Table 2

Theme 1: disruption

Quotation number	Participant ID, US region	Exemplar quotation
Blurred boundaries between work and home life
1	B, Pacific	I spent all day…in my COVID rooms wiping down counters, making sure everything is clean, coming in and out of PPE, and now I'm doing the same thing at home. So, I feel like I don't get that rest and that down time at home like I normally do. I'm surrounded by it…Dad comes out in his N-95 mask and is sitting at the breakfast table.
2	S, Northeast	We know what N-95s are, it’s a part of our day-to-day life, but to hear people that are non-medical all of a sudden mentioning N-95s and BiPAP and CPAP and how you can rig a machine that’s not a ventilator to operate like a ventilator, all of this medical stuff that’s part of our world, that’s not a part of society’s thinking.
3	A, Pacific	That escape from the sort of everyday hospital life to your personal life, that line has been blurred…It’s now a 24/7 thing…You don’t have that release afterwards of normalcy.
4	I, Pacific	People have said, if you are ill, you isolate yourself for 7 days…What about me as a family member?…There’s no guidance for a healthcare worker with a sick family member in terms of what you should do to reduce risk to others….I felt very confused.
5	C, Northeast	They’re telling people to mask at our grocery stores, and that literally happened before they were telling people to mask coming into our hospital…How does that make sense?
6	BB, Pacific	I was just so distracted that my mind was going a thousand places…I'm still sitting at my desk, and I'm not able to finish my work…What am I getting myself into? I do have a child at home and then my mother-in-law was here and she is [in her] 70 s, so just coming back to home and the fear of bringing something to your family. That was probably the most scary thing.
7	HH, Pacific	It's easy to feel that you're a little bit of a pariah…My daughter has a close friend that wants to spend time with her…[her friend's] parents don't want them together…I had this sense that part of it is because of me and what I do for a living.
8	L, Pacific	The actual clinical effects of the pandemic have not been super profound here. I would say the effects have been more personal with respect to like work/life stuff and dealing with kids at home all the time…The effect of this pandemic on parents of small children is just gigantic…You sort of take that [daycare] away, and it’s like oh my God, this is really a disaster.
Challenges to professional environment, roles and identity
9	L, Pacific	I get off of a 4-hour clinic session that I did all over Zoom, and I feel like someone hit me over the head. Which is not how I felt before with in-person visits…It’s not what we signed up for.
10	B, Pacific	In the hot zone [COVID unit], there's this white curtain of plastic around the nursing station…Once you're in, you spend an hour and a half to 2 hours of time in full PPE…It's a little bit like a spaceship. You put on your gear, you're in there, and now you're in outer space.
11	AA, Northeast	Maybe I shouldn't tell you this, but we have not been carrying stethoscopes for like, for the past eight weeks! It's been completely different medicine than we were trained to do.
12	A, Pacific	A ventilator is part of my job…This is what we do. That was definitely a challenge…I had to be mindful of the others who might need it in my own hospital. And then having to go to my colleagues in the ER and say…’if they’re stable enough to go somewhere else, we have to send them.’ And that’s not normal!
13	BB, Pacific	It kind of reminded me of intern year…Every day, every hour, I was learning something new and adapting to a change…There was no time for anything else in life. It was just that. And similarly, during the first week, it was just COVID! That's it. You are reading about COVID. You're learning about it. Your patients have to deal with it. How to protect yourself, the protocols, the protocol changes every hour.
14	K, Northeast	It’s one of the few times in my career where I potentially felt unsafe…Hearing stories about people who are young and healthy…When you see colleagues or people similar to yourself getting sick and affected, it hits very close to home. It made me feel vulnerable.
15	J, Northeast	I said to [my colleague], ‘You’re an older person…Stay home.’ Right? But meanwhile, the hospital wanted her to come in a couple of days a week…Her family was telling her to retire.
16	F, Pacific	I knew it was serious and out in the community. But I didn’t apply it to myself…I don’t think of myself that way. I would think of myself as: I’m a nurse, I’m a healthcare provider, I should be working. I never would’ve thought, oh, I’m high risk, I can’t work….It also felt like, am I also trying to cheat by not working?…My parents and my friends, they were like, ‘you shouldn’t be around all of these people all of the time.’ And I was like, that’s so strange, why do I not think that way?
17	JJ, Pacific	It's not hard to have empathy for people who can't breathe. But I had never experienced it myself. And I remember not being able to shower. I couldn't walk up the stairs. I would be turning the fan on to try to get air. It's the first time I've been really truly sick in my life.
18	LL, Pacific	I start all my visits off with patients asking, ‘Do you have food? Are you able to get your prescriptions? Who’s helping you?’…I feel like a lot of my patient interactions are less medical and more social or emotional support.
19	II, Pacific	It was just horrible. You know, I can tell myself she didn't die alone, and I can give her last message to her family, but it should never be that way. They should have been there. They should have been able to be there. Any other time they all would have been there for her.
Demands on leaders
20	H, Pacific	It started off running a sprint, moving into a marathon, [now] it feels like an ultra without a finish line; with bursts of speed in between that need to be added on, when you don’t really have the energy.
21	H, Pacific	It has been unparalleled in the amount of items that have come up from the surface and thrown at us from left, right, have fallen on us from above. Just when we feel that we have something under control…something else will have happened.
22	DD, Northeast	I explained to her [a nurse under the participant’s supervision] that, you know, [this] is the hospital policy. They want you to use a surgical mask, not the N-95 mask…She was one of the persons that got sick…If I had stood more firmly with her against what the hospital was doing…[I have] a lot of remorse, guilt, I wish I could do it again.
23	Q, South	The worst thing has really been seeing what the nurses have gone through during this crisis. I’ve felt a lot of guilt, I guess, about sort of overworking them and putting them in harm’s way.
24	KK, Pacific	My gut feeling all along was we should be masking, just because we didn’t know. But I wanted to support the [healthcare] organization and to set a good example to other staff…trying to follow policies.
25	W, Pacific	If you come up with a policy it may…be well thought out and make a lot of sense, what you're doing. But how that gets perceived, communicated, all of those things are actually vitally important…The optics of fairness play a major role in some of these considerations.
26	C, Northeast	I’ve really been thinking about how a document like this [looks] in the light of day, how does it read, how it’s interpreted. It makes sense to me, in my training, in my values and ethics, but does it make sense to potentially the folks it will be affecting?
27	H, Pacific	I tried pretty hard not to use the word ‘frontline…Because frontline really implies war…You don’t want staff to feel like they’re on a war front, it’s not like a battle every day that they’re at work, it’s their job and they’re there to take care of people who really need them.
28	D, Pacific	I’m not used to having to project confidence for the sake of the team when I myself have a certain amount of uncertainty. And it’s not dishonest, I think for the sake of them [the staff] and their daily ability to come to work and feel like they’re supported and functional, I had to, a little bit, project more confidence than I had.
29	LL, Pacific	I think there’s a lot of stress on healthcare workers during this time to be brave and to act like we know the answers, and to feel strong for those around us…That’s sometimes a hard façade to keep up under a stressful and uncertain time, and I would feel emotionally exhausted at the end of the day.

BiPAP, bilevel positive airway pressure; CPAP, continuous positive airway pressure; ER, emergency room; PPE, personal protective equipment.