Fight or flight-intensive care nurses' decisions to resign following the COVID-19 pandemic: a phenomenological hermeneutical study.

Background: Many intensive care unit (ICU) nurses who were crucial to the frontline response during the COVID-19 pandemic left their employment during or after the pandemic. Studies exploring the experiences of these nurses are lacking. The aim of this study was to explore ICU nurses' course towards making the decision to resign from work in the ICU following the COVID-19 pandemic.

Method: Advertisements on social media and a snowball sampling-inspired method were used to recruit 11 nurses from hospitals around Sweden who worked in an ICU during the pandemic and who then left employment. The participants were interviewed individually via telephone, online or in-person. An interview guide with a few open-ended questions was used to capture the nurses' narratives. The data were analysed using a phenomenological hermeneutical method.

Results: The nurses were tangled in paradoxes, described as three themes: 'To give it all and yet feel insufficient', 'To experience togetherness and yet feel lonely' and 'To prioritise others and yet need to eventually prioritise oneself'. The decision to end their employment was ambivalent but necessary, made with relief and no regrets, but with sorrow. During this decision-making process, there may have been a window of opportunity during which nursing management or the health care service might have influenced the outcome.

Conclusion: The ICU nurses' decision to resign was influenced by a tangle of challenging paradoxes that entailed ambivalence. The course to the decision to resign was marked by hesitancy. While it is important to understand and support nurses' willingness to care for patients during a crisis and to acknowledge their suffering as it relates to their professional efforts, it is also essential to address their individual struggles and needs.