Aim: To explore the impact of the COVID-19 pandemic on the mental health of nurses working in primary, secondary, and tertiary healthcare centers in Navarre (Spain). Background: Healthcare workers, especially nurses, are at high risk for developing mental health problems during the COVID-19 pandemic. Introduction: Spain ranks among the European countries with the highest incidence of and mortality from COVID-19 and has a 31% deficit in the number of nurses compared with the average for the European Union. Methods: This was a cross-sectional study involving 800 Registered Nurses in Navarre, Spain. Four standardized instruments, along with a self-administered online questionnaire, were used to measure the impact in terms of depression, anxiety, insomnia, and posttraumatic stress disorder. The STROBE checklist for cross-sectional studies was used to report this study. Results: Of the 800 nurses, 68% had some level of depression, anxiety, insomnia, and distress, and of these, 38% had moderate or severe symptoms. Those who worked in hospital COVID units and in nursing homes showed a higher impact on their mental health. Discussion: The sustained pressure that nurses have experienced in their work during the COVID-19 pandemic has negatively affected their mental health. Conclusion:This study found that nurses who worked in hospital COVID units and in nursing homes during the pandemic had worse mental health outcomes. Implications for nursing/policy: Recommendations for nursing policy include the need to implement coaching and emotional programs to support nurses on the frontlines of the pandemic. There is also an urgent need for the implementation of national training programs to strengthen health emergency preparedness, improve response capacity, and increase the resilience of nurses to disasters.

Accessible Summary What is Known on the subject? Working on the frontline during the pandemic has had a negative impact on the mental health of health professionals. A significant proportion experienced anxiety, insomnia, posttraumatic stress or depression. What the paper adds to existing knowledge? Analysis and synthesis of the evidence of the impact of the COVID‐19 pandemic on the mental health of nurses based on their work context. There exists a gap in the literature as no studies were found that analysed the effects on nurses' mental health according to the level of care they worked in (hospital–primary care–nursing home). What are the implications for practice? There is an urgent need to assess and respond to the impact of COVID‐19 on the physical and mental well‐being of nurses, and to monitor international policies for the improvement of nurses' working conditions. Abstract Introduction Health professionals have suffered negative consequences during the COVID‐19 pandemic. No review has specifically addressed the impact of the pandemic on the mental health of nurses exclusively according to the work context. Aim To analyse the impact of the COVID‐19 pandemic on the mental health of nurses who have worked in hospitals, primary care centres and social health centres. Method PubMed, CINAHL, PsychINFO and Cochrane databases were searched (Prospero number: CRD42021249513). Out of 706 papers, 31 studies (2020–2021) were included in the systematic review. A qualitative synthesis method was used to analyse the data. Results Most studies were conducted in hospitals or frontline settings. The prevalence of moderate‐to‐severe symptoms was for anxiety 29.55%, depression 38.79%, posttraumatic stress disorder 29.8%, and insomnia 40.66%. Discussion This review highlights the mental health effects among nurses working in acute hospital settings. It also evidences a data gap on mental health effects among nurses working in primary health care and in nursing homes. Implications for practice In the post phase of the pandemic, there is an urgent need to assess and respond to the impact on the mental well‐being of nurses, and to monitor international policies for the improvement of nurses’ working conditions.