Analysis

Redeployed in emergency care: anxiety and dread in one 12-hour shift

The RCN Nurse of the Year 2020 describes a day on the front line in the COVID-19 second wave

RCN Nurse of the Year 2020 Ana Waddington describes a day on a hospital front line in the COVID-19 second wave

  • Paediatric emergency senior nurse describes a 12-hour shift on the adult emergency department after being redeployed there to support the team
  • As new COVID-19 patients arrive, staff struggle to source much-needed equipment from other wards
  • First-hand account of how the emotionally and physically exhausting work is affecting staff well-being

Nurses have been at the forefront of care throughout the COVID-19 pandemic – often being redeployed to support colleagues in other areas.

Among those on the front line is Ana Waddington, the RCN Nurse of the

RCN Nurse of the Year 2020 Ana Waddington describes a day on a hospital front line in the COVID-19 second wave

  • Paediatric emergency senior nurse describes a 12-hour shift on the adult emergency department after being redeployed there to support the team
  • As new COVID-19 patients arrive, staff struggle to source much-needed equipment from other wards
  • First-hand account of how the emotionally and physically exhausting work is affecting staff well-being
Ana Waddington, RCN Nurse of the Year 2020 and paediatric emergency senior nurse at the Royal London Hospital
Ana Waddington Picture: Barney Newman

Nurses have been at the forefront of care throughout the COVID-19 pandemic – often being redeployed to support colleagues in other areas.

Among those on the front line is Ana Waddington, the RCN Nurse of the Year 2020, who works as paediatric emergency senior nurse at the Royal London Hospital. The hospital is part of Barts Health NHS Trust, home to one of the UK’s largest children’s hospitals, as well as a leading trauma and emergency care centre.

Here, Ms Waddington gives a vivid insight into helping colleagues in the adult emergency department (ED) during a 12-hour shift in January 2021.

‘I don't know what day it is, what shift I am on or if I am even on a shift’

Icon of an alarm clock

7am I reach over to silence the alarm. I don't know what day it is, what shift I am on or if I am even on a shift. My partner is still in bed, so that must mean it’s an early. I am exhausted. I have been sleeping with earplugs and an eye mask so that nothing can wake me, but it’s not working very well and my sleep is broken and I am haunted by vivid and confusing dreams about searching for medical equipment.

7.20am I’ve mastered the art of getting up, showered and dressed in my cycling gear in 20 minutes to give myself more time to sleep. We usually finish shifts at 8.30pm and, after showering at work, I’m home and in bed by 11pm to give myself eight hours before it begins again. I give the dog a bone. I really need a coffee, but I don’t have time.

8am I’ve arrived at work. In the quiet ED changing room we all look pale and tired. I worry about our workforce; there will be a lot of pressure on senior management to come up with imaginative ways to tackle the worst mass burnout the NHS will ever see.

8.30am I am in paediatrics today, with another senior nurse in charge. I’ve asked not to be in charge as this is my last of three 12-hour day shifts in a row. We’re in the paediatric ED for the handover from the night shift. We hear that the adult ED is busy and will probably need our help. I can sense some anxiety about the allocation of roles and who will end up with the adults and who will be working in the areas with the sickest patients.

‘For now it’s just me and a paediatric doctor as the other areas are too busy. We look at each other anxiously. “We can do this,” we say to each other with our eyes’

We have a lot of junior members of staff working today so I am volunteered to go and support the adult team, while someone coming in later will be allocated to the sickest area. This area is based in the paediatric department as it is near the entrance, but it also has individual cubicles so that aerosol-generated procedures can be completed without risk to other patients.

10.30am I've been supporting the COVID area cubicles. When we receive a patient, a free nurse enters the room to complete the COVID bundle – observations, insertion of an intravenous access line, taking blood samples and the swab test. Some patients require oxygen, an electrocardiogram or X-ray. We try to limit our time inside the rooms to reduce the risk of contamination.

10.45am We have a new patient. Everyone is busy, so I offer to see them. No one recognises me in the mask and hat I am wearing. I introduce myself and the doctor asks if I am happy to do bloods and observations. I say yes. I can cannulate, but I am a bit more anxious when I do this in adults. I don’t want to let the team down as they need our help.

Icon of a coffee mug

11am I’ve been in the room with the patient a while and I feel a little helpless. She is a renal patient and has difficult veins. I confess that I’m a paediatric nurse. Her face lights up – ‘Oh, how wonderful!’ – and I distract her with a paediatric emergency story as I try one last time to insert a cannula. I am successful and this is a win, as I don't want to have to ask an adult nurse to help me on top of their already heavy workloads. It’s my turn to have a 15-minute break. Finally, water and a coffee!

Anxious, tired and working outside our comfort zones

11.30am Our intensive aerosol area is filling up so we will have to open the area in paediatrics.

The paediatric nurse allocated to this area is junior and has not been fit-tested for the masks, so I swap myself in so we can open the area. I suggest another paediatric nurse who can carry on supporting the adult side. It’s really hard; although we are all eager to help, we are working outside our comfort zones at all times and we are all really tired. The nurse kindly says it’s okay, but I know she’s been helping the adult side a lot this week. We all have. I rush over and open up this area, ready to receive my blue call (an alert warning EDs of the impending arrival of a seriously ill or injured patient).

Usually there are 2-3 nurses staffing this area, along with 1-2 doctors. For now it’s just me and a paediatric doctor as the other areas are too busy. We look at each other anxiously. “We can do this,” we say to each other with our eyes. We are fully ‘gowned up’ in personal protective equipment (PPE) awaiting the patient, who we are planning to put on high-flow nasal oxygen therapy (Optiflow).

A patient arrives via ambulance at the Royal London Hospital
A patient arrives at the Royal London Hospital Picture: Alamy

12.30pm I now have two patients on Optiflow. Both have been quite difficult to manage – not medically, but psychologically. They are men in their 50s with high-risk factors and of minority ethnic backgrounds, who have been self-isolating for ten days. Oxygen masks are not enough, they need Optiflow, but both dislike it. It is uncomfortable and with the added stress of not being able to breathe properly because of the virus, they are screaming out for me. As I quickly type my notes, I can hear them calling ‘Nurse! Help!’.

The paediatric doctor and I take one patient each. This doctor has been a life saver. I ‘gown up’ again – hat, FFP3 mask, goggles, blue gown and gloves. The rooms are hot. My patient is sweating and he’s pulled off the oxygen monitor once again.

I try to explain it’s important for his breathing. I point to my chest and imitate breathing. He is Bengali and his English is poor and he has no one there to support him. He keeps trying to call his family but he is too unwell to speak for long. His oxygen levels are going below 90% despite the Optiflow. I need him to calm down. He is growing more tired and the next step would be to escalate to the critical care team to review his treatment and I know that they have limited capacity.

Putting on PPE, going in to help a patient, then starting all over again

1.30pm A consultant walks in with the dreaded small white slip of paper that usually has information about a blue call coming in. The paediatric doctor has been called to see a sick child. I am alone.

I call the nurse in charge for support and as the patient is brought in, an adult nurse and adult doctor come round to help. I want to hug them I am so relieved. We agree I need a break and as they gown up and go in to take the patient, I ask if someone from paediatrics can cover me.

2pm I needed that 30-minute break. You don’t realise how tiring it can be to keep the FFP3 mask on for long periods of time. You forget to drink, your face is sore from the mask and your forehead is sore from the tip of the goggles. I gown up again.

Icon of a 12-hour period

4pm We haven’t stopped. Patients keep deteriorating or require new medications and the process of gowning up, going into the room, sorting the patient out and then coming out again takes a long time. I’m very conscious I haven't yet phoned any relatives to let them know how their loved ones are doing.

We don’t have any more Optiflow machines or continuous positive airway pressure (CPAP) devices in our department. I call around the hospital asking wards whether they have one stashed away in a corner, but everyone is using theirs. I’m anxious about the prospect of getting another patient who requires one. I call the paediatric floors, and luckily find one that has just been cleaned. They lend it to us, fully aware that they probably won’t get it back for a while.

Team effort to support a very ill patient

5pm A third nurse who has been redeployed to the ED from research has been in a cubicle for ages with a patient who needs CPAP, which we have not done in a long time. We had to call the nurse in charge to help set it up.

We teach him how to put on the machine by signing through the window. It works despite our terrible acting. He can finally come out and have a break. Just as he gets his PPE off and washes his hands, that dreaded white slip appears again.

We have a really sick patient coming. Heart rate is very low… too low. This time we have two senior adult registrars in the area. One will take the patient. The nurse hesitates to go for break. ‘Go,’ I say. ‘We need you to have a break and the patient may need a transfer out of our hospital to the cardiac centre.’

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6.30pm The patient is really sick. Fortunately, the senior adult nurse who came to help is an experienced emergency nurse with a cardiac background and this is her specialty. The patient needs to be transferred urgently to St Bartholomew’s Hospital. We get things ready and she is happy to go despite not having had a break. I start to feel dread again, as we are back to just two redeployed nurses who are not used to managing these patients.

The research nurse is amazing. We talk it through and agree it will be absolutely fine. On the plus side, I've managed to help him with his sore hands and I have given him some DuoDERM to cover the wounds he has from endless handwashing. He is ready to go again.

Finally, a chance to speak to patient’s loved ones

8pm It’s almost home time. The day has gone by incredibly quickly and we’ve had another patient come in requiring Optiflow. Thankfully, we had the spare machine set up. I gowned up to apply the Optiflow and do the preliminary tests and observations. The patient is much more settled and comfortable on the Optiflow. As I degown and wash my hands I remember the relatives. I quickly get out of the room and speak to the doctor in charge and between us we update the families.

I speak to the daughter of my first patient, the man who was quite distressed with the Optiflow. Thankfully he is calmer now and is on his stomach; I decided to trial this and it made him relax, he has even fallen asleep and his oxygen levels have gone up to 98%.

His daughter is really grateful to hear from me and tells me that the family has been scared since her father called them, crying. I tell her where he will be admitted and reassure her that we will be in touch soon to update them. His phone is fully charged – I made sure of that – so they can keep in touch.

8.20pm We’ve made it. The night team are here and I am handing over. I feel embarrassed at my handover of adult patients, they have such long medical histories. I thank everyone and head to the changing room, then shower and wash my hair at work.

‘I feel jealous of friends not in this situation – it’s quite isolating right now’

9.15pm I’m really tired now. I cycle home and see my partner in the kitchen cooking pasta for my dinner. I couldn’t do this without him. My dog is very happy to see me. My partner asks about my day and I just tell him it’s all bad and it’s all sad. That’s all he’s getting tonight. I feel bad for him as I am tired and grumpy all the time. I sit down to eat my food but keep worrying about my patients.

I try to do some mindfulness and put my phone on airplane mode. I’ve deleted Instagram so I don’t mindlessly scroll through it and feel jealous of friends not in our situation. It’s quite isolating right now. Anyway, tomorrow is a new day, and I’m sure there will be new things to worry about. For now, I look forward to the day where I can download Instagram again.

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