Title: Lessons from the frontline: The impact of redeployment during Covid-19 on nurse well-being, performance and retention
Funder: Department of Health and Social Care

Abstract: During the coronavirus pandemic, NHS staff have moved to different roles and units (redeployed) in large numbers to meet changing demands of the service. At times, this meant that staff were working in unfamiliar environments doing unfamiliar tasks. With regard to nurses (the largest proportion of the workforce), some have been asked to work in more risky settings, while others have been pulled off patient-facing duties because they are in an 'at-risk' group. _x000D_ _x000D_ Rapid guidance was published by NHS England/Improvement on how to manage the redeployment of staff who were likely to be working outside their 'comfort zone' and how to do this while ensuring safe practice. This advice included having appropriate supervision and considering health and wellbeing. However, when planning how best to redeploy and support staff during this crisis (at national, organisational and ward level) there has been very little research evidence for senior staff to draw on. Moreover, there is no existing research on the long-term impact of different kinds of redeployment on staff outcomes: wellbeing, performance and retention. This is vital because nursing shortages are already a serious problem in the UK and so we need to know how best to support staff so that they are able to provide safe, effective and compassionate care. This programme of research addresses these gaps in knowledge._x000D_ _x000D_ Two different projects are planned here which, together, will provide a much better understanding of how to plan for and manage redeployment of nurses and how to support them during, and in the aftermath of, a period of redeployment. This knowledge will be useful for routine service delivery, where creating a more flexible NHS workforce is now a national priority and so redeployment may become more common, as well as for planning more specifically in a pandemic or other crisis situation. _x000D_ _x000D_ In this research programme, a highly experienced team of researchers will work with three NHS Trusts (already agreed) to deliver two work-packages (WP). An advisory group of nurses and lay leaders will guide and support the work. WPs are outlined briefly below. _x000D_ _x000D_ Research objectives and Methods:_x000D_ _x000D_ WP1: To examine how decisions were made in the redeployment of nursing staff, based on an ethical framework and the barriers and enablers to doing this._x000D_ Method: Interviews with 30 senior staff responsible for decision making about how, where and when staff were redeployed, what support was provided to these staff, and how their return to previous teams was managed._x000D_ _x000D_ WP2: To understand how nurses made sense of redeployment and how this effected their longer-term job performance and well-being._x000D_ Method: Questionnaires and interviews at 3 time points over 10 months with 50-60 nurses involved in different forms of redeployment._x000D_ _x000D_ We will work with key stakeholders (e.g. Royal College of Nursing, NHS England/NHS Improvement, NHS Employers) to share learning to inform future planning of redeployment strategies for nurses during the COVID-19 pandemic and beyond.

Lay abstract: 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._x000D_ _x000D_ 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._x000D_ _x000D_ 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._x000D_ _x000D_ 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._x000D_ _x000D_ We will work with 3 NHS Trusts in England. 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._x000D_ _x000D_ Two work-packages(WP) will achieve the programme aims as follows:_x000D_ _x000D_ WP1: How was the process of redeploying nursing staff managed prior to and during the Covid-19 crisis?_x000D_ _x000D_ Method: Interviews with 30 senior nurses and 3 senior HR managers responsible for decision making. One senior nurses focus group per Trust._x000D_ _x000D_ 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?_x000D_ _x000D_ Method: Questionnaires and interviews at 3 time points with 50-60 nurses involved in different forms of redeployment across the 3 Trusts._x000D_ _x000D_ 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.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE