The context, contribution and consequences of addressing the COVID‐19 pandemic: A qualitative exploration of executive nurses' perspectives

Abstract

Aims To explore (1) the context in which nursing executives were working, (2) nursing's contribution to the healthcare response and (3) the impact from delivering healthcare in response to the pandemic. Design Retrospective, constructivist qualitative study. Methods Individual interviews using a semi‐structured interview guide were conducted between 12 February and 29 March 2021. Participants were purposively sampled from the Victorian Metropolitan Executive Directors of Nursing and Midwifery Group, based in Melbourne, Victoria the epi‐centre of COVID‐19 in Australia during 2020. All members were invited; 14/16 executive‐level nurse leaders were participated. Individual interviews were recorded with participant consent, transcribed and analysed using thematic analysis. Results Four inter‐related themes (with sub‐themes) were identified: (1) rapid, relentless action required (preparation insufficient, extensive information and communication flow, expanded working relationships, constant change, organizational barriers removed); (2) multi‐faceted contribution (leadership activities, flexible work approach, knowledge development and dissemination, new models of care, workforce numbers); (3) unintended consequences (negative experiences, mix of emotions, difficult conditions, negative outcomes for executives and workforce) and (4) silver linings (expanded ways of working, new opportunities, strengthened clinical practice, deepened working relationships). Conclusion Responding to the COIVD‐19 health crisis required substantial effort, but historical and industrial limits on nursing practice were removed. With minimal information and constantly changing circumstances, nursing executives spearheaded change with leadership skills including a flexible approach, courageous decision‐making and taking calculated risks. Opportunities for innovative work practices were taken, with nursing leading policy development and delivery of care models in new and established healthcare settings, supporting patient and staff safety. Impact Nursing comprises the majority of the healthcare workforce, placing executive nurse leaders in a key role for healthcare responses to the COVID‐19 pandemic. Nursing's contribution was multi‐faceted, and advantages gained for nursing practice must be maintained and leveraged. Recommendations for how nursing can contribute to current and future widespread health emergencies are provided.

Reflections on nursing research focusing on the COVID‐19 pandemic

“…Nurses have been and remain at the heart of the response to the pandemic––nurses are central to preventative, curative and palliative activities associated with COVID‐19, and have taken these roles on in addition to their usual roles. Nurses of all levels and career stages have responded to and been affected by the pandemic––from students of nursing, through to academic and executive nurses (Heilferty et al, 2021 ; Ion et al, 2021 ; Riddell et al, 2022 ). Nurse researchers have also been very responsive to the pandemic.…”

“…Nurses have recognized the particular needs of people with chronic and underlying health needs during the pandemic and have modified approaches to care to ensure that patients and consumers still had access to the best possible care that could be delivered during the pandemic (Ryan & Meskell, 2022 ; Searby & Burr, 2021 ). Similarly, administrators and academic nurses have revised processes and their ways of working to be optimally responsive during the pandemic, in the constraints that were faced (Ion et al, 2021 ; Riddell et al, 2022 ).…”

“…The pandemic is not yet over and the final effects of the pandemic will not be known for several years. Despite the extent and demands of the COVID‐19 pandemic, nurses have and continue to collaborate and share information to address the challenges presented by the pandemic (Ion et al, 2021 ; Riddell et al, 2022 ), and this has resulted in the ability of nurses and nursing to effectively respond to a dynamic and rapidly changing situation. The empirical knowledge that nurses have produced and shared through the pages of the journal will help us to better respond to future public health crises.…”

Exploring the impact of the COVID‐19 environment on nursing delivery of family‐centred care in a paediatric hospital

“…Across 2020, the COVID‐19 pandemic significantly impacted the provision of usual patient care, largely due to the implementation of visitor restrictions and extensive use of personal protective equipment (PPE) (Riddell et al, 2022 ). For nurses in paediatric centres, this was particularly challenging.…”

“…In Australia, the first year of the COVID‐19 pandemic resulted in far fewer hospitalizations and deaths than in Europe and the USA, partly due to early strict lockdown and quarantine measures to slow the spread of COVID‐19 (Kontis et al, 2020 ). In March 2020, the Australian government enforced social distancing and isolation measures with further restrictions following a second wave in the state of Victoria in June 2020 (Riddell et al, 2022 ). In line with this, hospitals in Victoria, including the study site, introduced a variety of new visitor policies.…”