Investigating Factors Affecting the Nursing Shortage During the First and Acute Phase of Covid-19: A Systematic Review Publisher



Dorri S ; Shariatpanahi S ; Hosseini L ; Seyedhasani S N ; Mahdizadeh A ; Farahani M A
Source: Iranian Journal of Nursing and Midwifery Research Published:2026

Abstract

Background: The COVID-19 pandemic has resulted in a severe shortage of nurses in health care systems worldwide. The first and acute phase of COVID-19 was challenging for health systems due to the unknown nature and complexity of the disease. This study aimed to extract the factors that influenced the shortage of nurses during the first and the acute phase of COVID-19. Materials and Methods: Based on the PRISMA guidelines, a systematic search was conducted in PubMed, ScienceDirect, Cochrane, Scopus, and Web of Science databases from the start of the COVID-19 outbreak to 2021. Studies were screened separately; the inclusion criteria were applied. The risk of bias was assessed with the Hoy tool, and data extraction was conducted. Factors were extracted and categorized by thematic analysis. Results: In total, 1035 studies were found. Finally, 11 original papers met the eligibility criteria. Most studies (seven) were cross-sectional. After thematic analysis, the results showed that the nursing shortage during the COVID-19 outbreak can be attributed to three main categories: 1) The pandemic perceived threat, 2) Internal and External Factors, and 3) Professional and Psychosocial Support. Conclusions: This study highlighted the need for the healthcare system to switch from reactive crisis management to proactive and resilient strategies. To prevent nurse burnout and attrition and guarantee the continuity of care in future emergencies, it is essential to plan to address perceived threats and strengthen support systems in addition to implementing multilevel interventions in organizational and psychological domains. This integrated strategy will convert vulnerability into readiness and resilience. © 2026 Iranian Journal of Nursing and Midwifery Research.