From the Frontlines: A Qualitative Descriptive Study of Critical Care Nursing During the COVID-19 Pandemic

Abstract

Purpose: The purpose of this study was to describe the impact of the COVID-19 pandemic on nursing care delivery in the critical care work system in the United States (US). Background: The COVID-19 pandemic caused unprecedented admissions to critical care. There is little research evidence describing the impact of the COVID-19 pandemic on critical care work systems in the US. This is important to understand because nursing care delivery impacts patient and nurse outcomes. Knowledge from this study will create a foundation upon which critical care work systems can be redesigned to better meet needs of patients and nurses who work in them. Methods: Twenty critical care nurses with at least two years’ experience in critical care who worked for at least six months during the COVID-19 pandemic were purposively recruited online and interviewed for this qualitative description study. The study was guided by the Systems Engineering Initiative for Patient Safety Model (SEIPS) 2.0 model, which describes the relationships between healthcare work systems, processes, and outcomes. Interview transcripts were analyzed using a combined deductive and inductive content analysis approach. Results: The over-arching theme was adaptation. Critical care nurses described all areas of the work system adapting; however, responsibility of adaptation rested primarily on nurses. Deductive categories were organized by each of the concepts of the SEIPS 2.0 model and describe the critical care work system during COVID-19, the processes of nursing care delivery, and outcomes. Deductive adaptation category revealed three inductive themes: patient care, creativity, and (nurse) coping. Inductive results reveal a description of the COVID-19 wave progression, fear, lack of trust in the organization, super nurse culture, and external environment outcomes. Implications: Critical care nurses took on the majority of adaptation in the critical care work system to avoid impacts on patient outcomes. This impacted their well-being, and as a result, critical care nurses need immediate and ongoing support from organizations. These findings have implications for organizations to share the responsibility of adapting the critical care work system with critical care nurses. Critical care work system redesign is needed to avoid negative impacts on nurses’ well-being, patient outcomes, and organizational outcomes.