CANDID study surveyed hundreds of health workers
Nurses who worked in critical care during the COVID pandemic are at an increased risk of mental health problems according to a study, which has found three quarters showed signs of psychological distress, while a third reported clinically significant symptoms of post-traumatic stress.
The project, named CANDID, was funded by the National Institute for Health and Care Research (NIHR) and co-led by academics at Edinburgh Napier University and the University of Dundee.
They surveyed more than 400 critical care nurses (CCNs), as well as 200 who were redeployed to critical care (RDNs), across units in Scotland, England and Wales. 45 were also interviewed in depth, with one describing working shifts amid the crisis as being ‘like fighting a fire with a water pistol’.
The survey found growing levels of burnout among staff, compared to a similar study carried out before the pandemic by members of the team (Dr Louise McCallum), with a quarter of nurses planning to leave their role in the next year. Respondents expressed concerns about the quality of patient care and reduced attention to staff wellbeing and development during the pandemic.
Chief Investigator Professor Diane Dixon of Edinburgh Napier University’s School of Applied Sciences said: “The challenges thrown at nurses during the COVID-19 crisis have clearly left lasting concerns not just for their own wellbeing, but for the health service itself.
“They are likely to endure well beyond the end of the pandemic.”
Chief Investigator Dr Janice Rattray of the University of Dundee’s School of Health Sciences said: “These results are concerning as burnout is contagious, and symptoms of post-traumatic stress do not always resolve on their own. The NHS needs to prioritise the well-being of these nurses.
“Failure to address staff wellbeing is likely to have negative consequences for staff recruitment and retention, patient safety and quality of care.”
CANDID was carried out between January 2021 and June 2022, comparing its survey results directly with those from previous research in 2018. The percentage of nurses self-reporting levels of psychological distress and burnout through emotional exhaustion that would likely have a psychological diagnosis if interviewed clinically more than doubled in that time.
The study, which will now go through a peer-reviewing process, also measured the impact on organisational outcomes. Each of these worsened. Nurses reported reduced job satisfaction, less certainty about their future working for the NHS and were more likely to be planning to leave their role. Nurses also reported that both quality of care and patient safety had declined.
Although it was not recorded in the 2018 survey, a third of the nurses who responded reported clinically concerning symptoms of posttraumatic stress. During interviews, some spoke about the stress of dealing with relatives unable to see their loved ones in hospitals, as well as a feeling of isolation among RDNs separated from their usual teams.
The study recommends the NHS prioritises the welfare of CCNs and RDNs, implements workplace planning, supports them to recover from the pandemic, and creates an environment that will allow them to thrive in future.
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