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Table 3 Themes and Sub-themes with Example Quotes

From: Canadian critical care nurses experiences on the front lines of the COVID-19 pandemic: a qualitative descriptive study

Theme

Sub-Theme

Example Quotes

Team Work

 

“Most of our staff keep showing up and volunteering to fill holes in the schedule. The efforts of our staff have made all the difference in the world.”

“Senior nurses have supported me fully and I have gained great insight and experience”

"It is the teamwork, it is the colleagues, and it is the work relationships that have been so incredibly stable during this time. I have learned new coping skills and strengths that I didn't even know I had. This pandemic has forced me to become a stronger and better RN.”

Resource Shortages

Material Resource Shortages

“I am still having trouble obtaining adequate N95 supply. I am forced to use/re-use the same mask for the whole 12 h shift in the ICU.”

“Ensure adequate oxygen supply at all hospitals to support surge of covid patients—Should have been recognized earlier”

Staff Shortages

“Our covid unit was understaffed, patients suffered tremendously because of this. If anything was traumatic, it was the poor care that was given due to lack of staff, untrained staff and educators, as well as absent intervention by our management team to improve conditions for isolated patients.”

“The current situation makes me feel unprepared to care for my patients in the ICU. We often have 2–3 patients per ICU nurse with non ICU staff assisting. This becomes a problem try to manage very acute patients with multiple infusions, and provide even basic care like line changes and prone positioning”

Staff Redeployment

“It was good to see how fast the nursing community came together to help further outbreaks by having nurses come out of retirement and management roles to help. Great job to all redeployed staff.”

“I am stretched to the limit working with inexperienced poorly trained "extenders" and exhausted experienced nurses who are asked to support them”

“Altering the scope of nurses to staff units is also difficult as you are dependent on experienced staff to train the new staff and this is not a great environment for teaching/learning”

Organizational and Government Preparedness & Policy

Organizational level

“I have worked through the aids crisis SARS MERS H1N1 and now this. From my experience very little was learned in the previous crisis situations. We are again flying by the seat of our pants, the expectations for front line staff are unclear, and even when they are clear no one in management takes responsibility to ensure the expectations are met.”

“The illness and deaths are one thing but there is so much more suffering being created not only by the disease but by policies and planning that seems misguided or ineffective.”

“More policy to guide decision making. Currently we are told rules and it’s up to staff to determine how they wish to implement the rules, and there is nothing in place to guide decisions.”

“From an organizational perspective, we were given the appropriate PPE and received training on respirator usage. I felt supported by the organization I was working with. I was also able to receive my vaccine very quickly through my organization.”

Government Level

“Federal and Provincial governments, along with local hospitals need to develop a coordinated plan should this happen again. Everything from PPE stockpiling and distribution to informing visitation policies in hospital. Most of the time it felt like nurses on the ground were left making up rules as we went along because there was no effective leadership from anyone.”

“Our province was woefully under prepared for this pandemic, despite having time & warning to prepare. It has highlighted how severely short staffed the nursing profession is as a whole, and it has put many practitioners in unsafe situations regarding their practice

“The Federal government failed in closing the borders soon enough to travelers…”

“The provincial government has often failed to be consistent, trying to save lives and the economy simultaneously.”

Leadership & Communication

Leadership

“The expectations for front line staff are unclear, and even when they are clear no one in management takes responsibility to ensure the expectations are met.”

"The entire thing has felt like we (bedside nurses) were left alone to figure out how to care for people and how to protect ourselves. Very little effective leadership came from my institution or the government. Policies changed constantly but no effort was made to ensure the latest changes were known by people on the ground."

“My organization has great leadership, centralization of supplies including PPE, cohorting Covid patients, frequently updating us and answering questions in a weekly town hall.”

Communication

“When directives are being changed almost daily, it leads to lack of trust in the system. Recognizing that knowledge on a virus changes frequently and protocols are adapted to meet the growing body of knowledge, it must equally be recognized that making frequent changes can be unsettling to bedside staff and develop a sense of dishonesty and lack of trust.”

“Better communication about policies and procedures. I work mostly night shifts and there are no members of the leadership team available to inform decision making when new situations arise”

“Our unit managers were honest with us every step along the way, recognizing errors that were made and good decisions that were taken. Every week, they told us what the plan was for the following week”

“Consistency of direction from Public health and Government. Avoid confusing messaging. Would have been nice if provincially and federally there was consistency. Should not be Political.”

Impact on Staff

Burnout

“This has been the most stressful year of my professional practice. I've been constantly inundated with all things COVID. There has been nowhere for me to escape it- personally and professionally. This has led to a significant amount of burnout- not only for me personally but for many of my coworkers as well.”

Moral Distress

“In 30 years, I have never had this amount of moral distress caused by lack of insight by our management team. The daily suffering is not as distressing as the lack of intervention and support for our patients who are suffering because they can't get a bath or assistance with their meals”

Personal Safety and Impact on Family

“This is been personally a hard on. I have been an ICU nurse for 3 years. I worked the entire wave 1 + 2. At the begin[ning] of wave 3 I became pregnant. So navigating safety for me and my baby has been hard.”

Impact of Public Opinion

“It is exhausting to continuously see and hear members of the public saying that masks don't work and restrictions don't work and that the pandemic is a hoax when every shift we see physical evidence of the reverse of all those statements

“The apathy of the public towards the severity of the health risks and the need for precautions is shocking. …. The public really doesn't seem to understand or care and it has lead me to not want to be a nurse anymore.”

Professionalism & Work Ethic

“I am devastated by the lack of compassion and work ethic in the young nurses coming into our professional.”

“Not all of us are on the same page. Our allied health staff are not supporting nurses at all, shy away from work and nurses ending up doing everyone’s job”

Staff Wellness Resources

“There isn’t appropriate supports in place for staff wellness as this pandemic rages on…the [current] wellness program [was] created [with] strategies that they thought would benefit people without asking us what we need”

“I am tired of this lock down emotionally and physically tired. We need more emotional support for the workers inside hospitals that have had to watch people die every day from something could have been prevented.”

Staff Appreciation

"Listen to front line staff because we can actually explain what is happening and what we need."

"The recognition that a nurse is not a nurse. They are specialists in their roles."

“I would like pandemic pay to be carried through the entire pandemic for health care staff. It is a small way of [showing] appreciation.”