Organizational interventions and strategies for COVID-19 pandemic management in acute care setting: A qualitative interview study with nurse leaders in German hospitals.

Background: The rapid spread of SARS-CoV-2 in 2020 exposed unprepared healthcare systems worldwide. In Germany, acute care hospitals faced significant challenges, particularly in organizing adequate personal protective equipment, managing high mortality rates, and accommodating extended hospitalization of patients with COVID-19. Objective: This study aimed to explore the perspectives of nurse leaders on organizational interventions and strategies implemented in hospitals to address pandemic-associated challenges and derive knowledge for future crises. Design: A qualitative descriptive study was conducted between July 2022 and June 2023, utilizing semi-structured interviews with nurse leaders across different management levels (strategic, middle, and operative management) in hospitals in Saxony, Germany. Setting: This study was conducted in hospitals across Saxony, Germany. Participants: The study included 30 nurse leaders from nine different hospitals, representing a diverse sample in terms of hospital characteristics (ownership, hospital size, regional distribution, and level of care) and participant demographics. Methods: Data were collected through semi-structured interviews, transcribed, and analyzed using qualitative content analysis in MAXQDA. Results: Eight strategies were identified (four core and four secondary) with various corresponding interventions that hospitals used to manage the pandemic, including infection control, adaptation of hospital capacities, human resource management, direct patient care delivery, management of the provision of non-COVID-19 care, transparent organization of the flow of information and decision-making, cooperation and teamwork, and evaluation and flexible adaptation. This study highlights the importance of flexibility, creativity, internal and external support, leadership, crisis communication, participatory decision-making, evaluation, and error management in crisis management. Conclusion: This study provides a comprehensive documentation of hospital pandemic management from the perspective of nurse leaders, offering a basis for future research and practice. Effective hospital pandemic management requires a flexible, context-specific approach supported by strong leadership, internal and external support, and participatory processes. These findings emphasize the need for ongoing evaluation during crises and for a culture that encourages reflection and learning from crises to improve future responses.