Updated: Jun 6, 2020
by: Anonymous Nurse
I am a theatre nurse, trained to assist with surgeries -- from suturing a small wound to a complex laparotomy. I am competent. I am always ready. What I wasn't prepared for was looking after the critically ill hanging by the thread, being in the red zone where the coronavirus is floating around freely, and hear the most heartbreaking phone call in my life whilst looking after a patient, "Please can you tell my Dad, I love him so much." I couldn't even bear the thought that this little boy may lose his father whilst he fights for his life with Covid 19. The boy wasn't ready nor was I.
Covid 19 wreaked havoc to our society, took the lives of many and disrupted our once routine driven lives. The pandemic crisis created strategic changes within the NHS which included redeploying nurses to Covid wards or Intensive Therapy Unit to meet the rising demands of patient care. The theatre department, for instance, cancelled elective lists in order to free up ventilators, anaesthetists and ODPs which are crucial to managing the airway of patients severely hit by the deadly virus.
The technical skills I have gained as a scrub nurse was a far cry from caring for the critically ill. As a scrub nurse working in a specialised area, we only cater one patient at a time, we ensure that all equipment and sets are ready and sterile and we anticipate the surgeon’s needs whilst keeping the patients safe during surgery. I don't administer IV medications, don't do nasogastric feeding, and I have very little knowledge with ventilators. Although I have learned all of these from nursing school and from my previous training, I don't do it on a regular basis for many years and therefore I don't feel competent at it. Just like with any skill, you have to practice it regularly to feel confident in doing so. I have limited bedside skills that a ward or an ITU nurse possess. I was totally out of my comfort zone when I started in ITU. But there’s no other choice but to be brave enough to perform the tasks that I haven’t done before and just use my critical thinking ability. "I have a duty to perform and it is to be on the frontline, guide me oh Lord" I prayed fervently before I started my first shift.
I was sweating heavily under the hazmat suit covering myself from head to toe but more so due to my adrenaline rush. My heart was racing, rapidly pumping blood to oxygenate my brain to keep my senses heightened. With nine pumps beeping after one another, ventilators alarming, and preparing medications before they run out in the pumps, I was running like a headless chicken. Still, I prioritised the tasks at hand and doctor's orders that needed to be carried out to deliver the best possible care I can give to my patient. The fast track training clearly wasn't enough. Although I can ask questions to the ITU nurse in my bay, I still feel uneasy doing the nursing interventions that I'm unfamiliar with. I just thought, "as long as I won't do anything stupid and ask if I'm unsure with anything, my patient will be safe and that is my goal." Despite my positive pep talk, I still felt helpless and apprehensive. But I carried on. Due to the evident lack of experience, I barely managed my time in order for me to take regular breaks. I had my lunch at 5 pm that day. The very first time I sat down and free my mind from the lingering negative thoughts. Seeing the dents in my face created by the FFP3 mask, was like a dent in my heart feeling incompetent as a nurse. I felt devastated after my first shift, drained physically, mentally and emotionally.
Days have passed and working in the Covid ITU felt like a norm now. I am getting the hang of it. Performing critical care nursing skills (eye care, mouth care, input and output, medications, pumps, proning, managing ventilators) were doable and more importantly, I was managing a really sick patient appropriately. Despite the competence I gained as I face my fears everyday, I still feel I can do better. That I can be more reliable on what I do if only I had the proper training. But there's no time for it and it wasn't even an option. There was a time when I sought help from the ITU nurse and she couldn't comprehend why I didn't know certain things and will make belittling comments. I'm not generalising everyone, as some have been really helpful and supportive as they know that ITU is an unfamiliar place for us, scrub nurses. The stress and fatigue may also have contributed to their impatience and I can't blame them. So I just ignored the negative feedback and took it constructively to improve myself. After all, they're our only source of confidence in the ITU. Every time the ITU nurse goes for her break and it's only me and another scrub nurse left with 3 intubated patients in our bay, we are so terrified, enough to keep our eyes wide open to potential deterioration of any of the patients we're looking after.
I thought handling an acutely ill patient along with my anxiety of getting the virus will be the worst feeling as a nurse in the frontline. Little did I know, dealing with the emotional burden of the patient's family was the most heartbreaking experience I will ever encounter. As I receive calls from the anxious wife, worried husband, grieving daughters and sons, both young and old, asking how their loved ones are doing... Will my husband survive? Will my wife make it? Are we going to see my mom again? Please tell my dad that I love him. All they wanted to hear was a glimmer of hope in this battle that I felt like I'm always on the losing side. It breaks my heart into pieces every time I talk to the patient's relatives. Knowing that their loved ones may be taken away from them with this unseen enemy, forever.
It's just a matter of time when this will be all over. Two months has gone and I'm still working in the ITU. I am proud and privileged to be in the frontline. I have evolved to be a stronger person and a better nurse equipped with more knowledge and skills. The high intensity work may have caused physical exhaustion and fatigue but I learned to manage my time effectively now that I'm familiar with the tasks at hand. The Personal Protective Equipment may have given me discomfort, sweating and bruising, but I learned how to keep myself calm and perform the best nursing care whilst donned in it. The fear and anxiety I have concerning my health and my family's wellbeing may have made me vulnerable but I learned to cope and think positively. The agonising concerns for the patients and their loved ones may have broken my heart but it motivated me to acquire skills and be more reliable so I can help them recuperate from the illness.
I have designed a coping style which included physical and psychological adjustments. I learned self care at its finest --- exercise, healthy meals, taking vitamins regularly and practicing good hygiene. I became more adaptable to any situation thrown at me. I learned to be more grateful, compassionate and altruistic. I have valued life now more than ever. Most of all, I have nurtured my spiritual connection to God in the midst of all the uncertainty and chaos around us.
It was indeed growth under pressure. I gained not only resilience and bedside skills but a refined professional responsibility - adamant to learn skills necessary for this kind of situation should there be a second wave. Even though negative emotions arise from time to time, positive emotions still interweave with it and prevail in the end. Nevertheless, extensive training and support is still crucial to deliver my expertise with conviction and without apprehension. It takes time to be good at something. And if I needed to care for the most vulnerable patient in ITU again after "upskilling" myself, I hope I'll be truly ready.
About the author:
Anonymous nurse has worked in the NHS for seven years and currently a charge nurse in the Theatre Department.