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

Background: Delivering safe and effective healthcare requires sufficient staff numbers with the right skill mix. Thus, the rapid redeployment of nursing staff has been critical to the NHS response to COVID-19. The NIHR have recognised the significance of these changes and the challenges of rapidly reallocating staff without evidence on how best to do this or what the longer term consequences are. This proposal directly addresses this evidence gap (see NIHR COVID-19: Recovery and Learning call), falling squarely within the HS&DR remit. Senior NHS Trust staff had to plan staff redeployment in a short timescale with no existing guidelines and had to do this again when certain groups of staff (e.g. BAME) were identified as high-risk. The redeployment of frontline nursing staff has been varied. Some were redeployed to work in high risk areas, others to non-patient facing roles (Dunn et al, 2020). Many worked in unfamiliar teams, caring for frightened patients, dealing with inadequate PPE, and fearing virus transmission. While the psychological consequences of working through COVID-19 are emerging (Nursing Times, 2020), there is no empirical research examining the impact of redeployment on UK nurses. This research addresses two aims 1) understand the impact of redeployment during COVID-19 on nurse well-being, performance and retention 2) provide guidance for those responsible for redeployment at national and local level. Due to the possibility of local 'spikes'/second waves of COVID-19, this work will be of huge value in the on-going management of the NHS workforce in the current pandemic. As redeployment has become common for nursing staff, this work is also directly applicable to improving healthcare during normal service delivery. We will work with 3 NHS Trusts: Oxford, Royal Free and Bradford (all agreed). The multi-disciplinary research team, led from one of the 3 NIHR Patient Safety Translational Research Centres, has the expertise and experience to deliver this project. Close collaboration with a nurse advisory panel and two lay leaders will support the delivery and dissemination of the work. We will also explore the role of the public and patients via our citizen participation group. Two work-packages(WP) will achieve the programme aims as follows: WP1: How was the process of redeploying nursing staff managed prior to and during the Covid-19 crisis? Method: Interviews with 30 senior nurses and 3 senior HR managers responsible for decision making. One senior nurses focus group per Trust. WP2: How did nurses make sense of redeployment during the COVID-19 crisis and what effects does it have on well-being and job outcomes? Method: Questionnaires and interviews at 3 time points with 50-60 nurses involved in different forms of redeployment across the 3 Trusts. Further to these work packages we will work with stakeholders to develop recommendations and guidance based on our learning about how best to manage redeployment and support staff reallocation in future waves of Covid-19 and routine service delivery. We will disseminate our findings to academic (e.g. organisational behaviour and patient safety) and professional (e.g. nurse managers, HR managers) audiences through publications and conferences/meetings.