The unswerving dedication of NHS staff has been an outstanding element in the fight against Covid-19 over the past few months, winning them huge respect and admiration from the general public as they struggled to cope with enormous challenges. Often on the brink of exhaustion and with the constant fear that they too might fall victim to an unforgiving disease.
“I’m now in my sixth year of being a qualified nurse, having qualified with first-class honours in 2014, but nursing patients who have tested positive for COVID have presented challenges to my clinical skills that I haven’t encountered before.
“We have protocols, national and local guidance that is tried and tested, but the patients I was encountering were not responding in the usual way.
“When the news first broke about coronavirus, in honesty, I didn’t take much notice. That isn’t meant to sound harsh, but when you work in healthcare, you are continually working around illness and diseases, so you become desensitised.
“As more cases were starting to be reported, especially in Italy, I thought, oh, this isn’t looking like nothing. Italy has an excellent healthcare system, to hear that they were becoming overwhelmed started to make me feel uneasy, but even then, I didn’t envisage it becoming a global pandemic.
“In hindsight, I think I thought this is just the media being overzealous! How wrong I was! However, it is hardly surprising it’s turned into a pandemic. We can cross the globe in a day, and everything we do is about contact with others. From business, travel, social occasions and even healthcare, we are continually mixing with others from all over the globe – it was only a matter of time.
“I came across my first COVID positive patient at the end of March, so shortly after lockdown. It became very real, very quickly. Much of my department was redeployed to the wards, so it became my role to cover inpatients. I am a senior diabetes specialist nurse and independent nurse prescriber, so the inpatient role involves managing patients admitted with various complications of their diabetes. This can be anything from life-threatening issues to simple issues related to their medications. However, patients with diabetes who were COVID positive were presenting new challenges to me – these people were very sick.
“The Trust I work for quickly cascaded the latest information, rolling out a FIT test (medical grade face mask fitting to staff) and provided educational support and guidance on where to obtain PPE and advice to keep one another safe.
“I appreciate that other areas of the country have had major issues with PPE supplies. Personally, I have had access to all the PPE I have needed throughout the pandemic. If there have been any supply issues, I am unaware of them. I can’t imagine what other people around the country have been feeling. Having to go to work in the middle of a pandemic, knowing you may or may not have adequate protection should never happen. In my case, I haven’t encountered any issues. I’ve been fortunate.”
Did Sarah experience any kind of fear factor?
“Absolutely!” she replied. “We get a constant stream of new information from the media, and that naturally will add to any anxiety or worry. I’m a born worrier! However, I am also able to rationalise most things. The difference this time was my colleagues. In the NHS, we are one big family. We support one another and deal with stressful situations regularly and are mostly gutsy, tactile individuals.
“However, I noticed a very distinct change in the atmosphere very quickly. There was an air of fear, people were naturally more distant, and even the most experienced of my colleagues appeared to look worried. You know something is awful when even the most unshakeable of clinicians are looking worried.
“I struggled mentally when I heard of a young colleague dying of COVID. Although she wasn’t working for the Trust at the time, she had the type of personality that wasn’t easily forgotten. It brought it home to everyone that this is here in the UK, and it is a genuine, invisible, indiscriminate threat. For the following couple of weeks, I was very low and scared to go to work.”
“The routine takes a lot longer when dealing with any infectious illness. There are always standard infections controls, but with a relatively unknown virus, things get ramped up even further. Things take longer to do because you cannot risk transmitting it to anyone around you. “In everyday life, routines have changed dramatically – it’s no different inside the hospital.
“I can say I am fortunate, that while I have provided clinical support to ITU, I have been able to do this remotely. I can’t imagine how my colleagues have managed to work with so much PPE. Friends and colleagues working in that environment have said the masks are uncomfortable, causing sores to their face and ears. Still, overwhelmingly the response has been how incredibly hot it all is.
“Hospital wards are renowned for being stuffy environments, but add in several layers of plastic, restrictive masks, gloves and gowns, and you’ve reached a whole new level of stuffiness. Plus you’re dealing with patients who are very, very sick. It is a very stressful, emotionally charged environment.”
Sarah has found it particularly hard to cope with the fact that the pandemic has affected the personal relationships with patients that she has always found very important, reflecting her decision to make nursing her career.
“I didn’t originally want to be a nurse,” she explains. “I’ve always been in roles that involve working with the public, but being a nurse wasn’t ever really on my agenda.
“I grew up in Lewes, but when I was 25, I moved to North Wales and found a job working as a medical laboratory assistant in the local hospital, specifically, histopathology. I have always loved science, and this, to me, was a fascinating role. We were encouraged by the lead biomedical scientist to observe how various tissue samples are obtained, not only to increase our knowledge of the process but also to appreciate what the patient goes through.
“While I was fascinated by the science side, I found I became more distracted by the patients themselves. Some biopsies can be painful or even risky, and I found myself providing a supportive role to the patient and neglecting the science part. I was at a crossroads – I found I was starting to feel unchallenged by the environment I was in.
“I could have trained to become a biomedical scientist, but the idea of nursing became more pertinent. It provided the balance between being able to care whilst being underpinned by science – a perfect combination in my eyes. I became a student nurse in 2011, aged 28
“Personally, what I have struggled with because of the coronavirus situation is the inability to communicate with my patients. Practical nursing is providing support, education, reassurance and compassion. Face masks remove the ability to provide the majority of these components. Explaining medication regimes to patients that are hard of hearing, for example, is massively hindered. It makes it very impersonal, and sometimes a patient just needs to see a smile of reassurance, I haven’t even been able to do that.
“Also, healthcare professionals are finely tuned to pick up on non-verbal cues from patients. Not every patient will admit they are frightened or in pain, the use of non-verbal cues is often vital to understanding what the patient is feeling. This essential aid has been removed overnight.
“The group of patients I deal with in my speciality tend to have other comorbidities, and therefore that puts them at a higher risk of complications.
This, in turn, can make it harder to treat. What I have noticed is the increased length of time that patients need to stay in hospital with coronavirus—weeks as opposed to days to recover.
“In terms of a cure, I don’t think we are near to beating the virus. However, the longer the virus is around, scientists and clinicians are gaining vital knowledge on how to treat patients with it. They are learning very quickly, what is and isn’t effective. Vaccines can take years and years to develop so I would advise caution in thinking it is just around the corner, even if the whole world is racing to create one.
“In my personal opinion, the lockdown has been lifted too soon – I feel that the scientific experts have been mainly ignored in the pursuit of the economy. I am not an economist, but I think the message that has been coming out of the government has been confusing at best. I, for one at times, have been confused as to what I am or not allowed to do.
“The messages need to be more consistent and less confusing to ensure lockdown can happen, but safely. When people aren’t sure what they should or shouldn’t be doing, most of us are guilty of reverting to default – carrying on as usual or how we are used to living. It could have been handled better, but hindsight is a beautiful thing.
“The Trust I work in is always planning and preparing for eventualities. A second wave, if it materialises, will be met with the same gusto as the first wave, with the bonus of knowing more about the disease trajectory. I’m hoping a second wave doesn’t happen. However there is little point worrying about it, what will be, will be. I take each day by each day.
“I have been mentally and physically drained at times. I have been scared about going to work, but I have a strong sense of duty to help others. My partner is the technical manager at the Depot in Lewes and has been furloughed. He likes to keep busy, so has struggled at times with the imposed lockdown. He has had more time to sit worrying about me being at work.
“We have always had a very close relationship, but lockdown has put it under a microscope; a very positive microscope. I think we would agree; it’s made both of us realise what is important and what isn’t in terms of our relationships, goals and our future together. I am a lot more laissez-faire in attitude than I’ve ever been, which is so refreshing – it’s only taken me 38 years and a pandemic!
“After a busy shift, I have to process, and my way of doing this is talking through my day when I get home or talking through my day in my head to help me reflect. Sometimes if it has been a particularly hard day, a good cry and a cuddle are all that is needed then I can put it aside and forget about it until the next day. Pre-lockdown I would use the gym after work to switch off, without that, I have turned to home exercise as an alternative. It’s not quite the same, but it’s a good temporary measure, and my right hooks have improved!
“The response from the local community towards the hospital and its staff has on occasions brought me to tears. Some people have lost their jobs or businesses have been on the brink of collapse, and yet those same people have stepped forward and offered to help.
“The generosity has been overwhelming at times, and I don’t think those people understand the hugely positive impact that they have made to the morale of the staff in the Trust. It has restored the sense of community spirit with everyone joining together to fight the pandemic, and without sounding dramatic, it has kept us all going mentally and physically.
“To be honest, I’m nervous about going out socially again once more lockdown restrictions are lifted. The idea of being in a closed environment with lots of strangers isn’t appealing. However, in some ways, I miss the social interactions, and I do believe in supporting local businesses as much as possible.
“I won’t be rushing out again, but will be closely watching the effect that reopening is having on the transmission and then start to take baby steps back out into the world if I feel it is safe to do so.” •