Impact of leadership on the nursing workforce during the COVID-19 pandemic

  1. Natasha Phillips
  2. Luke Hughes
  3. Cecilia Vindrola-Padros
  4. Anika Petrella
  5. Lorna A Fern
  6. Flo Panel-Coates
  7. Rachel M Taylor

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Abstract

The aim was to determine how the learning about protective factors from previous pandemics was implemented and the impact of this on nurses’ experience.

Methods

Secondary data analysis of semistructured interview transcripts exploring the barriers and facilitators to changes implemented to support the surge of COVID-19 related admissions in wave 1 of the pandemic. Participants represented three-levels of leadership: whole hospital (n=17), division (n=7), ward/department-level (n=8) and individual nurses (n=16). Interviews were analysed using framework analysis.

Results

Key changes that were implemented in wave 1 reported at whole hospital level included: a new acute staffing level, redeploying nurses, increasing the visibility of nursing leadership, new staff well-being initiatives, new roles created to support families and various training initiatives. Two main themes emerged from the interviews at division, ward/department and individual nurse level: impact of leadership and impact on the delivery of nursing care.

Conclusions

Leadership through a crisis is essential for the protective effect of nurses’ emotional well-being. While nursing leadership was made more visible during wave 1 of the pandemic and processes were in place to increase communication, system-level challenges resulting in negative experiences existed. By identifying these challenges, it has been possible to overcome them during wave 2 by employing different leadership styles to support nurse's well-being. Challenges and distress that nurses experience when making moral decisions requires support beyond the pandemic for nurse’s well-being. Learning from the pandemic about the impact of leadership in a crisis is important to facilitate recovery and lessen the impact in further outbreaks.

Article activity feed

  1. Version published to 10.1136/leader-2021-000588
  2. Version published to 10.1101/2021.05.18.21256802v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.05.18.21256802: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Participants gave recorded consent and were assured of anonymity and confidentiality.
    Sex as a biological variablenot detected.
    RandomizationAnalysis was undertaken by two people but the framework and subsequent charting were randomly checked by two others.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Arguably the work and the impact of these decisions was greater in this case where the language used illustrates the moral distress experienced when making and communicating these decisions: While the technical limitations of the digital systems for deploying staff were widely reported, analysis also show the limitations of a digital system alone for redeploying staff. This is because they demonstrate that leadership decisions by matrons and ward sisters were not a direct translation of organisational policy or tools like a roster system but the result of bringing knowledge about and the expectations of affected individuals into view alongside the need for organisational need for safe staffing. This practical decision-making is the professional judgement of the experienced nurse leader and the complexity and impact of such judgements have the potential to lead to the moral distress that has been reported in previous studies (Phillips & Norman 2020, Ulrich 2014) The findings illustrate the impact of policy decisions on all participants; what was intended as a beneficial change when setting policy was experienced as both positive and negative across the organisation and this was situation dependent. This presents a challenge to existing thinking about command and control approaches to crisis management and may account for why some of the recommended protective measures did not always seem to afford protection to individual staff wellbeing in this case. Nurse leadership: It has ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2021.05.18.21256802v1 on medRxiv