Assessing Pandemic Response Implementation and the Workforce Impact Among Nurses and Midwives Internationally: Protocol for an Exploratory, Pragmatic, Online Descriptive Study.

Abstract

Background: The COVID-19 pandemic placed unprecedented demands on nurses and midwives worldwide, exacerbating existing workforce shortages and contributing to high rates of mental health issues and altered labor market dynamics. Nurses and midwives in low- and middle-income countries remain underrepresented in the literature.

Objective: The aim of this study is to describe and compare the impact of pandemic response implementation across countries and contexts on the global nursing and midwifery workforce who worked and delivered care between March 2020 and December 2023.

Methods: A pragmatic design guides this multinational, online, descriptive study. Eligible participants are nurses and midwives who cared for at least 1 patient with suspected or confirmed COVID-19. Country teams use opt-in convenience and network sampling, targeting 300 participants per country, or 60 participants for small island states. The self-administered 79-question instrument, hosted on Qualtrics XM software and available in 27 languages, was developed with country teams. It includes 8 open-ended free-text questions; 46 questions examining the impact of pandemic response implementation on mental health, career mobility, economics, and occupational exposures; and 25 demographic questions. After pilot-testing, data collection took place between July 2022 and June 2026. Summative content analysis combined with natural language processing techniques analyzed the qualitative data. Descriptive and bivariate analyses analyzed quantitative responses. Cross-country comparative analyses of quantitative data use funnel plots with binomial control limits to compare country responses and can accommodate unequal sample sizes. Psychometric evaluation of instruments developed and tested in this study is planned. Funding and ethics approval for the study were provided by the lead author's university.

Results: At the conclusion of data collection in June 2026, a total of more than 23,000 nurses and midwives from 108 countries engaged with this study's online instrument, with over 14,000 completing more than 50% of all the questions. Descriptive analyses of partial samples have been published, as have the pilot tests of the methodology. The analyses specified here will use the complete dataset and are underway, with the first multinational analyses expected in 2027. Country teams will lead analyses specific to their country.

Conclusions: Upon completion, this study will identify the common and unique factors that influenced pandemic response implementation relative to nurses and midwives during the COVID-19 pandemic, from low-resource to high-resource settings. Data may provide multilevel insights into the postpandemic workforce. Finally, this study will provide data that can inform country-level preparation to meet key articles of the World Health Organization Pandemic Agreement.