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COVID-19: Struggles & Lessons of an ICU Nurse

This pandemic has taught me a lot about myself and people around me. It has taught me that we ,human beings, are fighters. We are resilient and can cope even in extreme situations.

I am Selina, I am an ICU nurse working and residing in London. I moved to the UK in 2013 and applied as a nurse through the Overseas Nurses Program.

Back then, the application process was different. We had to complete a course in the University which was the Overseas Nurses Program in order to get my NMC pin. This was replaced by the CBT and OSCE.

I am working in a hospital that specialises in infectious diseases in London. When the Coronavirus pandemic started, Our trust has been one of the first to receive the Covid-19 cases in the UK. By March, the number of cases went up rapidly. We were receiving more than any other hospital in London. Our 34-bed ICU became a 69-bed unit, extending to our newly built SHDU (Surgical High-Dependency Unit), theatres and PITU area. The first few COVID-19 patients were being looked after by 3 nurses at a time (2 main nurses and a runner). However due to the rapid increase of cases, this changed to a ratio of 2:1, then 1:1, which later became a 1 nurse: 2 level-3 patient ratio. We could hardly fill in the staffing requirement on a normal shift, let alone an extended ICU unit during a pandemic.

One can imagine how extremely busy, stressful and draining our days were. Before the pandemic, a new patient is normally managed by a nurse and the team leader. But due to the increase of cases, our previous protocols and processes have to be changed. Shortage of trained staff and the need for extreme isolation also added to the challenge we had to face in the unit. As we can no longer cope with the spike of cases, more personnel were redeployed, trained and categorised as A, B C support staff. They were comprised of nurses who had previous ICU experiences, nurses with no ICU experience, military and navy personnel who came to help us cope with the surge. But even with the additional help, we, at times, felt that it was still not enough. We would sweat, catch our breath and pray that we can still give the best possible care for our patients. At the peak of the first wave, I had to look after 2 extremely unwell patients and covered for 4 (patients) during breaks. My colleagues and I needed to keep all alarm setting in place whether it was for the bedside monitor, ventilator, infusion pumps and CVVH machine. We had to attend to each and single alarm right away.

You may have seen the news from BBC about hospital staff experiencing PTSD (Post-traumatic stress disorder).

Given the current circumstances, it is really possible for one to develop this condition. It was like we were in a "war zone". It was physically exhausting and mentally, psychologically & emotionally draining. There were times where I found myself crying on my way home after shifts. All I felt was a mixture of tiredness, frustration, self-pity and fear.

Those months have been really rough, but its comforting to know that I was not alone in this battle. After a full day shift, as we stepped out from the isolated units, feeling deflated, the incoming staff and management would cheer us up. It helped knowing that we all have each other and would want to fight this battle together.

Now that the UK is on its 2nd wave, we all fear that we will be in the same situation as before. Will this be another “war zone”? We have not fully recovered but are we about to go through the same level of stress and trauma as before?

Although we are seeing that the number of cases is increasing, the situation in our ICU is not yet as severe as the 1st wave. This can possibly be attributed to the better management of the patients from the wards and even from their homes. We see lesser number of admissions compared to before. Most also come self ventilating, on CPAP or Optiflow (high pressure nasal specs) and are discharged to the ward within a week. This is very different from the experience we had during the first wave when patients arrived very sick, difficult to ventilate, intubated and proned.

I can also say that treatment and management of the disease have greatly improved. Since the first wave, our management in ICU for COVID-19 patients were regularly reviewed and adjusted by a team of ICU consultants. Continuous changes were sent to us on a regular basis as doctors found better ways to manage the virus. The experiences and trials we had greatly helped in managing the patients at present.

This pandemic has been big learning experience for all of us. What I learnt in the first surge taught me so much more than what I could possibly expect from that experience. I learnt that people cope in extreme situations. People can work together as a team in times of crisis. I also learnt that we also need to give more importance to our mental health. I have started meditation and learnt to take breaks for myself. This has certainly helped me cope. I learnt that pain is temporary and time can certainly heal all wounds.

The pandemic is not over. We are still fighting this virus. Will this whole COVID-19 experience make or break us?

About the Author:

Selina is an ICU nurse residing and working in London. Born in the UK, but raised in the Philippines since she was 3. She has decided to move back to the UK after working as an ER Nurse in one of the tertiary hospitals in Metro Manila. She started working in the Renal Unit then transferred to the ICU of the same hospital. She now works full-time bank and agency for the last 4 1/2 years.

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