Table 3.

Themes and sample quotes.

Themes	Sample quotes
Too many deaths	“The deaths were so great in a very rapid pace. That was the quickest change in the shortest amount of time.”
Grappling with grief	“You really get to know them, their family, and their story in both their greatness and their challenges. It’s a real loss when people die.”
	The big thing that has really impacted the staff, not only the social work staff, but the staff, as a whole, has been the deaths. That’s been hard.”
Pressure to adapt quickly	“It’s forced us to pivot a lot. This came on us like a bolt of lightning. To be honest with you, we didn’t see it coming and we weren’t prepared. I don’t think anybody was prepared for it.”
Guilt about care quality	“I felt bad. I felt so bad that as far as the patients were getting sick … it seemed like it was so different, the deaths anyway.”
	“ … we know we work with a very advanced ill population and we’re probably going to see them die. They’re all going to die whether we’re assisting, right? Right now, it wasn’t supposed to be their time.”
Rapid loss of confidence in one’s expertise	“I’ve never said ’I don’t know’ and ’I’m not sure’ so many times like in my life. I’ve never said that so many times as during this time period. So, it’s just like there was a lot that – I felt useless. I feel like sometimes treating some of these patients like I feel like – I’ve been an NP since 2002, and I just felt like I didn’t know what I was doing. It’s like, was I doing a bad job that I couldn’t provide for my patients?”
Feeling useless	“ … when I spoke to one of the providers, I was like, “Well, I felt useless because this is what happened.”
	It’s trying to balance the concrete needs of patients and families with the emotional piece and just being there on the other end, but also like the challenge of feeling helpless because there really wasn’t something good that you could do for them.”