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Development of a core outcome set for mental health nurse wellbeing: a Delphi study

Lead applicant: Dr Gemma Simons

Co-applicants: Prof Jane Ball, Prof David Baldwin, Dr Emma Wadey, Dr Catherine Smith

Project Title: Development of a core outcome set for mental health nurse wellbeing: a Delphi study

Project Summary:


There are 39,813 nurse vacancies in England. Nurse wellbeing was highlighted to the UK public by the Covid 19 pandemic with nurses treating patients with Covid 19, sometimes without adequate Personal Protective Equipment being provided and an unacceptable number of nurses dying due to exposure at work. Nurse wellbeing was causing concern in the years preceding the pandemic, with the need to improve nurse wellbeing being identified in the Health Education England NHS staff and learners’ mental wellbeing commission.  The NHS as one of the world’s biggest employers needs to rapidly implement the recommendations made, which included the measurement of nurse wellbeing. 

Wellbeing is not being measured in an appropriate way

Work has not yet been undertaken within the UK, or internationally, to standardise the measurement of wellbeing in nurses. In healthcare professional wellbeing research and policy there is no consensus on what wellbeing is. Burnout, in particular, is often used interchangeably with wellbeing, but like Depression and Anxiety it is now a condition listed in the International Classification of Diseases. By using Burnout measurement tools to capture wellbeing the most a nurse can achieve is an absence of ill health. The repeated measurement of the presence, or absence, of Burnout in nurses internationally has not led to successful interventions to improve their wellbeing.

An evidence-based, positive way of measuring wellbeing developed in doctors could work for nurses

Core outcome sets are increasingly being used in health research and clinical care. Core outcome sets are consensus minimum groups of outcomes, with recommended reliable and valid measurement instruments. Their use allows data between studies and organisations to be pooled, compared and successful interventions to be identified. A core outcome set for doctor wellbeing has been developed through systematic review, expert, regional and national surveys and a Delphi study by the Centre for workforce wellbeing. This work may be transferable to nurses.

Mental health nurses appear to be the group with the worst wellbeing

Registered mental health nurse posts have the highest vacancy rates in Wessex, as in all regions and are, therefore, the group patients need us to engage most. 

Research Questions

  1. Does the core outcome set developed for doctor wellbeing work represent what is important to mental health nurses?
  2. What is the relationship between the core outcome set for mental health nurse wellbeing and staffing levels?


  1. Produce a list of potential wellbeing outcomes and help text to describe them that are clear and meaningful for mental health nurses
  2. Develop a consensus with mental health nurses and their stakeholder groups on a core outcome set for their wellbeing
  3. Identify, and assess for quality, measurement instruments for any outcomes that differ from the doctor core outcome set
  4. Select measurement tools for any new outcomes
  5. Describe the relationship between the core outcome set and other staffing outcomes

Stages of the study

  1. Focus groups (invited through regional Trusts and RCN mental health forum (n=13449) and via the NIHR ‘People in Research’ facility)

To discuss the domains and 43 outcomes developed in doctors to check terminology, help text and applicability to nurses.

  1. Delphi study (invited through regional Trusts, RCN mental health forum (n=13449), Solent University Mental Health Nursing students)

To agree on a Core Outcome Set for nurse wellbeing. Using a 9-point Likert scale, participants asked to rate each outcome in the first round. The results are analysed and fed back to participants, in the second round, when they are asked to rate the outcomes again, with the aim of achieving a consensus.

  1. Critical review and quality assessment of the outcome measurement instruments

To identify available measurement tools for any outcomes that differed from those selected by doctors. To report on the properties of the outcome measurement instruments found.

  1. Selection of Outcome Measurement Instruments (experts in advisory group)

Consensus on the measurement tools to be used to measure the outcomes.

  1. Regional and national cross-sectional survey (invited through regional Trusts (n=3000) and RCN mental health forum (n=13449)

In collaboration with Prof Jane Ball the Core Outcome Set will be added to the part b cross-sectional survey, to allow the relationship between the core outcome set and other staffing outcomes to be explored.

How will the findings inform improvements?

Transferring the core outcome set development process from doctors to mental health nurses facilitates collaboration, prevention of research waste and the generation of big data. A core outcome set developed by mental health nurses for mental health nurses will provide researchers, and those undertaking governance, evidence-based, meaningful tools to evaluate wellbeing interventions with. Success would be to have a developed a core outcome set for mental health nurses that all mental health stakeholder groups are aware of and able to use.