The Impact of a 3-Tiered Model of Nursing Redeployment During the COVID-19 Pandemic: A Cross-Sectional Study

Exploring critical care nurses' experiences of redeployment to general medical-surgical wards for covering staff shortages: A qualitative research study

BACKGROUND

The impact of redeployment on staff was not widely recognized before the COVID-19 pandemic. The redeployment of critical care nurses is frequently employed in health care organizations as a last-minute staffing management approach without proper infrastructure. Studies exploring the feelings and experiences of redeployed critical care nurses in this manner are sparse.

AIM

The aim of this study was to develop an understanding of the experiences of critical care nurses during their redeployment to cover shifts in the general wards.

STUDY DESIGN

This study adopted a qualitative research design to explore critical care nurses' experiences of redeployment. Ten critical care nurses attending a postgraduate critical care course in one university were recruited between January and April 2019. Data were collected using a focus group which was thematically analysed.

RESULTS

Three themes were identified: 'challenges in transitioning to ward settings', 'concerns regarding patient safety and satisfaction' and 'insufficient infrastructure and support'. Participants expressed concerns about patient and staff safety during redeployment, describing feelings of anxiety and undervaluation.

CONCLUSIONS

The study illuminates the intricate challenges experienced by redeployed critical care nurses, highlighting the crucial need for comprehensive support, targeted training and strategic planning to safeguard patients' care and nurses' well-being during periods of staff shortages in health care settings. These findings emphasize the importance of proactive measures in fostering a resilient and adaptable health care workforce. This is a small study involving only one focus group of 10 critical care nurses, which may limit the transferability of the findings. As a result, the findings may not fully reflect the experiences of critical care nurses from other sites.

RELEVANCE TO CLINICAL PRACTICE

The study reveals that critical care nurses experience challenges and stress when redeployed to general wards because of insufficient support and infrastructure. It emphasizes the need for comprehensive strategies, such as job rotation, tailored training and collaborative efforts to address redeployment challenges. Research could focus on developing and testing different models of job rotation between critical care and general wards, evaluating their impact on nurse satisfaction, confidence, competence and overall experience. The findings highlight the importance of organizational support, leadership and local guidelines for effective teamwork. Conducting longitudinal studies to track the experiences of redeployed critical care nurses over an extended period would be beneficial. This approach would provide insights into the long-term effects of redeployment on job satisfaction, burnout and retention.

Understanding ICU Nursing Knowledge, Perceived Barriers, and Facilitators of Sepsis Recognition and Management: A Cross-Sectional Study

IMPORTANCE

Nursing workforce changes, knowledge translation gaps, and environmental/organizational barriers may impact sepsis recognition and management within the ICU.

OBJECTIVES

To: 1) evaluate current ICU nursing knowledge of sepsis recognition and management, 2) explore individual and environmental or organizational factors impacting nursing recognition and management of sepsis using the Theoretical Domains Framework (TDF), and 3) describe perceived barriers and facilitators to nursing recognition and management of patients with sepsis.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional survey was administered to nurses working in four general system ICUs between October 24, 2023, and January 30, 2024.

MAIN OUTCOMES AND MEASURES

Quantitative questions (single/multiple choice, true/false, and Likert-based questions eliciting agreement with a statement) were analyzed using descriptive statistics. Open-ended questions exploring barriers and facilitators to sepsis recognition and management were analyzed using qualitative content analysis.

RESULTS

A total of 101 completed survey responses were retained. Most nurses agreed early sepsis detection saves lives (n = 98, 97%, TDF domain Beliefs About Consequences) and that nursing care can improve patient outcomes (n = 97, 96%, TDF domain Optimism). Fewer nurses agreed it was easy to identify priority sepsis interventions based on order urgency (n = 53, 53%, TDF domain Memory, Attention, and Decision Processes). Reoccurring barriers and facilitators to sepsis recognition and management were commonly identified across the TDF domains of Knowledge, Skills, Environmental Context and Resources, and Social Influences, including competency deficit (with facilitators including support from colleagues), workload or staffing, and equipment or resource availability.

CONCLUSION AND RELEVANCE

ICU nursing sepsis recognition and management is impacted by numerous individual, environmental, and organizational factors. Recommendations include enhanced competency development or support, utilization of structured reinforcement measures (involving the interdisciplinary team and imploring the use of integrative technologies), and addressing equipment/resource-related gaps. Future research and improvement initiatives should use a theory-informed approach to overcome the pervasive, complex challenges impeding timely sepsis recognition and management.

Nurses' experiences and sense making of COVID-19 redeployment and the impact on well-being, performance, and turnover intentions: A longitudinal multimethod study

Background

During Covid-19 nurses were redeployed to new teams and specialties at a level never previously experienced. Little is known about how nurses made sense of and coped with this situation and what we can learn from this for future redeployment approaches.

Objectives

We sought to understand how nurses made sense of ongoing redeployment during the COVID-19 pandemic and how this related to their psychological distress, burnout, turnover intentions, and perceived performance.

Design

A longitudinal multi-method design. (ISRCTN: 18,172,749).

Settings

Three acute National Health Service (NHS) Trusts in England, selected for diversity in geographical location and ethnicity, with different COVID-19 contexts.

Participants

Sixty-two nurses (90 % female; 83 % white) who experienced different types of redeployment during the pandemic, with an average of 17 year's post-registration experience (mean age 41 years).

Methods

We gathered both interview and survey data from 62 nurses across two or three time points in 2020-2021 and sought to find commonalities and differences in patterns of experience using Pen Portrait analysis.

Results

The pandemic redeployment process was life-changing for all nurses, personally and professionally. The research uncovered an intertwined pattern of identity and sensemaking as nurses coped with COVID-19 redeployment. Three sensemaking 'journeys' were evident, involving professional identity as a nurse and identification with one's organisation. Nurses in journey one: 'Organisational Identification and Professional Identity Maintained' (n = 28) had the best outcomes for wellbeing, burnout, performance, and retention. Those experiencing the 'Devaluation of Organisational Identification But Maintenance of Professional Identity' journey (n = 24) maintained their professional identity, but their organisational identification deteriorated. Journey three nurses: 'Devaluation of both Organisational Identification and Professional Identity' (n = 10) had the worst outcomes for wellbeing, burnout, performance, and retention. A salient nurse identity triggered stoicism and resilient behaviours while external cues of control, support and contextual awareness affected organisational identification.

Conclusions

Nurses made sense of their experiences of redeployment during Covid-19 differently which, in turn affected their outcomes. Given the stark differences in how nurses perceived their psychological distress, burnout, turnover intentions and performance across the journeys, the importance of understanding the cues (e.g. having autonomy) associated with each journey is apparent. Thus, our research provides clear guidance for managers to help them support nurses during redeployment.

Managing nurse redeployment during the Covid-19 pandemic, lessons for future redeployment: A qualitative study

BACKGROUND

The mass redeployment of nurses was critical across countries necessitated by the acute health impact of Covid-19. Knowledge was limited regarding how to manage nurse redeployment or the impact that redeployment might have. Redeployment continues, particularly in response to the current staffing crisis and surges such as winter pressures. This study aims to address these gaps in evidence to inform guidance on how best to manage nurse redeployment in practice.

OBJECTIVES

First, to understand the processes and underpinning decisions made by managers when managing nurse redeployment prior to and during the Covid-19 pandemic. Second, to identify the lessons that can be learned to improve the management of on-going nurse redeployment.

DESIGN

Qualitative study utilising semi-structured interviews and focus groups with nurse managers (ISRCTN: 18172749).

SETTING(S)

Three acute National Health Service (NHS) Trusts in England with geographical and ethnic diversity, and different Covid-19 contexts.

PARTICIPANTS

Thirty-two nurse managers and four Human Resource advisors responsible for redeploying nurses or receiving and supporting redeployed nurses.

METHODS

Participants took part in face-to-face or virtual semi-structured interviews from February 2021 to November 2021 and virtual focus groups from July to December 2021. Qualitative data were analysed using reflexive thematic analysis.

RESULTS

Four themes were evident in the data, capturing four distinctive phases of the redeployment process. There was a fundamental mismatch between how different parts of the nursing and managerial workforce conceived of their decision-making responsibilities across different phases. This led to managers taking inconsistent and sometimes contradictory approaches when redeploying nurses, and a disconnect between nursing staff at all levels of the chain of command. Furthermore, in conjunction with limited guidance in operationalising redeployment and the distressing experiences vocalised by nurses, nurse managers found nurse redeployment logistically and emotionally challenging; and felt 'caught in the middle' of meeting both their managerial and mentoring responsibilities. This became increasingly challenging during subsequent phases of redeployment and remained challenging once the pandemic waned.

CONCLUSIONS

The approach to nurse redeployment in response to the Covid-19 pandemic prioritised nurse staffing numbers over personal well-being. Key principles of good practice relating to nurse redeployment during the Covid-19 pandemic can be applied to improve future redeployment of nurses and support positive outcomes. Having a planned approach for staff redeployment during normal service delivery comprising operational guidance for those tasked with implementing redeployment, that is scalable in a crisis setting, would be beneficial for the nursing workforce.

Factors Influencing Post-Traumatic Stress Disorder in Hospital Clinical Nurses during COVID-19 in Korea: Resilience, Social Support, and Professional Pride in Nursing

During the COVID-19 pandemic, clinical nurses in hospitals in South Korea were exposed to extreme stress, and many continue to suffer from post-traumatic stress disorder (PTSD). This study explores the factors influencing PTSD among hospital clinical nurses during COVID-19. In total, 121 hospital clinical nurses participated in 2022, providing demographic information and completing surveys designed to measure PTSD, resilience, social support, professional pride in nursing (PPN), and variables related to COVID-19. We observed statistically significantly higher levels of resilience (91.48 vs. 70.00), social support (47.37 vs. 35.41), and PPN (88.36 vs. 68.06) in the low-risk PTSD group compared with the high-risk PTSD group. Resilience was associated with a reduced risk of PTSD (OR, 0.91; 95% CI = 0.84-0.98). The subfactors of control (OR = 0.60; 95% CI = 0.43-0.86) and sociability (OR = 0.68; 95% CI = 0.44-0.97) decreased PTSD risk. Among the social support subfactors, family support had an OR of 0.47 (95% CI = 0.26-0.86) for reducing PTSD risk. Programs involving family participation that enhance resilience and provide psychological support can help hospital nurses affected by the COVID-19 pandemic manage their PTSD. Our findings serve as foundational data to develop interventions on psychological well-being for nurses dealing with new infectious diseases.

A qualitative study of the experiences of interdisciplinary nurses during the COVID-19 outbreak following the announcement of the "Ten new guidelines" in China

BACKGROUND

On December 7, 2022, the Joint Prevention and Control Mechanism of China's State Council released the "Ten New Guidelines" to optimize the coronavirus disease 2019 (COVID-19) prevention policies further. This signaled a broader shift from "dynamic clearing" to "coexisting with the virus" nationwide.

OBJECTIVE

This study aims to examine the experiences and perspectives of interdisciplinary nurses during the COVID-19 outbreak in China after the implementation of the "Ten New Guidelines". The goal is to understand the challenges faced by this unique nursing group and inform organizational support to bolster their well-being and resilience.

METHODS

Two tertiary hospitals in southeastern Zhejiang Province were selected, with interdisciplinary nurses chosen as subjects. A constructivist qualitative research approach was employed, using semi-structured face-to-face interviews. Research data were collected through interviews and analyzed using content analysis.

RESULTS

Fifteen interdisciplinary nurses were included in this study. The analysis revealed four main themes and nine sub-themes. The main themes were: (1) ineffective organizational support (inadequate organizational care, poor PPE, excessive workload), (2) physiological distress after contracting COVID-19 (extreme physical fatigue, leakage of urine due to severe coughing), (3) fear of being wrong (fear of being reprimanded in public, psychological anxiety), and (4) family responsibility anxiety (difficulty of loyalty and filial piety, obligations to their children).

CONCLUSION

We provide new evidence that organizations must proactively address the support, training, and communication needs of staff, particularly interdisciplinary nurses, to supplement epidemic containment. This is also essential in helping mitigate the work-family conflicts such roles can create.

Redeployment Among Primary Care Nurses During the COVID-19 Pandemic: A Qualitative Study

Introduction: Throughout the COVID-19 pandemic, primary care nurses were often redeployed to areas outside of primary care to mitigate staffing shortages. Despite this, there is a scarcity of literature describing their perceptions of and experiences with redeployment during the pandemic. Objectives: This paper aims to: 1) describe the perspectives of primary care nurses with respect to redeployment, 2) discuss the opportunities/challenges associated with redeployment of primary care nurses, and 3) examine the nature (e.g., settings, activities) of redeployment by primary care nurses during the COVID-19 pandemic. Methods: In this qualitative study, semi-structured interviews were conducted with primary care nurses (i.e., Nurse Practitioners, Registered Nurses, and Licensed/Registered Practical Nurses), from four regions in Canada. These include the Interior, Island, and Vancouver Coastal Health regions in British Columbia; Ontario Health West region in Ontario; the province of Nova Scotia; and the province of Newfoundland and Labrador. Data related to redeployment were analyzed thematically. Results: Three overarching themes related to redeployment during the COVID-19 pandemic were identified: (1) Call to redeployment, (2) Redeployment as an opportunity/challenge, and (3) Scope of practice during redeployment. Primary care nurses across all regulatory designations reported variation in the process of redeployment within their jurisdiction (e.g., communication, policies/legislation), different opportunities and challenges that resulted from redeployment (e.g., scheduling flexibility, workload implications), and scope of practice implications (e.g., perceived threat to nursing license). The majority of nurses discussed experiences with redeployment being voluntary in nature, rather than mandated. Conclusions: Redeployment is a useful workforce strategy during public health emergencies; however, it requires a structured process and a decision-making approach that explicitly involves healthcare providers affected by redeployment. Primary care nurses ought only to be redeployed after other options are considered and arrangements made for the care of patients in their original practice area.