Table 1 Dynamic clinical experience subthemes and exemplar quotes

Staffing concerns and ensuring sufficient workforce

“And so the days were a little bit long and exhausting in the fact that it really took some mind—and some energy essentially, so mental energy to do that. Not only are you thinking about all the clinical stuff, but then you're also thinking about all of your actions and your movements, which you're not normally doing” (APP, Interview/FG 19)

“I could imagine this having gone one of two ways. One where we asked providers, hospitalists to do more, meaning if I work, 14 days a month then I'm going to work 21, I’m going to work an extra week because we don’t have enough staff. There was never an assumption that there was—Almost like never an expectation that we would have to work extra shifts, what the division did, was they set up help from outside the division. And I think, when it comes to well-being, one, not overworking the provider and making sure the provider is being heard, are two most important aspects. I'm not a big believer that doing yoga in the office is going to improve your wellbeing if you’re working a ton.” (MD/DO, Interview/FG 25)

"Hey, like we need to be prepared for this, this, and this. We're going to potentially surge you to the intensive care unit. We're going to potentially surge you to X, Y, or Z" It was like all these potentials, which was great to talk about, but at the same time before it happened, you're gasping, "Oh my god, like how bad is this going to get?". And then, you know, you're just hearing all this stuff. So, you know, the initial anxiety level was out of this world. (APP, Interview/FG 4)

“We were willing to be moldable, and I think like that was really key, like everyone just being like we’re all in this together and even though we only have the schedule one or two weeks out, we don’t really know what things are going to look like. We’re all like on the same team, and I think sometimes there was maybe too much of trying to predict what all things are going look like and not just be like let’s just see how things evolve, but that – I think that’s a balance. Right? Because people want to have some predictability to their schedule.” (APP, Interview/FG 6)

Role delineation and appropriate training/working to top of license

“Splitting things from a provider side of things is really great, because it took a lot of the burden off and I very much trust my APP colleagues to, you know, go in and examine a patient. Again, they were, they're the experts in dealing with COVID patients.” (MD/DO, Interview/FG 13)

“COVID surge was when nursing got flipped from—they pulled ortho nursing into, taking care of these COVID patients. I mean that was like a whole new learning curve for them. Getting comfortable, again, with the communication expectations from nursing and us was just a little bit of learning curve because this wasn't a group that we normally work with. I had lots of conversations with, floor managers, nursing managers about expectations because we were getting calls constantly about these patients. And some of them, you know, really legitimate and some of them were like, you know, as the days and weeks like, no, this is just a COVID patient, sadly.” (APP, Interview/FG 4)

Information sharing – centralized hubs and colleagues as resources

“The up-to-date summary. I reviewed that every time before I went on service. I reviewed the latest one, in addition to other literature, but it was stellar. And the ability to have someone to synthesize stuff as things went on, I knew that I had a document I could go to about best practices was really helpful.” (MD/DO, Interview/FG 1)

“And so it was important to have those daily updates or, frequent updates, and then, the call-in meetings that we'd have sometimes multiple times a day, with clinical operations leadership to get real-time issues addressed and resolved. There was a lot of questions that we always had. I think that was all very helpful and helped the division be dynamic and kind of adapt to different issues as they came up, specifically with a lot of these patients being under insured or not insured at all, or undocumented.” (APP, Interview/FG 12)

“Some days, it was just like, "Oh, I missed an email, everything will change.” (Nurse Manager, Interview/FG 22)

Importance of choice in COVID care – sense of autonomy/control over one’s work

“I think the only other kind of weird thing about this COVID time was the fact that there were COVID providers and non-COVID providers, and it created this kind of weird separation in our group or like I don’t want to judge someone that’s not comfortable doing COVID, and I like the fact that our division respects people’s health and their ability to take care of COVID patients or not, but I think it also created – it creates this kind of weird dynamic… I think everybody respected people’s privacy, and – but you know who’s not a COVID provider.” (APP, Interview/FG 3)