"There was no panic"-Nurse managers' organising work for COVID-19 patients in an outpatient clinic: A qualitative study.

aimTo provide insight into the contribution of nursing to the establishment and running of a hospital-based outpatient clinic for COVID-19 infected patients, and thereby to inform the development of similar nursing care and healthcare more generally.

designQualitative descriptive study centred on collaboration between nurse managers and researchers.

methodsDrawing on Donabedian's model of quality health services and the work of Allen on "Nurses' organising work", data were collected using four semi-structured, audio-recorded, focus group interviews with five nurse managers. The interviews were conducted in May and June 2020, transcribed, and subsequently analysed using deductive and inductive content analysis into an overarching category, main categories, and sub-categories.

results"There was no panic - challenged by the unprecedented" was a strong thread, which was reflected in two categories: (a) Everyone walked in step, containing the sub-categories: Public officials set the tone, Creating order in disorder, and Mutual respect and teamwork, and (b) Inspired by extraordinary accomplishments, encompassing the sub-categories: Realising one's potential and Unexpectedly rewarding. In exceptional circumstances the nurse managers' decision-making authority grew, material and manpower resources were sufficient, promptly constructed work procedures were in place, and tasks were completed instantly in trusting and respectful interdisciplinary collaboration. With sound support and trust from hospital directors, the nurse managers utilised their expertise to the fullest and they were proud of their work.

conclusionThe findings portray the almost invisible work of nurse managers in organising complex care. Although the circumstances were exceptional the findings speak to the accomplishments that can be gained when nurse managers have autonomy and the opportunity to utilise their professional capacity to the fullest. IMPACT: The findings reveal the almost invisible work of nurses in organising complex care and can inform the establishment of outpatient clinics for patients infected with COVID-19 and of healthcare development more generally.