There has always been a need for the short-term redeployment of staff. The COVID-19 pandemic required a redeployment at scale to enable the required response to the demand for care of patients with COVID-19, while many other clinical pathways were paused.
Guidance was rapidly produced by NHS England (2020) on managing the redeployment of staff during the pandemic. However, there has been very little research evidence to guide us. Moreover, there is no existing research on the long-term impact of the different kinds of redeployment on staff outcomes, wellbeing, performance and retention.
My trust, along with two others, is participating in research funded by the National Institute for Health and Care Research (NIHR) (2020) concerned with this issue. The team is leading two work packages (WP) to address the research questions:
- WP1: ‘How was the process of redeploying nursing staff managed prior to and during the COVID-19 crisis?’
- WP2: ‘How did nurses make sense of redeployment during the COVID-19 crisis and what effects does it have on wellbeing and job outcomes?’
The initial findings of WP1 were shared at a recent Royal College of Nursing congress, exploring the experiences of nurse managers who made decisions about redeployment during the pandemic. At my trust, we have discussed our findings to learn from them and influence future practice. Nurses who were interviewed perceived several concerns about how the redeployment was conducted.
Younger, often inexperienced, nurses were more likely to be redeployed, and were often the nurses approached first by nurse managers. This was felt to be unjust but understandable, given the options of decision makers.
When redeployed, nurses arriving on a new ward often found that no one was expecting them. This had a big impact on the redeployed nurses' wellbeing by adding to the feeling that they were simply ‘a number’ and therefore not appropriately valued.
Tensions were created because of a lack of transparency about the length of redeployments. This was a struggle for nurse managers because so much about the course of the pandemic was unknown and therefore it was difficult to manage expectations.
There were concerns for the wellbeing of the redeployed staff. The participants reported having to redeploy ‘broken’ nurses. The knowledge that they had put staff in these positions had a huge emotional impact on the decision makers. It led to feelings of guilt for the nurses whose decisions on redeployment had led to staff illness.
There were concerns about the impact of de-redeployment on the team dynamic when the nurses returned to their ‘home’ wards. There was perceived resentment between nurses who had been redeployed and those who had been shielding or working in the ‘home’ ward.
There was a perceived disconnect between the decisions made at very senior levels and the redeployment decisions made on the ‘shop floor’. This meant the nurses who were enacting the plan faced a challenge between redeploying nurses to satisfy the numbers needed, and redeploying nurses in a way that best supported their wellbeing.
The interviews resulted in several initial recommendations about redeployment:
- Preparing orientation sheets with basic information about the ward and the tasks expected from the redeployed nurse and having them in place when they arrive for their first shift in a new ward
- Implementing a method for redeployed nurses to provide feedback to the wards to which they are redeployed
- Ensuring that redeployed nurses have a clear line manager, and that contact is maintained throughout the redeployment
- Ensuring that nurses are kept in teams where possible, or at least with a ‘buddy’ when being redeployed to a new unit
- Acknowledging that wellbeing support is needed for the senior nurses making the redeployment decisions and having to communicate those decisions with nurses
- There needs to be a process in place to manage nurses who refuse to be redeployed
- The redeployment plan and staff capacity must be matched up
- It is important to ensure that the right staff attend the redeployment-decision meetings so that they can contribute their knowledge of the nurses for whom they are responsible
- Developing a culture that supports the movement of nurses around the hospital and shifting the focus so that movement is a positive thing for career development
- Having a centralised view on the experiences and skills of staff to help make these decisions more skill focused
- Ensuring there is clear consistent leadership and that when questions are asked of management, justification is provided for decisions and staff will be told about any specific action that will take place as a result of any raised concerns.
This research is ongoing and will inform our practice in the future. But, given the need to continue to redeploy nurses, the initial findings are important for us to consider for our nurses' safety and wellbeing.