TABLE 6.

Themes Referenced in 17 Interviews With Healthcare Workers From the Surveyed Facilities

Themes, Subthemes, and SSTs		Transcript Quote	No. References
Theme	Immediate Working Conditions		1029
Subtheme	PPE	“I asked for a mask the third week in March. I was told, no we can’t wear masks until we have the first positive case of COVID”	216
Subtheme	Time off	“I had given a nurse holiday time and they [management] were like just have them do a double instead of taking the day off. I'm said, I'm going to give them a holiday, because he has five kids at home, who he now has to teach too. I mean, that's not a day off.”	175
Subtheme	Training	“I haven't put on PPE in 30 years since nursing school, other than the regular gloves and mask and face and eye shields, and I haven't had to decontaminate myself, since I got off active duty in the army. So, refreshing our training of the use before they just throw this stuff at us would have been helpful”	59
Subtheme	Infection control
SST	Testing	“We [staff] were designated to do covid testing…I did volunteer, but I had been doing it for about 3 months before I was properly trained”	61
SST	Exposures	“March we started testing the veterans and they all were positive and all the staff was positive, we lost ward afterward and had to open the quarantine floor.”	34
SST	Isolation	“We had a whole color system [for when] staff or a patient tested positive. Either the staff would be out, or the patient would go up to the COVID {“red”) unit. There was still the potential for infection within the unit so if the unit was red patients were encouraged to stay in the room, if the unit was orange or yellow then all activities stayed on the unit, but they could go to the dining room for food and groups could be held in other locations with small groups.”	11
SST	Entering/exiting the workplace	“Just getting in the buildings sometimes I was in a line of 15 people, standing outside waiting to get into this tent with a portable heater in November, freezing your butt off. Thank God, that there was a tent outside with the heater.”	13
Subtheme	Coworker relationships, social support
SST	Informal networks	“A weeklong workshop on posttraumatic stress with grief counselors and chaplains. Not everybody was comfortable doing that, though, so we have quite a few that still struggle because they're not able to be open about their experience or talk about how bad it affected them.”	59
SST	Teamwork	“I do feel a responsibility to the team here to stay as one of the pillars to help them; they’ve lost so much, the line staff with their leaders and who they relied on. So, even though I keep saying, I want to retire, [it] probably won't be until I feel like they’re in a good place.”	27
SST	Union	“The Union had done so much work that management just did not want to turn it over. In terms of turning over information about infection rates.”	49
SST	Incivility	“They [management] lost the human factor, there's so many more ways to motivate people than discipline. We're in a horrifying situation they started treating all of us like the enemies.”	65
Subtheme	Vaccine	“The vaccine came to our facility really quickly. So I think that gave people a lot of hope.”	13
Subtheme	Staffing	“People have been here working 18-to-20-hour days, so you're sleep deprived, trying to make decisions, you have no staff. I just think they thought it [combining units] would consolidate [staffing], close the whole unit and utilize resources better.”	108
Subtheme	Workload	“Suddenly I was doing schedules, watching the doors. I had to set up tents literally [in] 1 day … I called Connecticut, trying to find thermometers because we didn't have them. We had to [do a] staffing report every morning. You’re training on the PPE, you're watching your staff. Your staff are nervous, you're trying to calm them down. You have to order more supplies and leave your unit to get your supplies instead of having them delivered. We had people leaving in the mid-shift because they may have been exposed. People were sent home from the door, because of signs and symptoms”	120
Subtheme	Frequency of exposure to hazards at work	“Some employees could work from home, other couldn't. My wife was pregnant, I was very worried about bringing COVID back to her.”	19

Theme	Organizational Policy and Communication		360
Subtheme	Guidance from leadership	“People [leaders] were very transparent, we didn't really have a roadmap, so we had to kind of come up with the playbook as things were playing out. There was open dialogue and a pretty broad audience of administrators who were involved.”	85
Subtheme	Communication	“I don't know that it's something new, but communication [was a problem]. We had a conversation about this last week there's a lot of I don't want to call it secrecy, but it almost is you can't share this information, you know until the right time.”	117
Subtheme	COVID policy implementation	“We stopped visitors because it was a pandemic, an emergency. The crisis is over, now visitors must start back up, are we necessarily ready? No, but it must happen, because those are the rules and management is under that pressure, they don't get a chance to say no, stop, we need a break.”	66
Subtheme	Uncertainty about policies	“There was 1 day, where we had a meeting before clinical and we were given one direction; we went to clinical, got another direction; we came back from clinical and got another direction.”	88
Subtheme	Emergency preparedness	“It's not the first pandemic that we humans faced, they must be more prepared for it and not just prepare the material stuff, prepare mentally for it.”	4

Theme	Impact on the Organization		232
Subtheme	Employee morale	“We were questioned if too much equipment was missing. They made us open all the cabinets to check if we were hiding things. [The issue of supplies only lasted a couple of weeks; the impact of this search is still talked about]”	89
Subtheme	Impact on patients	“You're talking about people that have mental illness, locked facility; then an atmosphere where the staff are super anxious, the news is fear-mongering, and they're cut off from social supports, going outside, and told wear masks and stay away from people. For people that are already ill, you know it had quite an impact on them.”	143

Theme	Impact on Individuals		93
Subtheme	Impact of the media	“When I saw the local news of course I understand, but when we hit New York Times that was absolutely crazy. The media focuses more on ‘what's going on with the management’. They should honor the veterans more.”	30
Subtheme	Impact on mental health	“I’m not as social or as happy as I used to be. I’m trying to trust [that] the people in the community that don’t wear a mask really are vaccinated. I find that I get irrationally angry about stupid.”	34
Subtheme	Impact on family	“It was … like living in a horrible nightmare that just wouldn't go away. It did impact my relationship; there was more fighting, more bickering, more I'm too tired for this. I just didn’t have the energy for friends or family.”	22
Subtheme	Impact on sense of identity	“I was seen as somebody to call if you don’t know the answer, as somebody who had more information than the lay person or had better information than what you were hearing in the news.”	5
Subtheme	Trust in the community	“When this started, I was getting thank you and signs all over ‘we appreciate our essential personnel’. All of a sudden, it's like nobody cares anymore.”	2

SST, sub-subtheme