Dear Editor and authors of the letter:

We have reviewed with great interest the comments in the letter to the editor that accompanies the original article entitled "Climate and Pre-Pandemic Job Satisfaction of Nursing Personnel in an Emergency Service," published in Volume 23, number 02 of 2023 by Chávez M et al., where a significant correlation is highlighted between the work environment and the job satisfaction of the nursing team at the Vitarte Hospital¹.

The World Health Organization (WHO) reports that job performance in the health sector has decreased by an average of 47% during the COVID-19 pandemic, with a more pronounced impact in developing countries, particularly in the Americas. Latin, where the drop reaches 70% on average and up to 85% in nations such as Brazil, Peru, Chile and Colombia². This context of high demand and stress during the pandemic has significantly impacted nursing staff.

In addition to the factors mentioned in the previous letter, previous research offers relevant information, such as; Mo et al. (2020) found that an excessive workload is related to higher stress and anxiety levels in nurses, recommending psychological support as a relief measure³. Likewise, Ferreira et al. (2020) identified that nurses faced difficulties in health education, misinformation among the population and obstacles in making differential diagnoses, experiencing emotional fears and stress due to the pandemic⁴.

Jawed et al. (2020), evaluated the knowledge, attitude, practice and stress perceived by health personnel, finding moderate levels of stress related to concerns about the health of their families and the lack of protective equipment⁵. Similarly, Vagni et al. (2020), identified stressors that caused secondary trauma in healthcare workers, highlighting higher levels of physical and emotional stress among nurses working directly with COVID-19 patients⁶.

Morales (2020) found an inverse relationship between stress and motivation in health personnel during the pandemic, with high-stress levels associated with lower motivation⁷. Facts that undoubtedly allow us to reflect and learn to be prepared psychologically and with biosafety equipment to better face a new pandemic.

Several studies have investigated the relationship between stress and job performance in nurses at the national level. Among them, Delgado et al. (2020) found a negative and moderate correlation between work stress and work performance in health personnel in a care network⁸.

Machacuay et al. (2020), revealed a moderate relationship between stress and job performance in nurses, highlighting a high level of stress and a low level of performance⁹. Alcalá et al. (2021), reported that during the COVID-19 pandemic, workload and stress indirectly affected the work performance of nursing staff¹⁰.

Aranda et al. (2021) identified stressful situations for nurses, including a lack of staff and inappropriate working conditions, with a significant relationship between stress and coping strategies¹¹, Del Rosario et al. (2021), found that nurses faced challenges during the pandemic, which resulted in stress and affected their work performance in various dimensions¹². Obregón et al. (2021), indicated that work stress related to the pandemic had a negative impact on the mental and physical health of nursing staff, but a low to moderate level of stress and good work performance, in general, was found¹³, as well as like Ortega (2021), who reported that nursing staff faced stress due to unknown illness, long shifts, and fear of contagion, with a significant and moderate relationship between stress and job performance¹⁴, finally we have Zamora (2022), who found a strong and negative relationship between stress and job performance in nurses working in critical areas¹⁵.

In summary, these national and international studies consistently suggest a relationship between stress and job performance in nursing personnel. Research has been carried out on the relationship between stress and work performance in the nursing staff of the Vitarte Hospital during the COVID-19 Pre-pandemic, which seeks to contribute to the existing knowledge base and serve as a relevant background for future studies in this matter.