Registered nurses' experiences of working in the intensive care unit during the COVID‐19 pandemic

Abstract

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.

Stress of conscience of COVID-19 among perianaesthesia nurses having worked in a COVID-ICU during the coronavirus pandemic: an international perspective

“…This balancing act between work and personal life can threaten nurses’ health, leading to emotional exhaustion [ 22 ]. That this aspect of conscience was experienced as most stressful is not surprising, and can be an explanation to earlier studies reporting that working in a COVID-ICU has a high impact on the mental well-being of nurses [ 13 – 19 ]. Another aspect of sense of conscience “forced to provide care that felt wrong in the Covid-ICU” was highly rated and aligns with other research such as the Sugg et al [ 4 ] study about missed care among “COVID-nurses.” They found that the “COVID-nurses” struggled to support patients’ emotional wellbeing and mental health, and felt that they were unable to provide usual levels of support, reassurance, and interaction with patients.…”

“…It is important to analyze if there are any differences in how the nurses experienced their care encounters and stress of conscience when working in a COVID-ICU compared to their usual workplace. Colleagues working in a COVID-ICU have reported that they could not provide all of the care that they should have, i.e., missed care, and expressed alarm over the frequency of occurrence [ 13 ]. Therefore, due to the higher acuity of care, we included the item “Every hour”.…”

“…Several studies have reported that working in a COVID-ICU highly impacts mental well-being [ 13 – 19 ] and experiences of moral conflicts [ 20 ]. Yet, little is known about how perianaesthesia nurses who have been working in a COVID-ICU perceived their conscience.…”

“…Further, does the nurse’s stress of conscience differ if their usual workplace is a designated ICU, or not, because the environment and most care delivery equipment is the same in a COVID-ICU. It has been reported that non-specialized intensive care nurses feel poorly trained and prepared for working in a COVID-ICU treating severely ill patients[ 13 ].…”

Critical care staffing ratio and outcome of COVID-19 patients requiring intensive care unit admission during the first pandemic wave: a retrospective analysis across Switzerland from the RISC-19-ICU observational cohort

“…Our study is to the best of our knowledge among the rst to evaluate the impact of critical care sta ng on the outcomes of critically ill patients during a pandemic. There have been reports highlighting the importance of the nurse-to-patient ratio on the quality of critical care [37][38][39], but most, if not all of them, had been performed outside pandemic conditions [6,27,40]. Usually, studies compared patient outcomes across ICU centres that are run with different sta ng ratio [41,42].…”