Impact of the Covid-19 crisis on the hospital work environment and organization: A mixed-methods study

Figures & data

Table 1. Magnet components and their forces of magnetism.

Magnet component	Forces of magnetism represented
Transformational leadership	Quality of nursing leadership management style
Structural empowerment	Organizational structure Personnel policies and programs Community and the healthcare organization Image of nursing professional development
Exemplary professional practice	Professional models of care Consultation and resources Autonomy nurses as teachers Interdisciplinary relationships
New knowledge, innovation and improvements	Quality improvement
Empirical quality results	Quality of care

Table 2. Descriptive statistics of the socio-demographics and employment for the quantitative phase (COMET questionnaire).

Categories	Number (%)
Gender
Male	30 (30.61)
Female	67 (68.37)
Missing	1 (1.02)
Function
Physician	10 (10.2)
Resident	7 (7.14)
Nurse	81 (82.65)
Service
University Hospital
Emergency department	33 (33.67)
ICU	9 (9.18)
Recovery room	6 (6.12)
Oncology department	5 (5.1)
Pneumology department	9 (9.18)
Regional hospital
ICU	7 (7.14)
Recovery	8 (8.16)
Oncology department	12 (12.24)
Pneumology department	9 (9.18)
Unit
Covid	67 (68.37)
Non-Covid	31 (31.63)
Work length (in %)	100 [80; 100]
Length at hospital (in months)	118.5 [45.75; 213]
Length at unit (in months)	92.5 [38.25; 189]

Table 3. Descriptive statistics (median and interquartile range) of the sub-dimensions of the COMET over two time points.

Dimensions	Time 0		Time 1		Both group		N	Cronbach's alpha
	Non-Covid	Covid	Non-Covid	Covid	Time 0	Time 1
Professional involvement
Unit engagement	4.00 [3.50; 4.40]	3.60 [3.40; 4.20]	4.00 [3.60; 4.45]	3.60 [3.40; 4.00]	3.80 [3.40; 4.20]	3.70 [3.40; 4.40]	96	0.680
Standards reception	3.00 [2.00; 3.50]	3.00 [2.50; 4.00]	3.00 [2.00; 3.50]	3.00 [2.50; 3.50]	3.00 [2.50; 3.50]	3.00 [2.50; 3.50]	96	0.637
Perceived results of unit performance
Job satisfaction	3.67 [3.25; 4.00]	3.00 [2.75; 3.50]	3.50 [2.50; 4.00]	3.00 [2.25; 3.50]	3.25 [2.75; 3.75]	3.00 [2.50; 3.50]	98	0.696
Intention to stay	4.50 [4.00; 5.00]	4.00 [3.00; 4.50]	4.50 [4.0; 5.00]	3.50 [3.00; 4.50]	4.00 [3.38; 4.50]	4.00 [3.00; 4.50]	98	0.238
Absence of work overload	2.50 [2.00; 3.50]	2.00 [2.00; 3.00]	2.50 [1.50; 3.50]	2.00 [2.00; 3.00]	2.50 [2.00; 3.00]	2.00 [1.50; 3.00]	98	0.616
Absence of burnout	3.20 [2.60; 4.00]	3.40 [3.00; 3.80]	2.60 [2.20; 3.20]	3.20 [2.60; 3.60]	3.40 [2.80; 4.00]	3.00 [2.40; 3.40]	98	0.695
Perceived effectiveness of the unit	3.50 [3.25; 4.00]	3.25 [2.75; 3.50]	3.25 [2.50; 3.75]	3.00 [2.50; 3.25]	3.25 [2.94; 3.75]	3.00 [2.50; 3.38]	98	0.670
Unit management
Consideration of the individual in the collective	3.50 [2.75; 4.00]	3.00 [2.25; 3.50]	3.25 [2.25; 4.00]	3.00 [2.25; 3.50]	3.00 [2.50; 3.75]	3.00 [2.25; 3.75]	96	0.830
Weak discriminatory practices	5.00 [4.00; 5.00]	4.00 [4.00; 5.00]	5.00 [4.00; 5.00]	4.00 [4.00; 5.00]	4.50 [4.00; 5.00]	4.50 [4.00; 5.00]	96	0.858
Task and objective assignment	3.67 [2.67; 4.00]	3.67 [3.00; 4.00]	3.33 [2.67; 4.00]	3.33 [3.00; 4.00]	3.67 [3.00; 4.00]	3.33 [2.75; 4.00]	96	0.706
Organizational learning	3.50 [2.75; 3.81]	3.25 [3.00; 3.75]	3.38 [2.75; 3.75]	3.50 [3.00; 4.00]	3.50 [3.00; 3.75]	3.50 [2.89; 4.00]	97	0.699
Low conflict incidence	3.38 [3.00; 4.00]	3.25 [2.75; 3.75]	3.38 [3.00; 4.00]	3.25 [2.75; 3.75]	3.25 [2.75; 3.75]	3.25 [2.75; 3.75]	97	0.724
Relationship and communication
Relationships between paramedics	4.00 [3.67; 4.00]	4.00 [3.67; 4.00]	4.00 [3.59; 4.33]	4.00 [3.67; 4.33]	4.00 [3.67; 4.00]	4.00 [3.67; 4.33]	96	0.553
Relationships with and between physicians	3.50 [3.17; 3.87]	3.33 [3.00; 3.67]	3.67 [3.17; 4.05]	3.50 [3.00; 4.00]	3.50 [3.00; 3.83]	3.50 [3.00; 4.00]	97	0.779
Unit coordination	3.25 [2.50; 4.00]	3.00 [2.50; 3.50]	3.00 [2.50; 4.00]	3.00 [2.50; 4.00]	3.00 [2.50; 4.00]	3.00 [2.5; 4.00]	97	0.621
Information dissemination	3.42 [2.67; 4.00]	3.33 [2.67; 3.67]	3.42 [2.67; 4.00]	3.33 [2.67; 4.00]	3.33 [2.67; 4.00]	3.33 [2.67; 4.00]	97	0.804
Relationship with the patient and family	3.80 [3.15; 4.20]	3.40 [3.00; 3.80]	3.70 [3.00; 4.20]	3.60 [3.20; 3.80]	3.60 [3.00; 4.00]	3.60 [3.20; 3.80]	97	0.709
Hierarchical support	3.67 [3.11; 4.00]	3.67 [3.44; 4.00]	3.73 [3.11; 4.06]	3.78 [3.55; 4.03]	3.67 [3.44; 4.00]	3.78 [3.44; 4.00]	96	0.895

Table 5. Numbers and percentage of positive ratings of the three categorical sub-dimensions of the COMEt over two time points.

Dimensions	Time 0			Time 1			Both group			N	Cronbach's alpha
	Non-Covid	Covid	P-value	Non-Covid	Covid	P-value	Time 0	Time 1	P-value
Professional aspirations											0.605
Patient concern	28 (96.6)	65 (97.0)	1.000	27 (93.1)	64 (95.5)	0.636	93 (96.9)	91 (94.8)	0.625	96
Conflict management mode											0.711
Absence of problem denial	14 (48.3)	28 (41.8)	0.609	13 (44.8)	35 (52.2)	0.290	42 (43.8)	48 (50.0)	0.162	96
Type of behaviors encouraged in the unit											0.741
Productivity	24 (80.0)	59 (89.4)	0.055	22 (73.3)	60 (90.9)	0.017	83 (86.5)	82 (85.4)	0.572	96
Collaboration	26 (86.7)	57 (86.4)	0.896	25 (83.3)	69 (90.9)	0.387	83 (86.5)	85 (88.5)	0.990	96

Note. The numbers and percentages in parentheses represent the positive ratings (merging ratings of 4 and 5) of each sub-dimension.

Table 4. Effects of time and working unit across different dimensions of the COMET – results from mixed model analysis adjusted for work time.

Dependent variables	Time (1 vs. 0)			Unit (Covid vs. non-Covid)
	Coefficient (SE)	P-value	${\eta }_p^2$	Coefficient (SE)	P-value	${\eta }_p^2$
Professional involvement
Unit engagement	−0.027 (0.027)	0.334	0.005	−0.253 (0.122)	0.040	0.022
Standards reception	−0.042 (0.037)	0.266	0.007	0.199 (0.185)	0.284	0.006
Perceived results of unit performance
Job satisfaction	−0.270 (0.061)	<0.001	0.092	−0.420 (0.143)	0.004	0.043
Intention to stay	−0.056 (0.029)	0.052	0.019	−0.530 (0.156)	0.001	0.056
Absence of work overload	−0.051 (0.051)	0.316	0.005	−0.161 (0.211)	0.445	0.003
Absence of burnout	−0.361 (0.107)	0.001	0.056	0.305 (0.115)	0.009	0.035
Perceived effectiveness of the unit	−0.273 (0.043)	<0.001	0.175	−0.323 (0.132)	0.015	0.030
Unit management
Consideration of the individual in the collective	−0.070 (0.055)	0.206	0.008	−0.340 (0.184)	0.066	0.018
Weak discriminatory practices	−0.016 (0.024)	0.513	0.002	−0.099 (0.158)	0.531	0.002
Task and objective assignment^a	−0.114 (0.041)	0.006	0.045	0.237 (0.166)	0.157	0.012
Organizational learning	0.072 (0.045)	0.108	0.014	0.088 (0.148)	0.554	0.002
Low conflict incidence	0.004 (0.035)	0.904	0.000	−0.132 (0.158)	0.406	0.004
Relationship and communication
Relationships between paramedics	0.091 (0.035)	0.010	0.035	−0.006 (0.120)	0.963	0.000
Relationships with and between physicians^a	0.062 (0.030)	0.042	0.025	−0.198 (0.145)	0.175	0.011
Unit coordination	0.098 (0.069)	0.160	0.010	−0.013 (0.188)	0.945	0.000
Information dissemination	−0.012 (0.062)	0.848	0.000	−0.079 (0.181)	0.663	0.001
Relationship with the patient and family	−0.014 (0.048)	0.771	0.000	−0.254 (0.138)	0.067	0.017
Hierarchical support	0.035 (0.023)	0.125	0.012	0.114 (0.173)	0.509	0.002

^a Adjusted for work time.

Table 6. Number of pluses and deltas across the different COMEt dimensions.

COMEt Dimensions	Plus, n (%)	Delta, n (%)
Perceived results of unit performance	107 (33.75)	131 (46.45)***
Relationship and communication	70 (22.08)***	16 (5.67)
Hierarchical support	56 (17.67)	73 (25.89)**
Unit management	43 (13.56)	39 (13.83)
Professional involvement	38 (11.99)***	7 (2.48)
Relationship with the patient and family	3 (0.95)	16 (5.67)***
Total	317 (100)	282 (100)

***P < 0.001, **P < 0.05.