Work-related stress: the impact of COVID-19 on critical care and redeployed nurses: a mixed-methods study

Rattray, Janice; McCallum, Louise; Hull, Alastair; Ramsay, Pam; Salisbury, Lisa; Scott, Teresa; Cole, Stephen J.; Miller, Jordan; Dixon, Diane

doi:10.1136/bmjopen-2021-051326

Cited by 21 publications

(19 citation statements)

References 24 publications

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“…Staff well‐being has arisen as a major concern during the COVID‐19 pandemic, with one study in nine UK hospitals showing evidence of 49% of ICU nurses meeting criteria for post‐traumatic stress disorder (168/344) and/or depression (167/344) (Greenberg et al, 2021). Similar levels are reported in other studies (Rattray et al, 2021; Sampaio et al, 2021). Whilst these findings are important for future recruitment and retention of ICU nurses, our findings show that, among our participants, the shift‐by‐shift organisation of nurse staffing takes account of staff well‐being were possible.…”

Section: Discussionsupporting

confidence: 92%

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The organisation of nurse staffing in intensive care units: A qualitative study

Endacott

Pattison

Dall’Ora³

et al. 2022

J Nursing Management

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Aims To examine the organisation of the nursing workforce in intensive care units and identify factors that influence how the workforce operates. Background Pre‐pandemic UK survey data show that up to 60% of intensive care units did not meet locally agreed staffing numbers and 40% of ICUs were closing beds at least once a week because of workforce shortages, specifically nursing. Nurse staffing in intensive care is based on the assumption that sicker patients need more nursing resource than those recovering from critical illness. These standards are based on historical working, and expert professional consensus, deemed the weakest form of evidence. Methods Focus groups with intensive care health care professionals (n = 52 participants) and individual interviews with critical care network leads and policy leads (n = 14 participants) in England between December 2019 and July 2020. Data were analysed using framework analysis. Findings Three themes were identified: the constraining or enabling nature of intensive care and hospital structures; whole team processes to mitigate nurse staffing shortfalls; and the impact of nurse staffing on patient, staff and intensive care flow outcomes. Staff made decisions about staffing throughout a shift and were influenced by a combination of factors illuminated in the three themes. Conclusions Whilst nurse:patient ratios were clearly used to set the nursing establishment, it was clear that rostering and allocation/re‐allocation during a shift took into account many other factors, such as patient and family nursing needs, staff well‐being, intensive care layout and the experience, and availability, of other members of the multi‐professional team. This has important implications for future planning for intensive care nurse staffing and highlights important factors to be accounted for in future research studies. Implications for Nursing Management In order to safeguard patient and staff safety, factors such as the ICU layout need to be considered in staffing decisions and the local business case for nurse staffing needs to reflect these factors. Patient safety in intensive care may not be best served by a blanket ‘ratio’ approach to nurse staffing, intended to apply uniformly across health services.

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Section: Discussionsupporting

confidence: 92%

“…Similar levels are reported in other studies (Rattray et al, 2021;Sampaio et al, 2021). Whilst these findings are important for future recruitment and retention of ICU nurses, our findings show that, among our participants, the shift-by-shift organisation of nurse staffing takes account of staff well-being were possible.…”

Section: Discussionsupporting

confidence: 91%

The organisation of nurse staffing in intensive care units: A qualitative study

Endacott

Pattison

Dall’Ora³

et al. 2022

J Nursing Management

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“…These data were collected in June and July 2020, a similar timeframe to our data collection, and reflect the concerns of our participants. Data from other UK (Rattray et al, 2021) and international studies (e.g. Sampaio et al, 2021) further support these findings, which collectively have important implications for future nurse recruitment and retention.…”

Section: Discussionmentioning

confidence: 64%

“…Research and discussion papers from the United States (Akgün et al, 2020; Cadge et al, 2021; LoGiudice & Bartos, 2021, Robinson & Stinson, 2021) and elsewhere around the world (e.g. Arabi et al, 2021, reporting from six European countries, Asia, Australasia, North and South America and Canada; Moradi et al,2021, reporting from Iran) suggest that whilst these changes have negatively impacted nurses’ well‐being (Greenberg et al, 2021; Montgomery et al, in press; Rattray et al, 2021; Sampaioa et al, 2021; Wozniak et al, 2021), they also offer opportunities to consider how best to engage our limited nursing resource.…”

Section: Introductionmentioning

confidence: 99%

How COVID‐19 has affected staffing models in intensive care: A qualitative study examining alternative staffing models (SEISMIC)

Endacott

Pearce

Rae

et al. 2021

Journal of Advanced Nursing

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Aims To understand how COVID‐19 affected nurse staffing in intensive care units (ICUs) in England, and to identify factors that influenced, and were influenced by, pandemic staffing models. Design Exploratory qualitative study. Methods Semi‐structured, online interviews conducted July–September 2020 with regional critical care leaders including policy leads (n = 4) and directors/lead nurses (n = 10) across critical care networks in England. Findings The six themes emerging from the framework analysis illustrate how the pre‐pandemic ICU culture influenced ICU staffing models during the pandemic. Changes in staffing impacted on the workforce and the care delivered, whilst it was necessary to learn from, and adjust to, a rapidly changing situation. Variation across and between networks necessitated variation in responses. The overwhelming outcome was that the pandemic has challenged the central tenets of ICU nurse staffing. Conclusions Pandemic nurse staffing models resulted in changes to ICU skill‐mix and staffing numbers. Factors such as the impact of nurse staffing on care practices and on the workforce need to be taken into account when developing and testing future nurse staffing models for ICU. The extent to which ICUs will return to former staffing models is not yet known but there seems to be an appetite for change. Impact In common with many countries, nurse staffing in English ICUs was adapted to address surge requirements during the COVID‐19 pandemic. Findings highlight the challenge COVID‐19 presented to pre‐pandemic ICU nurse staffing guidelines, the impact on patient and staff well‐being and the potential legacy for future staffing models. Study findings have implications for ICU nurse managers, researchers and policy makers: nurse staffing models need to be adaptable to the local context of care and future research should investigate the impact of different models on patients, staff and health service outcomes.

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“…These conditions enforce certain mental and social demands, negatively affecting their health and well-being ( Galletta et al, 2016 ; Rattray et al, 2021 ). Example conditions included the constant care of high acuity patients, high workload and time pressures, reduced social support, and frequent unexpected critical events that often lead to suffering and death ( Galletta et al, 2016 ; Rattray et al, 2021 ). For these reasons, critical care units are considered high-strain workplaces that predisposed workers to adaptation disorders and job dissatisfaction ( Galletta et al, 2016 ; Rattray et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

What are the essential components to implement individual-focused interventions for well-being and burnout in critical care healthcare professionals? A realist expert opinion

et al. 2022

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BackgroundThis study aimed to determine what, how, and under what circumstances individual-focused interventions improve well-being and decrease burnout for critical care healthcare professionals.MethodThis realist approach, expert opinion interview, was guided by the Realist And Meta-narrative Evidence Synthesis: Evolving Standards II (RAMESES II) guidelines. Semi-structured interviews with critical care experts were conducted to ascertain current and nuanced information on a set of pre-defined individual interventions summarized from a previous umbrella review. The data were appraised, and relationships between context, mechanisms, and outcomes were extracted, which created theory prepositions that refined the initial program theory.ResultsA total of 21 critical care experts were individually interviewed. By understanding the complex interplay between organizational and personal factors that influenced intervention uptake, it was possible to decipher the most likely implementable intervention for critical care healthcare professionals. The expert recommendation suggested that interventions should be evidence-based, accessible, inclusive, and collaborative, and promote knowledge and skill development. Unique mechanisms were also required to achieve the positive effects of the intervention due to the presence of contextual factors within critical care settings. Mechanisms identified in this study included the facilitation of self-awareness, self-regulation, autonomy, collaboration, acceptance, and inclusion (to enable a larger reach to different social groups).ConclusionThis validation of a theoretical understanding of intervention that addressed well-being and burnout in critical care healthcare professionals by expert opinion demonstrated essential mechanisms and contextual factors to consider when designing and implementing interventions. Future research would benefit by piloting individual interventions and integrating these new theoretical findings to understand better their effectiveness for future translation into the “real-world” setting.

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Work-related stress: the impact of COVID-19 on critical care and redeployed nurses: a mixed-methods study

Cited by 21 publications

References 24 publications

The organisation of nurse staffing in intensive care units: A qualitative study

The organisation of nurse staffing in intensive care units: A qualitative study

How COVID‐19 has affected staffing models in intensive care: A qualitative study examining alternative staffing models (SEISMIC)

What are the essential components to implement individual-focused interventions for well-being and burnout in critical care healthcare professionals? A realist expert opinion

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