Background During the pandemic, increased numbers of patients requiring intensive care unit (ICU) admission required an increase in ICU capacity, including ICU staffing with competence to care for critically ill patients. Consequently, nurses from acute care areas were called in to staff the ICU along with experienced intensive care nurses. Aims and objectives To describe Swedish registered nurses' experiences of caring for patients with COVID‐19 in ICUs during the pandemic. Design Mixed method survey design. Methods An online questionnaire was distributed through social media to registered nurses who had been working in the ICU during the COVID‐19 outbreak. Data were collected for 1 week (May 2020) and analysed using content analysis and descriptive statistics. Results Of the 282 nurses who participated, the majority were ICU nurses (n = 151; 54%). Half of the nurses specialized in ICU reported that they were responsible for the ICU care of three or more patients during the pandemic (n = 75; 50%). Among non‐intensive care nurses, only 19% received introduction to the COVID‐19 ICU (n = 26). The analysis of data regarding nurses' experiences resulted in three categories: tumbling into chaos , diminished nursing care , and transition into pandemic ICU care . Participants described how patient safety and care quality were compromised, and that nursing care was severely deprioritized during the pandemic. The situation of not being able to provide nursing care resulted in ethical stress. Furthermore, an increased workload and worsened work environment affected nurses' health and well‐being. Conclusions The findings from the present study indicate that nurses perceived that patient safety and quality of care were compromised during the pandemic. This resulted in ethical stress among nurses, which may have affected their physical and psychosocial well‐being. Relevance to clinical practice The COVID‐19 pandemic had a severe impact on nurses' work environment, which could result in burnout and staff turnover.

Aim To evaluate frequencies, types of, and reasons for missed nursing care during the COVID‐19 pandemic at inpatient wards in a highly specialized university hospital. Background Registered nurse/patient ratio and nursing competence is known to affect patient outcomes. The first wave of the COVID‐19 pandemic entailed novel ways for staffing to meet the expected increased acute care demand, which potentially could impact on quality of care. Methods A comparative cross‐sectional study was conducted, using the MISSCARE Survey . A sample of nursing staff during the first wave of the COVID‐19 pandemic (n=130) was compared with a reference sample (n=157). Results Few differences between samples concerning elements of missed care, and no significant differences concerning reasons for missed care were found. Most participants perceived the quality of care and the patient safety to be good. Conclusion The results may be explained by three factors: maintained registered nurse/patient ratio, patients’ dependency levels and that nursing managers could maintain the staffing needs with a sufficient skill mix. Implications for nursing management Nursing managers impact on the occurrence of MNC; to provide a sufficient registered nurse/patient ratio and skill mix when staffing. They play an important role in anticipatory planning, and during infectious diseases outbreaks.

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At the end of 2019, a novel coronavirus resulted in an outbreak of coronavirus disease 2019 (COVID-19), which started in Wuhan, China. In March 2020, the World Health Organization (WHO) characterized COVID-19 as a pandemic (World Health Organization, 2020), and in line with other European countries, several regions in Sweden needed to expand their capacity for treating patients suffering from COVID-19.The literature indicates that nurse staffing has a large impact on whether the required nursing care can be delivered (Griffiths et al., 2018). Missed nursing care (MNC) is defined as any aspect of required patient care that is omitted (in part or in whole) or delayed (Kalisch et al., 2009). Moreover, MNC is associated with negative patient outcomes and is a threat to the quality of care and patient safety (Ball et al., 2014;Schubert et al., 2012).In the disease outbreak in spring 2019, the patients with SARS-Cov-2 were a new patient group for the entire staff. To deliver care for a completely new group of patients challenged the healthcare professionals in their work with patient safety and quality of care.

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