Supporting nurses' recovery during and following the COVID-19 pandemic

The impact of redeployment during COVID-19 on nurse well-being, performance and retention: a mixed-methods study (REDEPLOY)

Background

Mass redeployment of nurses was critical to the National Health Service response to COVID-19. There remains little understanding of how redeployment was enacted during the pandemic and its impact on nurse managers' and nurses' mental health and well-being, job performance and retention. This study aimed to understand how nurse redeployment was managed prior to and during COVID-19; explore how nurses made sense of redeployment; and the impact on their mental health and well-being, job performance and retention intentions.

Design

A mixed methods approach utilising semistructured interviews, focus groups and surveys with nurse managers and nurses.

Setting

Three National Health Service acute hospital trusts.

Participants

Thirty-eight nurse managers and human resources advisors participated in interviews and focus groups. Sixty-three nurses who were redeployed or worked with redeployed nurses participated in interviews and surveys over three time points between March 2021 and February 2022.

Data collection and analysis

Interviews asked nurse managers about redeployment decisions and nurses about their redeployment experiences. Interview data were analysed using thematic and pen portrait analyses. The survey measured well-being, performance and intentions to leave. Multilevel modelling was conducted to explore relationships between variables over time.

Results

Seven themes were identified that illustrate the redeployment process, decisions made, and the impact on nurse managers and nurses. Nurse managers redeployed nurses in response to directives focused on numbers of staff and allowable staff:patient ratios, whereas their decisions were more often person focused. This raised logistical and emotional challenges for nurse managers and a disconnect in the levels of the chain of command regarding the needs of nurses. Most reported feeling like they were treated as a commodity, with redeployment having profound impacts on their mental health, well-being, job performance and retention. The longitudinal pen portrait analysis revealed three 'journeys' that represented how nurses made sense of their redeployment, underpinned by two themes: nurse identity and organisational identification. Journeys ranged from those who retained their professional identity and organisational identification (journey one) through to those who experienced a demolition of dual identities (journey three). While most staff in all journeys reported burnout, psychological distress, anxiety, depression and intention to leave their jobs, this was more frequent and severe for those experiencing journey three. These findings, together with stakeholder input, informed the development of 11 recommendations for policy and practice.

Limitations

Nurses from minority ethnic backgrounds are under-represented in the sample despite efforts to encourage participation. The quantitative data were planned to be collected at discrete time points during the COVID pandemic for each trust but gaps between data collection time points were compromised by the challenge of ongoing COVID waves and the different set-up times for each trust.

Conclusions and future work

Mass redeployment of nurses in response to the COVID-19 pandemic prioritised nurse staffing numbers over staff well-being. Redeployment had a profound impact on nurse managers and nurses with significant and concerning implications reported for nurse well-being, performance and retention. The recommendations for policy and practice will require active endorsement and widespread dissemination and would benefit from evaluation to assess impact.

Funding

This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132041.

Prevalence, correlates, and network analysis of depression and its associated quality of life among ophthalmology nurses during the COVID-19 pandemic

Background

Nurses in Ophthalmology Department (OD) had a high risk of infection during the novel coronavirus disease 2019 (COVID-19) pandemic. This study examined the prevalence, correlates, and network structure of depression, and explored its association with quality of life (QOL) in Chinese OD nurses.

Methods

Based on a cross-sectional survey, demographic and clinical data were collected. Depression was measured with the 9-item Self-reported Patient Health Questionnaire (PHQ-9), and QOL was measured using the World Health Organization Quality of Life Questionnaire-brief version (WHOQOL-BREF). Univariate analyses, multivariate logistic regression analyses, and network analyses were performed.

Results

Altogether, 2,155 OD nurses were included. The overall prevalence of depression among OD nurses was 32.71% (95%CI: 30.73-34.70%). Multiple logistic regression analysis revealed that having family or friends or colleagues who were infected (OR = 1.760, p = 0.003) was significantly associated with higher risk of depression. After controlling for covariates, nurses with depression reported lower QOL (F(1, 2,155) = 596.784, p < 0.001) than those without depression. Network analyses revealed that 'Sad Mood', 'Energy Loss' and 'Worthlessness' were the key central symptoms.

Conclusion

Depression was common among OD nurses during the COVID-19 pandemic. Considering the negative impact of depression on QOL and daily life, regular screening for depression, timely counselling service, and psychiatric treatment should be provided for OD nurses, especially those who had infected family/friends or colleagues. Central symptoms identified in network analysis should be targeted in the treatment of depression.

The impact of COVID-19 pandemic-related stress experienced by Australian nurses

Globally, the impact of COVID-19 on healthcare workers' mental health has been a major focus of recent research. However, Australian research involving nurses, particularly across the acute care sector, is limited. This cross-sectional research aimed to explore the impact of pandemic-related stress on psychological adjustment outcomes and potential protective factors for nurses (n = 767) working in the Australian acute care sector during the COVID-19 pandemic. Nurses completed an online questionnaire with psychometrically validated measures of pandemic-related stress, psychological adjustment outcomes (depression, anxiety, and subjective well-being), and protective factors (posttraumatic growth and self-compassion). Descriptive analyses revealed that pandemic-related stress was reported by 17.7% of the participants. Psychological adjustment outcome scores above normal for depression (27.5%) and anxiety (22.0%) were found, and 36.4% of the participants reported poor subjective well-being. Regression analyses suggest that pandemic-related stress predicted greater depression (B = 0.32, SE = 0.02, 95% confidence interval [0.28, 0.35]) and anxiety (B = 0.26, SE = 0.01, 95% confidence interval [0.24, 0.29]) and less subjective well-being (B = -0.14, SE = 0.01, 95% confidence interval [-0.16, -0.12]). Self-compassion weakened the relationship between pandemic-related stress and greater depression, however, exacerbated the relationship between pandemic-related stress and less subjective well-being. Posttraumatic growth reduced the negative relationship between pandemic-related stress and psychological adjustment outcomes. These findings will inform strategies to facilitate psychological resources that support nurses' psychological adjustment, enabling better pandemic preparedness at both an individual and organizational level.

Mental health, safety and support during COVID-19: A cross-sectional study of primary health care nurses

AIM

The aim of this study is to explore primary health care nurses' mental health, concerns and perceived safety and supports during COVID-19.

BACKGROUND

Respiratory pandemics have negative impacts on nurses' wellbeing. While literature is replete with hospital nurses' experiences, there is less exploration of COVID-19 impacts on primary health care nurses. Given the importance of primary health care nurses in the health system, understanding their experiences is vital.

METHODS

Three hundred and fifty nine primary health care nurses responded to an online cross-sectional survey. The Depression Anxiety Stress Scales (DASS-21) was used to measure emotional state. Data were analysed using descriptive and inferential statistics.

RESULTS

DASS-21 scores indicated that 39.6% of participants were experiencing symptoms of depression, anxiety or stress. Of those, 41.8% were experiencing symptoms on one scale, 26.9% were experiencing symptoms on two scales and 31.2% were experiencing symptoms across all three scales. Most participants identified that their feelings were related to COVID-19.

CONCLUSIONS

COVID-19 is having a significant impact on primary health care nurses' mental health. Nurse managers need to develop strategies to effectively address nurses' concerns and effectively support them to sustain the workforce during and after the pandemic.

IMPLICATIONS FOR NURSING MANAGEMENT

Findings from this study can inform the design of effective nurse support programmes to reduce mental health impacts and promote staff wellbeing during the pandemic.

Houston, We Have a Workforce Crisis; I Repeat . . . We Are Facing a Workforce Crisis

As a result of the cornoavirus disease 2019 (COVID-19) pandemic, the health care industry is facing one of its worse workforce crises in decades. Nurse educators must influence the development and implementation of a strategic workforce plan to mitigate this crisis. [J Contin Educ Nurs. 2021;52(10):452-453.].