"Like fighting a fire with a water pistol": a theoretically informed study of the impact on critical care nurses working through the pandemic.

Background: Critical care nurses (CCNs) were essential to the COVID-19 pandemic response. Demands on this workforce were significant and sustained (Endacott & Blot, 2022).
Aim: To explore the impact on, and experiences of, CCNs working during the pandemic.
Method: From January to November 2021, CCNs (n = 461) from across the UK completed validated questionnaires assessing components of the Job Demands-Resources model (Bakker & Demerouti, 2017) including job demands (e.g., emotional load), job resources (e.g., autonomy), health impairment (e.g., psychological distress) and organisational outcomes (e.g., safety). Predictors of health impairment and organisational outcomes were identified through regression analyses, and comparisons were drawn with pre-pandemic survey data (n = 557) collected in 2018. Data from semi-structured interviews with 28 CCNs was deductively analysed using framework analysis and the JD-R model.
Results: During the pandemic job demands were higher, job resources were low, and the prevalence of mental health impairment, compared with pre-pandemic data, was markedly elevated. The risk of clinically significant health impairment was striking, CCNs had a six-fold elevation in risk of psychological distress and a four-fold risk of burnout compared with 2018. A third experienced post-traumatic stress symptoms. Perceptions of the quality and safety of patient care were poor, and considerably more care was left undone than in 2018. In interviews, participants described why job demands and reduced quality and safety of patient care were ‘impactful’, and how relationships with colleagues served as a vital job resource.
Implications for practice: Applying the JD-R model with a mixed methods approach enabled us to understand CCNs' experiences. This study highlights the enduring impact of the pandemic work environment on staff and on organisational outcomes.