Cast your minds back to February 2020, just 6 weeks ago. Emergency Departments throughout the country were experiencing their worst waiting times on record. Treating patients in the corridor was normal, there were even designated corridor nurses. Staff shortages, not enough beds in the hospital, no social care places to discharge patients- our EDs were bursting at the seams, (The Independent, 2020 and The RCN, 2020).
Now we are in April, the bank holiday weekend has just passed and for once it’s not raining, in fact apparently, it was hotter than Spain. If this was a typical sunny bank holiday then we’d be prepared; the alcohol, the injuries, the trauma, the dehydration, the sunburn, the ones who can’t wait that extra day for their GP to open, and the ones who put off that niggling chest pain because they had plans with the family- 24/7, we’d be ready for them all. Except its not a typical bank holiday, because this year there’s Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). A global pandemic unlike anything we have seen in our lifetime. It’s a very funny time, the schools are closed, we’re all on lockdown, unable to leave our houses but for the essentials and its nearly impossible to buy toilet roll or pasta, but theres something else very funny going on to. Our Emergency Departments are empty. Worryingly empty, (The Economist, 2020).
Almost overnight, my ED went from regularly having 50 patients in our 23 bedded majors, to barely having 20 patients in all areas. Where we once waited 12+ hours for a bed on the ward, patients are being ‘called for’ before we’ve even got them to X-ray. Critical internal incidents with managers working 24 hour shifts, nurses going home in tears and running out of stock, have become Opal 1, nurses twiddling their thumbs and a department so fully stocked and cleaned it looks like new. We are concerned obviously, for the people not coming and also hoping our regular attenders are ok, but it is also a nice break after the months of chaos.
This morning, post night shift, I took my one hours exercise in the local park. It was early, the sun was shining, the birds were singing, blossoms on the trees, flowers blooming, kids had drawn cheerfully on the pavement, ‘thank you NHS’ and everyone was saying good morning from a safe distance away- if it was a cartoon I’d be skipping. Then it occurred to me, this is what emergency nursing looks like at the moment. The stress has gone and instead my nurses are blossoming. They have passion and enthusiasm. Every shift is a learning opportunity; sims, turbo teaching, everyone is up to date with their e-learning. Senior nurses are teaching the junior nurses and the junior nurses are teaching the senior nurses. I enjoy going to work again, even with the threat and confusion that comes with Covid-19, there is a positive change.
It’s not just an increase in education, morale and appropriate attendance however. The anticipation of the Corona Virus has seen the whole hospital team think outside the box to imagine how we could create the best possible pathways for our patients in this time, and best of all they’re being given permission to make their ideas reality. For months we struggled to keep our mental health patients safe and seen in an adequate time, now we have a designated, staffed area for this patient group so long as they are medically well. Outpatient clinics are being delivered by phone or teleconference. This was something I touched on as being a possibility when I wrote my dissertation 8 years ago, now necessity sees it fast tracked as a priority. Front door streaming is working despite people saying it couldn’t be done.
Staff well being is also at the forefront. When ED was hitting peak numbers I was a huge advocate for supporting nurses mental health. Last year it was revealed that nurses were four times more likely to take their own life than the general population (Office for National Statistics, 2019). Reasons for possible causes included self sacrifice, bullying, staff shortages, long hours, pressure to ‘toughen up’ and workplace violence and abuse, (Independent Nurse, 2020). Now, the NHS is treating staffs’ physical and mental health as a priority, (NHS Employers, 2020). Occupational Health services are being promoted more than I have ever seen and conversations about what more we can do to support nurses are taking place online and in the workplace with some amazing ideas being developed. Every Thursday evening the whole country claps for the NHS, (Clap for Our Carers, 2020). It goes without saying that the stress of the Corona Virus brings its own challenges when it comes to staff well being and mental health, but in our currently very pleasant working environment, I no longer have nurses crying at the end of the shift about the care they couldn’t give or the patient that deteriorated in the corridor but we didn’t notice until it was too late. In addition there is now a dedicated phone line and text service for nurses who are experiencing mental health difficulties, (Nursing Times, 2020).
I understand there are many factors that prevented change pre Covid-19, and I don’t fully comprehend how we managed to put the brakes on so quickly to be able to adapt for the current climate. I hope however that now we are seeing positive changes, and have had some breathing space to look at our processes, we will continue to develop and actively encourage new ways of doing things.
This summer will be a testing time for us all, but lets not go back to how things were in the winter. Emergency Nursing is exciting and enjoyable once more, lets look forward to #TeamED becoming bigger and better than ever before.
- Barnes, T. 9/1/2020. NHS crisis: A&E waiting times hit worst level on record. Accessed 13/4/2020.
- Clap For our Carers, 2020. Clap for Our Carers. Accessed 15/4/2020.
- Davies, N. 10/2/2020. The Suicide Crisis in Nursing. Accessed 14/4/2020.
- Mitchell, G. 8/4/2020, New mental health helpline for NHS staff tackling pandemic. Accessed 15/4/2020.
- NHS Employers. 2020. Health, Safety and Wellbeing. Accessed 15/4/2020.
- Office for National Statistics, 24/10/2018. Suicide deaths among nurses aged 20 to 64 years, deaths registered in England and Wales between 2011 and 2017. Accessed 14/4/2020.
- The Economist. 8/4/2020. A sharp drop in accident-and-emergency admissions worries medics. Accessed 15/4/2020.
- The Royal College of Nursing Emergency Care Association. 26/2/2020. ‘Corridor care’ in hospitals becoming the new norm warns RCN. Accessed 13/4/2020.