud et al., 2017; Cirino and Knapp, 2019; Wang Y. X. et al., 2020). Occupation may be a factor in the prevalence of PTSD. For example, several studies report that the nurse population is highly susceptible to PTSD (Salmon and Morehead, 2019). In our research, multivariate analysis indicated that PTSD prevalence was associated with several work-related and sociodemographic variables. Length of service, number of children, and the NPPBS and PTGI scores were independent predictive factors (P < 0.05). Length of service and NPPBS score controlled the prevalence of PTSD (OR < 1). In contrast to previous studies, our research did not identify heterogeneity between the sexes, which might be due to a lack of male nurses in the sample. The preceding factors directly determined an individual’s work experience and knowledge of disease, which was consistent with international research outcomes (Mealer et al., 2017). In general, it is important to protect nurses’ physical and psychological health. Research has demonstrated that training, experience, perceptiveness, social support and effective coping strategies are key factors in preventing physical and psychological disorders; thus, improving nurses’ ability requires a combination of different approaches (Brooks et al., 2020).

In this study, the data were collected within the Chinese context on a large sample of nurses. The prevalence of PTSD was compared between nurses working inside and outside Hubei Province. Moreover, we analyzed factors associated with PTSD. However, this study had several limitations. First, this was a cross-sectional study. Second, our survey subjects were Chinese nurses, whose cultural context may cause their responses to differ from nurses who work in other countries. The results of this survey represented only the situation in China. In addition, the possibilities that our survey participants were involved in COVID-19 nursing at different time periods, their levels of exposure were different, and the fact that our survey was self-reported could increase the heterogeneity of the research. Lastly, we did not follow-up with participants, and we were unable to verify the relationship between exposure time and the PTSD prevalence rate.

The pandemic has caused a global disaster, and mainly nurses are fighting the pandemic. Healthcare managers and nursing supervisors should pay attention to their mental health while avoiding influence by nurses’ mental health disorders. In particular, psychological trauma is caused by long-term and continuous work. Increasing the number of nurses, reducing shifts, improving remuneration, and conducting psychological interventions are necessary and critical methods to prevent the loss of nurses, burnout and psychological trauma.

Our research found that nurses working outside the Hubei Province reported greater rates of PTSD than those working inside the Hubei Province. The occurrence of PTSD was related to PTG, professional benefits, monthly average income, job title, age, and the number of children. Nevertheless, for future pandemic control and management, efforts should be made to administer psychological intervention to medical personnel to improve their coping abilities.

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.

The studies involving human participants were reviewed and approved by the Ethics Committee of the First People’s Hospital of Zunyi. The patients/participants provided their written informed consent to participate in this study.

All authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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