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In addition, the aim was to describe other common situations they encountered during the pandemic.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Research Design<\/jats:title>\n            <jats:p>A cross-sectional multi-method study was conducted with participants recruited from a national cohort of Registered Nurses (RNs) between October 2021 and January 2022. In total, 3,958 individuals met the eligibility criteria, with 2,237 participants (56.5%) responding to the survey. Among these respondents, 1,881 answered questions about distressing situations, and 239 shared open-ended responses about their experiences.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The results showed that during the peak of the COVID-19 pandemic, between 24% and 70% of RNs encountered distressing situations on a weekly basis or more often. Over 70% reported difficulties in communication due to personal protective equipment. Additionally, just over 40% of RNs reported working in situations lacking clear guidelines and facing prioritization challenges. RNs exposed to these distressing situations were frequently nearly twice as likely to experience stress of conscience (44% vs. 21%, [OR]\u2009=\u20092.87) and showed a stronger intention to leave the profession (25% vs. 14%, [OR]\u2009=\u20091.98). Moreover, they reported lower job satisfaction (85% vs. 92%, [OR]\u2009=\u20090.50) and poorer self-rated health (34% vs. 50%, [OR]\u2009=\u20090.52) compared to their counterparts with less exposure. In addition, RNs experienced a lack of support, understaffing, and working beyond their expertise, leading to emotional and physical exhaustion. They felt inadequate due to overwhelming workloads and limited recovery time.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The COVID-19 pandemic has significantly impacted RNs, underscoring the need for strong organizational support and leadership. Nurses require guidance from leaders and institutions to manage distress and ethical challenges effectively. Future strategies should prioritize adequate staffing, skill development, teamwork, mental health resources, and transparent communication to support nurses\u2019 wellbeing and recovery, ensuring the delivery of high-quality care.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12912-025-03249-9","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T14:48:34Z","timestamp":1748443714000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Exposure to distressing situations among registered nurses during the COVID-19 pandemic: a cross-sectional study"],"prefix":"10.1186","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0068-943X","authenticated-orcid":false,"given":"Dara","family":"Rasoal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oili","family":"Dahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petter","family":"Gustavsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Ehrenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6388-5155","authenticated-orcid":false,"given":"Ann","family":"Rudman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,28]]},"reference":[{"key":"3249_CR1","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1111\/jnu.12855","volume":"55","author":"L Birt","year":"2023","unstructured":"Birt L, Lane K, Corner J, Sanderson K, Bunn D. 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The study was approved by the Ethical Review Boards in Stockholm, Sweden (Dnr 01\u2013045; 04-587; 2016\/793\u2009\u2212\u200932; 2021\u2009\u2212\u200900958; 2022-04898-02). Written informed consent was obtained from all participants prior to data collection.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All participants provided written informed consent for the publication of anonymized data obtained during the study. No identifiable personal information is included in this manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"611"}}