Lessons from the frontline: The impact of redeployment during Covid-19 on nurse well-being, performance and retention

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. A plain language summary of this synopsis is available on the NIHR Journals Library Website https://doi.org/10.3310/ EWPE7103.