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 satisfyer pro penguin next generation 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.Plain language summary Our question In response to COVID-19, nurses were moved around different wards in hospitals to areas where the need was greatest.This is called ‘redeployment’.Redeployment was done with very little knowledge of how best to do it or what the challenges might be.
In this study we asked: How did nurse managers make decisions about how to redeploy nurses before and during the COVID-19 crisis? How did nurses make sense of this redeployment and what effect did it have on their well-being, performance, and whether or not they wanted to carry on in their job? What we did We spoke to 100 nurse managers and nurses in three National Health Service trusts read more in England.We used interviews (nurses and nurse managers) and surveys (nurses only) to collect information.We tried to understand the experiences of nurses over a period of 6–9 months, from February 2021 to February 2022.Staff and patients volunteered to help us to design and deliver this research.
We shared our findings with organisations such as the Royal College of Nursing and NHS England.They helped us to develop recommendations that would change how redeployment happens in England.These ideas could be used in other countries too.What we found We found that nurse managers were uncertain about how to manage redeployment and this caused them stress.
They had to make decisions quickly about who to move where, and there was very little information to help guide how they did this.They were unsure how to support nurses during redeployment and how to rebuild their teams after redeployment.A few nurses enjoyed their redeployment experience.Most nurses experienced a lot of distress with just over half thinking about leaving their jobs.
We have used what we found to develop 11 recommendations for how to manage redeployment and help nurses to recover.What this means Our recommendations will help people who manage nurses to think about what they need to do to make redeployment a positive experience.It will also help them think about how best to support staff after they have been redeployed.By working with our national stakeholder group and by sharing our findings widely, we hope to make an important difference to how redeployment is managed in a crisis and in the everyday work of the National Health Service.