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Original research
Impact of leadership on the nursing workforce during the COVID-19 pandemic
  1. Natasha Phillips1,
  2. Luke Hughes2,
  3. Cecilia Vindrola-Padros3,
  4. Anika Petrella2,
  5. Lorna A Fern2,
  6. Flo Panel-Coates4,
  7. Rachel M Taylor5
  1. 1 NHSX, National Health Service England, London, UK
  2. 2 Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK
  3. 3 Rapid Research Evaluation and Appraisal Lab (RREAL) Department of Targeted Intervention, University College London, London, UK
  4. 4 Corporate Nursing, University College London Hospitals NHS Foundation Trust, London, UK
  5. 5 Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr Rachel M Taylor, University College London Hospitals NHS Foundation Trust, London, UK; rtaylor13{at}nhs.net

Abstract

Background 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.

  • COVID-19
  • analysis
  • communication
  • healthcare planning
  • nurse

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/leader-2021-000588

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors NP, RMT and FP-C developed the protocol. LH, AP, LAF and RMT coordinated the running of the study; LH, AP and RMT were responsible for data acquisition. All the authors contributed to the analysis, drafted, critically revised and approved the final manuscript. RMT acts as guarantor.

  • Funding The CNMAR is funded through UCLH Charity; RMT was a National Institute for Health Research (NIHR) Senior Nurse Research Leader; LAF is funded through Teenage Cancer Trust.

  • Disclaimer The views expressed in this article are those of the authors and not necessarily those of UCLH Charity, Teenage Cancer Trust, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.