Study finds high psychological distress among UK nursing and midwifery workforce during COVID-19

Extremely concerning levels of psychological distress are reported in results from a longitudinal study of the UK nursing and midwifery workforce during COVID-19. The findings could help how staff are supported in healthcare services now and in future.

The results from surveys of the UK nursing and midwifery workforce taken at three time points during the first wave of the pandemic in 2020 have found concerning levels of psychological distress, including experiences consistent with post-traumatic stress disorder (PTSD), stress, and anxiety in respondents.

A combination of pre-existing workforce challenges, rapid changes to professional life and ways of working, high patient mortality rates, risk of illness to both the individual and their family, and the way in which healthcare organisations responded to the pandemic may have important and demonstrable psychological impacts on the UK nursing and midwifery workforce.

The results, published today in the International Journal of Nursing Studies provide important information to help identify potential factors associated with psychological distress and inform workforce support planning for future pandemics for healthcare services in the UK and across the globe.

The Impact of COVID-19 on the Nursing and Midwifery workforce (ICON) study is a longitudinal national survey which aimed to assess the mental health effects of the pandemic over time on the nursing workforce and identify the personal and workplace factors associated with wellbeing to inform the response to the current pandemic and support preparation for future pandemics.

The surveys were taken at three time points between 2-14 April 2020 (during the first wave), 28 April-12 May 2020 (during the first wave), and 30 July-20 August 2020 (three-months following the first wave) and provide insight into psychological impact of the pandemic during the first wave and into the recovery period.

The ICON study was developed by the Royal College of Nursing Research Society and led by the University of Warwick and King's College London, with collaborators including Barts Health NHS Trust, City University of London, University of Nottingham, Cardiff University, University of Plymouth, and University of Surrey.

All members of the UK nursing and midwifery workforce were eligible to complete the survey, including registered nurses, registered midwives, student nurses, healthcare support workers, nursing associates, and trainee nursing associates. The survey was distributed by social media, the Royal College of Nursing, and other key professional organisations.

Across the three surveys, a total of 7,840 analysable responses were received.

At all three time points, both personal and workplace factors were associated with probable PTSD, although some specific associations changed over the course of the pandemic. Key workplace-related factors were associated with adverse psychological effects, including redeployment to other clinical areas without adequate training and inadequate infection control training. A key individual-level factor associated with probable PTSD was having a personal caring responsibility.

Findings from across all three surveys include:

• A significant proportion of participants were identified as having probable PTSD. While this declined over the three surveys, almost 29.3% continued to report experiences indicative of a probable post-traumatic stress disorder diagnosis three-months after the first pandemic peak.
• Severe or extreme stress was reported by almost 17.5% respondents three-months after the first pandemic peak.
• 63.2% of redeployed respondents reported that training to prepare for redeployment either did not occur or was inadequate.
• 40% reported that they lacked confidence in infection prevention and control training that they had received, or that training had not been received.
• 22.6% felt that the correct personal protective equipment was not always available.

• Prevalence of some psychological issues decreased following the first pandemic peak, but a significant proportion of participants continued to experience negative psychological effects during the pandemic recovery phase.

These findings can inform how healthcare organisations should respond to staff wellbeing needs both during the current pandemic, and in planning for future pandemics.

The study concluded that healthcare organisations should urgently implement evidence-based strategies to support the wellbeing of members of the nursing and midwifery workforce affected by the pandemic, and develop robust workforce plans in preparation for future pandemics.

We know that even prior to the pandemic, the UK nursing and midwifery workforce was under significant strain due to high levels of attrition and ongoing recruitment challenges. Our study clearly highlights that staff experiences during the COVID-19 pandemic has had significantly exacerbated this strain. The findings of our research show that the psychological impact of the pandemic on the UK nursing and midwifery workforce has been extremely concerning. The ongoing challenges during subsequent pandemic waves have likely exacerbated this impact."

Dr Keith Couper,  Project Lead and Assistant Professor in Emergency and Critical Care, University of Warwick

'Our findings should drive healthcare employers throughout the world to address shortcomings in their organisational response to COVID-19, and future health emergencies, to both prevent psychological issues developing and ensure that those affected receive timely high-quality evidence-based support during the pandemic and as needed thereafter.'

– Ruth Harris, Professor of Health Care for Older Adults in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care at King's College London

The ICON research team

Dr Keith Couper, Assistant Professor in Emergency and Critical Care, Warwick Medical School, University of Warwick

Trevor Murrells, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care at King’s College London

Professor Julie Sanders, St Bartholomew’s Hospital, Barts Health NHS Trust and William Harvey Research Institute, Queen Mary University of London

Dr Janet Anderson, School of Health Sciences, City University of London

Dr Holly Blake, Associate Professor of Behavioural Science, School of Health Sciences, University of Nottingham and NIHR Nottingham Biomedical Research Centre, Queen’s Medical Centre

Professor Daniel Kelly, Royal College of Nursing Chair of Nursing Research, School of Healthcare Sciences, Cardiff University

Professor Bridie Kent, Professor of Leadership Nursing, Faculty of Health, University of Plymouth

Professor Jill Maben, Professor of Health Services Research and Nursing, School of Health Sciences, University of Surrey

Professor Anne Marie Rafferty, Professor of Nursing Policy, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care at King’s College London

Professor Ruth Harris, Professor of Health Care for Older Adults, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care at King’s College London