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Department: Team Concepts

The experience of nurses deployed out of their clinical specialty role during the COVID-19 pandemic

Griffis, Leigh DNP, RN, CPN, NEA-BC; Tanzi, Donna PhD(c), MPS, RN, NE-BC, NPD-BC; Kanner, Kimberly MSN, RN, OCN; Knoepffler, Susan MPA, BSN, RN, NE-BC

Author Information
Nursing Management (Springhouse): September 2021 - Volume 52 - Issue 9 - p 6-10
doi: 10.1097/01.NUMA.0000771772.25770.c7
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When the COVID-19 pandemic hit the US in January 2020, the precipitous rate of infections overwhelmed hospitals and the medical community at large.1 Resources, such as nursing staff, were stretched beyond any previous experience.1 The data are still changing but as of June 2021, the total cases in the US were over 33 million, with more than 590,000 deaths.1 To meet the needs of caring for the vast number of COVID-positive patients, hospitals designed COVID units, which caused many nurses to change their roles.

The purpose of this qualitative study was to understand and describe the experiences of RNs who were deployed out of their clinical specialty role during the COVID-19 pandemic to care for COVID-positive patients. Deployed is defined as being assigned to a new unit/department and/or a new/different patient population. This deployment resulted in a role change for nurses who may have been unprepared for the new assignment. Additionally, some of the deployed staff members not only experienced a role change, but also moved to a new physical location/unit to care for this new patient population. The results of this study can help guide future education, services, and support when deployments and role changes are unexpected and unplanned.

Literature review

Research has been conducted describing nurses' responses to their roles and practices during a crisis or pandemic situation.2-5 Von Strauss and colleagues studied the experience of nurses deployed to Africa during the Ebola virus disease outbreak. The results provided knowledge on how to better prepare nurses for future outbreaks, including mental health support afterward.6 Additionally, the concept of floating to another unit isn't foreign to nurses. These types of short-term deployments are usually for one shift. Matlakala studied the views of ICU nurses deployed for one shift to cover the nursing shortage on a general care unit, finding the need for formal policies and procedures regarding floating.7 Hellman and Hurley discussed the deployment of nursing students during a disaster in roles for nonpatient-related tasks, as well as caring for noncritical patients under supervision.8 Whereas VanDevanter and colleagues reviewed the impact of nurses deployed to a completely different hospital in the wake of a natural disaster that resulted in their own hospital's closure, finding the practice challenges they encountered due to the new and unknown environment.9

A study by Chenevert and colleagues discussed role change readiness within organizations and the impact on role stressors, including role ambiguity, conflict, and overload.10 There's an additional challenge in healthcare regarding change readiness due to the high level of stress.11 Murray studied the experience of practice-based career changes in nurses who transitioned from hospital-based to home care nursing using role theory as the framework.12 In contrast, these role changes were during a purposeful and planned timeline rather than the immediate need during a crisis/pandemic situation.

There's a lack of research describing when nurses' roles change because of a crisis or pandemic, specifically when a nurse is deployed from their clinical specialty to care for a different patient population for greater than one shift. As documented by VanDevanter and colleagues, awareness of the concerns and competing demands that nurses experience in a disaster and its following aftermath can guide education and services to allow nurses to perform their clinical duties while minimizing risk to self and patients.9 Additionally, in a qualitative study by Cranley and colleagues, it was found that “nurse responses to uncertainty include physiological and affective responses, strategies to manage uncertainty, and the outcomes of managing uncertainty.”13

Methods

This qualitative study took place at a nonprofit, 371-bed, Level III trauma center located in the town of Huntington on Long Island in New York. The hospital is a four-time Magnet® redesignated facility. To care for the surge of COVID-19 patients, nurses were deployed from their clinical specialty role to become medical-surgical and critical care nurses during the pandemic. Although some nurses stayed on their home unit with only the patient population change, others were caring for the new patient population on a different unit due to their home unit being closed. Eighty-eight percent of respondents stated that they were deployed to a new unit.

Purposive sampling was done. The inclusion criteria for the study included nurses who were full-time and part-time employees working in the cardiac catheterization lab, interventional radiology, postanesthesia care unit, electrophysiology lab, obstetrics department, endoscopy department, ambulatory surgery unit, and OR who were deployed for greater than 1 week.

The study used a narrative open-ended question survey to collect data. (See Table 1.) Content analysis was used to analyze the responses and provide themes to describe the experiences of nurses as they practiced in both an area and time of uncertainty via the following six steps: all surveys were transcribed verbatim by the study team members, all transcribed surveys were checked for completeness, phrases were coded that focused on the aim of the question, categories were then formulated with like phrases, the categories were reduced and collapsed to overall conceptual themes, and emerging themes were identified.14 The data were analyzed by the three-person study team, which consisted of the principle investigator and two coinvestigators, to increase objectivity and reduce bias.

Table 1: - Open-ended survey questions
How did you prepare yourself to be deployed? (Consider both professional and personal preparation in your response.)
How did you prepare your family for your deployment?
What information were you provided before being deployed?
Who provided the information?
Was the provided information helpful?
What information (if any) was missing?
What expectations did you have before deployment about the upcoming experience?
How were these expectations formulated?
How prepared were you for your new role?
What did you experience as the riskiest aspect of the new role?
Why was this risky for you?
What was the most significant risk of your new role for you personally?
What was the role of your supervisor and peers in the deployment?
How were they most supportive?
How were they least supportive?
What intrapersonal strategies did you use and find helpful to deal with the deployment? (Consider ways you might cope or decrease stress, such as meditating, prayer, and so on.)
What resources did you need or want?
Were the resources available?
What new or different clinical interventions related to the deployment concerned you the most?
Why did these new or different clinical interventions concern you?
Were there positive experiences you focused on? If so, what were they?
Describe the learning needs you had going into the deployment?
Were the learning needs resolved?
How were the learning needs resolved and how long did it take to resolve?

The theoretical framework that guided this study was role theory, which “contends that normative expectations and requirements, such as culturally defined behavioral rules, are attached to positions in social organizations.”15 The deployment of these nurses resulted in a role change that could lead to role strain, stress, and potential ambiguity due to the upheaval of the nurses' normal and expected practice.15

Results

A total of 40 respondents participated in the study. The demographic and work characteristics of the nurses are shown in Table 2. The average nurse was age 52, female, and a full-time employee married with children at home. Most nurses were baccalaureate-prepared, with 25 years of experience and an average of 8 years on their respective units. Many nurses were relocated to a new unit, only learning of the deployment the day they were being deployed, with the average deployment lasting up to 2 months. The majority didn't receive orientation, had never been deployed before, and didn't have previous pandemic experience.

Table 2: - Demographics
Age (years) Average 52
Youngest 33
Oldest 64
Gender Female 37 92.5%
Male 3 7.5%
Ethnicity Hispanic or Latino 0 0%
NonHispanic or Latino 39 97.5%
Race American Indian or Alaska Native 0 0%
Black or African American 0 0%
Asian 2 5%
Native Hawaiian or other Pacific Islander 1 2.5%
White 35 87.5%
Marital status Married 28 70%
Separated 3 7.5%
Divorced 5 12.5%
Single 2 5%
Children No children 2 5%
Yes, living at home 30 75%
Yes, not living at home 8 20%
Nursing education Diploma 1 2.5%
ADN 6 15%
BSN 24 60%
MSN 6 15%
Doctorate 1 2.5%
Years as a nurse Average 25
Least 3
Longest 44
Length of time in department(years) Average 8.725
Least 0.33 (4 months)
Longest 25
Length of deployment (months) Average 2.3
Least 0.75 (3 weeks)
Longest 6
Stay on home unit Yes 15 37.5%
No 25 62.5%
Relocate to new unit Yes 35 87.5%
No 5 12.5%
Time between informed and deployment (days) Average 1.4
Received orientation before deployment Yes 4 10%
No 36 90%
Ever been deployed Yes 5 12.5%
No 34 85%
Past disaster/crisis/pandemic experience Yes 3 7.5%
No 37 92.5%
Employment status Full time 34 85%
Part time 6 15%

The identified themes showed that new advanced competencies and skills are needed in an unplanned, rapidly changing environment, as well as increased clinical skills promoting flexibility and organizational benefit. The themes included fear of the virus and spreading it to family, unpreparedness and the need for greater support and education on caring for critically ill patients, and consistent acknowledgment of peer support and teamwork. The deployment caused the nurses role strain, stress, and overload due to patient acuity and volume.

The nurses' fears centered on contracting the virus and spreading it to their family. As one nurse wrote, “It was stressful fearing the unknown.” Another said, “I was afraid I was going to do something wrong, which would negatively affect my patient. I also was afraid that I was going to get sick.” There was an overwhelming feeling of unpreparedness. One nurse stated, “I didn't have time to prepare. I had to act to save my life and the life of my patients.” Another nurse remarked, “No one was prepared. That's like asking if we were prepared for 9/11.”

There was also the need for greater support and education on caring for critically ill patients, specifically the severity of illness, critical care documentation, medication administration, ventilator management, and caring for prone patients. This new environment and unknown virus created what one nurse called “chaos.” Another nurse stated, “There was something new almost every day for the first 3 to 4 weeks regarding the care of the patients.” One nurse wrote, “The patients were so critically ill and difficult to stabilize, the fear of negative outcomes affected me the most personally. I cried everyday driving to and from work because of the fear that I just wouldn't be able to do enough or that my best wouldn't be enough.” Another nurse said, “I thought we would save more patients” and “nurses were so out of their comfort zone.”

The nurses adapted, learning as they continued with on-the-job training and asking questions. One nurse indicated, “I learned what I could and reached out to my colleagues for support with what I couldn't accomplish myself.” Another nurse stated, “My coworkers from my unit were extremely supportive of one another. Everyone helped when they could. Our nurse educator was very supportive and got us the resources we needed and never left our side.”

The inspiring, positive theme was teamwork and team bonding. One nurse said, “Everybody dove in to the best of their abilities. Supervisors gave us updates and peers worked together to care for the patients.” Another nurse stated, “Everyone was kind. Everyone was also so busy with their own patients. We did the best we could.” Although providing stability in the rapidly changing and unknown environment was challenging, one nurse indicated that leaders “listening and reassuring you that you were doing all you could do to help our patients” was helpful.

Implications

The nurses' voices requesting additional support and education to care for critically ill patients were apparent throughout the study. Nurses were outside their comfort zone while caring for an unknown disease process. Being deployed and assuming new roles brought forth educational needs for patient management, including medication administration, ventilator management, and caring for prone patients. As the severity of the situation rapidly increased, the demand for immediate planning and execution intensified. In no other recent time have organizations and nurse leaders faced such an enormous challenge, one that required a multitude of leadership attributes all at once. (See Table 3.)

Table 3: - Organizational implications for nurse leaders
Problem Solution
Fear of the virus and spreading to family Communication, reassurance, and stability
Unpreparedness and the need for greater support and education on caring for critically ill patients Education and nurse educator involvement
Lack of peer support and teamwork Leadership involvement and presence

When planning for a future pandemic situation, nurse leaders should consider the need for the following:

  • frequent and transparent communication
  • deliberately calm but optimistic, visible, approachable, supportive, and empathetic leadership
  • mission-driven coordination, with common goals and cohesive teams
  • rapid, yet deliberate decision-making
  • reflection on what worked well, what to do differently, and what to add.

Limitations

The experience of caring for COVID-19 patients wasn't limited to the nurses at one hospital; this pandemic has affected nurses worldwide. Because this study focused on the experience of nurses at one hospital in New York, it's recommended that additional studies are conducted to garner the experiences of nurses from multiple hospitals.

Never the same

The COVID-19 pandemic forced organizations to face challenging situations, and the impact is still being felt. The pandemic made leaders and staff alike feel softer but stronger, cynical but more sincere, discouraged but hopeful, saddened but joyful, uncertain but wiser, and alone but together. This study reinforced that the pandemic changed the world so rapidly, nurses didn't have time to prepare for their new roles. Yet it also highlighted what nurses do best: focus on their patients to provide the best possible care. They relied on their inner strength and support systems, banding together to become one team and staying true to organizational values. As one nurse stated, “The most positive experience really was how the staff became one to help fight this pandemic. I really learned what I was working with to get through this.” And another nurse summed it up, “We'll never be the same.”

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