Resource Utilization in a Post-pandemic World

Extracorporeal Membrane Oxygenation is a resource intensive therapy;heavily reliant upon specialized equipment, unique disposables, and skilled staff. The Covid-19 pandemic and following events exposed flaws in multiple phases of the care delivery system. The combination of high patient census, acuity, manufacturing delays, and supply chain disruptions led to our center's reassessment of the way in which limited resources are utilized. As a combined pediatric and adult center, we possess the ability to share resources amongst all patient populations. Currently, the majority of our equipment and disposables support a heavier use of Centrimag. We adjusted our general weight guidelines in order to best serve the most patients. (<8kg Sorin Rollerhead, 8-20kg Sorin Revolution, >20kg Centrimag.) Presently, a major challenge is the cessation of production of the -inch Better Bladder. The ECMO Coordinator team collaborated with key physician stakeholders. It was decided that the fluid reservoir and air trap benefits of a bladder outweighed the risks of running without one on our Sorin Rollerhead circuit. We designed a circuit with a 3/8 Bigger Better Bladder. Recognizing the increased risk of clotting with the 3/8 segment, we added a post-oxygenator shunt. This allows for adequate blood flow to maintain circuit integrity, while limiting the amount of flow to the patient. The nationwide nursing shortage is well-known. Though our multidisciplinary ECMO Specialist Team supports nursing and respiratory therapy, the nursing shortage still impacts our staffing models, resulting in the inability to safely staff bedside nurses and ECMO specialists. At times of high census, ECMO patients are cohorted into one geographical location. This allows for a temporary 2:1 staffing model for Centrimag patients. Our goal remains to staff pediatric cases as a 1:1 ECMO Specialist assignment. The ability to obtain this is assessed shift to shift;factoring patient stability, experience of the ECMO specialist, and unit staffing. The collaboration with ICU Nurse Managers, Hospital Supervisors and Central Staffing Office is imperative to the success of staffing model alterations. Our ECMO department has increased its FTEs, implementing a core team to be preassigned to two ECMO beds. The objective is to alleviate the burden on ICU staffing, limiting the number of nurses pulled from staffing grids. In uncertain times, flexibility is vital. It is important to remain vigilant and proactive. Our ECMO program feels that continuous assessment of supplies, equipment, and open communication has been the key to successfully serving our patients.

The Impact of the Early COVID-19 Pandemic on Registered Nurses' Intent to Stay in Nursing.

The COVID-19 pandemic has been difficult for registered nurses. Media reports, most of them anecdotal, have reported upticks in nurse resignations, and plans to resign and/or leave nursing due to COVID-19. This article reports findings from an online anonymous 95-item survey completed by about 1,600 nurses from a New York City metropolitan area health system's (HS) four hospitals and ambulatory care centers about their COVID-19 experience in the spring of 2020, their intent to stay at the HS, and their intent to stay working as a nurse. Conducted early in the pandemic, this survey addresses a major gap in the literature, as there was no timely evaluation of nurses' intent to leave during the "Great Attrition" wave or to stay during the "Great Attraction" trend. Among those nurses completing the survey, 85.7% reported that they planned to work as a nurse one year later and 77.9% reported that they planned to work at the HS one year later. Those nurses who obtained a master's or doctoral degree as their first professional degree in nursing, or had a high level of mastery, were less likely to report an intent to stay at the HS. Those with no children, those who thought the HS was more supportive, and those who thought that registered nurse-medical doctor relations were higher were more likely to intend to stay at the HS. Those nurses who reported worse communication with their nurse manager were less likely to report an intent to stay in nursing. Those who reported lower stress, who were unmarried and had no children were more likely to intend to work as nurses. Our findings on nurses' intent to leave their organization and their intent to leave nursing are much lower than reports in the popular press. Our data were collected early in the pandemic and it may not reflect the accumulated stress nurses experienced from witnessing the death of so many patients.

Nurses with workplace violence in pneumology settings during Covid-19

Background: Workplace violence (WPV) has consequences both for healthcare workers and healthcare organizations. Nurses are the most exposed healthcare workers to vertical WPV. Aims and Objectives: Describe the Italian WPV and identify its predictive factors. Method(s): This is a secondary analysis conducted in hospital pneumology settings from a larger study between January and April 2021. Data were collected through the Practice Environment Scale of the Nursing Work Index (PES-NWI;Likert scale 1 to 4) and the Violence in Emergency Nursing and Triage (VENT) Questionnaire. Result(s): The analysis was conducted on 484 pulmonary nurses (72.9% female;mean age 38.9 years, SD 9.8). Thirty-four per cent (n=164) of them have had an experience of WPV in last year and/or their last week and 16.7% (n=81) only in their last week. Comparing main results between nurses with WPV vs no WPV the number of patients was higher for nurses with WPV (MD +4.8;p<.001). The PES-NWI results were significantly worse for nurses with WPV: global mean scores (MD +0.2;p<.001);nurse participation in hospital affairs (MD +0.3;p<.001);nurse manager ability leadership, and support of nurses (MD +0.2;p<.001);physician-nurse relationship (MD +0.2;p<.001). Conclusion(s): Public health companies should reduce WPV by investing in resources for the management and prevention of the phenomenon. Integrated and multimodal programs of prevention and management of WPV are useful to combat it. Improving the work environment and job satisfaction should reduce WPV.

Leadership Styles of Nurse Managers and Employees' Organizational Commitment during the COVID-19 Pandemic

Objective: The aim of this study was to determine the leadership styles of nurse managers and then determine the relationship of the respective styles with the organizational commitment of the nurse managers during the COVID-19 pandemic. Method(s): A quantitative correlational study design was employed in this investigation. Simple random sampling yielded 259 nurses who participated in this study. It was conducted between October and November 2021 at the government hospitals of the Hail Region, Kingdom of Saudi Arabia. Result(s): The nurses' perceived that their nurse managers employed an idealized influence leadership style (9.15). Age, years of experience, and ward assignment were found to have no statistically significant difference on organizational commitment;however, a significant difference was found with nationality. No significant difference was found regarding age with idealized influence, inspirational motivation, intellectual stimulation, or management by exception;however, it differed significantly with individualized consideration, contingent reward, and laissez-faire leadership. No significant differences were found with the years of experience to idealized influence, inspirational motivation, intellectual stimulation, individual consideration, or management by exception;however, it was found significantly different with the contingent reward and laissez-faire leadership. Concerning nationality, a significant difference was found with idealized influence and inspirational motivation. However, no significant difference was found between nationality and intellectual stimulation, individual consideration, contingent reward, management by exception, or laissez-faire leadership. With the ward assignment, no significant difference was found with idealized influence, inspirational motivation, intellectual stimulation, or contingent reward management by exception;however, a significant difference was found with individual consideration and laissez-faire leadership. Conclusion(s): During the pandemic, nurse managers employed idealized influence leadership styles. Age, years of experience, and ward assignment were found to be of no significant difference to organizational commitment, but they did have a significant difference to nationality. Age differed significantly with individualized consideration, contingent reward, and laissez-faire leadership. Years of experience was found to be significantly different with contingent reward and laissez-faire leadership. Concerning nationality, a significant difference was found with idealized influence and inspirational motivation. With the ward assignment, a significant difference was found with individual consideration and laissez-faire leadership.Copyright © 2023 The Author(s). Published by S. Karger AG, Basel. This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.

Managing the Nursing Shortage During the Covid-19 Pandemic: A Qualitative Study.

Background: Nursing care contributes to the safety and the quality of care of patients. During the COVID-19 pandemic, nurses became frontline care providers. Materials and Methods: A qualitative study was conducted using an online focus group discussion of eight nurse committee members from six hospitals. After the data were collected, the study continued with inductive thematic analysis. The data were organized and extracted to identify meaningful statements and formulate meanings. Inductive thematic analysis was used, resulting in three themes and six subthemes. Results: The themes related to managing the nursing workforce, schedules, rosters, shifts, goals of re-design staffing, and the nurse-patient ratio. Conclusions: The management of the nursing staffing was modified to protect nurses during the COVID-19 pandemic. The nurse manager redesigned workforce planning to ensure a safe environment for nurses.

What is needed for oncology nursing in times of COVID-19-results from two round-table webinars

Introduction: With the outbreak of the COVID-19 pandemic, clinical practice had to be adapted very quickly. As cancer patients are considered to be at higher risk, in cancer care substantial organizational and treatment related changes had to be implemented. Our presentation will focus on consequences of these changes for oncology nursing. Method(s): The Academic Society for Oncology Nursing in cooperation with the Swiss Oncology Nursing Society organized several webinars with oncology nurses, nurse managers and clinical nurse specialists. Tese experts from French and German speaking regions shared their experiences discussing a) major practice changes and b) needs of nurses to meet the care needs of patients and relatives in two webinars in French and in German. Result(s): The major practice changes included the use of personal protective equipment (PPE), the rapidly implemented changes in treatment and care resulting in changing patients needs. Facemask and protective glasses were standard PPE in many places. PPE impacted nursing interventions and communication with the patient. The lack of visibility of facial expressions hampered nurses' capacity to express empathy or to recognize the emotional state of their patients. Terapies were switched to longer cycles or postponed entirely. This resulted in an increased informational and educational needs of patients. Tey expressed the fear to be exposed to a higher risk of SARS CoV-2 infection or to receive a less efective cancer therapy. In turn, patients who did not come to cancer centers worried that something missed care could have fatal consequences. To meet these needs many centers reinforced remote consultations, mainly via phone. Centers with established procedures for telephone consultations felt better prepared for remote consultation during the pandemic. Overall, webinar participants highlighted the lack of guidelines for conducting telephone consultations and policies for reimbursement. Conclusion(s): The round-table webinars provided a platform for oncology nursing to exchange on challenges and solutions in times of COVID-19. Regarding telephone consultations, the webinars have stimulated the development of nursing guidelines for remote consultations. An important subject for future round-table webinars could be the preparation of oncology nurses for a second epidemic wave.

The Experience of Nurse Managers Implementing A Nursing Management System in COVID-19 Wards: A Descriptive Phenomenology Study

Background: The nurse manager is one of the nurses who has authority to implement a nursing management system in a nursing organization to achieve goals based on the input, process and output stages, whether the Covid-19 pandemic has positive and negative impacts on the implementation of the nursing management system. Nursing management is a form of coordination and integration in achieving nursing care and nursing services. Purpose: The purpose of this study is to explore the experience of nurse managers in implementing nursing management system in the COVID-19 wards. Methods: This study used a phenomenological descriptive design and in-depth interview data collection methods. Furthermore, the implementation of this research was carried out in 10 hospitals in North Sumatera, especially Medan City, Deli Serdang Regency and Serdang Bedagai Regency. The participants involved in this study were 20 participants and used the Collaizzi data analysis method. Results: This study revealed 7 themes related to the experience of nurse managers running a nursing management system in the COVID-19 treatment room;(1) Requires extra high discipline to carry out nursing management functions, (2) There is a psychological disorder for nurse manager to carry out nursing management, (3) Requires moral and material support in carrying out their duties, (4) Performs various efforts to disseminate information on nursing care management systems, (5) Experiences more benefits in implementing nursing management in the COVID-19 ward, (6) Faces complicated obstacles in carrying out nursing management, and (7) Has high expectations in carrying out increasingly complex management functions. Conclusion: From the themes above, the researcher concludes that the nursing management system in the COVID-19 treatment room involves psychological feelings, requires extra self-preparation, requires support from all parties in providing nursing care, improving nursing services to the fullest and can develop the concept of nursing management system during a pandemic. © The Author(s) 2022.

Improving Picu Patient Safety by Implementing a Robust Supply Chain Management Process

INTRODUCTION: With recent gaps in the timely availability of critical pieces of intensive care-specific equipment, clinical care has been affected by the COVID-19 pandemic. Presently complex systems are in place for the essential supplies unique to the pediatric intensive care unit (PICU), such as endotracheal tube sizes, central line supplies, etc. A robust multidisciplinary process can ensure an adequate and timely supply of critically important ICU equipment. This quality improvement initiative's goal was to establish a supply chain management (SCM) process map to reduce elements of inefficiency and acquire resources that would enhance patient safety. METHOD(S): Our goal was to redesign the process that ensures an adequate supply of critical equipment in the PICU, ensures adequate communication during supply chain breakdowns, and minimizes waste by six months. We provided education to increase the patient safety event report (PSER) entries for missing supplies (process metric). We developed an SCM process map (PM) through collaboration with nursing, physicians, and central supply and identified key PM steps. Adherence >50% to the three key steps in the event of missing supplies (process metric) and a decline in days with missing critical supplies was the outcome metric (75% by 6 months). RESULT(S): In our 12-bed pediatric and cardiac intensive care unit, PSERs with missing critical supplies were measured over six months. 21 PSERs were reported compared to 9 over the preceding 2-year period. The three key steps identified in the PM were the Central Issues (CI) specialist sent a daily email to the group (nurse manager (NM), physician, CI Manager, Special order manager) regarding missing supplies. The 2nd step was the expected arrival time (ETA) provided by the special-order manager to the NM within 24 hours for back-ordered items. The 3rd step was a replacement item is expeditiously ordered if the ETA for the item is not acceptable to the PICU team. The three measures adhered to 79% of the time, and the number of days with missing critical supplies decreased to 9 in 6 months. CONCLUSION(S): Implementation of SCM strategies in healthcare has been slow despite the essential need. SCM PM increases productivity in critical care by enhancing safety, shortening product/service cycles, and can lower inventory costs.

Sleep disturbances in nurse managers during the early and late stages of the COVID-19 pandemic.

Introduction: Working conditions during the COVID-19 pandemic have affected health professionals' quality of sleep. To date, most of the studies that assess the impact of the COVID-19 pandemic on sleep have been carried out with front-line health personnel, and almost none of them have been carried out with managers. Objective: To evaluate the quality of sleep and the level of stress in nurse managers during the early and late stages of the COVID-19 pandemic. Methods: Cross-sectional studies were carried out at two time points: after the lockdown period (July 2020) and a year and a half after the start of the pandemic (October 2021). A total of 102 nurse managers of a tertiary hospital were invited to participate. The Perceived Stress Scale (PSS-14) and Pittsburgh Sleep Quality Index (PSQI) were administered to assess stress levels and sleep quality. Results: The response rate was 85.2% in 2020 and 81.3% in 2021. Nursing managers showed alterations in sleep quality throughout the pandemic: 70.1% after confinement and 61.4% at the beginning of the second wave. In addition to stress, the fear of contagion by COVID-19 influenced sleep problems. More than a year after the start of the pandemic, the professionals' fear of contagion decreased. Perceived stress also decreased, but sleep disturbances remained. Conclusion: High stress and poor sleep quality among nurse managers require special attention, and specific interventions need to be implemented. Hospitals should develop programs that help nurse managers develop skills to mitigate stress levels and thus improve sleep quality and professional quality of life.

The Nurse Manager Role of Yesterday, Today, and Tomorrow: A Qualitative Study in an Academic Health System

COVID-19 has presented health care providers, including nurse managers (NMs), with unprecedented challenges. The purpose of this study was to explore the perception of the future NM role in an academic health system peripandemic and identify variability in levels of experience. This was a qualitative phenomenological multisite study. The study did show that regardless of the level of experience, opportunity and resources are needed for leadership development, innovative communication strategies, contemporary business acumen, and workforce wellness techniques. This study identified competencies that NMs deemed important. Additional longitudinal research is needed to ensure that the role remains contemporary. © 2022 Elsevier Inc.

Nurse managers' challenges and opportunities in the COVID-19 pandemic crisis: A qualitative descriptive study.

AIM: The study was conducted to understand the experiences of nurse managers with regard to the difficulties and opportunities they encountered during the pandemic. BACKGROUND: Although many studies have been carried out to understand how nurses were affected in the COVID-19 pandemic, there are few studies that treat the experiences of nurse managers. METHODS: In this qualitative descriptive study with 19 nurse managers working in pandemic management at a university hospital in Turkey during the first three waves of the pandemic, data were collected between April and July 2021 using the semi-structured interview method. Content analysis was performed to analyse the data. RESULTS: Six themes were identified with respect to the experiences of nurse managers during the pandemic. These themes were initial reactions to the crisis, ineffective crisis management, excessive workload, the moral burden in decision-making, support of colleagues and other multidisciplinary team and nurse manager empowerment. CONCLUSIONS: The nurse managers had difficulties in their managerial roles during the pandemic. However, they also viewed the crisis as an opportunity because they were able to note the deficiencies in management at all levels of the hospital and their leadership and decision-making roles took on more importance. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers may use the results of this study to be prepared for the continuing COVID-19 pandemic and any other emergency circumstances that they may have to face in the future.

Between a rock and a hard place: Nurse managers' experiences of large-scale organizational change in the public health service.

BACKGROUND: Nurse managers are often at the forefront of implementing organizational changes. Studies suggest that conflicting pressures and stress are high during such times, though little is known of how nurse managers experience the continuing run of change initiatives. AIMS: To explore nurse managers' experience of large-scale organizational changes and its impact on their working lives and conditions. DESIGN: A qualitative phenomenological hermeneutical study utilizing a Ricœur-inspired method of interpretation. METHODS: Semi-structured interviews were conducted with 12 nurse managers at a public sector university hospital that had recently undergone large-scale organizational changes. Interviews were conducted in 2021 during the covid-19 pandemic. The analysis is based on the three-stage Ricœur-inspired analysis method by Pedersen and Dreyer. RESULTS: Three themes emerged outlining the nurse managers experiences of large-scale organizational change: The need for support structures to be incorporated in the change process, The need for a guiding star, and The challenge of the values embedded in the Nurse Manager mindset. These themes were consistent across both predominantly positive as well as mainly negative experiences. CONCLUSION: This study reveals the potential that receiving support from management, staff and peers has to positively influence the experiences of nurse managers during large-scale organizational changes. However, lacking a clear vision for the process negatively influences their ability to support high-level quality care within their wards, potentially increasing their feelings of stress and conflicting pressure. IMPACT: Participants offered important insight into the sparsely explored subject of nurse managers' experiences of organizational change, the complexity they face and the potentially high personal costs. The study highlights the detrimental effects of not providing support to all managers in organizations undergoing change, and the parallels to the covid-19 pandemic. No Patient or Public Contribution was required for this study due to its aim.

Safeguarding early pregnancy and emergency gynaecology care in a crisis

Objective: This paper details a quality improvement project (QIP) spanning a period of 18 months (February 2020 -August 2021), during which we optimized the care delivery system in order to safeguard early pregnancy and emergency gynaecology services during the pandemic. In response to the Covid-19 pandemic, the Royal Wolverhampton Trust (New Cross hospital) in line with government guidance for infection control, relocated early pregnancy and emergency gynaecology wards to distant “non-gynae” areas of the hospital. This was challenging for junior doctors;patient care was compromised as they were seen in new wards where the nursing staff lacked the requisite training to care for them. The new locations lacked items required for clinical reviews;causing prolonged hospital stay and some increase in admissions. This QIP, highlights innovative and cost-effective measures to safeguard quality of care our patients received regardless of the location within the trust. Design: Process mapping exercise was performed to ascertain the issues, team discussions were held, human systems and human factors analysed to come up with an action plan. The action plan involved;specific teaching to members of staff who lacked the skill to care for these patients in the remote areas. We procured trolleys stocked with gynae items and consumables, a gynae bag-pack containing these items was assembled for junior doctors to take along for patient reviews. Methods: Teaching was done by Gynae consultants for staff, procurement processes were followed through to acquire trolleys for items and resources. Necessary adjustments in stages were made to determine the list of items and contents of the Gynae bag-pack. A survey was carried out to assess extent of improvement in the system, we sought support from our trust's continuing quality improvement (CQI) team who help with patient attendance data analysis. Results: Our survey showed 98% Junior doctors were satisfied with ease of access to resources at all remote locations, and felt more confident when carrying the gynae bag pack. The nurse managers and representatives gave feedbacks that they feel more confident in caring for gynae patients after the training they received. Patients received same day emergency care (SDEC) and discharged home, with associated drop in admissions from 48% to 20%. Conclusion This project was successful in utilizing systems optimization approach to safeguarding the quality of care our patients received and also ensured that health care staff safely discharged their duties in a difficult time. The improvement chain is ongoing.

Developing nurse managers through an evidence-based education program

This study explored the lack of formalized managerial education and training for nurses new to leadership. This quantitative study specifically explored the knowledge gap of beginner nurse managers based on a lack of formalized education, a universal approach is supported by the research. Currently, there is no standard or formal nurse manager education program through the Department of Nursing or the Department of Learning and Development. The focus of the evidence-based project was to evaluate pre- and post-data assessing the impact of instituting a formal education program for beginner level nurse managers in collaboration with the human resources department of learning and development. For this project, Benner's theory of novice to expert stages of clinical competence provided the guiding framework. The program was offered to nurse managers in their role 1 to 2 years. Using a quantitative, correlational design, results indicated that beginner nurse managers did not vary significantly in perceived human resource management knowledge following the nurse manager education t (10) = 1.544, p = 0.154. Issues related to the COVID pandemic impacted the study, as did loss of participants, and moving from in-person to online education;only 50% of the post surveys were completed. While there were limitations, this program can help nurse educators identify and address the gaps in the knowledge for new nurse managers and guide the development of managerial programs, which can effect positive social and clinical practice change. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Indonesian hospital's preparedness for handling COVID-19 in the early onset of an outbreak: A qualitative study of nurse managers.

BACKGROUND: Hospitals must be well-prepared to respond to pandemics. Hospital preparedness is critical to ensure optimal health service functioning and care delivery to reduce the transmission of COVID-19. Nurse managers play critical roles and provide expert advice on hospital preparedness models, to facilitate the delivery of safe and effective care, within the pandemic context. AIM: To explore nurse managers' perspectives of hospital preparedness to handle the COVID-19 pandemic in its early phase. DESIGN: Descriptive qualitative study. METHODS: Nurse managers were recruited from two public hospitals designated for handling COVID-19, in East Java of Indonesia, using purposive sampling. Semi-structured interviews were conducted via phone and video conference. Data were analysed using the content analysis. RESULTS: A total of nine nurse managers participated and were included in analyses. Three main categories were identified. These were (1) operational policy, (2) infrastructure arrangement, and (3) healthcare personnel management. CONCLUSIONS: The Indonesian healthcare system has made responsive adjustments to handle COVID-19 by increasing the flexibility and adaptability of institutional physical structures, services, and human resources on the early phase of the COVID-19 pandemic.

Optimising communication with families of patients on acute stroke and geriatric medicine wards in a large tertiary hospital

Background: Good communication with patients and families is important for older adults admitted to acute stroke or geriatric medicine wards, particularly with COVID19-related restricted visiting. These patients often have communication difficulties including aphasia, delirium, cognitive or hearing impairment, limiting their own communication with relatives. Using the Plan, Do, Study, Act (PDSA) approach we undertook a quality improvement project to optimise communication with families of patients on above wards in a large tertiary hospital. Methods: PDSA cycle 1: Staff were surveyed to identify satisfaction level with communication and ways to optimise communication. Inpatients on study wards were identified, we recorded demographic and clinical details and prevalence of communication difficulties. We created a designated folder with individual 'communication sheets' in conjunction with ward doctors and the nurse manager. PDSA cycle 2: We performed a rapid interval audit of the communication folder use. 'Outlier' patients were excluded as their teams did not receive education about folder use. Results: PDSA cycle 1: A total of 90 inpatients on three wards were included, mean age 78y (SD ±14.4y), 47% were male. Three-quarters (73%) had a communication difficulty noted, reported by nursing staff. Two patients were intubated and six had stroke-related aphasia. Half of surveyed staff reported communication with families was suboptimal. Most (86%) suggested a centrally-located communication logbook would be helpful. PDSA cycle 2: Over two weeks, communication sheets were reviewed for all included patients. Median frequency of calls to families was 4 days (range 0- 14). Most (79%) had the name of the primary contact clearly documented. Many (52%) included no contact number. Only 9% had secondary contact information documented. Conclusion: Communication with families of patients on acute stroke and geriatric medicine wards was suboptimal. Over a short interval this improved with regular phone calls using specific centrally-located communication folders. Further optimisation of their use is needed.

The doctor will see you now-optimising inpatient and outpatient paediatric care during the COVID-19 pandemic in a UK district general hospital

Introduction: The first wave of the COVID-19 pandemic required paediatric departments to quickly adapt to changing infection control policies, including altering physical space, pathway and rota restructuring, and adopting telemedicine platforms. As it emerged that COVID-19, as a disease entity, does not severely affect children, it became apparent the biggest challenges in delivering excellent care would be to overcome operational and organisational obstacles. Other challenges included delayed presentations of other conditions, waning staff morale and lack of paediatric specific infection control data and guidance. Methods: Our district general hospital's paediatric department established working groups comprising senior paediatricians, infection control leads and nursing managers. They regularly met during the first wave with the aim to optimise inpatient and outpatient paediatric care, agree on paediatric specific pathway changes and ensure staff morale was maintained. Actions: Paediatric doctors took over management of the paediatric emergency department (ED) to support adult services. Consultants became residents overnight to help manage ED and the requirements of a 'red' and 'yellow' admission pathway. We implemented a thrice-weekly multi-disciplinary resuscitation simulation to ensure all staff were aware of COVID adaptions to paediatric resuscitation algorithms. Weekly staff debriefs held to ensure the dissemination of pathway updates and to prioritise staff morale. Emergency funding led to the acquisition of new equipment to avoid cross-contamination with adult areas (e.g. blood gas analysers). Outpatient referrals were double-vetted by consultants and seen promptly. Over one year from January 2020, 8,104 children were seen in the clinic;4,619 (57%) were new referrals and seen face-to-face. We worked with adult services;the paediatric outpatient area was converted to an overflow adult ED. Paediatrics utilised an adult area with a larger footprint to continue face-to-face outpatient appointments. We extended our community nursing service to 7 days a week (from 5) to ensure more streamlined ambulatory care. Conclusions: Adaptability and flexibility were fundamental in implementing paediatric specific pathways. Schedule supportive team debriefs to promote staff wellbeing. Work with adult services to maintain excellent patient care throughout both specialities-we took over paediatric ED and utilised adult space to continue outpatient clinics. Anecdotally paediatricians preferred, and felt safer, undertaking face-to-face consultations for new outpatient appointments. Most children were not seen by their general practitioner prior to referral. We advocate ensuring all new outpatient referrals are seen face-to-face. Telemedicine was the preferred method for reviewing outpatient follow-ups. More research is required into the opportunities and barriers of paediatric telemedicine.

Nurses' experiences during COVID-19 pandemic: Coping and resilience strategies in oncology setting. A multicenter mixedmethods study

Background: The study stems from the need to identify the resilience and coping mechanisms that oncology nurses adopted during the period of the COVID-19 pandemic and explore their individual experience. Little information is available to date on nurses about this topic, therefore, we designed a mixed-methods study to evaluate these strategies in nurses working in the oncology setting. Material and methods: A multicenter, sequential explanatory mixed-methods study will be conducted, in which quantitative and qualitative data will be collected and analyzed sequentially and individually. The study will begin in June 2021 and be conducted for 4 months in two Oncology Departments in Northeastern Italy (National Cancer Institute of Aviano and Teaching Hospital of Udine). The quantitative study will be based on the accuracy of estimating resilience with a 95% confidence interval and a standard deviation of 20% and 95%. Two questionnaires in Italian will be mailed to 276 nurses who have been working during the COVID-19 pandemic. Data will be collected through an electronic procedure (REDCap). The study findings will support the development of an interview guide for the qualitative study. Here, semi-structured interviews will be conducted involving a purposeful sampling until saturation. Interviews will be transcribed verbatim and the Colaizzi framework (1978) will be used for content analysis with the NVivo program. Results: Data collection has not yet started, but the results of both the quantitative and qualitative studies will be available by the time of the conference. Conclusions: We expect that this study will provide information about difficulties, resilience, and coping strategies adopted by oncology nurses who are working on the frontlines during the COVID-19 pandemic. The results will help the organization and nursing managers develop effective strategies to cope with future emergency situations.

Experiences of frontline nurse managers during the COVID-19: A qualitative study.

AIM: To explore experiences of frontline nurse managers during COVID-19. BACKGROUND: The COVID-19 pandemic has complicated care provision and healthcare management around the world. Nurse managers have had to face the challenge of managing a crisis with precarious resources. Little research has been published about the experiences of nurse managers during the COVID-19 pandemic. METHODS: A qualitative descriptive study of 10 frontline nurse managers at a highly specialized university hospital in Spain was carried out. Semi-structured interviews were conducted between June and September 2020. The Consolidated Criteria for Reporting Qualitative Research checklist was used for reporting. RESULTS: Six themes emerged: constant adaptation to change, participation in decision-making, management of uncertainty, prioritization of the biopsychosocial well-being of the staff, preservation of humanized care and 'one for all'. CONCLUSIONS: This study provides evidence for the experiences of nurse managers during the COVID-19 pandemic. In addition, analysing these experiences has helped identify some of the key competencies that these nurses must have to respond to a crisis and in their dual role as patient and nurse mediators. IMPLICATIONS FOR NURSING MANAGEMENT: Knowing about the experiences of frontline nurse managers during the pandemic can facilitate planning and preparing nurse managers for future health disasters, including subsequent waves of COVID-19.