From protection of sacrificial self to critical turning points and growth: Redeployed nurses’ experiences on the frontline during the COVID-19 pandemic

Sinéad Creedon; Anna Trace

doi:10.1371/journal.pone.0314830

Peer Review History

Original SubmissionDecember 10, 2024
24 Apr 2025 Decision Letter - Moustaq Karim Khan Rony, Editor Dear Dr. Creedon, Please submit your revised manuscript by Jun 08 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. 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Direct, non-author contact information (preferably email) for the body imposing the restrictions upon the data, to which data access requests can be sent Additional Editor Comments: The reviewers suggested several revisions to improve the manuscript. Reviewer 1 recommended emphasizing the redeployment context more clearly in the title, abstract, and aim, and suggested that the introduction, while thorough, should be shortened and better organized. Minor wording and formatting issues were also noted, including the logical flow of certain paragraphs (e.g., Lines 112–116), the use of conjunctions, the ordering of references, and inconsistencies in reporting participant characteristics. Reviewer 2 emphasized the need to rewrite the introduction to clearly present the study's purpose, define key variables, and ensure coherence. Additional feedback included clarifying data collection details (e.g., interview timing), improving comparisons with existing literature—especially regarding themes like self-sacrifice and resilience—avoiding citations in the conclusion, simplifying the presentation of key findings, and including actionable recommendations for managers, policymakers, and future research. We kindly ask that you revise the manuscript accordingly, ensuring that all points are addressed to enhance clarity, structure, and scholarly contribution. Please see the detailed comments below. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: N/A Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: Thank you for the opportunity to review this paper. It was thorough and well-written overall. There is some new information in that the focus was nurses who were redeployed and it is set in Ireland. I think the fact that the participants were all redeployed should have been emphasized in the title, abstract and Aim. The introduction was very thorough but also very long. Some specific suggestions include: Line 69: "most exposed" Are you referring to most exposed to changes? Line 83/84: I wouldn't assume that the nurses who were not redeployed "got to carry [on] as normal" Line 101: "and" instead of & Some paragraphs would benefit from a more logical flow/organization. One example is lines 112-116. The two sentences are very different and it isn't clear why they are together. The references also seem out of order (18, 20, 21, 19, 22). Line 133. Is this meant to be two sentences (ie. a period instead of a comma)? Participant Characteristics: There is a high proportion of clinical nurse managers/educators. Is this typical for the nurses who were deployed? Line 235 refers to ages 21-65 but this doesn't match the ranges reported in the Table. The methods were described and the data transparency/analysis is sufficient and reader-friendly. The quotes and presentation of the results were engaging and easy to follow. Reviewer #2: Thank you for the opportunity to review this manuscript. Introduction -The introduction needs a major rewrite. I didn't understand your work. Please explain the need for your work. -There is no need to state the introduction in separate items.Please state it coherently.Also define the main variables of the study.Summarize the introduction. It's too long. Data Collection Gaps: Unclear interview duration and timeframe (e.g., pandemic wave timing). The findings of your study do not compare well with other studies. Please compare the discussion of self-sacrifice and resilience with your study. -There is no need to cite the source in the conclusion section. -In the conclusion, please state the main results in simple sentences. Please also provide suggestions for managers, policies, and future studies. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0314830.r001
Revision 1
7 Jun 2025 Author Response 07/06/2025 Dear Editors, Sincere thanks for your feedback on my manuscript. I was happy to revise the major changes, and I have included the following with this re-submission: • A marked-up copy of my manuscript entitled 'Revised Manuscript with Track Changes' highlighting the changes made to the original version. • An unmarked version of my revised paper without tracked changes. You should upload this as a separate file labelled 'Manuscript'. • A pdf copy of this response to editors and reviewers. In relation to the manuscript edits, please see my responses below: 1. I have reviewed my manuscript again to meet PLOS ONE's style requirements, including those for file naming. I hope that everything is now in order but if I have missed something specifically, please let me know. 2. We have indicated that there are indeed restrictions to data sharing for this study. To that end, we respectfully request to make our data sets available upon request. a. De-identified extracts from qualitative transcripts are available only upon request as the participants consented to “extracts” from their interviews being quoted in the thesis, and in any subsequent publications, and not the full transcripts. Raw format (verbatim transcripts) contains both potentially identifying and sensitive participant information (e.g., detailed discussions, mental health challenges, potentially identifiable patient details, and participant geographical locations). Hence, there is a risk that sharing publicly would compromise participant anonymity and confidentiality. Data requests should be fielded to the School of Applied Psychology Research Ethics Committee (APREC), at University College Cork, at ethics.ap@ucc.ie. The Data Availability statement has been updated accordingly in the submission form. 3. Please accept my apologies, I indicated that I would make my data available on acceptance; this was an error and oversight on my part. This is my first publication (apart from a review protocol) as a novice researcher and I am still navigating terminology and etiquette in relation to open access and data sharing. As per details outlined in section 2 and subsection a above, I now understand fully that PLOS One policy applies to all data except where public sharing would breach compliance with the protocol approved by my research ethics board. I have revised my statement to explain my reasoning and hope that the editor's input on an exemption will be permitted, to allow de-identified extracts from the qualitative transcripts be made available only on request. 4. Thank you for this. I have now updated my supplementary figure upload from file type 'Figure' to file type 'Supporting Information'. I have also re-checked that each Supporting Information file has a legend listed in the manuscript after the references list. 5. I have noted and agree with the deletion of Supporting Information file < S1 Table Participant characteristics.docx>. 6. As per section 2a above, participants only consented to “extracts” from their interviews being quoted in a thesis, and in any subsequent publications. We will therefore make our data sets available upon request. We will provide a de-identified version of the data or excerpts of interview responses, and we will also provide information regarding how this data can be accessed. a) the grounds for restriction - Participants only consented to “extracts” from their interviews being quoted in a thesis, and in any subsequent publications. Furthermore, there is highly sensitive information on both participants and patients, in the participant transcripts. b) the name of the ethics committee, Institutional Review Board, or third-party organization that is imposing sharing restrictions on the data - Data requests should be fielded to the School of Applied Psychology Research Ethics Committee (APREC), at University College Cork, at ethics.ap@ucc.ie. d) Any relevant data set names, URLs, DOIs, etc. that an independent researcher would need in order to request your minimal data set – the doi link is also provided. Response to Additional Editor Comments: Thank you for highlighting your overall recommended revisions to improve our manuscript. We have responded to each point below. Reviewer 1: We have emphasizing the redeployment context more clearly in the title, abstract, and aim. We have also shortened the introduction significantly and better organised the content and points. We have reviewed the manuscript for minor wording and formatting issues, including the use of conjunctions and improved upon the flow of paragraphs. The order of references had to be edited significantly due to re-writing most of the introduction to reduce word count and make it easier to read. Participant table has been removed and I can confirm that the participant characteristics are correct. Reviewer 2: The introduction was completely re-written. In doing so, we more clearly presented the purpose of the study, and defined more clearly the key variables to ensure more coherence. We have further clarified data collection details and made significant improvements to improve our comparisons with the existing literature. We did focus specifically on self-sacrifice and resilience. The citation was removed from the conclusion and was an oversight on my part. The presentation of key findings have been presented in a simpler format and hopefully this improves the readers experience. We have added in actionable recommendation for managers, policymakers and future researchers. Author Responses to Reviewers: Response to Reviewer #1: Thank you sincerely for your detailed review of our paper. There is some new information in that the focus was nurses who were redeployed and it is set in Ireland. I think the fact that the participants were all redeployed should have been emphasized in the title, abstract and Aim - We have emphasizing the redeployment context more clearly in the title, abstract, and aim, and hope that this enhances our study. The introduction was very thorough but also very long - we have shortened the introduction significantly and better organised the content and points. Some specific suggestions include: Line 69: "most exposed" Are you referring to most exposed to changes? – further clarification has been provided here. Line 83/84: I wouldn't assume that the nurses who were not redeployed "got to carry [on] as normal" – we have re-phrased this for further clarification and context. Line 101: "and" instead of & - corrected thank you. Some paragraphs would benefit from a more logical flow/organization. One example is lines 112-116. The two sentences are very different and it isn't clear why they are together. – further clarification has been given here and throughout the manuscript. We hope this has improved the flow significantly. The references also seem out of order (18, 20, 21, 19, 22) –The references had to be completely re-ordered due to re-writing the introduction and we have both given them a final check before re-submission. (Your reference to 18, 20, 21, 19, 22 above may just have been that a historical reference was subsequently referenced more than once in the manuscript). Line 133. Is this meant to be two sentences (ie. a period instead of a comma)? – this has now been corrected. Participant Characteristics: There is a high proportion of clinical nurse managers/educators. Is this typical for the nurses who were deployed? – In fact it was quite typical to have clinical nurse specialists / managers redeployed so as not to deplete the headcount of staff nurses from the main wards. These nurse managers and nurse specialists (e.g., cardiac, renal, neurosurgical, diabetes nurse specialists etc.) were redeployed from their specialist areas to work on the frontline while their specialist areas were effectively shut down during lockdown. I hope this answers your query. Line 235 refers to ages 21-65 but this doesn't match the ranges reported in the Table – this has now been corrected. The methods were described and the data transparency/analysis is sufficient and reader-friendly – noted thank you. The quotes and presentation of the results were engaging and easy to follow – noted thank you. Response to Reviewer #2: Thank you very much for taking the time to review our paper. The introduction needs a major rewrite. I didn't understand your work. Please explain the need for your work - On reading the introduction again, taking into consideration your recommendations, we both agree that the introduction needed to be re-written and shortened. There is no need to state the introduction in separate items. Please state it coherently. Also define the main variables of the study. Summarize the introduction. It's too long. – we have removed the separate introduction sub-headings and stated the main points more clearly and coherently. We have re-defined the main variables and summarised the introduction by re-writing and shortening it. Data Collection Gaps: Unclear interview duration and timeframe (e.g., pandemic wave timing). – we have now provided dates for data collection and included timeframes for interview duration, and also included which wave applied, to give further context. The findings of your study do not compare well with other studies. Please compare the discussion of self-sacrifice and resilience with your study – we have made significant enhancements to improve our comparisons with the existing literature. We did focus specifically on self-sacrifice and resilience. There is no need to cite the source in the conclusion section – noted and corrected thank you. In the conclusion, please state the main results in simple sentences – this has now been addressed by re-writing the conclusion section to read more clearly. Please also provide suggestions for managers, policies, and future studies – this has also been added in, thank you. I hope I have fulfilled all of the requirements for re-submission but in the event I have omitted something or not clarified anything fully, please let me know so that I can address expediently. I look forward to hearing from you. With Best wishes, Sinéad Attachments Attachment Submitted filename: Response to Reviewers.pdf https://doi.org/10.1371/journal.pone.0314830.r002
11 Jul 2025 Decision Letter - Moustaq Karim Khan Rony, Editor From protection of sacrificial self to critical turning points and growth: Redeployed nurses’ experiences on the frontline during the COVID-19 pandemic. PONE-D-24-52634R1 Dear Dr. Creedon, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Moustaq Karim Khan Rony, RN, MSS, MPH Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: (No Response) ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: (No Response) ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: (No Response) ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: (No Response) ****** Reviewer #1: Thank you for your thoughtful response to my initial feedback. The manuscript is much clearer and reader-friendly. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: No ******** https://doi.org/10.1371/journal.pone.0314830.r003
Formally Accepted
Acceptance Letter - Moustaq Karim Khan Rony, Editor PONE-D-24-52634R1 PLOS ONE Dear Dr. Creedon, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Mr. Moustaq Karim Khan Rony Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0314830.r004

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