Back to the bedside: our reflections on returning to clinical practice in the pandemic
Volunteer ICU nurses talk tight teamwork, coping strategies and dealing with their families’ COVID-19 fears
Kim Tolley and Elizabeth Tysoe are volunteer staff nurses in ICU at Ashford and St Peter’s NHS Foundation Trust in Surrey. Both work for the General Medical Council but decided their response to COVID-19 should be to return to their roots in clinical practice
Kim Tolley writes
After 25 years away from intensive care (ICU), I initially struggled to adapt to my new clinical role. The work is intense, both physically and emotionally, and being older means I get tired more easily than I used to. I had forgotten how much my feet throb at the end of a shift.
Without patients’ loved ones to provide information, person-centred care is hard
One particularly challenging aspect of caring for patients with COVID-19 is the absence of relatives and friends at the bedside. I sometimes finish a shift with an overwhelming feeling of sadness at having to care for patients without their loved ones with them at such a scary time.
Friends and relatives provide staff with personal information about the patient. This helps us deliver person-centred care and knowing so little about my patients is hard.
The PPE (personal protective equipment) we wear can also make care feel depersonalised, but on the advice of a colleague I think of my PPE as a suit of armour, protecting me not only physically from COVID-19 but also emotionally from the sadness and distress it causes.
Coping strategies and understanding other people’s emotional reactions
Shortly after I started on the unit, the hospital chaplain came to talk to us about resilience and uncertainty. He spoke about people’s emotional reactions to uncertainty, such as becoming snappy or angry, and the need to have plans in place to manage our well-being.
‘Returning to ICU has been hard for my family, who are uncertain how my decision might affect us all’
When we were asked to share our personal strategies for coping with difficulties, I talked about the box beside my bed where I ‘put’ all my anxieties before I go to sleep, a strategy that has worked well for me in the past.
Returning to ICU has been hard for my family, who are uncertain how my decision might affect us all. But I have explained the precautions I am taking so I don’t bring the virus home and pass it on to them.
I have settled well, but I’m still scared
As the weeks have passed, things have become easier, and I have settled well into the team. Although I am still scared, I have found ways to manage my anxiety. Talking to Elizabeth has been a great help.
As all nurses know, having someone to off-load on is vital. We often phone each other at the end of our busy shifts to share our experiences and feelings, supporting each other as best we can.
The work is physically and emotionally demanding, but it is an honour
Elizabeth Tysoe writes
I am not an ICU-trained nurse, so I thought hard about my role boundaries on the unit. I chose not to do ventilator training so that I can retain my role as a ‘runner’ and provide essential nursing care to patients.
The unit nurses have phenomenal technical knowledge, and doctors will seek their advice on the management of individual patients. I can assist by providing essential nursing care, such as washing and talking to patients, mouth care, and helping to position them comfortably.
The work is physically and emotionally demanding, but it is an honour to be part of the team who have happily accepted me.
Communication and teamwork while wearing PPE
Coping in full PPE is not easy. One of the main problems is that no one recognises anyone, so we all have to write our names on the front of our gowns. I also write ‘runner’ on mine and the nurses who do not usually work on the unit add their normal workplace to help with identification.
‘A vital role is spotting when a member of staff is having a wobble’
The regular ICU staff just write their names though, which can cause some confusion. It was quite amusing when the consultant was mistaken for the porter, but it was all taken in good humour as we are all part of the same team.
In this crisis, there’s no room for the NHS hierarchy
The traditional NHS hierarchy has been flattened, and previously strict professional boundaries have been blurred to promote effective teamwork.
I have worked alongside junior doctors learning how to complete nursing safety checks, position patients and change pumps, and an anaesthetist who taught a group of non-ICU nurses about the ventilators and machines for monitoring cardiac output.
Another vital role on the unit is ‘noticing’ – spotting a member of staff who is having a ‘wobble’ or a bad shift. We can get them relieved from their duties and take them for a cup of tea, be a listening ear or even just put an arm around their shoulder – full PPE, though hot to wear, does have some advantages. It seems everyone is missing physical contact as staff often hug each other when we initially don our PPE.
My husband has struggled with my decision to go back to clinical practice
I have always been able to ‘switch off’ from work at the end of the day. Now more than ever, this ability is immensely helpful. I use the drive home to phone a friend and unwind, chatting about our lives, families and shared interests – anything but work.
I was not married when I last worked clinically, and while my husband has been supportive of my decision, I know he has struggled to come to terms with it and the new ‘normal’ that now exists in our home.
Returning to clinical practice has been tough, but the kindness on the unit, between fellow clinicians and towards patients, has really helped. Seeing staff pull together to support each other in these unprecedented times is a privilege.
Kim Tolley is training development manager and Elizabeth Tysoe employer liaison adviser at the GMC