Work-related stress: the Impact of COVID-19 on Critical Care and Redeployed Nurses

Background: Critical care nurses (CCNs) and nurses deployed to critical care areas experienced significant challenges during the pandemic. They were faced with a multitude of difficult and new demands, including the high acuity and associated mortality rate of COVID-19 patients, the need to deliver care using personal protective equipment, to communicate and support relatives at a distance, and the well-publicised potential risks to personal and family health. There is a need to understand the impact of these increased demands at the individual, unit and organisational levels in order to know how best to support staff now and through possible second and third waves of the pandemic. This 2-phase, mixed methods study will use a theoretical model of occupational stress, the Job Demand Resource (JD-R) model to understand the impact of the COVID-19 pandemic on CCNs and staff deployed to critical care areas. The JD-R model specifies individual factors (personal resources e.g. resilience), work environment and job characteristics (job demands (e.g. workload) and job resource (e.g. autonomy)) variables that may lead to either negative (health impairment, reduced job satisfaction, burnout) or positive (work engagement, commitment) outcomes for staff, and organisational outcomes (intention to remain and quality of care). Phase 1: Questionnaire study: All CCNs employed within NHS ICUs in 20 adult critical care units across Scotland and three units in England (around n=2000) and registered nurses who were redeployed to critical care areas on at least 2 occasions will be invited to complete a questionnaire designed to measure all components of the JD-R model of stress. We have a recently completed study that employed the JD-R model to assess stress in CNNs prior to COVID. This study will act as baseline data for the current study. Structural equation modelling analyses will be used to assess the ability of the JD-R model to account for the data. These analyses will identify the sources of stress that impact on individual wellbeing and organisational outcomes, such as intention to remain in post. It will also identify factors that mitigate the impact of stress on individual and organisational outcomes. Phase 2: Qualitative Interviews: in depth interviews with CNNs and redeployed nurses (up to 35 interviews with a stopping criterion) will explore the challenges and consequences of delivering critical care services during the pandemic and information about the support services they were offered, used and found useful will be recorded. Framework analyses will be applied to the data with the JD-R model providing the initial codes for charting. Interview text that remains after extraction of the JD-R coded text will be analysed using the usual framework method. The use of the same theoretical framework for the quantitative and qualitative components of the study will facilitate integration of results across phase 1 and 2 of the study. Information about the support services offered, used and found useful by staff will be compared to the sources of stress and the factors that mediate or moderate the effect of stress on health and wellbeing identified in phase 1. Understanding the match and/or mis-match between stressors and support services provided will identify services to be retained, services that are candidates for discontinuance and areas of unmet need.