Thank you Nurse Bloggers, we need more of you.

I’m writing this because I remember times, which I will likely have again in the future, where I needed someone to tell me that my voice mattered and was making a difference to others. I hope that by the time you get to the end of this blog you will realise that your voice matters too. 

I’m going to be honest, the reason for RCNNQN and RCN Students encouraging other members of our nursing family to blog, tweet, post on your facebook wall, do an IG story, etc etc was due to a very disappointing narrative we have seen recently from a select few on Twitter. I am currently in a relatively strong place mentally (don’t get me wrong, this has not been the case in recent times I have been struggling with the weight of RCN Students alongside being a Newly Registered Nurse), and therefore I felt the ability to stand up to this behaviour and challenge it. Other people reading those tweets, may not have been in the same situation as I and have taken it personally. I know for a fact that this has made some individuals feel like they should not release a blog because of this narrative. So let’s stand shoulder to shoulder with those inspirational nurse bloggers, those selfie taking professionals, those who are bold and brave enough to share snippets of their nursing journey. And let us remind others that small actions x many = big changes. 

I am a very ad hoc blogger, I don’t allow myself the time to sit and pour my thoughts into a blog. I wish I did it more, as it has a therapeutic benefit for me. I’m going to try and work on this for myself. Recently, I have been reminded by a student nurse that I have been doing this not only for the benefit of myself, but for others too. They told me how my words, via an Instagram story, helped give them the boost to continue on their nursing journey when they were at a low point. If this individual didn’t tell me this, I would have had no idea. I would like to use this blog solely to tell you, the nurse blogger, vlogger, selfie taker, avid tweeter, that you are having more of an impact than you realise. Keep going. 

It is not new news to you that we are in a global nursing workforce crisis. Despite being an activist in the Royal College of Nursing, and being connected with nurses across Europe and beyond, it wasn’t until I recently wrote a piece for an assignment for my Masters course that I truly started to understand the scale of the issue and it is frightening. Not only for us as professionals having to keep these many sinking ships afloat but for the populations that we support. The inequalities of health globally are already staggeringly variable, if we do not sort out our workforce crisis it will only get much much worse. And a way of contributing to make things better? Nurse bloggers. 

Nurse bloggers showcase the variety of nursing, they inspire others to consider nursing as a career, they remind those who have lost their way of their passion for nursing, they are contributing to the recruitment and retention of our workforce. Thank you nurse bloggers from me, we need more of you. 

#SmallActionsBigChanges

Jessica Sainsbury, Registered Nurse

http://www.twitter.com/JessLSainsbury

#SmallActionsBigChanges

Many of you will be thinking – what on Earth are RCNNQN and RCN Students up to? Hopefully, the ramblings below will shed some light on our idea, and we hope they will inspire you to join in!

What a year – we have heard it repeatedly. And when we meet, all we talk about are restrictions, vaccinations, how intense work is etc…etc… Then if you’re like me, you try and focus on the positives 2020 has brought.

For me, it is completing my degree, registering, getting a promotion, and finally being in the job I have dreamed of. But, if I am honest, those thoughts are fleeting. While I am proud of them and know how important they are, on a day-to-day basis, they don’t stop me feeling low and struggling with getting out of bed to face the day full of uncertainty, negativity and recently for me, bad news.

This week my team received the news that a colleague had died at the weekend; suddenly and without warning, one day she was there in her ‘Merry and Bright’ Christmas jumper and then the next, we received a phone call to say she was gone. The week before, my uncle died, two years after being diagnosed with Motor Neurone Disease, and my heart shattered into a thousand pieces.

These things, on top of a world full of negativity in the news, on Twitter and in work all felt like too much to cope with. I have been angry and short-tempered, snapping at everyone and struggling to see the point. Twitter, a place that in the past has helped me be positive, has felt negative, personal and like a reflection of my bad mood and anger.

Those who know me well know this isn’t usually what I am like. I am, as my husband once described me, annoyingly positive. And not feeling like that each day made me angrier, and more negative until that was all that consumed me, and I couldn’t think of anything else. It hasn’t helped that I am also peri-menopausal – but that is a whole other discussion!

Then out of the blue, I had a short message from a friend who pre-covid I saw and spoke to every week, but we have both found online chats tiring and draining, so have spoken much less frequently. The message simply said, “I miss you.” These three simple words were a tiny thing, a small action.

But what that small action did was stop me feeling invisible, forgotten and insecure. It made me remember friendships that had meaning, and it gave me hope for the days to come. Later that day, my son, who has a diagnosis of ASD, said to his big sister, “sometimes I do love you a bit”.  Not much you may think, but that is possibly the first time in 15 years that I have heard him be spontaneously affectionate to one of his siblings. And finally, the last thing on that day to lift my spirits was my youngest coming home saying, “my Secret Santa was so excited by my present because you had wrapped it so nicely”.  Again, a tiny thing, but there is a repeated joke with my best friend about how slack I am with my wrapping. This year I’ve chosen brown paper to be environmentally friendly, some red string and wooden tags and spent a few more seconds making them look festive with Christmas stamps. I also worry endlessly about being a terrible mother whose kids feel neglected and have a mother not as good as everyone else’s.  Just that comment meant loads, in so many ways.

What those three small actions did individually was made me smile. What they did together is made me more positive. And what I then did, was a few small things for others, to make them realise the little things matter to me. I felt better for it, and hopefully, they did too.

The upshot of it is – the big, tragic stuff is still there, they still hurt like hell, but focussing on the little things has let me move forward, they have given me moments to smile; stringing those moments together has made me feel happier, more productive and most importantly, hopeful.

So, how can we use this in nursing?  What can we do on #NurseTwitter? What do we want you to do?  There are without doubt things that are negative that need addressing and changing and challenges we will face in the coming months. We can’t shy away from these, and I am not for a moment suggesting that we do. But, if those three small actions could make a difference to me, imagine what the force of us all doing small actions could be.

My favourite equation (I never thought I would say that when I was doing my GCSEs!) is Small Actions x Many People = Big Change, and that is what we are asking you to do. Small Actions. Do them write about them, tweet about them. Because sitting at home in my dining room writing this blog, I am sure as hell not going to cure Covid, find a treatment for Motor Neurone Disease or sort out a Brexit deal. But, I might make you smile, I remind you to do something for someone else or to just challenge someone in a way that doesn’t attack them personally. And if we all do that – 2021 may just be the year for #SmallActionsBigChanges

Clare http://www.twitter.com/MannersOfMarple

New beginnings, new lessons…

On my last blog, I discussed how it felt to be shielding and awaiting to return to the placement and finishing my management hours. So, I finally went back to the ward, and the first thing that I noticed was that everything was different. Personal protective equipment was more abundant than it was in March, infection control was a lot clearer, and it felt safe.

That being said, all I can see were eyes as everyone had their masks on throughout the shifts. It was interesting because my brain had to quickly learn to recognise facial expressions by just looking at the eyes. For example, when the eyes get narrowed, and creases start forming on the sides, then there’s a high chance that the person may be smiling. This, of course, depends on the context of your interaction.

The noticeable changes aside, it was great to be back in the ward and adapting to the phrase we all despise the ‘new normal’. I was happy to completely engross myself into having my own patient workload and develop my prioritisation skills. It felt great to be back in familiar grounds from the patients to staff members. One of the advantages of training in a small trust is that you very often get to see the same patients that you have met in different contexts—for example; the ward, emergency department or neonatal units.

However, right now, I want to fast forward you to 2300 long placement hours later, which fell on the 27th of November 2020, and the day that I completed my last shift EVER as a student! It seemed impossible three months ago but let me tell you, time really does fly when you’re having a whale of a time. All the doubts that I had of how ready I would be to qualify have vanished. 

Today as I start my new career as a children’s nurse, I feel hopeful and have faith that I will be able to fill in gaps of any knowledge deficits that I may have. I am grateful that my Trust has given me a comprehensive induction and supernumerary time up until January when I will officially be in the numbers.

I am a bit nervous about starting in a new environment to the Trust that I trained in, albeit mostly excited to learn new ways and conditions. I am ready for the challenge and looking forward to meeting the new team this week. 

Judging from the many polls that we run within the @RCNNQN Twitter account a lot of our newly registered nurses often disclose that they feel overwhelmed. Therefore, I have mentally prepared to go back to feeling like my first day as a student nurse on placement. A mentor once said to me, ‘learning starts once you have officially been registered’.Therefore, cheers to new beginnings and new lessons. To my fellow Cohort 2017, also known as #ClassOf2020, I want to say let’s keep learning, be easy on ourselves and continue to grow, we can overcome anything.

Lily http://www.twitter.com/MissWolday

The importance of empowerment to my nursing journey

This week I have found myself thinking about empowerment quite a lot; which the dictionary would define as the process of giving people power and status in a particular situation and the NMC would say is a vital part of the fundamental standards for nursing.

This week represents the start of the next chapter in my nursing journey, I gave my first lecture as a visiting lecturer at my university and I am about to start working as a community learning disability nurse.

This combination of events has caused me to think back to around three and a half years ago when I started my nursing journey. When I started the course, I was feeling far from empowered. I was anxious that I might be the oldest on the course, possibly the only man, and would anyone like me? I had very little healthcare experience, so wasn’t sure that I would be able to do what was required of me, which would be exacerbated by my being dyspraxic. I also felt quite pressured; having left a job that no longer made me happy but paid me well and provided a certain sense of stability. As it turned out, I was very lucky to have a fantastic student experience, which significantly developed my feelings of empowerment. Upon reflection, this development was helped by several key areas:

Improve your knowledge. When I started the course, as with starting anything new my level of knowledge was quite low and I felt self-conscious about this. The more I have been able to learn, the more I realise I still have to learn but I now know how to address this ongoing process. In the same timeframe my level of confidence has become greater and I no longer worry that I will somehow be “caught out” in the same way by a lack of fundamental knowledge. This makes improving my knowledge easier as I feel much happier asking a question.

Take opportunities. Returning to university for a second time, I was determined to make the most of the experience and therefore tried to take every potential opportunity to develop myself. From chairing the University of Chester’s Student empowerment group, applying for awards and giving talks I could never have imagined the opportunities that this approach would lead to but it has led to some truly amazing experiences and has perhaps had the greatest impact on my personal development.

Face your fears. Working on things you find difficult is something that very few of us enjoy doing. It is by its very definition difficult. However, it is hard to ignore the fact that moving out of your comfort zone builds confidence and learning. I have had the opportunity to give various talks and to take part in meetings with senior people from both the university and practice to develop a new curriculum. Initially the idea of doing these things was very intimidating but having done it I felt I had developed a new set of useful skills. Self-reflection exercises helped me to acknowledge tasks and issues that intimidated me. This allowed me to work on reducing the number of things, I was worried about and enabled me to better prepare.

Look for Mentors. It is widely recognised by successful people from the Obamas to Tim Ferris, that having a mentor, someone who has done the sort of things you want to do in the future will increase the likelihood of you achieving your goals. In my case a mentor started my interest in learning disability nursing in the first place and I have been lucky to meet some other great people, during my studies who have really helped to develop me and my feelings of empowerment and continue to do so. It is important to look for the strengths and weaknesses in others to learn from. Having good mentors makes it easier for you to then be a good mentor.

Create a support network. Qualifying, transitioning and working as a nurse is recognised as being very difficult. Consequently, it is likely that we will all have difficult days. That has certainly been the case for me. Talking to my friends and being a part of RCNNQN seems to suggest that this is a universal experience. Having someone you can talk to who knows what it is like to work all day in the library on a paper or care for a patient intensively is vital to maintaining your mental wellbeing and sense of positivity. Awareness that there will be days that are more difficult and being honest about that with myself and others will make dealing with them more constructive.

Set short terms goals. It is a good idea to have a long-term goal of what you want to do. But it is also a good idea to have short term goals. The course was quite helpful for this. The sequence of assignments and the range of extra-curricularactivities provided a good template for this as you could always try and get a better mark or achieve something new. As I start my new job this might be to complete my initial training to a good standard or to make a good impression with my new team.

I would not like to give the impression that my feelings of empowerment have consistently increased. We all face challenges and this year in particular has presented us with challenges we could never have anticipated. But while the dips are inevitable, I know that applying these techniques will build my feelings of empowerment up again. 

So, whilst at the start of a new chapter I am nervous about the new challenges I face as I continue to transition from student to nurse, I feel reassured that I have a template I can use both for myself and my patients.

Daniel http://www.twitter.com/MAGEOFJUSTICE

Find your role and your people: An Army nurse perspective

Like everyone, my route into nursing was unique. I served for seven years as an officer in the British Army’s Royal Engineers(RE) before transferring to the Queen Alexandra’s Royal Army Nursing Corps (QARANC). My transfer saw me studying in a civilian university away from the military for the first time since joining. I found university hard but not in the way my peers seem to. I was used to working hard, being in uncertain situations, and am fairly academic, so the course content wasn’t too challenging. I found it hard because I went from a position of huge responsibility where I felt valued and respected, to a student nurse where, sometimes, staff on placement couldn’t spare you a smile or a good morning. Things were pretty bad. Although convinced that nursing was an incredible profession, I wasn’t happy and resigned to the fact that I had made a mistake in transferring. However, the sorry state of my student nurse experience is a whole other blog, this one is about finding your role and your people.

I knew from day one of my first staff nurse post it was going to be ok. On that first day, I put my MTP (combats) back on for the first time in three years. Although I had a new capbadge and other insignia (as I am now part of QARANC and no longer a RE) I felt like I was home. I know this sounds cheesy; however, I am proud to serve in our Armed Forces and after a decade of doing so, I have realised it is part of my identity. Things only got better as I met and was welcomed by the staff at my new unit; I felt encouraged as I was around like-minded people again. I had missed the banter and support of the military, the physical training, and the opportunities to develop.

At my military unit (Joint Hospital Group (South) Army, Royal Navy and Royal Airforce registered nurses and health care support workers work alongside their NHS colleagues in Queen Alexandra University Hospital Trust. We split our time between clinical and military training. Newly qualified nurses at JHG(S) have a year preceptorship where they have placements in both medical and surgical ward/units followed by an elective. Our preceptorship is slightly different from our NHS colleagues and designed to prepare us for our deployed role wherever it may be. Indeed, many military nurses deploy on exercises and operations around the world as soon as they finish their preceptorship; sometimes, in extremis, they will deploy before.

Luckily, things have remained positive since putting my clinical uniform on. I have been allocated the Acute Medical Unit as my first preceptorship post, an area I didn’t have an opportunity to experience as a student, and I am really enjoying the fast pace and variety of work. No two days are the same. Importantly, I am also enjoying being part of the team of people I am working alongside, both military and civilian. Both my new NHS colleagues and my military peershave been incredibly welcoming and brilliant mentors. All my fears about regretting my career change have gone; I finally feel valued and have purpose again.

I guess the moral of my story is similar to that which Dawn described in her brilliant blog last month. If you are not happy where you are, perhaps you should think about making a change. Although admittedly I didn’t actively choose my change and simply went where the military told me, returning to a military environment and changing trust and work area has made a huge difference to how I feel about my career. If you are feeling unhappy at work, you should have a think about what would make you happier. Nursing is ridiculously diverse – there is so much on offer. Changing your role to suit your skillset, likes and dislikes could have a huge impact on how fulfilled you feel. Changing your role may also introduce you to a different team and they might just be your people.

Kendal http://www.twitter.com/kendal_moran

Using mindfulness as a Newly Registered Nurse

Being a nurse can be stressful, I don’t think that’s a secret. It’s also very rewarding and like no other carer but still… stressful. I’m 14 months registered and something that has helped me throughout my newly registered nurse period is mindfulness.

Mindfulness is defined by the Cambridge English Dictionary as: “The practice of being aware of your body, mind, and feelings in the present moment, thought to create a feeling of calm.” As a Mental Health Nurse I spend much of time discussing mindfulness but how can we apply it to our working lives as nurses?

A misconception I often find is that people think mindfulness is something which takes lots of time or has to be done in a silent room, with your legs crossed and gentle music playing in the background. This can be a form of mindfulness but in reality mindfulness (also known as grounding) can be done in most settings with just our bodies.

We can firstly use our senses, often when we are rushing around; especially in nursing when we are confronted with many different smells, sights, noises etc, our mind can become overwhelmed. Take a moment to stop and focus on five things that you can see. Now use your touch, focus on four things you can feel, maybe your shoes pinching on your toes or your scrubs label on the back of your neck. Think about three things you can hear, two things you can smell and one thing you can taste. Allow your mind to focus on your own senses to bring you back into the present moment.

Feelings; as nurses we are around others who are frequently in very intense emotional situations. It can be easy to work through a shift without acknowledging our own feelings then when we get home, those feelings demand to be felt. It’s important to take a second every now and then during the shift to focus on ourselves and acknowledge what we feel, name those feelings without judging or criticising ourselves.

When it comes to mindfulness one of the simplest ways we can use it is through breath, when the to do list is increasing and our mind is racing; our breath and body begins to tense and race to. Simply stopping for one minute and taking three deep breaths, focusing on how the body feels as you breathe in and then out can relax our body and mind. If you have your phone on you, you can simply search “mindfulness breath gif” and there’s some great gifs to guide you through three deep breaths.

These are three very simple mindfulness techniques that I use in my day to day working life, each one takes under a few minutes. If you want to learn more mindfulness techniques, the RCN has some great resources on mindfulness in nursing, including The Time and Space Project which includes six videos on mindfulness skills you can use through six stages in your working day.

Here’s the link: https://www.rcn.org.uk/healthy-workplace/healthy-you/time-and-space#step1

After doing just a minute of mindfulness, I always feel my mind is clearer. When I was a month into my preceptorship, I had a near miss experience. When I reflected upon the event, I concluded that, my head was too busy which nearly led to me making a mistake. The lesson that I learnt was that stopping and taking three deep breaths could have prevented this near miss. From that near miss I began using mindfulness in my role as a nurse and wanted to share this story and blog with others because I feel mindfulness could really benifit us during those busy shifts.

Abby http://ww.twitter.com/MHnurseabby

Critical care as an NQN: The pros and the cons.

Nine months ago I nervously but excitedly went to work or the first time in my new job as a newly qualified staff nurse in critical care. Whilst a student weighing up my options for my first job, I was frequently offered conflicting advice from already qualified nurses; some saying to get more experience on the wards first to consolidate your learning before heading to a specialist environment, others saying to go straight into critical care if that is what you’re passionate about. I clearly followed the advice of the latter and now I’ve got the best part of a year as an NQN behind me, I’ve decided to take some time to reflect on the pros and cons I’ve experienced from starting my career as a critical care nurse. 

I suspect there are many more pros and cons than what I discuss in this blog, but to keep things simple I’ve decided to pick three of each based on my own experiences which have had the biggest impact on me personally over the past nine months since starting in my role, and here’s what I came up with:

Pro #1 – The supernumerary time

I had about six weeks supernumerary time before going into the numbers (I know this will vary from trust to trust – I have heard of some critical care areas offering up to twelve weeks), much more than I know many of my colleagues have received in other clinical areas. This gave me a good amount of time to become familiar with my surroundings, the equipment, the staff, and to develop my own routines before taking patients on my own. I certainly found this time invaluable and was a huge factor in helping me feel confident in stepping into my NQN role.

Con #1 – Information overload

Wherever you go as an NQN, there is going to be a huge amount of new information to take in unique to that area; new colleagues, new skills to learn, new pathologies, new medications, new IT systems, and the list goes on, and critical care is certainly no exception to this rule. One example is we have ventilators which require an enormous amount of learning to operate and maintain safely, another is the medications which aren’t used in ward areas, such as inotropes which can have severe consequences if administered incorrectly. I personally found this not only hard to take in because of the volume of information, but also because of the responsibility that comes with it and the consequences of getting such crucial things wrong.

Pro #2 – The staff support

Nurse-patient ratios in critical care are generally 1:1, or 1:2 depending on patient acuity. This means there are a lot of staff around you all of the time which, personally, I think has been amazing as there is always someone around who I can ask questions to when I am unsure about something (which is pretty much all of the time!). At the end of the day, they were once in my position and had to learn from scratch as well.

Con #2 – It’s a niche environment

The main reason I was often told to get ward experience prior to going to critical care was to consolidate my learning as a student in a much more general nursing role. Reflecting on this, I have to concede they made have a good point, at least to an extent. A lot of what happens in critical care is unique to that environment, and there are certainly some skills I have not done since I was a student. Perhaps six months or a year on the ward may have enabled me to find my feet faster. However, at its core, I have found the fundamentals of holistic patient care are still exactly the same in critical care as they are in any other nursing setting, it’s just the practical skills that are different, and, in many ways, I actually found I am much better able to deliver care up to standard that I am happy with as we have all day with one patient, something I know many of my colleagues struggle with in areas where they are caring for many patients.

Pro #3 – The learning opportunities 

As I have already alluded to, there is a lot of things to learn when starting in critical care. As a result, or at least where I currently work, this means I have had a number of educational sessions to help get my head around all this information. Additionally, we are also a melting pot of patient groups; one day I may be caring for a patient with acute pancreatitis, the next I’m looking after a polytrauma patient. As a result of this, every day is very much a school day, and nine months in I’m still learning more each day.

Con #3 – Lack of patient consistency can make it hard to find your feet

Having just in my last point praised how having lots of patient groups is great for leaning, it can also have a negative side: you are constantly reminded of how much you don’t know. In other areas where you may end up looking after patients with similar conditions and you become familiar with many of the needs of these patient groups. In critical care I have found, especially in my first six months or so, it very difficult to get into a rhythm as every day I need to understand something that I have never seen before and that is something that can only come with time and experience.

So there you have it, my own top three pros and cons from being an NQN in critical care, there are of course many others, and please do add your own to the list! I guess the question I have to ask myself now is: If I could speak to my student nurse self, would I encourage younger me to go straight into critical care for a first nursing role? Definitely… maybe. Do I feel I could have benefited from working in a more general role first? Probably. But, do I love what I do and, now that I’m starting to find my feet, do I feel confident as a critical care nurse? Absolutely. Each person is different with different strengths and experiences and it’s up to them to decide what NQN role is the best option for them.

Michael http://www.twitter.com/DrMLJCarter

It takes a family: critical care and Covid-19

FAMILY   /   noun  :  “a group of people from a common stock”

                                  “ a group of one or more … living together as a unit”

TEAM   /  noun  :   “two or more people working together”

Team   / verb  :     “come together as a team to achieve a common goal”

The most striking thing I’ve found in my first three months since joining critical care is the close-knit community who inhabit it.  Being new, and looking at all those around you for guidance and support, you are in the unique position of watching how this team works together.  You observe a multi-faceted balance of emotional fortitude and empathy, combined with quick thinking, a dedication to continuous learning, alongside an observant eye on the most critically ill patients.

The direct balance of strength to get through tough situations, with the emotional intelligence to communicate with patients, families and each other at the most difficult times.

The impact Covid will have, not only on patients, but all healthcare workers, is as yet, unknown.

I, like many of my healthcare colleagues, am often uncomfortable with the warlike rhetoric used when discussing the current situation, we were none of us conscripted to any ‘frontline’.  However, unquestionably, the challenges the pandemic has faced us with are often synonymous with a ‘battle’ and in some instances, the solidifying of teams as healthcare professionals ‘fighting against’ it has strengthened resolve and even emotional capacity.

Given this current climate, where the world is, in many cases, taking notice for the first time, and recognizing the value of its health systems.  I wanted to attempt to shine that spotlight on the amazing team I have been able to join.  And, in doing so, give an accurate depiction of life on critical care during Covid.  And who better to tell you than the team themselves.

The ACCP in the covid pandemic.     Anwen Williams – Advanced Critical Care Practioner 

I have been a qualified nurse for 30 years, worked on critical care for 19 years and as an accp since 2013 and thought that nothing could come along and shock me, what’s the saying? been there, done that, got the tshirt, then along came covid19.

The newspapers,television programmes and social media were rife with how it was sweeping the world, how countries were coping or not and how health care institutions and providers were under immense pressure due to the demands on the service and the unpredictability of the disease process.

Preparation for the unknown was intense, supplies, equipment, staff training and upskilling of staff outside of the critical care unit, we all chipped in, still no real idea what was in store.

It felt like we were waiting for covid for ages, our colleagues in the south were swamped and we were waiting and waiting and then it arrived….

All the drills, all the teaching, all the sim training could not and did not prepare us for the reality.

Two things had a massive impact on me and will always stay with me:

1. On first assessment the patients look well- to the point that the normal ‘end of the bedogramme’ would not trigger your spidey senses. Sat there, chatting, on O2, looking extremely comfortable but tachypneic- then you see the ABG- po2 of 6-7, pf ratio of < 18 in normal circumstances we’d be prepping the drugs and grabbing an ET tube- CPAP initially was not to be used- the patients tired quickly and that ET tube was never far away. Multiorgan failure, respiratory and cardiovascular instability came on so very quickly- being the accp donned in the ventilated covidbay was a scary place to be, always aware that if you needed help it would not come quickly also who was going to be your help a ward doctor with some critical care experience or one of your colleagues and communication and advice given over walkie talkies was difficult-

2. Communicating with relatives over the phone has to be one of the hardest things I have ever done. Knowing that it was unlikely that the relative had a support mechanism at home and you were about to have some of the most distressing conversations they will ever have over the phone, without that relative having any real concept of how unwell their relative really was, there is a lot to be said about seeing a critical care patient with all the machinery and infusions. Updates were given daily and although some patients did improve and recover to the point of discharge from the critical care unit many didn’t. Although the relatives were always grateful for the phone call, for those making the calls the impact psychologically was massive. I will never forget sitting at the bedside of a patient while he died with one of the nurses and then phoning their wife to tell him he’d passed away. You hold it together for their sake, its their loss not yours, but once I put that phone down I sobbed, it went against everything you’ve been taught.

Ollie Smith – CT2 Anaesthetics

“I moved from theatre where I had just started my Anaesthetics training, to ITU, when the Covid pandemic started.  I felt very helpless.  Patients were intubated early, quickly went into multi organ failure, and decisions had to be made about treatment, as we only had a limited number of machines and staff to manage them.

Patient progress was very slow, and I was very worried we would not cope if more and more patients required critical care.  Thankfully, it seemed to ease after 3 very hard months, and we did cope as a team.”

Nursing during Covid – a nurse’s perspective

“My name is Rachel and I’m a critical care nurse in the Wrexham Maelor Hospital.  I will never forget hearing about ‘coronavirus’ back in December / January, and I never thought it would affect us the way it has.  I have a clear memory of being on a night shift, sat in the restroom during my break, and listening to Boris announce the first lockdown.  It all began to feel very real at that point, and things just progressed from then on.  

Initially, I felt quite anxious; worrying about catching the virus and passing it on to my family; worrying about the PPE, but also worrying for the patients, and if they would survive.  As time progressed, I learnt to trust the PPE, and gradually we all got used to working in a different way and in different conditions.

We also learnt so much about the virus itself, and how best to care for our patients, and started to see patients leave the critical care unit and recover.  It has been, without a doubt, a strange year, and I’m hoping things begin to normalisenext year for all of us (and from a personal perspective as I get married next year!!) “.

“My name is Clariza and I am a critical care nurse in Wrexham Maelor hospital.  I had heard a lot of things about Covid and how it spread rapidly in different countries, causing severe respiratory distress.  I had lots of worries and uncertainties of how it would affect us as nurses and affect our families.  

Initially, we were advised if the hospital reached full capacity with Covid, one option may be for us to stay at the hospital, to safeguard our families,  as our service might be needed continuously.  So, we came to each shift with a bag packed with basic toiletries, clothes and snacks in the boot of our car, in case that day came.

When I told this to my family, my daughter was very upset and I remember her clearly, asking “Can you not be a nurse and stay home with us?” and I answered,“we have to help these patients, it’s our line of duty”.

We were taught and trained by one of our consultants, who is highly trained in infectious diseases and had worked in Sierra Leone working with Ebola patients.  He taught us how to don and doff correctly and how to protect each other in the unit.  

In March, Covid-19 patients cases in ITU rose and so did stress and anxiety levels.  The patients coming in were very sick – they were hypoxic, requiring high pressure oxygen, and many ended up on ventilators to maintain their oxygenation.  They were difficult to ventilate and we often proned them, with the help of our physiotherapy colleagues.  Keeping the fluid balances was a challenge too, and many of them ended up needing haemofiltration.  The coagulation was a problem too, and now one of the first line treatments for these patients are high doses of clexane.

It was physically and mentally draining, I have seen many tears among colleagues.  I rely on my colleagues and family for support.  It has been a very difficult time and looking back, I’m glad I’m still here and want to say thank you to my fellow nurses who stand by me every day”. 

Healthcare Support Workers

“Although i have worked as a health care support worker for over 30 years, i joined the critical care team in March, just as Covid hit.  It was very scary at times, i felt mentally drained after some shifts as well as physically exhausted- seeing people ventilated and proned for hours at a time was something I was not used to.  It got quite upsetting at times as some of these patients were so young.

Wearing PPE for most of the 12 hour shifts was hot and tiring and made communication difficult.  I found the first wave of Covid very challenging, both physically and mentally and was worried about taking it home to my family.”

Physiotherapists during Covid

“We had to change our working pattern, as we were involved in the proning team.  We were able to help our nursing colleagues in the nursing care of the patients – repositioning, washing and even last offices.  

We felt part of the big critical care team, it broke down barriers and hierarchy and made us appreciate the value of our nursing colleagues, and vice versa.  

There were some difficult times also – the wearing of the PPE, the sadness of patients passing away, and relatives not being able to visit.

As physiotherapists, we were able to follow patients on their journey to recovery from critical care to the ward, getting them back on their feet ready for discharge.

Domestics

“As one of the relief domestics who works on critical care, we had to change the way we work.  There became many extra tasks, wearing the same full level 2 PPE as our colleagues, and this was, at times very challenging.  Throughout this whole time however, we have felt very safe and felt part of the wonderful critical care team”

Ward Clerks

“My roles as a ward clerk on the critical care unit are to be the first point of contact for relatives, medical teams and all other visitors to the ward and direct people to the where they want to go.  I do all of the administration and paper work for patients and take telephone calls

Whilst working through the Covid-19 pandemic, I felt a mixture of feelings including fear – of contracting the virus and passing it on to family and friends.  I also felt very proud to be a part of an incredible team that are supportive, caring and still keep a sense of humour to cheer us all up.

Some days were very busy and hectic but we still all remained calm and professional.  I think this pandemic has shown us just how well we all work together as a team”

Icnarc Clerk

“It has been very different collecting the Intensive Care audit data during the Covid period.  One of the most challenging things been access to the daily data due to the need for PPE.  The data was also needed to be submitted daily at times, which has me having to ask the already busy nursing staff for the information that I would normally collect myself.  Even though they were obviously very busy, they never complained and the unit always made the deadline for the data”.

It goes without saying there are many more people who make up the critical care family, including pharmacy, dieticians and many others, and it wouldn’t run without the help of every one of them.  

Like families, teams come in all sorts of shapes and sizes. Whilst there are many theories on what makes an effective team, or the best leaders – there is no surefire recipe for success. Whilst it is unquestionably a combination of effective leadership, good communication, access to resources and the ability for all members to collaborate, the essence of a good team seems to be people who understand each other and work well together through thick and thin. Covid may have tested the team but it made the family.

Kayte www.twitter.com/kayte83

The impact of Covid-19 on new registrants and what this means for our profession’s future.

Now, anyone who knows me knows just how much I hate the warlike rhetoric that is often used when discussing nursing, particularly concerning the Covid-19 pandemic and our reaction as the nursing profession towards it.

We are nurses, not soldiers. And we have not been conscripted to fight in the frontlines. I genuinely dislike the term “frontline” worker and find it an exclusive term, discounting many of our valuable nursing colleagues who do not work in direct patient-facing roles.

That being said, with the second peak of Covid-19 unquestionably raising its head, six months into my first staff nurse role, working in infectious diseases, I do feel for the first time that it does feel like we are at war. I can empathise with soldiers, and members of the armed forces, placed into dangerous situations as a part of their job and everyday lives.

Let me preface this by saying, I have a hugely supportive team of nursing and multidisciplinary colleagues. But I would be lying if I said I did not feel an impending sense of worry about the unknown every day when I go into work. Sometimes, this even affects me sleeping beforehand.

Primarily, I worry about the patients I look after, and their family members, friends and loved ones, who are often alienated from them due to government policy that quite rightly prevents them visiting. But, I too worry about my colleagues. And, yes, selfishly, I do worry about myself and the impact it would have on my loved ones if I were to contract Covid-19.

Nothing could have ever prepared us newly registered nurses to start our careers during a global pandemic. Our adrenaline got us through the first wave. It had to. We had no choice, and things were moving and changing so quickly.

But now I worry so much about the emotional impact this protracted period will have on all of us nurses, not just newly registered nurses, but all of as human beings. It is impossible to do our roles and detach ourselves from our humanity. The majority of us got into nursing because we wanted to make a difference to people. And that is a human act.

I genuinely worry about the post-traumatic stress we may experience due to what we have seen and been exposed to; the emotional burnout we may feel, and what all of this means for the future nursing profession. I wish I had an answer; I genuinely wish I did. But I think this recuperation period will take us years.

So, what can I say? Because I don’t want this blog post to seem all doom and gloom. I guess, what I want, and hope is that our nursing and healthcare leaders acknowledge just how much support we newly registered nurses will require to help us get over this period, alongside all of our colleagues. However, I hope that they do not only acknowledge this but act upon it. And quickly. Because quite frankly, this has been a baptism of fire for all of us. We know nursing retention within the first two years is already a significant problem, and we can’t afford to lose any nurses. For those of us who go on to become our future nursing and healthcare leaders, never forget what we have learnt during this period. Let this define what kind of leaders we will become.

Most importantly, as one human being to another, please stay safe. Your physical, mental, and spiritual health is so important. There is no no material value you can place on this.

Please see an attached link for the RCN’s country-specific covid-19 and your mental well-being links:

https://www.rcn.org.uk/get-help/member-support-services/counselling-service/covid-19-and-your-mental-wellbeing

All my love Craig www.twitter.com/CraigDavidson85

The end is nigh!

Bit of a dramatic statement, but it is genuinely how I feel this year is heading. With five weeks to go until I lose the safety net of being a student nurse, the fear of the unknown is becoming all too real.

Being part of a cohort that has completed all placements of 3rd year during a pandemic, in a health service that was previously so understaffed the nurses of Northern Ireland had already felt the need to invoke industrial action to address safe staffing issues, we are no stranger to the unknown and uncertainty that we face daily in practice.

However, I found myself having moments when I ask, “why am I doing this?” I hear from those who came before me who tell me nothing prepares you for the day you stop being Student Nurse Cairns to Staff Nurse Cairns, and again I ask “why am I doing this?” thankfully though these moments are few and far between.

As I reflect, I found the reason why I am doing this. It is at the end of every busy day I go home knowing I have learned something new and often fascinating! It is when I am with my patients, and we share an anecdote and a laugh. It is when I can hold a patient’s hand and give comfort when they are afraid and uncertain about their future. It is when I am waving a discharged patient off the ward with a fond farewell knowing I contributed to the smile on their face, that is why I do it.

Yes, the fear of the unknown is strong but not as strong as the inherent want to help that lies within each nurse.

I know it has been said before, but a good support network is invaluable. I find myself surrounded by amazing people, my peers have just or who are about to qualify beside me, the staff that have supported me through my learning both in practice and academic, my friends who have understood why I have cancelled yet another lunch date, my family who give me that boost when energy levels are low and, my husband who has proofread my work and listened and share my ups and downs with an encouraging nod. I thank you all.

Marie www.twitter.com/MarieShaw1