by: Phillip Gonzales
The Covid-19 pandemic has undoubtedly brought an enormous strain in the healthcare system globally. Due to the virus’ highly infectious characteristic, the disease spread so easily that has caused an influx of patients overwhelming the National Health Service (NHS). One of the dilemmas for most Trusts is the inadequate number of trained nurses to work in the ward or Intensive Care setting in response to the rapid increase of infected patients needing hospital admission.
Non-emergency services have been postponed such as outpatient and elective theatre lists as a strategic preparation to the outbreak. As a result, staff from these areas were asked to move from their normal working environment; mainly in the ward or Intensive Therapy Unit (ITU).
The redeployment required health workers to be flexible and adapt to unfamiliar settings in order to meet the demands of patient care. Despite the “can do” attitude that nurses possess, many have revealed apprehension on handling patients beyond their individual competence due to lack of training. The extraordinary situation necessitated them to look after infected patients with severe symptoms and critically ill which they were not trained to do in their current practice.
To gain understanding about redeployment, I asked few Filipino nurses working in Theatres, Cardiac Cath Lab and Outpatient Department who have been moved to Covid wards and ITU about their experience, their feelings and views about it. I have used aliases throughout the article to protect their identity.
Nurse A, a recovery nurse, stated that the redeployment in ITU compelled them to learn fast with the minimal training they received which included donning and doffing of PPE, proning, and about ventilators.
“ They expected that we already have basic nursing skills such as IV administration as well as figuring out how the documentation works in that area. As a recovery nurse, I learned to adapt quickly but I have seen some scrub nurses who struggled as they may have few bedside skills.”
“Most of the staff understand that I am not from the critical care unit. It was overwhelming initially.”,she added
It was evident that nurses who did not have any bedside experience, found it more difficult to adjust to the new setting compared to those who did.
The RCN suggests that it is the unit’s responsibility to orient staff to the new area and a basic induction to safety procedures must be discussed. It was a relief to hear that, in some hospitals, theatre staff have been prepared by their department’s leads even before sending them to ITU.
“We did a 2 day training and 2 long day shadow shifts before we were included in the numbers. I had 2 hours training about intubated patient safety and basics about the ventilator” expressed Nurse B, who works as a Day Surgery Nurse and was moved to ITU.
However, in some hospitals, staff either missed the training or did not have any at all.
“I did not receive any training. It was more of the on the job, sort of learn as you go” revealed Nurse C, an Emergency Theatre scrub nurse.
“ Our manager arranged a two day training, however I was on annual leave in those days. I still went to ITU when I came back to work. Luckily, I did not have to handle the patient the whole shift on my own.”, affirmed by Nurse D, a scrub nurse from a NHS general hospital.
Nurse E, a theatre nurse revealed “There was no orientation. I only had a 2 hour ITU crash course”
Although the national guidelines from Public Health England have been released, every NHS Trust still differ when it comes to protocols in response to Covid 19. It was difficult to discern the specifics on how each hospital have responded to such unforeseen circumstances. Nevertheless, these nurses have shown great courage and reacted to the situation positively.
Nurse F, a theatre sister in a NHS hospital said, “ I was given the days I will work there and that is it, off you go. I was the one who took the initiative to ask and learn from my colleagues on how to use pumps, syringe drivers and how an anaesthetic machine works with a ventilated patient.”
One of the most important factors for a successful redeployment, was the amount of support provided by the nurses in the new area. I was pleased to hear they were supported quite well.
“The staff I worked with were amazing and approachable, they were experts on their field. It was a learning experience indeed to be rotated in a new area especially on how to handle critically ill patients.” said Nurse G, also a theatre nurse
“I worked initially with a fellow Filipino who explained to me the routine and the how to’s inside ITU”
However, some days may be burdensome to the ITU nurses when they needed to look after 2-3 intubated patients at the same time. They will still help the redeployed nurses as much as they can but it may be insufficient with their full workload in place.
Nurse D added," I was just giving a hand to ITU nurses on tasks that won't involve handling patients and later shadowed an ITU nurse to get an overview of their routine. However, her other patient began desaturating so I was left on my own with a patient for a while. Luckily, the patient I was looking after was not intubated. I needed to double check everything with the ITU nurse before carrying out any doctor’s orders and administer any medication. Being in ITU for the first time, no training and being a scrub nurse since I started my career, I felt that was the safest way. However, the patient felt I was not competent enough to look after him. It was disheartening to hear that but I have explained to him the situation and he understood where I was coming from.”
“The support was not ideal, I was told that there would always be someone out in the nurse’s station if I needed any help. Honestly, they were not there most of the time. Luckily one of the nurses was a friend so he looked after me from time to time. My second day was a lot more daunting as I had a patient who was intubated and had 9 pumps. The hand over just blew my mind literally. On the back of my mind this was just too much to handle. Luckily my ITU nurse was very supportive and told me that I did not need to put too much pressure to myself and just asked anything, even if it is a stupid question.” expressed by Nurse C.
The NMC Code guides us to practice within the limits of our competence. This unprecedented time challenged everyone in the healthcare sector to practice above and beyond whilst ensuring patient safety. This gray area made me ponder: Is this practice safe, especially from someone who lacks bedside experience and care for a critically ill patient?
“It is challenging to juggle between trying to work within the boundaries of safe practice when we are in a situation to provide care that we are not trained for” said Nurse K, an out patient department nurse.
The NMC recognised that some nurses needed to work outside their usual practice and have been flexible with its guidelines (stipulated in the joint statement with other health care regulators) in response to this national emergency.
Learning about the experiences of these redeployed nurses gave me a deeper insight about resilience, adaptability and “can do” attitude. It amazed me how they have seen the unenviable situation in a positive light. Their deeply rooted compassion kept them going despite the risks involved with a desire to help sick people, their Trust and their colleagues in such difficult situation.
Nurse A revealed with passion, “ There was a feeling of resistance at first, but the duty of care is our commitment.”
“ We do not know how long we can face this crisis. But one thing I am proud of is that our PACU team is still standing tall, stronger than ever amidst the displacement and chaos and sweating and bruising under the PPEs.” Nurse J, a theatre nurse, positively added.
Nurse C contemplated, “ I felt lost at first. But looking back, I don’t mind working in ITU as long as I have someone there to support and guide me. I have always wanted to help cover patients and contribute to their recovery even in small ways”
Nurse I, a scrub nurse, stated, “It is a good learning opportunity and also a good morale boost to everyone who are working hand in hand in the frontlines”
“It is good to learn. In cases like this, it is understandable to be moved where I am most needed. Everyone is trying to work together to fight this crisis, so I don’t mind being redeployed” pondered Nurse H who works in theatres.
Nurse E considered,“ I am happy to gain new skills and learn from the experience the redeployment offers.”
“ At the end of the day, I vowed to save lives and I am privileged that I am doing exactly just that” said Nurse G with pride.
There is no doubt that support in an unknown setting could make or break the redeployment experience and staff well-being. Having someone to ask and guide you can make all the difference. Assertiveness and proactive attitude can go a long way but never be afraid to speak up. It is ok to say no if you feel uncomfortable or feel that the task or situation is unsafe. Speak to your manager and make your concerns known. Putting your concerns into writing might is not a bad idea as well.
Ultimately, it is your pin on the line but also keep in mind the oath you have sworn to care for patients. As long as every decision you make regarding patient care is within the basic principles of best practice using your critical thinking skills, moving from your comfort zone especially in this time of global health crisis will surely make you a better nurse more than ever before. Going above and beyond to save lives and make a difference.
About the author: Phillip is an agency nurse working as a Theatre Scrub Nurse and an active member of Filipino UK Nurses Community.
Tags: Filipino Nurses UK, Filipino UK Nurses, Covid 19, Corona virus, Redeployment, front line workers, ITU, NHS