Response to "Protecting the role of the intensive care research coordinator during pandemics".

Worldwide, severe acute respiratory syndrome coronavirus 2 and the resulting coronavirus disease 2019 pandemic has seen more than 107,000,000 cases and 2,300,000 deaths worldwide. In some countries, this has caused enormous strain on the healthcare system and on intensive care units (ICUs), in particular, with a reported mean rate of ICU admission of 20.1% (range = 4.6–32%) for patients admitted to the hospital with coronavirus disease 2019. The reported deaths in the ICU were highly variable and ranged from 0 to 72% (mean = 34.9%); in the hospital, the mean mortality was 45% (range = 5–72%). Such increases in ICU admission stretch resources in a sustained manner during pandemics, which is complicated by simultaneous reductions in available staffing as clinicians also become unwell.

In a situation where in requirements outstrip resources, it is natural to prioritise staff for the provision of patient care. However, as Hammond and Bates rightly point out, we need to be mindful of unintended consequences of deploying nurse researchers into clinical roles; this can inadvertently influence the generation of high-quality evidence that is needed to guide clinical practice and improve patient outcomes. When developing the pandemic staffing framework, we were careful to consider roles that support the delivery of clinical care and took this a step further to encourage organisations to consider the value of role expansion in these areas. Recommendation 18 states that ‘Expansion of nonclinical roles, such as those in education, research, and leadership, may be required to support staff development, service delivery, and data acquisition which are fundamental to the delivery of safe and high-quality clinical care’.

As we have pointed out in our framework (Recommendation 3), the local context should be considered carefully, and multidisciplinary consultation should be used, when making decisions about changes to staffing when ICU resources become stretched. A collaborative effort considering the benefits and limitations of practice change needs to be considered, and this should involve consultation with a wide range of stakeholders. ICU researchers and research coordinators should be included in these discussions so that opportunities to advance knowledge are optimised for the future.