Self-designed, including the gender, age, education, marital status, working years of the surveyor, department before working in COVID-19 ward, etc.

The “Chinese Nurses’ Work Stressor Scale” was adopted [4] [5]. Based on the research of the scale, consulting experts and referring to relevant domestic and foreign literature [6] - [11], a supplementary pressure source scale was designed and generated by us. A total of 39 items were divided into seven dimensions: professional, psychological, working environment, interpersonal relationship, conceptual pressure, occupational hazards, and family aspects. The score ranges from 0 to 3, where 0 represents no stress, 1 represents mild stress, 2 represents moderate stress, and 3 represents severe stress. The total score of each dimension divided by the number of items is the score of that dimension. The theoretical maximum value is 3 and the theoretical minimum value is 0. The higher the score, the greater the degree of stress. The total Cronbach’s α coefficient of this scale is 0.85.

This questionnaire was compiled during the atypical pneumonia (SARS) epidemic in 2003. It is used to evaluate the psychological behavior after public health emergency. According to actual needs, it can be used for individual or group survey. There are 27 items which is divided into 5 dimensions: Depression, Neurasthenia, Fear, Compulsive-anxiety, and hypochondriasis. According to the degree of psychological behavior (no, mild, moderate, severe) and frequency (occasionally, sometimes, often, always), the corresponding score ranges from 0 to 3. The total score of each dimension divided by the number of items is the score of the dimension. The theoretical maximum value is 3, and the theoretical minimum value is 0. The retest correlation coefficient of the five dimensions is between 0.401 - 0.920, and the total score is retested correlation coefficient is 0.631. The Cronbach’s α coefficient of the entire questionnaire is 0.692. The Cronbach’s α coefficient of the five dimensions is between 0.755 - 0.804.

Ranked first among nurses’ stressors, it belongs to the dimension of conceptual stress. It is related to the characteristics of COVID-19, which is a new type of corona virus infection, which is generally susceptible to infection in the population and easy to transmit at home. The professional mission of nurses is to save the dead and heal the wounded. In the face of this epidemic, professional ethics urged nurses to devote themselves to the fight against the epidemic without hesitation, but at the same time they were worried that they would be infected and may transmit the infection to the entire family, causing great pressure on nurses [14] [15]. This required the hospital leaders and nursing managers to: Support the nurses in the COVID-19 ward, by arranging a single room in a hotel so they can be isolated from their families to ensure their safety during their working

and 14-day self-quarantine period; At the end of the self-quarantine period, the nurse will be tested for COVID-19 infection, and then they are allowed to go home if the result is negative.

Ranked second among nurses’ stressors, it belongs to the dimension of conceptual stress. It is related to the high infectiousness of COVID-19 and the current limitations of understanding of the disease. Since the outbreak of COVID-19, the number of medical staff infected has reached 3387, and many have unfortunately passed away. It is highly risky to nurse patients with COVID-19, which requires direct contact and long exposure with the source of infection. Even if the nurses have done a good job of safety protection according to the protocol, due to the complicated nursing process, they are worried that something is not implemented in place, leading to the occurrence of infection, which has caused great pressure on nurses [16]. This requires hospital leaders and nursing managers to strengthen the safety protection of medical staff to ensure “zero infection”, and achieve the following five points: 1) Targeted training. Compared with ordinary wards, protection and disinfection Isolation of knowledge and training of high-risk operations under three levels of protection is the top priority [17]. The combination of online theoretical learning, offline simulation training, online theoretical assessment, and one-to-one operation clearance before starting the job is adopted. Cloud classroom, video teaching, scenario simulation and other forms of centralized training, on-site learning, and one-to-one guidance are combined to ensure the learning effect, and only after passing the assessment, they can take the job. 2) Guarantee the supply of protective materials. Establish a ledger for protective products and disinfection products, dynamically grasp the material reserves in the COVID-19 ward, and ensure the basic dosage of protective equipment and the occupational safety of medical personnel. 3) Establish a reasonable physical barrier. It is important to ensure that the ward has a reasonable “clean area, potentially contaminated area, and contaminated area” partition, and have medical staff passages and patient passages to ensure that there is no cross infection. 4) Establish a standardized behavior barrier. The behavior of nurses in areas with different cleanliness should follow the corresponding systems and operating procedures to ensure the implementation of various details [18]. 5) Each ward is equipped with full-time personnel for hospital infection control to promote the implementation of the daily prevention and control concept. It is recommended to supervise via surveillance on implementation of disinfection and isolation in the ward, and the standardized process of putting on and taking off of protective equipment. Strengthen the full-process tracking management of medical waste.

Ranked third among nurses’ stressors, it belongs to the dimension of conceptual stress. In order to ensure safety, the hospital centrally arranged the lives of the medical staff. The nurses wanted to go home to visit their family member, but was worried that it would affect the family. Some communities fear that nurses will bring the virus back to the community and thus restricted the nurses from entering the community. As a result, nurses cannot go home [19]. These all add pressure on the nurses. This requires hospitals and nursing managers to pay attention to: 1) To implement nurses’ rotation system: to ensure the physical and mental rehabilitation of nursing staff, implement echelon work system, fixed time, fixed personnel, regular rotation rest, and ensure the rest period of nurses and their family members reunion time [20]. 2) It is necessary to rationally allocate medical resources to ensure that the nurses are properly fed and dressed, and try to solve their family difficulties so that they have no worries. 3) Propagate the knowledge of COVID-19 scientifically, impartially and objectively to the public, so that the public can treat nurses rationally.

Increases the chance of infection: it ranked fourth among nurses’ stressors and belongs to the dimension of occupational hazards. These high-risk operations may be splashed by body fluids, blood, and secretions of patients with COVID-19, and aerosols may be generated, which may lead to direct exposure of nurses and increase the risk of infection [21]. This requires hospitals and nursing managers: 1) Define high-risk operations and formulate protection details for high-risk operations. 2) Conduct protective simulation training and occupational exposure emergency drills for high-risk operations, and work normally only after mastering them. 3) Principle of selection of support staff. According to the number and severity of patients, and the operations needed, arrange the corresponding resource to ensure the correct implementation. 4) Ward supervisors should incorporate high-risk operation protection details into the supervision content, and continuously improve to ensure that the prevention and control details of each operation.

It ranked fifth in the stressor dimension of nurses. Irregular working hours (such as unable to eat, drink, go to the toilet, etc.), protective clothing and uncomfortable supplies rank sixth and seventh in the stressor category of nurses. This is related to the long working hours, the need for strict protection, the inability to eat, drink, or go to the toilet during work, and solve the “three emergency” of life. It is also related to the use of protective equipment that causes nasal and facial pressure sores, protective equipment allergies and inability to wear protective equipment correctly cause ischemia and hypoxia [22]. This requires hospitals and nursing managers to take the following actions. 1) Reasonably arrange nursing human resources and working hours: rationally allocate and deploy nurse human resources, and scientifically arrange working shifts and times. The working time of each shift is 4 - 6 hours [23]; Implement mandatory rotation rest; ensure nurses’ diet and rest, and implement more humane management. 2) Formulate procedures for the prevention and treatment of head and face skin damage caused by protective equipment, and supervise the implementation to avoid or reduce damage. 3) Establishing health records of nursing staff: The hospital shall set up a psychological assistance team to conduct psychological assessment and guidance for front-line nursing staff. The head nurse shall assess the physical, psychological, family, and menstrual conditions of the nurses daily According to the actual conditions of the nurses and the number of patients, the degree of severity and the difficulty of nursing, the nursing staff should be arranged and dynamically deployed to ensure the safety of the nursing staff [24].