Nursing Workforce Management and Competencies for Secondary and Tertiary Care during the COVID-19 Crisis in Health Region 10

Abstract

The increasing number of COVID-19 patients during the pandemic posed a great challenge for health care services. Nurses have a vital role, not only in providing care, but also in managing other health care services, in regard to the varied hospital resources challenges. This qualitative research aimed to synthesize lessons learned from the COVID-19 crisis experiences regarding nursing competencies and workforce management in Health Region 10 of Thailand. Document analysis, in-depth interviews, and focus group discussions were used to collect data from October 2021 to April 2022. The 293 key informants included the Ministry of Public Health (MOPH) inspector of Health Region 10, representatives of the Thailand Nursing and Midwifery Council, representatives of the Nursing Division of the MOPH, the provincial chief medical officer, a group from the emergency operation center (EOC) committee, hospital directors, heads of nursing departments, physicians, infection control (IC) nurses, and nurses engaged in COVID-19 patient care. The data were analyzed using content analysis. The study revealed that: 1) workforce management in response to the crisis included 1.1) implementation of nursing staff pooled from different units through nurses volunteer co-operation or direct command; 1.2) modifying working hours from 8-hour shifts to 12-hour shifts; and 1.3) assigning head nurses of lower workload units as supervisors to the COVID-19 cohort wards. And 2) strengthening nursing competency focusing on: 2.1 designing educational modules on nursing care for COVID-19 patients with regard to infection control and prevention; 2.2) on-the-job training; 2.3) training self-directed learning skills to nurses to independently online search available COVID-19 knowledge resources; and 2.4) the IC nurses played a major role in infection control competency of the hospital staff, as well as informing the most update COVID-19 practice guidelines. The most common training sessions included the donning (putting on) and doffing (removing) of personal protection equipment (PPE) and the powered air purifying respirators (PAPR), intubation in COVID-19 patients, automatic cardiopulmonary resuscitation (auto-CPR), prone positioning in ARDS (acute respiratory distress syndrome) COVID-19 patients, and mechanical ventilation care. The key success factor for coping the crisis was the collaboration from all partners and stakeholders. The policy recommendations for the present study included setting measures for comprehensive nursing workforce management and essential competency to handle crisis situations, developing the nurse workforce system and mechanisms in order to retain nurses in the system, implementing education and training programs to promote nurses’ competency, continuously, and creating working environments conducive to nurses providing direct patient care professionally.