Leading In Crisis: Lived Experiences of Head Nurses to Covid–19 Pandemic Challenges in Covid-19 Tertiary Referral Hospitals

This qualitative study explores the lived experiences of head nurses during the COVID-19 pandemic in tertiary referral hospitals in Iloilo City. Guided by Roy’s Adaptation Model of Nursing, Crisis Leadership Theory, and Situational Leadership Theory, it highlights the challenges faced, leadership styles employed, and the impact of the crisis on nurse leaders' roles. Participants navigated severe resource shortages, staffing gaps, emotional strain, and rapidly evolving protocols. Their leadership styles ranged from autocratic to empathetic and transformational, reflecting adaptability and resilience. The study employed a descriptive phenomenological approach using Colaizzi’s method and thematic analysis. Data were gathered through semi-structured interviews with six purposively selected head nurses—two each from Western Visayas Medical Center, West Visayas State University Hospital, and Iloilo Doctors Hospital. Participants had at least one year of experience in COVID-specific or emergency units and were currently employed. This study upholds ethical standards, ensuring informed consent and participant confidentiality. Conducted from February to August 2024, the research provides localized insights, which may not be generalizable to other settings. The findings underscore the importance of emotional intelligence, crisis preparedness, and leadership flexibility in managing public health emergencies. This research offers insights for policy-makers, hospital administrators, and nursing educators in strengthening leadership capacity and supporting nurse leaders in future crises.

hospital administrators, and nursing educators in strengthening leadership capacity and supporting

1. AJMC. (2021, April 24). A timeline of COVID-19 developments in 2020. AJMC. https://www.ajmc.com/view/a-timeline-of-covid19-developments-in-2020 [Google Scholar] [Crossref]

2. Ali, H., Cole, A., Ahmed, A., Hamasha, S., & Panos, G. (2020). Major Stressors and Coping Strategies of Frontline Nursing Staff During the Outbreak of Coronavirus Disease 2020 (COVID-19) in Alabama. Journal of Multidisciplinary Healthcare, Volume 13, 2057– 2068. [Google Scholar] [Crossref]

3. Amin, K., & Cox, C. (2021, June 9). COVID-19 pandemic-related excess mortality and potential years of life lost in the U.S. and peer countries. Peterson-KFF Health System Tracker. [Google Scholar] [Crossref]

4. Arnetz, J. E., Goetz, C. M., Arnetz, B. B., & Arble, E. (2020). Nurse reports of stressful situations during the COVID-19 pandemic: Qualitative analysis of survey responses. International Journal of Environmental Research and Public Health, 17(21), 8126. https://doi.org/10.3390/ijerph17218126 [Google Scholar] [Crossref]

5. Ballotpedia. (n.d.). Documenting New York’s path to recovery from the coronavirus (COVID19) pandemic, 2020–2021. [Google Scholar] [Crossref]

6. Barclay, E., & Scott, D. (2020). The huge surge in Covid-19 hospitalizations, in one chart. 2020-2021. [Google Scholar] [Crossref]

7. Bookey-Bassett, S., Purdy, N., & van Deursen, A. (2020). Safeguarding and inspiring: In-patient nurse managers' dual roles during COVID-19. Nursing Leadership (Toronto, Ont.), 33(4), 20–28. https://doi.org/10.12927/cjnl.2021.26424 [Google Scholar] [Crossref]

8. Cadge, W. et al (2021). Intensive care unit nurses living through COVID‐19: A qualitative study. Journal of Nursing Management, 29(7), 1965–1973. [Google Scholar] [Crossref]

9. Cedars, S. (2021). Hundreds of nurses reassigned to meet COVID-19 needs. [Google Scholar] [Crossref]

10. Centers for Disease Control and Prevention (CDC). (2020). Use Personal Protective Equipment (PPE) When Caring for Patients with Confirmed or Suspected COVID-19. [Google Scholar] [Crossref]

11. Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. (2021). COVID-19 map. Johns Hopkins Coronavirus Resource Center. [Google Scholar] [Crossref]

12. Del Vecchio, L., & Locatelli, F. (2020). Hypoxia response and acute lung and kidney injury: possible implications for therapy of COVID-19. Clinical Kidney Journal, 13(4), 494– 499. [Google Scholar] [Crossref]

13. Department of Health and Public Services. (2020). Hospital experiences responding to the COVID-19 pandemic: Results of a National Pulse Survey March 23– 27, 2020. [Google Scholar] [Crossref]

14. Di Tella, M., Romeo, A., & Benfante, A. (2020). Mental health of healthcare workers during the COVID-19 pandemic in Italy. Wiley Online Library. [Google Scholar] [Crossref]

15. Firew, T. et al (2020). Protecting the front line: a cross-sectional survey analysis of the occupational factors contributing to healthcare workers’ infection and psychological distress during the COVID-19 pandemic in the USA. BMJ Open, 10(10). [Google Scholar] [Crossref]

16. Garcia, A. et al (2021). Parenting stress, self-efficacy, and COVID-19 health risks as predictors of general stress among nurses. Wiley Online Library. [Google Scholar] [Crossref]

17. Hofmeyer A, Taylor R, Kennedy K. Knowledge for nurses to better care for themselves so they can better care for others during the Covid-19 pandemic and beyond. Nurse Educ Today. 2020 Nov; 94:104503. doi: 10.1016/j.nedt.2020.104503. Epub 2020 Jun 15. PMID: 32980179; PMCID: PMC7295457. [Google Scholar] [Crossref]

18. Magbee, T., & Yoder, L. H. (2021). The experiences of critical care nurses caring for patients with COVID-19 during the 2020 pandemic: A qualitative study. Applied Nursing Research, 59. [Google Scholar] [Crossref]

19. Gray, K., Dorney, P., Hoffman, L., & Crawford, A. (2021). Nurses’ pandemic lives: A mixed-methods study of experiences during COVID-19. Science Direct. [Google Scholar] [Crossref]

20. Hammen, C., Kim, E. Y., Eberhart, N. K., & Brennan, P. A. (2009). Chronic and acute stress and the prediction of major depression in women. Depression and anxiety, 26(8), 718– 723. [Google Scholar] [Crossref]

21. Hernandez, J. et al. (2021). Traumatic stress among frontline American nurses during the COVID-19 pandemic: A survey study. Traumatology. Published. [Google Scholar] [Crossref]

22. Iheduru-Anderson, K. (2021). Reflections on the lived experience of working with limited personal protective equipment during the COVID-crisis. Wiley Online Library. [Google Scholar] [Crossref]

23. Maben, J., & Bridges, J. (2020). Covid-19: Supporting nurses' psychological and mental health. Journal of Clinical Nursing, 29(15-16), 2742-2750. [Google Scholar] [Crossref]

24. Mental Health America. (2020). The mental health of healthcare workers in COVID-19. [Google Scholar] [Crossref]

25. Mental Health Foundation. (2020). The impact of traumatic events on mental health. [Google Scholar] [Crossref]

26. Minissian, M., et al (2021). Multispecialty nursing during COVID-19: Lessons learned in southern California. Elsevier Reader. [Google Scholar] [Crossref]

27. Mo, Y., et al (2020). Work stress among Chinese nurses to support Wuhan in fighting against COVID‐19 epidemic. Journal of Nursing Management, 28(5), 1002–1009. [Google Scholar] [Crossref]

28. Moore, K. S., Hemmer, C. R., Taylor, J. M., & Malcom, A. R. (2021). Nursing professionals' stress level during coronavirus disease 2019: A looming workforce issue. The Journal for Nurse Practitioners: JNP, 17(6), 702–706. [Google Scholar] [Crossref]

29. NCSBN. (2020). NRB exceptions for inactive and retired licenses in relation to COVID-19. [Google Scholar] [Crossref]

30. Northouse, P. G. (2021). Leadership: Theory and Practice (8th ed.). Sage Publications. [Google Scholar] [Crossref]

31. Ousman K. Cultural humility: A concept analysis. Journal of Transcultural Nursing. 2016;27(3):210–217. [Google Scholar] [Crossref]

32. Raso, R., Fitzpatrick, J., Masick, K. Nurses' Intent to Leave their Position and the Profession During the COVID-19 Pandemic. JONA: The Journal of Nursing Administration 51(10):p 488-494, October 2021. | DOI: 10.1097/NNA.0000000000001052 [Google Scholar] [Crossref]

33. Sagherian, K. et al (2020). Insomnia, fatigue, and psychosocial well‐being during COVID‐19 pandemic: A cross‐sectional survey of hospital nursing staff in the United States. Journal of Clinical Nursing. Published. [Google Scholar] [Crossref]

34. Sharma, M., et al. (2020). Healthcare Professionals’ Perceptions of Critical Care [Google Scholar] [Crossref]

35. Resource Availability and Factors Associated with Mental Well-being During Coronavirus Disease 2019 (COVID-19): Results from a US Survey. Clinical Infectious Diseases, 72(10), e566–e576. [Google Scholar] [Crossref]

36. Sherman, R. O., Bishop, M., & Eggenberger, T. (2007). Development of a leadership competency model. Journal of Nursing Administration, 37(2), 85-94. [Google Scholar] [Crossref]

37. U.S Department of Health and Human Services, National Center for Health Workforce Analysis, & Health Resources and Services Administration. (2019). National Center for Health Workforce Analysis 2018. U.S Department of Health and Human Services. Retrieved November 14, 2021. [Google Scholar] [Crossref]

38. Zheng, J. (2020). SARS-CoV-2: an Emerging Coronavirus that Causes a Global Threat. International Journal of Biological Sciences, 16(10), 1678–1685. [Google Scholar] [Crossref]

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