Table 3.

Nurses' pandemic lives: themes and subthemes.

Theme	Subthemes	Quotations
1. What is going on here?	i. Overwhelmed and Unprepared	“My initial reaction was overwhelming. I was worried more about my family than myself.” “As someone who works in the ER, I knew I would be facing the pandemic head on. It was unsettling at times, but most stress was due to lack of good information…” “My initial reaction to caring for patients was overwhelming. I have never seen such sick patients in most vulnerable and alone state.”
	ii. Fear, Worry, and Uncertainty	“I was fearful that I would give the infection to family members or other members of the community” “The fear of protecting family members and protecting ourselves and the staff around us made us almost hide from our patients.” “Scared of the unknown and ever-changing information” “I was absolutely terrified” “Constant worry of infecting family members, being forced to isolate from family and being treated like a leper”
	iii. Sense of Duty	“I felt it my duty to help take care of patients with COVID-19 and in a way, it felt empowering to be on the frontline so that I could do something to aid the crisis.” “I felt apprehensive but also knew it was my duty to take care of the patients no matter their diagnosis.” “Stressed but ready to take action as a nurse”
2. How much worse can this get?	i. Unclear Guidelines and Constant Changing Protocols	“For weeks on a daily basis our beginning shift huddles consisted of forget what we said yesterday about xxxx, today we are doing xxxx. We were constantly changing protocols which made it difficult to function at work on a daily basis, it was stressful because it was impossible to keep up with the ever-changing protocols in our department.”
	ii. Personal Protective Equipment (PPE) Use and Availability	“Uncertainty about PPE availability, treatment procedure” “The anxiety in the air was palpable, even though everyone was trying their best, overall, the biggest stressor was what was expected of us – to provide good and safe patient care while the resources were limited.”
	iii. Fear of Viral Transmission and the Unknown	“The unknown: the constant floating to COVID units and constantly changing PPE guidelines. Also not being told about exposures and being told you weren't considered an exposure if you had a surgical mask on.” “Not knowing enough about the disease progression or how the virus works” “Wearing an N95 mask all the time and the unknown of what was truly happening.”
	iv. Mortality Sadness	“Witnessing people's condition deteriorate very quickly and watching them struggle and pass away with no family present.” “…stressors from families calling and holding the iPad so families could video chat and see their dying loved one…” “Major stressor was watching patients die alone with no human touch”
3. What do I do now?	i. Mental/Emotional Strategies/ Physical Activities	“Humor and accepting the situation and I made sure to get at least 30 min of exercise outdoor if the weather permitted.” “Coming home to having alone time. Taking a hot shower. Sitting with my family.” “Recognize self-physical and mental health is important and reducing hours worked”
	ii. Information Seeking or Avoidance (COVID)	“Tried to find as much research and information as I could to ease my anxiety about taking care of these sick patients.” “…trying to avoid constantly watching the news or talking about it.” “Thinking about COVID like the flu. Not thinking about COVID at all.” “I took the opposite approach of many people and I watched updates about the pandemic daily.”
	iii. Supportive Conversation	“Talking with friends and family and venting with coworkers and manager.” “Venting to family, playing and cherishing kids, hugs from my husband, joking with people at work.” “…relationships with my coworkers (worked with the same ‘team’ every shift for 2 months) kept me sane.”
4. What motivates me to do future work?	i. Supportive and Safe Work Environment	“More appreciation from the healthcare institution worked. We did not receive bonus pay. Any meals or donations were from the community and not the hospital. Also, adequate information about exposure.” “Increased support from employer by providing clear guidelines, appropriate PPE, enough PPE, hazard pay.” “Having appropriate PPE and staffing. Feeling and appreciated for working through tough times. Not feeling like another number coming into work.”
	ii. Call to Duty	“The calling and the opportunity to be of service to my community. That's what drew me to nursing initially, and what keeps me in the field.” “I'm a nurse. It's my duty to care for the sick.” “It's my job to care for people. Not a question of motivation.”
5. Lingering frustration	i. Lack of PPE ii. Public Restrictions iii. Hospital Environment iv. Sacrifices v. Burnt out vi. Changing policies	“I had no choice, and I was sick of hearing that I signed up for this. It made me question my career choice because of the amount of weight on nurses with such a lack of support.” “The emotional stressors are far more exhausting than any physical ones. It is important to keep your mental health in check “I do not believe that hospitals are designed well enough to handle pandemics.” “It would seem that if the goal is to reduce transmission, the hospital should have facilities such as showers, laundry, hygiene stations as they do in operating room areas that would help to reduce the number of nurses and healthcare staff tracking possible contaminants home.”
6.Moral distress	i. Tired/Fatigued ii. Patient Death iii. Emotionally iv. Fragile Mental Health Concern v. Moral Anguish	“My mental health and the mental health of all my co-workers were placed in jeopardy and we need to protect each other from this moral distress if this happens again.” “I still feel emotionally fragile. I question my own emotional strength to continue bedside nursing.” “Watching people die from this virus alone with no family except maybe through FaceTime is not something you forget easily.
7. Sense of community	i. Unity Among Colleagues and Peers ii. Sense of Belonging	“…It took a whole pandemic for people to truly appreciate nurses.” “My fellow teammates at my workplace were what got me through COVID. Yes it was scary at certain times with the staffing ratios, but we pulled through as a team.” “…We bonded over the issues at work. We became better friends outside of work which only made working together better.” “The whole experience has been enlightening and my team was amazing. Knowing how strong we are when we work together is truly motivating that we can conquer anything thrown at us.’