Hartley Hannah, Dunning Alice, Dunn Michael, Grange Angela, Murray Jenni, Simms-Ellis Ruth, Unsworth Kerrie, Marran Jayne, Lawton Rebecca
Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford BD9 6RJ, UK. Electronic address: https://twitter.com/HartleyHL.
Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, University of Sheffield, Sheffield S1 4DA, UK.
Int J Nurs Stud. 2024 Sep;157:104828. doi: 10.1016/j.ijnurstu.2024.104828. Epub 2024 May 27.
The mass redeployment of nurses was critical across countries necessitated by the acute health impact of Covid-19. Knowledge was limited regarding how to manage nurse redeployment or the impact that redeployment might have. Redeployment continues, particularly in response to the current staffing crisis and surges such as winter pressures. This study aims to address these gaps in evidence to inform guidance on how best to manage nurse redeployment in practice.
First, to understand the processes and underpinning decisions made by managers when managing nurse redeployment prior to and during the Covid-19 pandemic. Second, to identify the lessons that can be learned to improve the management of on-going nurse redeployment.
Qualitative study utilising semi-structured interviews and focus groups with nurse managers (ISRCTN: 18172749).
SETTING(S): Three acute National Health Service (NHS) Trusts in England with geographical and ethnic diversity, and different Covid-19 contexts.
Thirty-two nurse managers and four Human Resource advisors responsible for redeploying nurses or receiving and supporting redeployed nurses.
Participants took part in face-to-face or virtual semi-structured interviews from February 2021 to November 2021 and virtual focus groups from July to December 2021. Qualitative data were analysed using reflexive thematic analysis.
Four themes were evident in the data, capturing four distinctive phases of the redeployment process. There was a fundamental mismatch between how different parts of the nursing and managerial workforce conceived of their decision-making responsibilities across different phases. This led to managers taking inconsistent and sometimes contradictory approaches when redeploying nurses, and a disconnect between nursing staff at all levels of the chain of command. Furthermore, in conjunction with limited guidance in operationalising redeployment and the distressing experiences vocalised by nurses, nurse managers found nurse redeployment logistically and emotionally challenging; and felt 'caught in the middle' of meeting both their managerial and mentoring responsibilities. This became increasingly challenging during subsequent phases of redeployment and remained challenging once the pandemic waned.
The approach to nurse redeployment in response to the Covid-19 pandemic prioritised nurse staffing numbers over personal well-being. Key principles of good practice relating to nurse redeployment during the Covid-19 pandemic can be applied to improve future redeployment of nurses and support positive outcomes. Having a planned approach for staff redeployment during normal service delivery comprising operational guidance for those tasked with implementing redeployment, that is scalable in a crisis setting, would be beneficial for the nursing workforce.
由于新冠疫情对健康造成的严重影响，各国护士的大规模重新部署至关重要。关于如何管理护士重新部署或重新部署可能产生的影响，相关知识有限。重新部署仍在继续，特别是为应对当前的人员配置危机以及冬季压力等高峰情况。本研究旨在填补这些证据空白，为在实践中如何最好地管理护士重新部署提供指导。
第一，了解在新冠疫情之前及期间，管理人员在管理护士重新部署时的流程及相关决策依据。第二，确定可吸取的经验教训，以改进对正在进行的护士重新部署的管理。
采用半结构化访谈和焦点小组的定性研究（国际标准随机对照试验编号：18172749）。
英格兰的三个急性国民医疗服务体系（NHS）信托机构，具有地理和种族多样性，且新冠疫情情况各异。
32名护士管理人员和4名人力资源顾问，他们负责重新部署护士或接收并支持重新部署的护士。
参与者在2021年2月至2021年11月参加了面对面或虚拟的半结构化访谈，并在2021年7月至12月参加了虚拟焦点小组。定性数据采用反思性主题分析进行分析。
数据中出现了四个主题，涵盖了重新部署过程的四个不同阶段。护理和管理工作人员的不同部分在不同阶段对其决策责任的理解存在根本不匹配。这导致管理人员在重新部署护士时采取不一致甚至相互矛盾的方法，并且指挥链各级护理人员之间存在脱节。此外，由于重新部署的操作指导有限，以及护士所表达的痛苦经历，护士管理人员发现护士重新部署在后勤和情感方面都具有挑战性；并且感觉自己“夹在中间”，既要履行管理职责又要承担指导职责。在重新部署的后续阶段，这一挑战日益加剧，即使在疫情减弱后仍具有挑战性。
应对新冠疫情的护士重新部署方法将护士人员配置数量置于个人福祉之上。新冠疫情期间与护士重新部署相关的良好实践关键原则可用于改进未来护士的重新部署并支持取得积极成果。在正常服务提供期间，为工作人员重新部署制定一个有计划的方法，包括为负责实施重新部署的人员提供可在危机情况下扩展的操作指南，这将对护理人员队伍有益。
