Emergent Organizing in Crisis: US Nurses’ Sensemaking and Job Crafting During COVID-19

Abstract

Crisis situations may render some roles meaningless or modify the meanings of existing roles. In general, employees participate in job crafting to alter or redefine their tasks and relationships to enhance their meaningfulness. Drawing on Weick’s sensemaking theory, this article explores how nurses working directly with COVID-19 patients participate in job crafting amid a pandemic crisis. It proposes an iterative conceptual framework in which sensemaking via the cycle of enactment, selection, and retention informs job crafting, thus contributing to emergent organizing. This enactment of emergent organizing provides fodder for further sensemaking, which highlights the symbiotic relationship between sensemaking and job crafting. Practically speaking, in order to facilitate sensemaking, job crafting, and organizing, management must acknowledge and impart flexibility, and must be open to impromptu thinking by nurses.

Keywords

crisis emergent organization sensemaking job crafting resilience

When COVID-19 first emerged, frontline healthcare workers faced extraordinary challenges: hospitals overtaxed by record numbers of admissions and deaths along with a scarcity of essential resources. Health care workers did their best to improvise, and nurses took on a variety of new duties, from phlebotomy to physical therapy to mopping floors (Stone, 2020). News reports suggest that improvisations formulated by these workers during the first wave of the pandemic were instrumental in creating a safer work environment for them as subsequent waves emerged.

Crisis often presents both role challenges and opportunities for employees (Berg et al., 2010; Lewis, 2019). During crisis, stakeholders take the challenges and turn them into opportunities by improvising or modifying their procedures, equipment, status, and locations (Cunha et al., 2002; Webb, 2004). Improvisation may be conceptualized as actions that unfold as organizational members draw on available cognitive, affective, material, and social resources (Crossan & Sorrenti, 2002). “Improvising” is often used interchangeably with “job crafting” (Leana et al., 2009), where job crafting denotes “the actions employees take to shape, mold, and redefine their jobs” to make them more meaningful (Wrzesniewski & Dutton, 2001, p. 180). We believe it is crucial that stakeholders engage in job crafting during a crisis, when many roles are rendered meaningless, role meanings are modified, and novel, discursively created meanings emerge both intentionally and inadvertently. This improvisation or job crafting also facilitates resilience by helping organizations, teams, and individuals recover (Doerfel et al., 2010; Kendra & Wachtendorf, 2003) because stakeholders are able to relax their institutional modus operandi to accommodate the current organizational needs (Rerup, 2001; Wolbers et al., 2018). Importantly, we know that during crisis situations, when stakeholders are formulating new plans to cope with the crisis, they engage in sensemaking to reduce the ambiguity, uncertainty, and equivocality around organizing (Weick, 1988; Weick & Roberts, 1993). However, not enough research exists on understanding the relationship between sensemaking and job crafting and how these unfold in crises.

The current inductive study explores how nurses improvise and craft their tasks and relationships during the pandemic and utilize the framework of sensemaking, especially enactment, selection, and retention, to understand the nuances of this process. The study contributes to management and communication theories by suggesting an iterative cycle, in which sensemaking contributes to job crafting, which provides fodder for sensemaking. This encapsulates the ongoing emergent organizing that takes place during crisis. As individuals modify their roles and relationships, they draw upon their past assumptions and create new ones through their interactions, which may sometimes contradict one another, and inform their decisions to craft individually or collaboratively.

A Cascading Crisis: The Pandemic

According to Seeger and Mitra (2019), a crisis is “a specific, unexpected, non-routine event or a series of events that creates a high level of uncertainty and a significant or perceived threat to high priority goals” (p. 253). Crisis may be seen as a singular event in time or as a process that unfolds before, during, and after an event (Chewning & Doerfel, 2013; Seeger & Mitra, 2019; Williams et al., 2017). Pandemics exemplify crisis both as event and ongoing process, which Stephens et al. (2020) called a “cascading disaster”. The initial emergence of COVID-19 itself was a cataclysmic, precipitating event that led to many unique challenges that intensified the crisis for multiple stakeholder groups. For instance, lack of protective equipment, ventilator shortages, noncompliance with mask wearing, and hoarding commodities, such as toilet paper, fostered the cascade. In addition to the cascading aspects, pandemics may be differentiated from other crisis situations because no one body or organization may be held accountable for the crisis (Seeger & Mitra, 2019). Building on Seeger and Mitra’s suggestion, our goal in this article is to explore how individuals participate in job crafting during a transnational crisis. Recent research has shown that a crisis such as the COVID-19 pandemic poses remarkable challenges for organizations and requires quicker turnaround and integration of resources along with tough, on-the-spot decision making by frontline workers (Thürmer et al., 2020). Thus, reinventing channels and processes of communication to overcome hurdles faced by existing channels and practices becomes critical. We argue that improvisations of communication strategies and channels are key to crisis management that helps develop resilience.

Job Crafting: Role Meaningfulness, Improvisation, and Resilience

Improvisations are common during crisis, to accommodate the changing needs that arise during an uncertain situation (Doerfel et al., 2010; Kendra & Wachtendorf, 2003). Improvisation is equated to job crafting, as individuals improvise to make their roles more meaningful (Wrzesniewski & Dutton, 2001). Job crafting is known to increase job satisfaction and motivation and ultimately enhances performance. Job crafting helps employees proactively attain (i.e., reach desirable goals) and reactively meet (i.e., cope with adversity) the changing requirements of the organization (Demerouti et al., 2015; Lazazzara et al., 2020). The three categories of job crafting include task crafting, relational crafting, and cognitive crafting (Berg et al., 2013). Employees may craft their tasks by deviating from their prescribed responsibilities via adding or dropping tasks, altering the nature of tasks, or changing the time, energy, and attention devoted to various tasks. Relational crafting focuses on employee interaction with others, in which they may vary how, when, or with whom they interact. Cognitive crafting occurs when employees change the way they perceive the tasks at hand and make them more meaningful.

Scholars have also begun to look at the communicative aspects of job crafting, which occur at the team level and are collaborative in nature (Leana et al., 2009). In teams, such as nursing units, individuals work closely with one another, which requires communication, cooperation, and coordination. As Leana et al. suggested, job crafting can thus be carried out collaboratively through the joint efforts of teams or it may be conducted individually. Discretion, task interdependence, supportive supervision, and social ties motivate collaborative job crafting.

These improvisations and innovations are also key in developing resilience (Doerfel et al., 2010; Kendra & Wachtendorf, 2003). As stakeholders engage in fragmented environments with different types of coordination, they increase loosely coupled actions that facilitate improvisation and resilience by relaxing their institutional modus operandi (Rerup, 2001; Wolbers et al., 2018). Williams et al.'s (2017) review of the literature found a link between improvising and resilience, a link that is important because the ability and latitude to improvise leads to the ability to cope with crisis and to bounce back. This article seeks to explore similar job crafting interactions and improvisations in the context of nursing work during crisis by utilizing Weick’s sensemaking framework.

Sensemaking and Crisis

Weick’s (1979) work on sensemaking is vital to understanding crisis because crisis brings about ambiguity, uncertainty, and equivocality. Sensemaking is rooted in the idea that when catastrophes suddenly occur, there is no time to think them through in the moment and instead, a post-event reasoning and discursive process occurs that affects not only what we do but also who we believe ourselves to be—our very identities (Weick, 1988; Weick et al., 2005). Sensemaking helps us shed light on organizational resilience during devastating events, especially as individuals and collectives endeavor to craft and improvise new ways of understanding a problem and finding solutions (Stephens et al., 2020; Weick, 1993). We believe that, with regard to improvisation, the sensemaking framework is especially useful as it pays attention to identity construction, the ongoing/cyclical process of identifying problems and their solutions, extracting cues from past familiar situations to understand the current one, and the plausibility associated with workable solutions (Weick et al., 2005).

Organizations essentially talk/think their realities into existence via these three activities: enactment, selection, and retention (Weick, 1979; Weick et al., 2005). Enactment is “action that produces the raw materials that can then be made sensible,” selection is essentially pulling out cues considered relevant from experiencing a situation and using them to figure out what is happening, while retention is a matter of saving the conclusions we derive from selection (Weick, 1979, p. 133). During crisis, people “reinterpret their surroundings and craft new understandings of and solutions to a new set of problems” (Stephens et al., 2020, p. 427). For instance, in high-reliability organizations that constantly operate in catastrophic, highly complex, and risky contexts, such as the military or firefighting, it is helpful if leaders encourage and enable team members to derive their own interpretation of the volatile situation in order to avoid fatal and disastrous errors (Baran & Scott, 2010).

Weick and Roberts (1993) also talked about heedful interrelating, which focuses on how behaviors are enacted by team members or coworkers as they engage in sensemaking. Team members or coworkers interact sensitively to the task at hand, develop assumptions about the given evolving situation, and pay attention to how their action can impact the overall functioning of their team or unit (Daniel & Jordan, 2017). Therefore, their actions have implications for the team and the unit with both intended and unintended consequences. It is an important process by which team and unit members draw conclusions about what is plausible.

Relatedly, researchers have examined the important role of sensegiving, which is “to influence the sensemaking and meaning construction of others towards a preferred definition of organizational reality” (Gioia & Chittipeddi, 1991, p. 442). Sensegiving is an attempt to reframe the sensemaking process through communication (Will & Pies, 2018). Stakeholders use hypotheticals, framing of particular ideals, and emotional expressions as sensegiving strategies (Corley & Gioia, 2004; Scarduzio & Tracy, 2015). For instance, nurses engage in sensegiving with their patients to encourage meaningful involvement (Gilstrap, 2020) and with their peers to support their work (Lunkka & Suhonen, 2015).

Nursing Identity

Scholarship has often suggested that a nurse’s identity is patient-centered (Fagermoen, 1997). However, we now know that this identity is very fluid and dependent upon complex constructs associated with social and cultural values, education, work values, work context, and public image (Bell et al., 2015). More current research also iterates the growing needs around collaborative work practices and team-based organizing in nursing work (Barry et al., 2019). For instance, public health research details effective teamwork as including facets of accountability, autonomy, openness, trust, psychological safety, and collective efficacy, where members believe that their teams can succeed (Pype et al., 2018; Traylor et al., 2021). Traylor and colleagues discussed the need for team resilience during public health crises with leaders fostering inclusiveness to welcome new ideas. While necessary, this collaborative climate can also increase the communication demand, which may lead to feelings of disengagement and stress (Apker et al., 2020). Coworker support has been found to be important for the demanding nature of nursing work, and it can improve nurses’ resilience (Wang et al., 2018).

Nurses encounter other notable stressors as well, including exposure to infectious diseases, toxic substances, violence, and radiation (Institute of Medicine, 1995; Lim et al., 2010; McVicar, 2003), which were evident during the COVID-19 crisis (Mo et al., 2020; Zhan et al., 2020). These exogenous factors bolster the collective identities of health care workers, which facilitates improvisation (Wiedner et al., 2020).

While scholars have looked at these changing expectations in the healthcare industry that often add to both tangible demands and stress on nurses, few studies have focused on the communicative aspects of the nurse’s identity and role improvisation during pandemics (Iserson, 2020; Sheng et al., 2020). Of particular interest here is understanding how nurses engage in sensemaking and sensegiving during a crisis and its impact on job crafting. This lens is especially useful as we approach the inductive data analysis, drawing upon improvisation-related job crafting theory to help understand the data. Therefore, our research question asks:

RQ1: How do nurses engage in sensemaking with respect to improvisation and job crafting during a global health care crisis?

Methodology

Sample

Qualitative research, consisting of semi-structured telephone interviews, was conducted in May 2020, at the height of the first wave of the COVID-19 pandemic in the United States. This facilitated gathering a detailed description that helped us explore the lived experience of the participants (Emerson et al., 2011). We conducted pilot interviews (data not used in our analysis) with five nurses to understand the current context, which helped us narrow our semi-structured interview questions (Sampson, 2004).

Twenty-four hospital-based nurses who cared directly for COVID-19 patients participated in the interviews. They verbally consented to the study, which was in agreement with our institutional review board’s approval. It was a difficult population to reach during this time, especially as these nurses were working around the clock. The researchers connected with the nurses via messaging through snowball sampling. Nurses often were interviewed during their breaks or when their shift ended. We continued interviews until we reached theoretical saturation (Morse, 1995).

The lead researcher used their network of medical professionals to draw the initial sample, contacting five nurses and one nursing manager in these states: New York, New Jersey, Pennsylvania, and Illinois. Snowball sampling followed.

Of the 24 nurses, 20 were female and four were male. Also, the majority (18) were from the East Coast states mentioned above, and six were from the Chicago area (see Appendix). All were between 24 and 61 years old; four were under 30, and four were over 45. They had been nurses for at least 3 years and less than 20 years, but most had 5–10 years of nursing experience, all had a baccalaureate degree, and nearly all (23) were employed in 800-bed or larger facilities. These nurses were normally assigned to medical/surgical units (10), intensive care (6), and pulmonary care (5) before being reassigned to COVID-19 cases. The remaining few had worked in various areas as floaters.

Data Collection

The interviews averaged 52 minutes in length, ranging from 35 to 118 minutes. Where allowed by the participant, interviews were recorded (n = 21), then transcribed. In those instances where participants preferred not to be recorded (n = 4), copious notes were taken. Memos were compiled, and one-third of the nurses were asked to review the emerging themes as a way of member checking or as a validity check. Interview questions included: was your work influenced by COVID-19, what concerns has this pandemic caused, what are some new challenges for you, were you able to overcome these challenges, and how did you do that?

Data Analysis

The established method of thematic analysis was implemented to explore themes in emergent organizing in the raw data with respect to job crafting through the framework of sensemaking (Braun & Clarke, 2006; Nowell et al., 2017). Our goal was to create a rigorous, well-documented, epistemologically based analysis using Nowell et al.'s phased approach to guide this inquiry (Holloway & Todres, 2003; Nowell et al., 2017). Nowell et al.'s six phases include the following: becoming acquainted with the data, creating preliminary codes, seeking themes, rethinking themes, giving definitions and names to themes, and creating a document to report the themes. What follows describes how each of Nowell et al.'s phases was applied in this research.

Phase 1: All raw data were examined multiple times, and after careful consideration and deliberation, the main concepts and possible codes from data collection regarding job crafting were noted. Phase 2: The researcher plus an additional coder discussed their impressions of the research and collaboratively coded three transcripts through open line-by-line coding to develop preliminary codes and definitions. This was an ongoing, iterative process with electronic meetings between the coders occurring on a regular basis to discuss their notes and impressions of the data. Phase 3: As a hierarchy of themes was extracted from the codes, interrelationships among themes were also explored. Phase 4: Themes were explicated, and the two researchers communicated frequently to delve deeper into the themes and develop and agree on subthemes. We used the sensemaking lens to explore these themes further. Phase 5: This phase consisted of additional review and discussion of the themes as well as finalizing and documenting the name of each theme. Phase 6: For member checking, nurses assessed the themes and findings for accuracy.

To illustrate this process, flexing rules emerged as a recurring code, and that was related to other codes such as credibility and retribution, which fell under the umbrella theme of task crafting. This was confirmed during member checking.

Findings

Drawing from the job crafting and improvisation literature, the study found that nurses relied on their occupational identity and reinvented their roles and relationships. Nurses participated in sensemaking to reduce uncertainty and ambiguity, which contributed to emergent organizing through job crafting. The cycle of sensemaking via enactment, selection, and retention was evident in these data (Weick, 1979; Weick et al., 2005).

Sensemaking Identity

Nurses’ multifaceted identity was used as a building block for improvisation and job crafting. Our data indicate that nurses made sense of their role during the crisis by paying attention to the various aspects of their identity, especially perceptions about their expansive mission, adaptability, flexibility, risk, and knowledge.

Perceptions about the Expansive Mission

Nurses spoke about a comprehensive mission, which included the patient, multiple lives associated with the patient, and the society as a whole. This cognitive reframing emphasized a more expansive objective. As one nurse said, “It is a reminder that our work is much more than just taking care of a patient. It is about multiple lives attached to that patient. It is about our society and public” (NURSE 3). The environmental cues, including the responsibility nurses recognized in being at the forefront, legitimized this more comprehensive need for their service. They bracketed this need, in which they were motivated and even directed to play different caregiving roles, allowing them to make their roles more multifaceted. These extra roles require additional effort, which is motivated by a refocus on their adaptability, and, importantly, on perceptions of safety and knowledge, as this nurse points out: “we are going above and beyond, changing constantly and adapting to keep us and our patients safe.… We rely on our experiences, on-the-job knowledge, and even schooling” (NURSE 8). Nurses focused on the shifting and almost experimental nature of their roles, in which they tried to find solutions to help these different stakeholders, especially given the paucity of constructive information about the virus and limited resources.

Perceptions about Adaptability

When in doubt about modifying the rules, nurses often focused on the adaptation rationale. They emphasized that nursing work had always been flexible and open to change. They reiterated that this strength was perceived and sanctioned by other stakeholders including hospital administration during COVID-19. One nurse emphatically explained her impressions of nurses’ flexibility, as well as their management’s communication of their attitudes toward it as enactment, “we are flexing more now because it’s necessary… It comes with the territory. Everyone gets it, even the higher ups” (NURSE 12). This explanation was plausible and ratified by several other nurses. As COVID-19 reshaped nurses’ roles, most nurses felt that their management, especially their direct supervisors, was more open to them flexing rules and practices. The above excerpt also indicates that before COVID-19, there may have been some tension between nurses and management regarding flexibility, in terms of who was managing the nurses and how much flexibility and bricolage was acceptable. One nurse explains the verbal and nonverbal communication involved in this emergent organizing:

We adapt, but again in the past there were rules around how much and who was overseeing this. That changed with COVID. Nothing worked. So we focused on adapting. [Nurse] managers were more accepting of this, [who] either told us to find whatever worked, or provided unspoken approval, sometimes by looking away. (NURSE 8)

During the crisis, nurses focused on the adaptability rationale when all else failed, which allowed them to create innovative solutions. Nurses were thankful especially to their direct management’s flexibility, whether it was communicated overtly or tacitly. The sensemaking cycle shows that nurses and their nurse managers bracketed the dysfunctional situation, which led them to select and retain the adaptability rationale, which contributed to emergent organizing and enhanced resilience. Nurses spoke favorably about the flexibility offered by direct managers. As this nurse posits, “we work very closely with our unit supervisors and their opinion matters the most. Other [senior] management is not really on the floor, especially now” (NURSE18).

Perceptions about Risk and Safety

Even amid massive uncertainty, nurses found ways of reassuring themselves that they were protected and could function in severely adverse situations. They did this by shifting the focus from uncertainty and fear to a more positive narrative of protection and safety in order to carry on during the crisis. This helped them do their jobs better and also helped them craft tasks like making masks when personal protective equipment [PPE] was scarce. A nurse reflects on this:

And we all just looked, kind of breathing in really fast and like how are we controlling it. And I just looked at them, and I was like, guys, look. We are protected as much as we can. You just have to not think about it. (NURSE 21)

Another nurse asserted that they all constantly reminded each other of these safety measures to provide some sense of security, which also helped develop team efficacy:

Just yesterday, I broke down, and this other nurse reminded me, “We will be fine, we have been handling ourselves and we know it can get real, but we can do this.” I think she was assuring me and herself. (NURSE 10)

Nurses understood the need for a more optimistic narrative focused on their current actions. This helped them reassure both themselves, through sensemaking, and each other, through sensegiving, that the precautions they were taking were adequate. Reassuring others through sensegiving helped build team efficacy because it reduced anxiety and provided much-needed support. As this nurse points out, “things changed and we all on the unit felt better, safer. She [coworker] just reminded us that we were doing it right” (NURSE 16).

Perceptions about Expertise and Knowledge

Importantly, nurses relied on their existing knowledge and education when making sense of their safety. They bracketed their concerns regarding the dearth of knowledge about the disease while reminding themselves of the fundamentals of care and the aspects of the human body that they were knowledgeable about. This knowledge was their greatest asset in dealing with the COVID-19 infection, as reflected here: “There were so many things where we were like, all right, we don’t know this, but we know what we’ve been taught. We know to look at other disease processes, how we went about with that” (NURSE 22). Past knowledge and expertise motivated improvisation, because nurses felt confident communicating about building on the basic knowledge and expertise they already had. This was also helpful for the unit as a whole, because many nurses in these units were moved to a COVID-19 unit from other departments and were unacquainted with each other and unaccustomed to working together, as this nurse indicates:

Other than the Med-Surg nurses who knew each other, everyone else was fresh. We didn’t know each other’s styles, but we know basics of patient care and hygiene, we have similar experiences, so we talked to each other and found common ground. This helped with finding solutions together. (NURSE 21)

Nurses’ perceptions of their expansive mission, adaptability, and safety also influenced improvisation of tasks and relationships.

Sensemaking Roles and Tasks

Nurses reinvented and improvised their roles by interacting with material, spatial, and social systems to remain afloat as they made sense of the crisis. They crafted their roles to make the best of the situation when moved into other roles. They also used spatial innovation, technological innovation, and flexed rules to accommodate changing needs during the crisis. Task improvisation and job crafting became essential because of the dire situation the pandemic created.

Repurposing Nurses

Many nurses were reshuffled and moved to different units because elective procedures were no longer being performed during the pandemic. “Repurposing” was a term that was widely used by the nurses during the interviews. While this restructuring was officiated by the organization, nurses working in the COVID-19 units discussed different ways in which they proactively used the new help as an extra set of hands. The nurses who were reshuffled to COVID-19 units were not asked to work directly with the COVID-19 patients. Instead, they were involved in other important chores and nursing work that required significant attention, like recording protective gear and helping nurses safely don and remove PPE. As one nurse pointed out, “If you’re my extra hands, that is perfect, because you have nursing knowledge and skills. You might not know how to do ICU skills, but you know how to do your skills, and we will utilize you as best we can” (NURSE 8).

The same nurse explained that, despite uncertainty and pandemonium during the initial weeks of the pandemic, she figured out a way to utilize the additional help, paving the way for others to follow her strategy:

I started to request them [nurses moved from other units] to do other things like help with PPE or just with cleanup or charts… It was enormous help… I think other members from my floor thought it was useful too and then we all started to do this and later this became more formalized. (NURSE 8)

Here, the nurse brackets the very common repurposing phenomenon that emerged during COVID-19 and discusses how she utilized the additional help for other necessary tasks precipitated by the crisis. This enactment of repurposing nurses led this nurse to formulate a particular plan for division of labor through selection that was later retained and formalized by the organization. Nurses engaged in heedful interrelating and reframed tasks to help others who were moved from different units.

Heedful Interrelating

To exemplify this emergent organizing, a nurse noticed that most nurses who were asked to relocate to the COVID-19 unit without expertise in infectious diseases felt uncertain with the sudden shift, which they communicated to their new peers. These communication cues led this nurse to bracket the instance and select ways to reconstruct roles. As she explains:

I could sense this uncertainty. She [a nurse who was newly moved to the COVID-19 unit] told me that she hadn’t done a direct bedside service, dealing with alert patients, in a long time… I was like, then why don’t we give them [the nurses who were reshuffled] these other tasks, so that they don’t have to be in the room with the patient. (NURSE 8)

Through heedful interrelating, the nurse contributes an idea based on the needs of the unit and the hesitations expressed by her new peers. This heedfulness provided new meaning to these uncertain roles, as nurses found novel ways of organizing the redistributed personnel via communication. Therefore, to make the reorganization more meaningful and sensible to individual nurses, it became important to assign them critical and relevant tasks, which helped the unit and also added to nurses’ resilience. This new allotment of work helped create some level of certainty in the very ambiguous crisis. As the nurse states, “I had other nurses approach me and tell me that this provided them with some solid understanding of what they were required to do, especially because they were from other floors and areas of expertise” (NURSE 8). This improved the overall effectiveness and efficacy while reducing uncertainty and added to their resilience, as nurses resumed their work robustly.

Reframing

As these new roles were enacted, however, many nurses felt unhappy with their new duties, saying that these undermined their expertise. In such cases, peers helped them change their narrative by setting forth a positive vision, and communicating that through sensegiving:

Many felt that their expertise was not put to use or [was] undermined. I remember convincing some senior nurses from medsurg [medical/surgical units] that this was important work. We all spoke about the essential services, pointed out a different perspective, where we needed them, which was very different from their initial reaction. (NURSE 5)

By reframing the narrative, this direct approach to sensegiving between peers was important for job crafting and increasing nurses’ acceptance of the restructured roles. Nurses participated in sensegiving by communicating with others and persuading them that the new work they were doing was invaluable. In summary, as evident here, the sensemaking cycle paved the way for job crafting, and as job crafting was enacted, it led to additional sensemaking and sensegiving.

Spatial Innovation

Space was an important variable in this crisis due to the communicable nature of the disease. Nurses found effective ways of coping with both the risk of the illness and the large volume of patients. For instance, nurses restricted the number of people directly providing care to their patients and had nurse runners on standby outside each room to help bring them necessary items such as intravenous (IV) lines. In another instance, they created “hallway pods, where nurses with assignments in one hallway could rotate between patients based on their need and availability” (NURSE 11). In this case, the nurse mentioned that these spatial strategies were collaboratively crafted through discourse with management and other nurses. It was evident to the nurses that the usual strategies were not working during this pandemic, and they often collectively discussed these challenges and participated in sensemaking to form new strategies. For instance, the same nurse who spoke about the genesis of the hallway pods said, “So, we sat down. We’re like, ‘How are we gonna make this work?’” Therefore, much of this job crafting was organically collaborative in nature, when nurses and nursing managers came together, discussed and bracketed situations, selected strategies through heedful interrelating, and retained those that worked.

Nursing management was generally open to having such discussions that afforded nurses the freedom to brainstorm solutions by sensemaking collaboratively and even sharing their ideas through sensegiving. This contributed to emergent organizing, as pointed out here:

Our supervisor called a meeting and asked us to identify the space-related problems. Unit nurses and an infectious disease expert came to the meeting to find solutions. This was new for us. We shared our experiences from the past 2–3 weeks to change how we were managing our space. (NURSE 23)

Through this collaborative effort promoted by the direct supervisor, the enactment of space use was identified as a problem. During selection, nurses highlighted the types of challenges they were facing and came up with the hallway pod plan, and then retained the plan, making the sensemaking cycle clearly visible, which contributed to more emergent organizing whereby the supervisor brought together multiple stakeholders to aid in interpreting the challenges, brainstorming, and thinking through diverse possibilities.

Technological Innovation

Nurses recognized that either technology could be used to aid the care process or technology could be modified to make it safer. Nurses bracketed several challenges that were created by the usual technologies, as these were not ideal for COVID-19 times. For instance, they realized that many procedures were causing issues due to the slow speed of sterilization and many people required to accomplish it. They recognized that reducing the rooms to negative pressure would solve both problems. As the nurse explained, “My [direct] supervisor asked us to figure it out, and I was like let’s try this. Move the patients to rooms with negative pressure” (NURSE 20). This excerpt also reflects the autonomy and flexibility afforded by direct supervisors that assisted with improvisation. Similarly, another nurse spoke about how the freedom to make decisions made the technologies and procedures safer, when normal intubation practices did not work. For example, nurses “put a bag over the intubation tube and took it out directly and put the mask right over the patient’s face” (NURSE 22).

Some of these innovations also required the nurses to break existing rules, which was identified as a key theme for task crafting.

Flexing Rules

This theme was closely linked to sensemaking around the adaptation rationale discussed earlier. Nurses often mentioned flexing rules and procedures to provide better patient care during the pandemic crisis. “Flexing rules” was the exact verbiage they used. Many of them drew a distinction between flexing rules and breaking rules, justifying flexing as crucial for both their patients and the inundated health care system:

Oh yes, we flexed. We had to in order to accommodate the number of patients we were getting. For instance, everything needs to be scanned. We put off the scanning for later. It got done, but we were shifting patients and controlling their oxygen levels and didn’t have the time to scan right when we were doing multiple things. (NURSE 15)

Nurses talked about how scanning items, such as medications, while providing patient care had become an issue. The preceding excerpt reflects the need for better and more plausible patient care that arose, especially because the existing practices created more challenges. This again reflects emergent organizing that was prompted through sensemaking. Nurses observed and bracketed the instances when they were receiving a large number of patients, and in order to tend to those patients, they decided to delay scanning. However, in these instances, nurses formulated and tested different correcting strategies before initiating discourse with their units. For example, the nurse who brought up the scanning idea explained, “The nurse first tested it and then told us that it was faster. She wanted to be sure before she brought it to us because first, we are flexing the rules and second it is about her credibility as a nurse, her name is on the line” (NURSE 15). While the adaptation rationale was important, the capacity to adapt was based on multiple factors. Taking accountability was concerning due to past assumptions about flexing rules, because nurse management had not been very supportive of that in the past. Therefore, as nurses bracketed the needs for flexing, they also struggled with interpreting past assumptions that led them to initially improvise individually to avoid facing any ramifications regarding liability and credibility. However, even though nurses were improvising individually without coordination, it was still heedful interrelating, as they accounted for the needs of their unit and the challenges they faced.

Furthermore, this individual bricolage required some degree of autonomy, which the crisis situation afforded, especially as the governing bodies at multiple levels within the organization (nurse managers, nursing executives, and those overseeing the joint commission’s safety standards regarding processes and procedures in the hospitals) often turned a blind eye to what was being done due to the novelty of the disease or simply because they did not have time to check on the rules:

If people would see the things we are rigging, and how we are doing it, they would be spinning… It’s funny how none of them have come to check on us either. So, in order to have these IV poles outside of the room, we have to rig extension tubing. It’s all over the place. We have it organized, but it’s on the floor … it’s so against all the Joint Commission’s standards. But we’ve adapted. (NURSE 8)

Nurse managers and leadership communicated their tacit approval by overlooking how certain standard procedures were tweaked and carried out. Moreover, flexing was also important for resilience to create a more workable system for nurses during difficult times. As one nurse posited, “it [flexing] helped us look forward. We weren’t stuck anymore. It was worth the risk” (NURSE 9). As this nurse posited, flexing helped nurses cope with the crisis, which was worth the risk.

In many cases, the tested ideas were adopted by the unit, where members began to work with and refine them. For instance, a nurse explained voluntarily doing due diligence to improve these ideas: “We also saw a lot of nurses stepping up and making masks for each other when the PPE was low. Some other nurses were constantly doing research to find out ways to better what we were doing to help the hospital” (NURSE 6). Therefore, these ideas moved from individual to collaborative efforts, where teams fine-tuned them further.

Sensemaking Relationships

Job crafting and improvising social relationships were important for forging nurses’ resilience. The study found that this type of improvisation was especially salient as nurses were job crafting their relationships not only with other nurses but also with patients and their families.

Atypical Patient and Family Support

Nurses participated in providing exceptional patient and family support, especially since families could not be in the room with patients. Nurses connected patients with their families by using their own personal technology, staying with patients until the end, constantly updating families, and motivating and celebrating patient recovery. While this caused additional emotional labor, they deemed it necessary, as is evident here:

We were using smartphones before to make sure that our patients could talk to them [their families] … We have been taking pictures and making videos. I made a slide show. We try and do social media videos, like for TikTok and Instagram. (NURSE 12)

By using their personal phones to connect the families, nurses engaged in an organically collaborative communicative improvisation. When discussing use of private cell phones, one nurse stated that they were getting more calls from different family members because they could not be there with the patient. There was no guidance around using their personal phones to connect the families, and they realized “if we all did it, there wouldn’t be official trouble” (NURSE 16). Nurses collectively engaged in sensemaking around this issue from day one. They pulled out relevant cues that indicated, “more family members were calling us for information” (NURSE 17), as enactment. These cues motivated the nurses to create and maintain more avenues of communication for the families to see the patients, including use of personal technology, as selection. However, nurses felt that utilizing their cell phones and social “apps” like Facetime could generate negative repercussions from nurse management, if individually adopted; therefore, they united in a collaborative effort that helped shield individual nurses from being singled out. As one nurse pointed out, this was based on their interpretation of past assumptions: “we have never really had to do that. I believe there were regulations around this, so it made sense to protect ourselves, but still help in all the ways we could” (NURSE 6).

Adopting and retaining these personal technologies further enhanced the communication between patients and their families. This is a direct example of how sensemaking is engaged in emergent organizing, with nurses deciding to job craft collaboratively to shield individual nurses. This particular way of organizing also provided fodder for further sensemaking and finding solutions for other challenges, highlighting the iterative relationship between sensemaking and job crafting. As another nurse pointed out, “As we worked on this [personal technologies] together, I realized we could also come together to resolve our PPE limitations and create masks and shields” (NURSE 6). The technology-related enactment became a baseline for further sensemaking for PPE development, thus highlighting the iterative in-the-moment organizing process.

Nurses did everything in their power to keep patients and their families connected and communicating. Even though her patient was unresponsive, NURSE 8 would whisper in her ear and tell her things her family wanted her to know. She felt obligated to connect patients with their families and stayed with patients as they transitioned. These cues indicated to nurses that they had to play multiple roles, such as the role of a grief counselor, and highlighted their expanded core identity, which helped them make sense of the situation, and also disclosed their emotional labor.

Additional Peer Support

Nurses sought and provided additional peer support with their colleagues, especially because of the uncertainty around this disease, the high mortality rate, and the reshuffling of units. This enactment needed enhancement in light of the unusually difficult times. Nurses provided counseling support to each other by using motivational boards and mediated spaces. A nurse summed it up: “It’s more peer to peer … We just kind of work on this on our own. We talk about our bad days. We cry to each other when we need to” (NURSE 8).

Nurses used their established relationships to positively adjust and function in the COVID-19 environment, which defined an important aspect of the process of team resilience. This peer-to-peer support was particularly useful when nurses lost patients and needed to vent and cry. The same nurse spoke at length about how those nurses who were moved from different units also needed the additional support, “These nurses need that extra help because they really are starting afresh. We have changed their tasks from being a surgery nurse to a PPE expert. They need to feel like they also belong and have an important part to play” (NURSE 8). This was another example of sensegiving and reactive improvisation as nurses provided additional motivation to peers.

Nurses also established more proactive, social spaces to motivate each other, as this nurse explained, “We started an Instagram page to motivate our nurses and also our managers went and wrote motivational messages in the parking lots” (NURSE 2). This was particularly helpful for nurses’ self-efficacy and confidence. Nurses understood the importance of all of these inspirational messages, especially as they received demoralizing cues from caring for those with COVID-19. They selected and retained the need for establishing these venues to provide peer-to-peer support and motivation.

Discussion

These interviews call upon scholars to consider how emergent organizing materializes as nurses engage in sensemaking (Weick, 1979; Weick et al., 2005), as they craft their roles, tasks, and relationships during a crisis to make them meaningful and sensible (Wrzesniewski & Dutton, 2001). We propose a conceptual framework based on this that also includes theoretical implications for nursing identity (Bell et al., 2015; Fagermoen, 1997) and resilience (Doerfel et al., 2010; Kendra & Wachtendorf, 2003). Practical implications are also explored.

Conceptual Framework

The data suggest that sensemaking contributes to the process of job crafting in two ways that are interdependent. First, sensemaking helps individuals interpret and identify roles, tasks, relationships and even cognitions that need shaping, molding, or redefining to make them more understandable, and ultimately more meaningful. Interpreting and understanding the different assumptions is critical for deriving meaningfulness, which allows individuals to organize in particular ways. Individuals invest in job crafting for themselves and for the collective good to surmount challenges thrown at them, their patients, and their peers during crisis. Second, sensemaking impacts how individuals go about crafting their jobs, which is vital to emergent organizing occurring during the sensemaking process.

Conceptualizing this symbiotic dance between sensemaking and job crafting highlights an iterative sequence, in which both the process and the outcome of job crafting influence and are influenced by sensemaking. This iterative process contributes to emergent organizing. This emergent organizing is simultaneously bracketed, which leads to further modifications in assumptions and ideas via sensemaking that further modify organizing.

Sensemaking and Job Crafting Tasks and Relationships

Our data suggest that by bracketing events [enacting], selecting job crafting techniques, and retaining them, nurses made sense of what was required and implemented improvisations to make their crisis tasks and relationships more plausible. As nurses engaged in sensemaking, they drew upon their nursing identity (Bell et al., 2015; Fagermoen, 1997) which promoted job crafting. Their past knowledge and expertise provided nurses with the confidence to improvise, while their adaptive identity and the expansive mission allowed nurses to make much-needed technological changes and enabled making spatial adjustments, flexing rules, and providing atypical patient and peer support. Nurses realized that they had to offer each other additional sustenance through motivation and sensegiving to improve feelings of efficacy around completing tasks (Wiedner et al., 2020; Will & Pies, 2018; Williams et al., 2017). These adjustments led to nurses developing even greater resilience as they coped with the crisis together (Doerfel et al., 2010; Rerup, 2001; Wolbers et al., 2018).

Sensemaking the Job Crafting Process

Relatedly, the sensemaking process led to emergent organizing as individuals made sense of how they should go about crafting their tasks and relationships and reframe the meaning of the new roles. Unlike high-reliability organizations that are used to controlling disaster through knowledge of teammates and collective experiences (Baran & Scott, 2010), the nurses in our study had minimal experience with this crisis or with some of their unit members. Sensemaking helped them find commonalities for connection. For instance, the sensemaking around nursing identity, especially identification with coworkers based on common understandings of patient care and past experiences, promoted collective thinking. Older nurses participated in heedful interrelating to craft roles for those new to the units, as a way to help. As the newly moved nurses enacted the newly formed roles, they further engaged in sensemaking and expressed the challenges they felt, which were later addressed through reframing and sensegiving. Importantly, nurses developed new assumptions around organizing, which were applied to resolving other challenges.

For some nurses, the interpretations around old assumptions versus the new ones conflicted with each other, further complicating organizing. While autonomy was important for job crafting, the conflicting assumptions around autonomy and retribution impacted emergent organizing. Organizing often occurred more hurriedly than usual because the crisis compressed nurses’ timeframe for engaging in this process. Even with management’s tacit (e.g., nurse managers provide their acceptance by looking the other way) or active (e.g., nurse managers actively create and promote collaborative spaces) openness to flexing, nurses felt that they were in uncharted territory and often responded based on previous negative notions associated with flexing. As a result of these two factors, nurses selected to improvise on their own and then shared their tried and tested methods with others. This allowed them to job craft but protected them from deleterious ramifications and threats to their credibility. In other situations, nurses chose to participate in collaborative crafting as a way to avoid being singled out for retribution. In sum, through sensemaking, individuals comprehended the contradictions around assumptions related to autonomy, credibility, and anticipated repercussions that contributed to job crafting as a form of emergent organizing.

Practical Implications

Nurses are survivors, adept at adapting to unique and challenging situations (Institute of Medicine, 1995; Lim et al., 2010). They need autonomy and discretion to create workable solutions to evolving problems (Iserson, 2020). Therefore, it is useful for hospital administrators, especially those who work directly with these nurses, to permit and encourage greater flexibility for nurses to alter their modus operandi.

Nurses must also receive special training for the multiple roles they may be required to fill during a pandemic crisis. Their technical and interpersonal skills are highly relevant in crises. However, this does not mean that the nurses are solely responsible and obligated to perform all tasks. Organizations will have to restructure and reconfigure ways to divide responsibility and reduce the extraordinary physical and emotional labor nurses experience. This crisis highlighted the autonomous role of nurses, who in many cases are singlehandedly taking care of their patients and calling the shots on a minute-by-minute basis. However, nurses also felt the tension between autonomy and retribution, because prior to the COVID-19 crisis, their direct managers were not open to flexing. Therefore, they were invested in finding ways to job craft that would not cause them problems. These findings underscored nurses’ need for more structural, emotional, and social support to help change the assumptions and the mindset around job crafting.

This research demonstrates that nurses value their peer relationships (Apker et al., 2020). Management can encourage and facilitate these peer support groups. Nurses expressed appreciation of management when they either passively or overtly allowed improvisations that ran counter to the usual hospital guidelines and past assumptions.

Limitation and Future Research

An important limitation here is the evolving nature of the crisis. Government and academic research communicated different recommendations and information regarding the COVID-19 contagion process as time progressed. We expect that if this study were conducted now, after many months of experience with the pandemic and with more reliable information about the virus, nurses’ focus for improvisation, job crafting, and emergent organizing may differ. Therefore, follow-up studies may explore changes in nurses’ perspectives as the crisis continues.

Future studies would be useful for determining where to draw the line in allowing nurses the freedom to coopt solutions to problems without jeopardizing health and safety regulations or conflicting with management objectives. Focus groups with hospital management and nurses could be used to explore that. Another option would be creating a series of survey questions based on the themes that emerged from this research and implementing it with a broader sample of nurses in the United States to understand how sensemaking and job crafting can impact efficiency and resilience.

Conclusions

Job crafting was evident in interviews with nurses who worked with COVID-19 patients. Nurses engaged in both sensemaking and sensegiving that helped identify and modify roles and relationships that needed crafting. Importantly, sensemaking contributed to emergent organizing as individuals were making their roles more meaningful, by reflecting on their identities, which created resilience. Job crafting was either individual or collaborative in nature and depended on shifting and sometimes conflicting assumptions around autonomy, credibility, and anticipated retribution.

The overarching conceptual takeaway from this research is that, due to the unstable nature of the evolving crisis generating a pervasive atmosphere of uncertainty, nurses used sensemaking and sensegiving to job craft. Weick’s (1979) cycle of enactment, selection, and retention was reflected in our data, as nurses identified what they needed to change and how they needed to go about changing it. Sensemaking and job crafting were thus symbiotically related, where nurses participated in sensemaking to identify and craft their roles, relationships, and the process of improvisation, contributing to emergent organizing.

Footnotes

Acknowledgments

We would like to thank Dr. Matthew Weber for his insights on the article, along with our reviewers and editor for their terrific feedback.

Declaration Of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Surabhi Sahay

Appendix

Participant	Age	Gender	State
1	24	Female	IL
2	28	Male	PA
3	28	Male	NJ
4	29	Female	PA
5	30	Female	IL
6	32	Male	IL
7	33	Female	NY
8	33	Female	NY
9	35	Female	NJ
10	36	Female	NJ
11	37	Female	PA
12	37	Male	PA
13	40	Female	PA
14	41	Female	PA
15	42	Female	NY
16	42	Female	IL
17	43	Female	PA
18	43	Female	NY
19	43	Female	IL
20	44	Female	NJ
21	46	Female	NJ
22	48	Female	IL
23	52	Female	PA
24	61	Female	NY

Author Biographies

Surabhi Sahay (PhD, Rutgers University) is an assistant professor of corporate communication at Pennsylvania State University, Abington, USA. Her main research interests include investigating stakeholder participation during organizational change.

Maria Dwyer (PhD, Rutgers University) is a retired lecturer from Rutgers University, USA. She continues to be involved in research on organizational change and leadership communication.

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