Nursing executives' response to COVID-19 in Spain. An ethnographic study

To describe the role of Executive Nurse Leaders (ENLs) in the response to the COVID-19 pandemic in Spain.

A qualitative descriptive study with an ethnographic approach and direct qualitative content analysis was designed. Twenty-five semi-structured interviews were conducted with ENLs who held senior management positions in one of the two management areas: autonomous health policy and healthcare organisation. The study includes the following executive roles: Chief Nurse Executive in autonomous government policy, Chief Executive Officer, Chief Nurse Officer, and Assistant Chief Nurse Officer in healthcare organisations. The sample includes most autonomous communities in Spain.

Four themes and seven subthemes were identified. Theme 1. Health crisis: Negative outlook on the situation despite the new opportunities made possible by the pandemic. Theme 2. Action areas: The ENLs were involved in areas of management: autonomous policy, healthcare organisation and shared areas. Theme 3. Accompanying patients: Widespread criticism of visitation bans and the nurses' response to the restrictions. Theme 4. Communication: Characteristics' communication description, information management and communication strategies towards staff or the public.

The results demonstrate the vital role that ENLs played in managing the response to the pandemic. In the context studied, the interviewees' scope and degree of participation differed in each autonomous community. Understanding the role of ENLs helps respond to major healthcare challenges, raises their leadership visibility and facilitates social and institutional recognition. Advocating for the involvement of ENLs at the executive levels studied will help to improve the country's preparedness for future health crises.