Working conditions and nurses' mental health in Latin America and the Caribbean during the COVID-19 pandemic: a multinational cross-sectional study

Background The COVID-19 pandemic placed unprecedented pressure on health systems across Latin America and the Caribbean. Although studies have documented adverse working conditions and psychological distress among healthcare workers, evidence focused specifically on nursing personnel has largely been derived from single-country studies, limiting understanding of regional patterns. Analyses spanning multiple countries remain limited. This study aimed to describe the working conditions and mental health symptoms reported by nursing staff in work and home environments during the COVID-19 pandemic across Latin America and the Caribbean. Methods A cross-sectional, multinational study was conducted among nursing professionals in 20 Latin American countries between July 2022 and April 2025. Self-report measures assessed working conditions, institutional support, training, occupational recognition, emotional symptoms at work and at home, and burnout. Descriptive analyses and Pearson’s chi-square tests were performed. Cramér’s V (Vc) with 95% confidence intervals (CI) was used to estimate the magnitude and precision of associations between emotional symptoms reported at work and at home. Results A total of 6,986 nurses participated. Overall, 16.2% had temporary contracts. 21.3% held multiple jobs, and more than half reported that their income was insufficient to avoid poverty (51.8%) or to cover household needs (52.9%). Another 41.8% had a COVID-19 infection, although only 37.2% were recognized as having an occupational illness, and 14.3% received additional benefits. Job reassignment occurred in 30.7% of cases, and 9.3% were laid off. Statistically significant associations were observed between emotional symptoms reported at work and at home (χ², p < 0.001). The largest associations were observed for irritability (Vc = 0.566, 95% CI 0.550–0.582), depression (Vc = 0.562, 95% CI 0.547–0.577), difficulty concentrating (Vc = 0.548, 95% CI 0.532–0.564), and fatigue (Vc = 0.512, 95% CI 0.492–0.531). Conclusions Nursing staff in Latin America experienced adverse working conditions during the pandemic, characterized by contractual instability, insufficient wages, limited institutional recognition, and high exposure to biological risk. Emotional symptoms showed moderate to large associations across work and home settings, highlighting the need for policies that strengthen workforce protection, occupational recognition, and mental health support.