A Mixed‐Methods Study of Nurse Managers’ Managerial and Clinical Challenges in Mental Health Centers During the COVID‐19 Pandemic

Abstract

Purpose:The worldwide outbreak of the COVID-19 pandemic has posed challenges for nurses. The aim of this study was to examine the managerial and clinical challenges of nurse managers in mental health centers during the current COVID-19 pandemic. Design: A mixed-methods study based on an analysis of data obtained in focus groups with 25 nurse managers from two mental health centers in Israel. Methods: The quantitative phase was conducted prior to the group sessions using a structured self-administered questionnaire that examined the nurse managers' (a) background data, (b) communication with the staff nurses, (c) perceptions of nurses' functioning, (d) perceptions of their own functioning, and (e) management as impacted by the pandemic. The qualitative phase included three sessions of focus groups in which the nurse managers discussed both their challenging and positive issues during the pandemic. Findings: The most important challenges were related to the need to protect patients from infection and communicating with families and primary caregivers. Work policies and procedures were less well adapted to pandemic conditions; nevertheless, nurse managers felt a sense of purpose, duty, and pride in their work. Three themes emerged: (a) "management complexity" included the change from a familiar routine to a new reality, working in capsules, protecting against infection, functional confusion, and insights into future epidemics; (b) "challenging communication" included communication with patients through glass walls and communication with staff through screens and (c) "bright spots" referred to staff cohesion and the provision of respectful care. Conclusions: Mental health nurse managers have experienced during the pandemic a change in their roles from being less managerial to focusing more on clinical work. Communication between nurse managers and staff nurses and between mental health patients and staff were the main challenges. Nurse managers favorably noted the uniformity and humanity of the staff, sense of cohesion, and shared responsibility. Clinical Relevance: In the first wave of the pandemic, there was confusion as to the functional role of ward nurse managers, as the focus of their activities became more clinical and less managerial. During and after the pandemic, preventive interventions should be carried out in order to assist patients, staff nurses, and nurse managers in mental health centers.

Practices and experiences of European frontline nurses under the shadow of COVID‐19

“…Healthcare workers learned to work in a redesigned format, were exposed to clinical challenges, acquired additional skills, and faced difficulties, all of which were accompanied by uncertainty, risk of infection, threat of morbidity, and unusual workloads (Schwarz & Bouckenooghe, 2021 ). Indeed, nurse managers in mental health centers reported on the change from a familiar routine to a new reality with family members' and volunteers' visits forbidden, and working in capsules (Kagan et al, 2021 ).…”

A cross sectional study of nurses' perceptions of nurse leaders' internal crisis communication during the COVID‐19 pandemic

“…A different image of the job, the greater physical distance from nurse leaders and general limitations placed on interpersonal communication by the pandemic may explain these lower perceptions. This explanation is supported by Kagan et al's study ( 2021 ), which revealed that nurse leaders have felt difficulties leading and communicating to and with staff through screens during the pandemic.…”

“…Nurses are at the sharp end of the pandemic, and nurse leaders have been handling uncertainty and learning from their experiences to help manage crisis events in the future (Bergeron et al, 2006 ; Catania et al, 2021 ). In studies focusing on nursing leadership in the COVID‐19 pandemic, the importance of effective communication has been widely recognized (Catania et al, 2021 ; Digby et al, 2021 ; Kagan et al, 2021 ; Lake et al, 2021 ; Lord et al, 2021 ; Simonovich et al, 2021 ). Communication is described as nurse leaders' most vital tool and core responsibility (Lake et al, 2021 ); indeed, one study found that leadership communication is the only predictor of a nurse's willingness to care during the COVID‐19 pandemic (Lord et al, 2021 ).…”

“…Constantly updated and clear information relayed through different communication channels has been important to nursing staff trying to navigate the uncertain environment which the COVID‐19 pandemic has created (Zorn et al, 2021 ). Previous research has revealed that lack of communication and constantly changing and unclear information increased the fear, anxiety, stress and distress experienced by nurses (Catania et al, 2021 ; Crowe et al, 2021 ; González‐Gil et al, 2021 ; Kagan et al, 2021 ; Lake et al, 2021 ; Ness et al, 2021 ). Lake et al ( 2021 ) found that transparent, timely and effective communication tended to decrease nurses' moral distress and improve poor mental health symptoms.…”

Factors affecting the professional functioning of health care workers during the COVID‐19 pandemic: A cross‐sectional study

“…Exposure to COVID‐19‐related stressors was reported to be associated with mental health problems and a decrease in self‐reported professional functioning among front‐line HCWs in Australia and China (Hendrickson et al, 2020 ; Kang et al, 2020 ). Among nursing managers in mental health centres in Israel, the professional functioning focus changed from managerial to more clinical roles (Kagan et al, 2021 ). However, there is still a gap in knowledge concerning the factors that affect the professional functioning of health care professionals during a pandemic.…”