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.

Workforce management and patient outcomes in the intensive care unit during the COVID-19 pandemic and beyond: a discursive paper.

AIMS: To highlight the need for the development of effective and realistic workforce strategies for critical care nurses, in both a steady state and pandemic. BACKGROUND: In acute care settings, there is an inverse relationship between nurse staffing and iatrogenesis, including mortality. Despite this, there remains a lack of consensus on how to determine safe staffing levels. Intensive care units (ICU) provide highly specialised complex healthcare treatments. In developed countries, mortality rates in the ICU setting are high and significantly varied after adjustment for diagnosis. The variability has been attributed to systems, patient and provider issues including the workload of critical care nurses. DESIGN: Discursive paper. FINDINGS: Nursing workforce is the single most influential mediating variable on ICU patient outcomes. Numerous systematic reviews have been undertaken in an effort to quantify the effect of critical care nurses on mortality and morbidity, invariably leading to the conclusion that the association is similar to that reported in acute care studies. This is a consequence of methodological limitations, inconsistent operational definitions and variability in endpoint measures. We evaluated the impact inadequate measurement has had on capturing relevant critical care data, and we argue for the need to develop effective and realistic ICU workforce measures. CONCLUSION: COVID-19 has placed an unprecedented demand on providing health care in the ICU. Mortality associated with ICU admission has been startling during the pandemic. While ICU systems have largely remained static, the context in which care is provided is profoundly dynamic and the role and impact of the critical care nurse needs to be measured accordingly. Often, nurses are passive recipients of unplanned and under-resourced changes to workload, and this has been brought into stark visibility with the current COVID-19 situation. Unless critical care nurses are engaged in systems management, achieving consistently optimal ICU patient outcomes will remain elusive. RELEVANCE TO CLINICAL PRACTICE: Objective measures commonly fail to capture the complexity of the critical care nurses' role despite evidence to indicate that as workload increases so does risk of patient mortality, job stress and attrition. Critical care nurses must lead system change to develop and evaluate valid and reliable workforce measures.