Analysis

What happens now: the state of nursing after the COVID-19 pandemic

Six nurse leaders discuss how the past 18 months have affected their roles and their workplaces

Six nurse leaders reflect on how the past 18 months have affected their roles and their workplaces

  • Staffing is a major concern, with nursing staff left traumatised and exhausted, and demoralised by governments response
  • Backlogs for treatment are also a serious issue, with many long-term conditions thought to have worsened due to delayed treatment
  • Some feel COVID-19 has highlighted existing staffing, funding and equality problems in the health system

The UK is, hopefully, over the worst of the COVID-19 pandemic.

But as the country embarks on the road to recovery, nurses across the NHS and social care sector face some daunting challenges. Here, six

Six nurse leaders reflect on how the past 18 months have affected their roles and their workplaces

  • Staffing is a major concern, with nursing staff left traumatised and exhausted, and demoralised by government’s response
  • Backlogs for treatment are also a serious issue, with many long-term conditions thought to have worsened due to delayed treatment
  • Some feel COVID-19 has highlighted existing staffing, funding and equality problems in the health system

COVID-19: what the future holds
Picture: iStock

The UK is, hopefully, over the worst of the COVID-19 pandemic.

But as the country embarks on the road to recovery, nurses across the NHS and social care sector face some daunting challenges. Here, six nursing leaders from different sectors describe the biggest tests they now face.

Felicia Kwaku
Felicia Kwaku

THE HOSPITAL NURSE: Felicia Kwaku is associate director of nursing at London’s King’s College Hospital NHS Trust

While the number of patients with COVID-19 in hospital has decreased significantly, the demands on hospitals are still huge, says Felicia Kwaku.

‘There’s a big focus on recovering services – tackling backlogs and seeing patients who have stayed away during the lockdowns,’ she says.

‘We have noticed the deleterious impact on patients’ health. People with long-term conditions, such as heart failure, have not been receiving the support they normally would. And even with conditions like dementia, I suspect some people have deteriorated more than usual. Then there are all those people waiting for elective treatments.

‘What worries me is the pace of recovery when staff are still in varying stages of trauma – they have not had sufficient time to recover.

‘Nurses are traumatised. We have seen our patients die struggling for breath and we have seen colleagues die with higher numbers of death among ethnic minority staff. Emotionally and physically we are exhausted.’

Ms Kwaku says senior nurses are doing their best to provide support with debriefs for staff who have returned after being redeployed.

‘There is plenty of support available but what staff need is time out. I would like to see the NHS create more flexibility for nurses to take longer holidays all in one go and, where possible, to allow more home working for appropriate staff. This could make a big difference.’

But it is not just those nurses that need support.

‘Nurses and staff who have been shielding are returning and new nurses – those coming from abroad or newly-graduated – are joining the NHS in the middle of a pandemic. This is challenging.’

And while all this is going on, there is always the lingering fear of another wave. If that happens, Ms Kwaku is concerned how hospital workers would handle it. ‘Our coping mechanisms are not inexhaustible.’

Alison Hill
Alison Hill

THE CANCER NURSE: Alison Hill is Macmillan director of cancer and palliative care nursing at Barts Health NHS Trust

The number of cancer treatments is increasing back to pre-pandemic levels after the drop seen last year when the pandemic first hit.

But Alison Hill is still worried about patients – those who are getting treated and those who have yet to come forward.

‘Undergoing cancer treatment with the intensive treatment and isolation is hard. Patients need people around them,’ she says.

‘Our nurses are seeing more people struggling emotionally and with depression.

‘And, of course, late diagnoses are a big concern as a consequence of that drop in referrals. We are beginning to see lots more emergency department presentations. It is going to mean more later stage cancers, which reduces the chance of survival.

‘There is a lot of work going on nationally to encourage people to come forward and we have been doing some initiatives locally involving short videos with staff.’

She also says services will need to keep adjusting as restrictions ease.

‘We’ve relied heavily on virtual appointments, on the phone and digitally. The pandemic has made us innovate. But we know these don’t work for everyone.

‘I am not sure the balance is quite right. We’re trying to do more face-to-face, especially for those first appointments and discussion of treatments.

‘It is so important to build up relationships with the treating team at those points. Later on and for follow-ups, virtual appointments can be more suitable.’

Staff also need more support in delivering care remotely, she says.

‘It’s a different skill set. We’re now doing some training with actors to help our nurses develop their skills in this area so they can make sure the support offered to patients does not suffer.’

Chris Dlamini
Chris Dlamini

THE EDUCATOR: Chris Dlamini is a senior lecturer in learning disabilities at Teesside University

There is still a lot of uncertainty about what the future holds in the teaching sector, says Chris Dlamini.

A hybrid model has been developed for nursing students where they come in for face-to-face teaching for skills training, while doing the theory remotely.

‘This time of year we have a lot of students on placement so it will not be until September that we see a big return to campus for nursing students,’ he says.

‘But even then I cannot see us cramming 500 students into lecture theatres. We will have to think carefully how we do this as COVID-19 is not going away.

‘I do hope we do more face-to-face teaching. It’s hard for students and lecturers alike. For lecturers it is isolating teaching at home all the time and I know some students find it hard. Engagement during online learning is difficult and you do lose some of that discussion and interaction that you have with face-to-face teaching.’

Placements are also affected, he says.

‘We are having to do a lot of juggling as services have not been able to take on as many students as they would in the past, so we have had to stagger things. ‘Face-to-face placements have continued in inpatient settings but in the community there has been a lot of remote placements.

‘The experience is different – you do lose something – but what I say to the students is that you are learning different skills. You are learning to adapt and in the future you will be the innovators.

‘They are training during a unique period of time, being asked to adapt, and that will stand them in good stead too.’

Sally Shearer
Sally Shearer

THE CHILDREN’S NURSE: Sally Shearer is executive director of nursing at Sheffield Children’s NHS Trust and chair of the Association of Chief Children’s Nurses

The rise in children and young people needing help for eating disorders is the issue that is concerning Sally Shearer the most.

‘Our mental health wards are full of children and young people, some as young as ten and 11. It is upsetting to see. Nationally it looks like cases have nearly doubled,’ she says.

‘Some patients on our acute children’s wards are there because they are too ill to be inpatients in a mental health setting but the other problem we face is that there are not enough tier 4 CAMHS (child and adolescent mental health services) beds nationally.’

Professor Shearer says a shortage of mental health nurses means children’s nurses are having to care for these children on general wards.

‘They can need care for weeks and we know when we discharge them there are more eating disorder patients in the community who will need to take their place.’

There are challenges elsewhere too, with the trust still working to tackle the backlog created during the first lockdown.

‘We do 50 operations a day, so that has created a significant backlog. It is going to take some time. We’re having to prioritise which patients need to be treated first based on their clinical need.’

And even with the threat of COVID-19 receding, she is worried next winter could see a rise in other respiratory infections that will affect children.

‘I’ve worked in the NHS for 40 years – that’s 40 winters. Every winter has been the same with admissions of babies and young children with respiratory viruses. This winter there were hardly any – most likely because of the positive impact of social distancing, hand washing and mask-wearing. What will the effect of that be to their immunity?’

Francis Fernando
Francis Fernando

THE COMMUNITY NURSE: Francis Fernando is head of nursing at Central London Community Healthcare NHS Trust and founder of the Filipino Nurses Association UK

Much of the focus has been on hospitals but Francis Fernando says nurses working in the community have been badly affected too.

‘The challenges have been unprecedented. I had COVID-19 at the beginning of the pandemic. Fortunately, I only suffered from mild-to-moderate symptoms that did not require hospitalisation,’ says Mr Fernando.

‘But many health and care workers were not as fortunate as me and most of those who died were from the black, Asian and minority ethnic communities.

‘Nurses were called heroes and were applauded but in fact we only wanted to work with adequate PPE and in a safe environment.

‘A lot of my own staff succumbed to COVID-19.’

He says the legacy of that is a workforce that is burnt out and mentally and physically exhausted.

‘That’s why it is important that mental and physical well-being are prioritised. There are already thousands of nurse vacancies in the UK. It’s expected that more will leave.’

Mr Fernando says continuing with remote working will help.

‘We have shown that services can still be delivered efficiently without compromising quality.’

And he also says the NHS must not lose sight of the long-standing challenge of supporting ethnic minority staff.

‘It’s important that all staff are treated with respect and dignity. They have to be developed professionally and all given equal opportunities for career progression.

‘But the official data in the past five years tell us a different story. These issues must be addressed if the NHS wants to retain its multicultural workforce and attract more international nurses coming to the UK, especially post-Brexit.

‘The Philippines, for example, has been the number one source of foreign nurses in the past five years but there are only 31 of us who are at band 8b and above.’

Anita Astle
Anita Astle

THE NURSING HOME NURSE: Anita Astle is managing director of Wren Hall Nursing Home in Nottingham

Ms Astle says the relaxation of restrictions, which means care home residents can have visitors, is wonderful but has created logistical difficulties.

‘Members of staff have to bring them out to pods. We have three areas where families can meet. There is the lateral flow testing of visitors too. It all means staff are taken away from what they would normally be doing – looking after other residents. That has an impact,’ she says.

‘Families also have to wear PPE – a mask, apron and gloves. Most of our family members – that's what we call our residents – have dementia so it can be difficult.

‘Families can get upset because they feel their loved ones don't recognise them in the PPE. They want to take it off. We find ourselves having to be the PPE police, which is not something we would want to do.’

A combination of this extra work and the toll the pandemic has taken means she is growing increasingly worried about staffing.

‘The sector has got extra funding until the summer and we needed that. We have had to increase our staffing by around 10% and reorganise how we do things.

‘But this all comes with extra costs. Financially we won't be viable with those extra costs if government funding ends.

‘And then there is the impact the pandemic has had on resilience and well-being of staff – some are struggling.’

Working in the care sector for nurses has always been more isolating than it is in the NHS and the pandemic has exacerbated that.

‘COVID-19 has once again illustrated the desperate need to get the whole sector on a better financial footing.’


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