The impact of COVID-19 on the wellbeing of the UK nursing and midwifery workforce during the first pandemic wave: A longitudinal survey study

Abstract

Background The specific challenges experienced by the nursing and midwifery workforce in previous pandemics have exacerbated pre-existing professional and personal challenges, and triggered new issues. We aimed to determine the psychological impact of the COVID-19 pandemic on the UK nursing and midwifery workforce and identify potential factors associated with signs of post-traumatic stress disorder. Methods A United Kingdom national online survey was conducted at three time-points during the first wave of the COVID-19 pandemic between April and August 2020 (T1 and T2 during initial wave; T3 at three-months following the first wave). All members of the UK registered and unregistered nursing and midwifery workforce were eligible to participate. The survey was promoted via social media and through organisational email and newsletters. The primary outcome was an Impact of Events Scale-Revised score indicative of a post-traumatic stress disorder diagnosis (defined using the cut-off score ≥33). Multivariable logistic regression modelling was used to assess the association between explanatory variables and post-traumatic stress disorder. Results We received 7840 eligible responses (T1- 2040; T2- 3638; T3- 2162). Overall, 91.6% participants were female, 77.2% were adult registered nurses, and 28.7% were redeployed during the pandemic. An Impact of Events Scale-Revised score ≥33 (probable post-traumatic stress disorder) was observed in 44.6%, 37.1%, and 29.3% participants at T1, T2, and T3 respectively. At all three time-points, both personal and workplace factors were associated with probable post-traumatic stress disorder, although some specific associations changed over the course of the pandemic. Increased age was associated with reduced probable post-traumatic stress disorder at T1 and T2 (e.g. 41-50 years at T1 odds ratio (OR) 0.60, 95% confidence interval (CI) 0.42-0.86), but not at T3. Similarly, redeployment with inadequate/ no training was associated with increased probable post-traumatic stress disorder at T1 and T2, but not at T3 (T1 OR 1.37, 95% CI 1.06-1.77; T3 OR 1.17, 95% CI 0.89-1.55). A lack of confidence in infection prevention and control training was associated with increased probable post-traumatic stress disorder at all three time-points (e.g. T1 OR 1.48, 95% CI 1.11-1.97). Conclusion A negative psychological impact was evident 3-months following the first wave of the pandemic. Both personal and workplace are associated with adverse psychological effects linked to the COVID-19 pandemic. These findings will inform how healthcare organisations should respond to staff wellbeing needs both during the current pandemic, and in planning for future pandemics.

‘You can't walk through water without getting wet’ UK nurses’ distress and psychological health needs during the Covid-19 pandemic: A longitudinal interview study

“…Using the concept of "information power" to guide adequate sample size for qualitative studies ( Malterud et al, 2016 ) data saturation was achieved. The participant sampling for this study included those who had completed both of the first two ICON national nurse and midwife surveys (April and May 2020) and who expressed an interest in being contacted to take part in further research ( Couper et al, 2022 ). Of those contacted via email, 123 individuals expressed an interest in taking part.…”

“…Limitations of these COVID-19 workforce studies to date include cross-sectional designs with many studies focussing on hospital nurses, particularly those working in Intensive Care Units (ICU). Indeed, our own initial survey findings highlighted the urgent need for qualitative research to understand the impact of the COVID-19 pandemic on nurses in more depth, hence this study ( Couper et al, 2022 ).…”

“…During the COVID-19 pandemic, the already poor state of some nurses’ mental health was further exacerbated by unprecedented demands and unfamiliar working conditions over a prolonged period of time (West et al, 2020; Kinman et al, 2020 ). Our longitudinal three time point survey conducted over the first wave of the pandemic found that, even three months after the first wave had subsided, 30% of nurses reported symptoms consistent with PTSD ( Couper et al, 2022 ). These findings align with many other studies (e.g.…”

Healthcare workers’ perceptions and medically approved COVID-19 infection risk: understanding the mental health dimension of the pandemic. A German hospital case study

“…This pattern might also impact negatively in the perception of protective workplace measures. Feeling poorly protected and cared for by the organisation are important sources of stress, which may be correlated to burn-out of HCWs, as a recent study with UK nurses and midwives during the first wave of the pandemic shows (59).…”

“…This pattern might also impact negatively in the perception of protective workplace measures. Feeling poorly protected and cared for by the organisation are important sources of stress, which may be correlated to burn-out of HCWs, as a recent study with UK nurses and midwives during the first wave of the pandemic shows (59). Individual perceptions and concerns need greater attention in health workforce research and policy, no matter whether there is a technical ‘objective’ reason or not.…”