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. 2023 Jan 12:10.1111/nhs.13012. Online ahead of print. doi: 10.1111/nhs.13012

Organizational support and Nurse–Physician collaboration during SARS‐CoV‐2 pandemic: A qualitative study

Hussan Zeb 1, Shahzad Inayat 2, Ahtisham Younas 3,✉
PMCID: PMC9880708  PMID: 36581738

Abstract

Health care professionals experienced multiple uncertainties during the pandemic. Exploring health care professionals' views about collaboration and organizational support can offer insights into organizational processes and issues during the pandemic. This research explored the perspectives of nurses and physicians about organizational support and nurse–physician collaboration during the SARS‐CoV‐2 pandemic. Using a qualitative descriptive design, interviews were conducted with nurses and physicians working in hospital settings. The interviews lasted for 24–61 min. Reflexive thematic analysis was used for data analysis. Nurses and physicians were disappointed with the organizational support, but they were satisfied with nurse‐physician collaboration. The theme “Management Abusing Authority and Blaming the Victimized Workforce” included organizational nepotism, unethical managerial actions, and neglecting frontline workforce. Nurses and physicians supported each other in tackling the intensive and complex demands of the pandemic. The theme “Demonstrating Professional Humility and Overcoming Patient Care Issues at Hand” entailed subthemes ‐ negotiating conflicts and prioritizing patient care, practicing kindness, and jointly managing conflicts with patients' families. Nurses and physicians reported frustrations with limited organizational support and abusive practices of managers. Still, they prioritized patient care needs and family‐related conflicts over interprofessional tensions.

Keywords: health workforce, interprofessional collaboration, management, nurse–physician collaboration, pandemics, SARS‐CoV‐2

Key points.

  • Nurses and physicians noted unethical and abusive practices of managers during the SARS‐CoV‐2 pandemic in Pakistan.

  • Nurses and physicians noted that management practiced favoritism and nepotism in scheduling, appreciating, and rewarding staff during the pandemic.

  • Nurses and physicians practiced professional humility and support each other to compensate for inadequate organizational support.

1. INTRODUCTION

The SARS‐CoV‐2 began as an epidemic in Wuhan, China, in 2019 and spread to about 200 countries/regions of the world (World Health Organization, 2020). The outbreak of SARS‐CoV‐2 has been debilitating to the health care system around the globe (Abdi, 2020; Remuzzi & Remuzzi, 2020), resulting in heavy workload, financial crises, ethnic and racial disparities, and negative physical and psychological impact on the health care workforce (Blumenthal et al., 2020; Shaukat et al., 2020). A scoping review identified that SARS‐CoV‐2 resulted in psychological issues (stress, anxiety, depressive symptoms, distress, and insomnia) as well as physical issues (skin damage, nasal bridge ulceration, fever, cough, weakness, and COVID‐19 infection) (Shaukat et al., 2020).

SARS‐CoV‐2 pandemic has put health care professionals in unprecedented circumstances, prompting them to make difficult decisions such as providing resources equally to patients with low‐ and high‐income status, balancing their mental health, isolating themselves from friends and family, and working with scant resources (Greenberg et al., 2020; Palacios‐Ceña et al., 2021). Various studies explored the experiences and challenges of health care professionals about combating SARS‐CoV‐2 (Alizadeh et al., 2020; Bennett et al., 2020; Kackin et al., 2020). These studies noted that health care professionals experienced uncertainties, fears, alterations in perceptions of time and space, positive and negative emotions, hopelessness, post‐traumatic stress disorder, guilt, and remorse (Arcadi et al., 2021; Liu et al., 2020). They adjusted their personal and emotional lives while striving to provide the best possible care to their patients (Ardebili et al., 2020; Giusti et al., 2020).

SARS‐COV‐2 had incapacitating physical, emotional, ethical, and organizational challenges for health care professionals and health care organizations (Greenberg et al., 2020; Shaukat et al., 2020). Such challenges could influence health care professionals' collaboration and dynamics among interdisciplinary teams (Giusti et al., 2020; Shaukat et al., 2020). Prepandemic research noted that nurses often work under normativity hierarchical structures as physicians have the ultimate authority in patient decision making (Gleddie et al., 2018; Lee et al., 2022; Reese et al., 2016). Power struggles are common among nurses and physicians; in particular, physicians disregard and neglect nurses' viewpoints on patient care (Morrow et al., 2016; Todorova et al., 2014). This power struggle negatively affects nurse–physician collaboration and deteriorates the quality of patient care (Cullati et al., 2019; Morrow et al., 2016).

Nurse–physician collaboration refers to teamwork in the workplace, collaborative problem‐solving, decision‐making, and shared responsibility to develop and implement care plans and procedures to improve the quality of care (Boev & Xia, 2015). Nurse–physician collaboration plays an instrumental role in providing high‐quality care to patients and their families and improving health outcomes (Rosen et al., 2018; Sabone et al., 2020). Greater collaboration among health care professionals and adequate organizational support are also critical for the well‐being of the professionals and for promoting a caring culture in organizations (Rosen et al., 2018). Organizational support is the degree to which individuals feel valued and cared for by their management and administration (Eisenberger et al., 2016). Organizational support can positively affect job performance, retention, satisfaction, and collaboration among nurses and physicians (Abid et al., 2015; Pahlevan Sharif et al., 2022). Nurse–physician collaboration is also associated with increased satisfaction with organizational support (Endris et al., 2022). When nurses and physicians feel supported and valued, it enhances their teamwork toward improving the quality of care (Endris et al., 2022; Karam et al., 2018).

Previous research highlighted the differences in the perceptions of nurses and physicians about their collaboration under no pandemic crisis (Hossny & Sabra, 2020; Sabonesuggests, 2020). Some research suggests that nurses had more positive perceptions of collaboration (Filizli & Önler, 2020; Kaifi et al., 2021), whereas research also indicates that physicians were more supportive of collaboration (Nair et al., 2012; Tang et al., 2013). Previous research noted conflicting views on nurse–physician collaboration during nonpandemic situations (Filizli & Önler, 2020; Nair et al., 2012). Hence, an exploration of nurses' and physicians' perceptions about their collaboration during the pandemic is needed. Because organizational structures may affect nurse–physician collaboration (McInnes et al., 2015; Szafran et al., 2018), it is essential to explore health care professionals' views about the extent of support received during the pandemic.

2. AIM

The aim of this study was to explore the perspectives of nurses and physicians about organizational support and nurse–physician collaboration during the SARS‐COV‐2 pandemic.

3. METHODS

3.1. Design

A descriptive qualitative design was used to explore participants' perspectives in their everyday life (Sandelowski, 2000) as a direct experience (Bradshaw et al., 2017). Descriptive qualitative studies also enable researchers to describe and interpret findings closest to the data set (Sandelowski, 2010).

3.2. Setting and sample

The research was conducted in multiple settings in Pakistan. The target population comprised nurses and physicians who worked as frontline care providers during the pandemic. The participants were recruited from hospitals designated by the government to manage SARS‐CoV‐2 cases. Purposive and snowball sampling techniques were used. The inclusion criteria were health care professionals working in tertiary care hospitals who cared for people with a confirmed or suspected diagnosis of SARS‐CoV‐2.

3.3. Data collection

Semistructured interviews were conducted because such interviews are flexible and can be tailored to the needs of the research (Kallio et al., 2016). The interview questions explored the perspectives of participants about organizational and system‐level challenges during SARS‐COV‐2 pandemic, the role of management in addressing their challenges, the nature, extent, and type of support offered by the organizations, interprofessional collaboration, nurse–physician collaboration, and support and challenges concerning nurse–physician collaboration.

The invitations to the potential participants were sent through posters and social media. The poster included the contact information of the researchers. Interested participants contacted the researchers through email or WhatsApp and scheduled a time for the interview. Three researchers experienced in qualitative research who had master's degrees conducted interviews through Zoom. The interviews were conducted from February to March 2021. Interviews were conducted in Urdu and English and lasted 24–61 min. The interviews were recorded. The interviewer encouraged the participants to engage in an open discussion and share all the experiences they deemed relevant. They were encouraged to ask any questions before, during, and after the interview. They were reminded of the right to leave the session at any time. The researcher used attentive listening, made notes and personal observations, and practiced reflective listening. The interviews were conducted until it was considered that the sample was adequate, and no new codes or patterns seemed to emerge from participants' responses.

3.4. Data analysis

The interviews were manually transcribed and translated before the data analysis began. All three researchers were bilingual and made every effort (e.g., keeping reflective journals and peer debriefing) to ensure that no personal biases and assumptions were incorporated during translation. Data were analyzed using reflective thematic analysis, which is one of the methods of data analysis under the family of thematic analysis (i.e., code reliability, codebook, and reflexive thematic analysis) (Braun & Clarke, 2022). These three approaches are different in terms of “enactment of coding and theme development, underlying research values, and the conceptualization of key concepts” (Braun & Clarke, 2022, p. 1).

Reflexive thematic analysis is a nonpositivist qualitative approach to analysis that embraces researcher subjectivity and promotes reflexivity during analysis (Braun & Clarke, 2022a, b). It entails a six‐phase process: (a) data familiarization; (b) coding; (c) generation of initial themes; (d) developing and reviewing themes; (e) refining, defining, and naming themes; and (f) writing results (Braun & Clarke, 2022). Transcripts were read multiple times to develop an in‐depth understanding of the participants' responses. The coding was completed at both semantic and latent levels by line‐by‐line reading of the individual transcripts and identifying the key messages of each line; reading and analyzing the initial codes across transcripts analyzing for similarities and patterns and condensing the codes into broad codes, and broad codes into subthemes. The final subthemes were examined, named, and combined to generate themes. After this comparison, any discrepancies were resolved, and the generated themes were reviewed, refined, and then finalized.

3.5. Strategies to establish rigor

The semistructured interview guide was based on the five‐step methodological framework outlined in Kallio et al. (2016): (a) identifying the rationale and need for semistructured interviews, (b) utilizing previous knowledge about the subject (c) formulating the interview guide, (d) preliminary testing (i.e., using internal and field testing), and (e) finalizing the guide. The interview guide was first tested with three participants before actual use and then amended as the needs emerged during interviews. All three researchers accounted for personal biases throughout analysis and interpretations and engaged in intrapersonal dialogues. After initial coding, the subthemes were examined after moving back and forth to the individual transcripts to assess data consistency with the developed themes. Reflexive journals and an audit trail were maintained to ensure credibility. Researcher triangulation allowed for cross‐verification of codes and subthemes and decisions made during analysis. Thick descriptions through contextualized and interpretative narratives of study results and methods also contributed to the trustworthiness of the research (Younas et al., 2023).

3.6. Ethical considerations

Ethical approval was obtained from the relevant ethics board and the management of the hospitals from where data were collected. Participants provided written informed consent. We ensured the confidentiality and anonymity of the participants by storing data in an encrypted USB and computer, allowing data access to the researchers only, and coding participants' names.

4. FINDINGS

4.1. Demographic information

In total, 16 nurses and physicians participated in the study including nine female and seven male participants with a mean age of 29 years. The years of clinical experience ranged from 1–10 years. All the participants were relocated to work in the SARS‐CoV‐2 units. The themes and subthemes are discussed as follows and presented in Table 1 with codes.

TABLE 1.

Codes and themes

Codes Subthemes Themes
Favoritism in scheduling Organizational nepotism Management abusing authority and blaming the victimized workforce
No merit‐based appreciations
Choosing favorite workers
Limited psychological support Neglecting frontline workforce
Nonavailability of organizational management
Unapproachable management
No appreciation or rewards
False accusations Unethical managerial actions
Organizational corruption
Overlooking differences in opinions Negotiating conflicts and prioritizing patient care Demonstrating professional humility and overcoming patient care issues at hand
Handling misunderstandings
Prioritizing patient needs over interpersonal issues
Sharing workload Practicing kindness
Emotional support
Being there for each other
Valuing each other's contribution
Counteracting aggressive family members Jointly managing conflicts with patients' families
Collaborative counseling for difficult patients and families
Handling conspiracy theories of patients and their families
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4.2. Theme 1: Management abusing authority and blaming the victimized workforce

This theme captured participants' views about organizational support during SARS‐CoV‐2. They were dissatisfied and saddened by the abusive actions and limited organizational support of the management. The participants noted that organizational management abused their authority, violated health care professionals' fundamental rights, and disrespected them. The administrators and managers also blamed the health professionals for personal wrongdoings. The following subthemes contribute towards a better understanding of this theme.

4.2.1. Organizational nepotism

Organizational nepotism was conceptualized as systemic biasness, favoritism, and discrimination of administrators and managers (Safina, 2015) toward health professionals. Participants believed that nepotism was widespread because the organizational management and the political leaders practiced bias. Health professionals noted that they also experienced discrimination in scheduling, appreciations, and rewards. They discussed that managers and administrators had their “favorite workers” who were never scheduled to work in the SARS‐COV‐2 units. This favoritism was based on personal acquaintances, political connections of the workers, and sometimes religion.

“I would have to say that management also discriminated based on religion. All the Christian nurses were scheduled to work in the SARS‐CoV‐2 unit. The management selected Christian nurses from emergency and intensive care units and told them to work in SARS‐CoV‐2. All of our management is Muslim.” (Participant 4)

One of the participants noted discrimination in scheduling.

“If health care providers had connections with the higher authorities or political leaders, they were not scheduled to work in SARS‐CoV‐2 units. This sort of bias was very blunt. I worked for 36 h, and then the next doctor who was supposed to relieve me did not show up. I received a call from the higher authorities ordering me to keep working in the same unit. Those who had links with authorities were able to change their duties and units without any issues.” (Participant 14)

Nurses noted that sometimes the managers discriminated against them and provided better resources to the physicians because physicians are more respected than nurses in the country. Participants shared that the appreciation for excellent work during SARS‐CoV‐2 were given to individuals based on their relationship with political leaders or organizational managers and administrators. It was noted that none of the awards were given on a merit basis.

“Support, not at all. Like, now the provincial government, the ministry of health, and different health care organizations, organized a ceremony and distributed certificates of appreciation among some health care providers, mainly managers. These certificates are meaningless and were not even given on a merit basis. None of the frontline nurses, doctors, and paramedical staff received any appreciation or reward for their work during the pandemic”. (Participant 2)

4.2.2. Unethical managerial actions

Participants noted that the managers and administrators engaged in unethical practices involving outright corruption and making false accusations against the health care providers. They noted that the provincial government announced rewards and salary packages for frontline health professionals, but these professionals never received those rewards and additional salary. One of the participants provided an elaborated account of this issue.

“Our country is far behind all other countries in health care. Health care is not given the emphasis that it deserved. There is a minimal budget for the pandemic. You would have seen the news too that only a small percentage of the budget was devoted to pandemic issues. Many politicians received extra salaries and rewards, but health care providers did not receive rewards or additional benefits. I mean if health care providers do not feel supported and rewarded, they may feel discouraged.” (Participant 11)

One participant raised a concern that the rewards were never distributed among the frontline workers.

“The government announced that health care providers would receive a double salary. But no one got the extra salary. We don't know If the management kept it, or the government did not provide the extra amount.” (Participant 10)

The participants noted that it was unclear how the funds were distributed across the health care system. They indicated that the management did not provide adequate resources, instead they accused the frontline workers of misusing the available resources.

“Whenever there were issues related to health care, these managers and administrators kept blaming the frontline care professionals. Like we had limited supply of oxygen for the patients in the units, and the administrators the unit in charge and nurses for using extra oxygen cylinders and not informing the shortage of supply timely.” (Participant 2)

4.2.3. Neglecting frontline workforce

Participants noted that the administrators and management neglected their needs and did not offer any emotional and psychological support. They raised concerns that seemingly the management and administration neglected the frontline workforce. The participants were either not allowed to or frowned upon entering the administrative offices. Except for a few managers, most of the administrators and managers did not visit the frontline workforce for any emotional or moral support. The participant also noted were minimal to no resources for frontline workers to seek support for stress, burnout, and emotional distress.

“The organizational management did not offer any support or rewards whatsoever. They never even visited and inquired the frontline workers about their issues. Yes, some unit managers were supportive and advocated for the frontline workers. But many managers did not. One of the managers locked himself in the room during working hours because he did not want any interaction with the frontline workers. Another manager went on a month‐long leave even though there was an extreme shortage of the staff.” (Participant 1)

The participants noted that the managers and administrators usually made decisions about health care professionals without considering their needs and challenges. They agreed that it was justified during the crisis but also expected the management to be more open in involving frontline workers in decisions. They were concerned that such decisions ultimately affected the quality of care for the patients.

“The management made some decision haphazardly. We expected them to be more open about involving health care professionals in making such decisions. Many important units like the cardiac emergency unit were shut down, and all the doctors were transferred to intensive care units. Then, many doctors were expected to manage their units and conduct additional rounds in covid units. These decisions are reasonable because we had a staff shortage, but I think it is management's responsibility to communicate about such changes on time. It is difficult and exhausting for us to switch units or work in multiple units without any prior notice. It just happened so fast that we could not do anything. Such abrupt decisions and our frustration and stress resulted in mismanagement of many cases. I do feel bad that we were not able to provide better care in such cases.” (Participant 13)

4.3. Theme 2: Demonstrating professional humility and overcoming patient care issues at hand

This theme captured the collaboration among nurses and physicians. In the absence of support from the administration and management, the participants supported each other, practiced compassion and kindness toward each other, and recognized the hard work that each other were doing. Although minor conflicts were noted, the participants overcame those issues. They focused on the more critical patient care‐related issues.

4.3.1. Negotiating conflicts and prioritizing patient care

The participants recognized that conflicts could arise due to intrapersonal and interpersonal challenges, stress, and burnout during such unprecedented times. Nevertheless, they noted that everyone made a deliberate effort to negotiate any arising conflicts. The participants also discussed that they had similar priorities and they all wanted to provide the best quality of care to their patients. Therefore, they overlooked minor differences and conflicts and collaborated to surmount the challenges posed by the pandemic.

“Whenever you work with individuals with different qualifications and professions, differences in opinions are a common thing. Like, nurses may have conflicts with doctors and vice versa. I think it happens because everyone is trying to do their best to care for the patients. But during this pandemic, I felt the conflicts and differences of opinions were overlooked, and nurses and doctors supported each other. Everyone's priority was to save patients' lives, so all health care professionals worked in great collaboration.” (Participant 15)

Nurses and physicians remarked about communication challenges, and misunderstandings among them arose due to workload and burnout. They were in physical, emotional, and moral distress and needed time to cope with their issues. Despite minor communication and collaboration problems, nurses and physicians cooperated and developed solutions to deal with issues that arose.

“SARS‐CoV‐2 led to frustration in nurses as well as doctors. Everyone believed that they are overburdened. Like nurses believed that they had more workload than doctors and vice versa. Now in this sort of situation resulted in many conflicts. But everyone did their best to address those issues.” (Participant 5)

4.3.2. Practicing kindness

Despite the challenging workplace settings and issues with the management and administration, participants practiced kindness toward each other. They appreciated each other for the hard work and valued each other's contribution toward effective patient care. The participant were providing emotional and psychological support to each other while trying to manage their fears and uncertainties and handling patients and their families' conflicts.

“I think nurses were considerate of the issues faced by doctors, and doctors also supported nurses when they had issues with their nursing management. I felt a lot of conventional issues among doctors and nurses were lessened during the pandemic. They respected each other and jointly worked to resolve any uncertain situations. There was more kindness than ever in the unit among frontline professionals.” (Participant 16)

Nurses noted that sometimes they felt physicians were not attending to the patients and were sending the nurses to handle their work. However, they realized that everyone was equally burdened and needed help in completing their responsibilities. Becoming more aware of other health professionals' stress enabled them to be more respectful and kinder toward each other.

“There were limited conflicts among and nurses. Yes, we had a few issues, like nurses felt that doctors did not attend to the patients and sent nurses to do their work. But all in all, thanks to God, there was great teamwork and support. I felt the management was more verbally abusive towards frontline workers.” (Participant 6)

4.3.3. Jointly managing conflicts with Patients' families

The participants discussed the issues surrounding negative behaviors, aggression, and abuse from patients and their families. They talked about the beliefs of patients' families on conspiracy theories. They outlined that these beliefs arose out of desperation and sometimes illiteracy. It was noted that many family members abused the nurses and physicians and blamed them for complicating their relatives' condition and even killing them. Participants acknowledged that they looked out for each other in such situations and collaborated to handle aggressive families. Therefore, they conducted collaborative counseling and teaching.

“I did not have any conflicts with nurses. In fact, it was good to see that nurses and doctors supported each other and collaborated well. We had many issues with the patients' families. Like many family members believed in conspiracy theories and were determined that doctors and nurses were injecting poisonous injections to their patients. While handling such aggressive family members, alhamdulillah doctors and nurses supported each other. They took collaborative measures to manage aggression from these families. We engaged in collaborative counseling and teaching of aggressive families and conducted some press conferences.” (Participant 12)

Nurses and physicians were devoted and dedicated to patient care and strived to meet their patients' needs. Nurses and physicians discussed that the situations were challenging and uncertain, requiring them to be more cognizant of the negative attitudes of patients' families. It was noted that all the participants focused on collaboratively addressing the demands of patients and their families in the best possible way.

“The collaboration among doctors and nurses was excellent during covid. Occasionally, there could be issues in general wards. But during the pandemic, I did not see any conflicts among doctors and nurses. Everyone was devoted to meeting the needs and demands of their patients and patient's families. The work was overwhelming, but all the doctors and nurses did their best to work out the issues with patients' families.” (Participant 8)

5. DISCUSSION

This study offered insights into nurses' and physicians' views about organizational support and nurse–physician collaboration during the SARS‐CoV‐2 pandemic. Nurses and physicians indicated a lack of support from the organizational administration and management. They recognized that lack of support could be because of the burden on health care organizations due to the pandemic. However, they also raised concerns about inadequate support and resource provision for emotional and psychological support to the frontline workforce. The participants highlighted that administrators and managers neglected the frontline workforce and their needs. Consistent with our study, Bennett et al. (2020) found that health care professionals in the United Kingdom described a sense of abandonment and disconnection from the organizational administration and management. These findings bring to our attention that health care organizations must play a proactive role in supporting the frontline workforce during the pandemic. Beckman et al. (2020) noted that organizational support could entail simple and concrete steps such as maintaining access to food, snacks, and bathroom breaks to advanced steps like providing assurance or taking care of their family members if they get infected. Many other authors outlined various strategies for organizations to offer psychological support to the frontline workforce. These include (a) offering regular and timely communication, (b) providing evidence‐based information about the management of SARS‐COV‐2, (c) becoming more available to health care professionals, (d) providing emotional and material support, (e) leading from the front, (f) giving autonomy to the professionals but being available to them, (g) providing staff in quarantine with supportive resources, and (h) educating and preparing unit‐level leadership for conducting debriefing sessions (Bolino, 2020; Guven, 2021; Hossny et al., 2022).

Nurses and physicians highlighted the issue of organizational nepotism that entailed discrimination and bias based on personal acquaintances, political connections, and sometimes religion. Consistently, health professionals in Turkey (Ay & Oktay, 2020; Yavuz et al., 2020), Pakistan (Abbas et al., 2021), and Saudi Arabia (Shubayra et al., 2022) also highlighted that nepotism is common in health care settings and resulted in a negative workplace environment, lack of trust and conflicts among professionals and management, and job dissatisfaction and attrition. These findings underscore the malpractice and power abuse of administrators and managers during the pandemic as experienced by frontline nurses and physicians. To date, only one study reported corruption and misuse of authority in health care during the pandemic (the Gonzalez‐Aquines & Kowalska‐Bobko study, 2022). Our study offers a new insights on the misuse of power by management during the pandemic. Health care organizations must take the necessary initiatives to address misuse of power, malpractice, and nepotism from managers and administrators and offer equitable working environments to health care professionals.

Tomlin et al. (2020) discussed that the pandemic's traumatic effects might affect the well‐being of frontline health care professionals in the long run. Therefore, organizations must support the workforce after the pandemic is over. Our results suggest that if the nurses and physicians did not receive adequate support during the pandemic, inadequate support would remain after this pandemic. We iterate calls to action to develop sustainable organizational‐level strategies to offer psychological support to the frontline workforce. Health administrators should continuously examine the usefulness of strategies and tailor them to meet the emerging needs of the frontline workforce (Tomlin et al., 2020; Walton et al., 2020).

We identified that to compensate for the limited support from administrators and managers, nurses and physicians encouraged and supported each other to tackle the intensive demands and burdens during the pandemic. Initially, the participants had some conflicts and miscommunication. However, it is interesting to note that the perceived lack of organizational support prompted them to engage in better collaborative work. Chemali et al. (2022) also noted that during the pandemic the relationships among interprofessional teams became more supportive and empowering. In this study, the health professionals looked beyond their conflicts, respected each other's views, and worked together to address patients' and their families' negative behaviors and attitudes. They also stay focused on their ethical and professional responsibility of saving patients' lives and ensuring effective medical and nursing care. Consistently, previous studies identified that initially, health professionals experienced a lack of communication, unrealistic role expectations, and lack of teamwork. Nevertheless, a few weeks into the pandemic, the collaboration improved (Arcadi et al., 2021; Liu et al., 2020).

5.1. Strengths and limitations

Pakistan is a low‐income country, and the resources available to handle the pandemic were limited compared to high‐income countries. This is the first study from Pakistan about the perspectives of health professionals regarding interprofessional collaboration and organizational support during the pandemic. Gaining insights from a purposive sample of nurses and physicians enabled the comparison of their views to generate a better understanding of organizational support. The use of a qualitative approach offered a more contextualized account of health professionals' experiences.

The views of health professionals were contingent on the nature of organizational culture in Pakistan's health care facilities. Therefore, the study results may have limited transferability to other countries with more sophisticated health care systems and organizations. The study was conducted in a few medical facilities in Pakistan and also may not be transferable to the entire country. The extent of organizational support and interprofessional collaboration may also be affected by contextual factors (e.g., the burden of SARS‐CoV‐2, staffing, workload, and resources) across different organizations. Therefore, further cross‐cultural research is needed to develop a more comprehensive understanding of organizational support and interprofessional collaboration during epidemics and pandemics across contexts.

6. CONCLUSIONS

The SARS‐CoV‐2 pandemic resulted in the dismantling of conventionally known nurse–physician hierarchical issues. Nurses and physicians prioritized patient care needs and family‐related conflicts over interprofessional tensions. Health professionals agreed that organizational support was inadequate, and some managers engaged in unethical and abusive practices. Health care organizations must not neglect to safeguard the rights of the frontline workforce and offer necessary physical, emotional, and psychological support during such a global crisis. Unit‐level management has an essential role in advocating for the rights of the frontline workforce.

7. RELEVANCE FOR CLINICAL PRACTICE

Nurses and physicians must continue to support each other even after this pandemic is over and sustain productive interactions to improve safe and effective patient care delivery. Nurses and physicians should remain aware of the factors that may affect their ability to sustain collaboration and provide safe patient care. Greater collaboration among nurses and physicians can help effectively address the negative beliefs of patients' families about SARS‐CoV‐2. Administrators and managers should (a) lead from the front and collaborate and support frontline health care workforce in sustaining collaborative practice to provide safe and effective care, (b) should assist the frontline workforce in managing the hostile and aggressive behaviors of patients and their families, and (c) use alternative methods (e.g., online and telephonic) of providing psychological support to frontline health care professionals, and ensure that professionals receive their deserved support and appreciation.

AUTHOR CONTRIBUTIONS

Hussan Zeb: Conceptualization; data curation; formal analysis; investigation; methodology; writing – original draft; writing – review and editing. Shahzad Inayat: Conceptualization; formal analysis; methodology; writing – original draft; writing – review and editing. Ahtisham Younas: Data curation; formal analysis; methodology; writing – original draft; writing – review and editing.

CONFLICT OF INTEREST

None declared.

ETHICS STATEMENT

Ethical approval was obtained from the relevant Ethical Review Committee (Approval No. 8/ERB/2021).

Zeb, H. , Inayat, S. , & Younas, A. (2023). Organizational support and Nurse–Physician collaboration during SARS‐CoV‐2 pandemic: A qualitative study. Nursing & Health Sciences, 1–9. 10.1111/nhs.13012

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Associated Data

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Data Availability Statement

The data that support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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