The COVID-19 pandemic created unprecedented challenges for health professionals around the world. A new study published in the journal Nursing Inquiry describes violence that nurses and midwives in Latin America endured—not only physical aggression, but also ethical and emotional harm.
"This study of violence experienced by nurses in Latin America during COVID-19 reveals a regional pattern that has been underrecognized until now: violence and moral suffering resulted from a combination of care overload, social stigma, and structural accountability," said study author Allison Squires , professor at NYU Rory Meyers College of Nursing and director of the Global Consortium of Nursing & Midwifery Studies .
The COVID-19 pandemic put extreme pressure on health systems, increasing the workload and exposure of its workforce to harm. Violence against health professionals—including abuse, threats, or aggression that threatens physical and psychological well-being—was prevalent long before COVID-19. But studies show that violence against nurses intensified during the pandemic.
Some healthcare workers also experience less visible versions of harm, including moral distress and injury. Moral distress occurs when professionals know the appropriate course of action but cannot act on it because of system and resource constraints, while moral injury refers to more enduring harm from events such as acting against one's core values, bearing constant witness to unnecessary suffering, or being unfairly blamed for systemic failures.
Significant gaps remain in understanding these experiences of violence and harm as they occurred in Latin America—a region marked by fragile health systems and historically precarious working conditions. In this study, one of the largest nursing workforce studies ever conducted in the region, an international team of researchers assessed how nursing professionals experienced and described different forms of violence during the pandemic.
The researchers analyzed written responses from 3,860 nurses and midwives in 18 Latin American and Caribbean countries who completed a questionnaire for the Global Consortium of Nursing & Midwifery Studies. Data were collected from July 2022 to May 2025, covering the final period of the COVID-19 pandemic and the following two years.
The researchers found recurring patterns in the narratives of emotional overload, professional challenges, and exposure to multiple forms of violence. Three interconnected themes emerged:
Direct violence (e.g., verbal and physical aggression)
Stigma, fear, and disruption of social belonging (e.g., fear of contagion and isolation)
Ethical-political suffering associated with structural blame (e.g., nurses held responsible for failures beyond their control, such as a lack of beds and medicines or long wait times)
Despite contextual differences across the region—for instance, in countries with weaker healthcare systems, the intensity of blaming nurses for structural issues increased—the themes reveal commonalities that drove Latin American nurses' and midwives' pandemic work experiences.
"This regional pattern suggests that violence against nurses is not an episodic phenomenon, but rather a persistent structural phenomenon rooted in longstanding inequities in the organization of Latin American and Caribbean health systems, which became more visible under pandemic conditions," the authors write.
The researchers note that their findings underscore the need for policies that strengthen workforce protection, ethical accountability, and institutional support in both routine healthcare settings and future public health emergencies.
Additional study authors include Liana Amorim Corrêa Trotte, Marluci Andrade Conceição Stipp, Maria Gefé da Rosa Mesquita, and Monaliza Gomes Pereira of the Federal University of Rio de Janeiro; Javier Isidro Rodríguez-López, Juana Jiménez-Sánchez, Sandra Milena Aponte-Franco, and Paola Andrea Dixon of the Growing Up Foundation; María Guadalupe Casales-Hernández of the Universidad Autónoma Metropolitana in Mexico City; Gabriela Castillo-Veras of the Universidad Autónoma de Santo Domingo in the Dominican Republic; Julio Alejandro García García-Castillo of the Universidad de Carabobo in Venezuela; and Marcella Gabrielle Betat and José Luís Guedes dos Santos of the of the Federal University of Santa Catarina in Brazil. This study was supported by the National Council for Scientific and Technological Development of Brazil (Grant No. 443719/2023-3).
