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‘I know some of you want to run away and not come back – you didn’t sign up for this’

A former AIDS nurse’s message to colleagues on today’s coronavirus front line

How striking similarities between the early days of HIV and the COVID-19 pandemic shed light on the challenges nurses are facing

When one of the UKs first COVID-19 patients was diagnosed at my hospital last March, it struck me that many of my colleagues may be experiencing the same rollercoaster of emotions I once did as an HIV nurse.

There are many parallels between nursing in the coronavirus pandemic and the HIV epidemic of the 1980s and 1990s .

All the staff exposed to that patient with COVID-19 were sent home to self-isolate: two weeks to wait to get sick or not.

Back when I worked with people with HIV, staff feared needlestick injuries. In the event

How striking similarities between the early days of HIV and the COVID-19 pandemic shed light on the challenges nurses are facing

Picture: iStock

When one of the UK’s first COVID-19 patients was diagnosed at my hospital last March, it struck me that many of my colleagues may be experiencing the same rollercoaster of emotions I once did as an HIV nurse.

There are many parallels between nursing in the coronavirus pandemic and the HIV epidemic of the 1980s and 1990s.

All the staff exposed to that patient with COVID-19 were sent home to self-isolate: two weeks to wait to get sick or not.

Back when I worked with people with HIV, staff feared needlestick injuries. In the event of such exposure, we had to wait three months to see if we were antibody-negative.

Whether the potential exposure is to COVID-19 or to HIV, we nurses get the all-clear and go straight back to the front line.

That is our job.

Early days of HIV nursing could feel overwhelming

I began my career in HIV and AIDS nursing in 1992 when I took up a post at the Kobler Outpatient Clinic, a specialist day care unit at what had been St Stephen’s Hospital, where Chelsea and Westminster NHS Trust in London.

Working on the front line of the HIV epidemic sometimes felt overwhelming and miserable, and was often nerve-wracking.

Taking blood or cannulating patients living with AIDS when there were no treatments felt risky but we would fight the fear and do it anyway.

It wasn’t until 1996 that a combination of drugs, known as highly active antiretroviral therapy (HAART), became the standard treatment for HIV in the UK, drastically reducing the death rate.

To friends outside of work, I often likened it to what survivors of the Vietnam war said: you had to be there to understand what it was like.

Being exposed to death over and over, and witnessing the loss felt by family and friends, took its toll on my – and my colleagues’ – mental health.

Strategies for reducing stress

  • Clinical supervision Not just ‘a chat with a colleague’, but proper timetabled sessions, away from work, in a safe space with someone you don’t work with, for reflective practice. Being listened to for an hour, without disruption from bleeps, pagers or telephones, helps nurses feel valued, appreciated and make sense of their roles
  • Exercise Top-up on endorphins and help reduce stress and anxiety
  • Well-being or ‘wobble’ rooms Break rooms on wards won’t help relieve tension if buzzers can be heard. Spaces in other parts of the hospital with low lights could be used to unwind in
  • Have a change, not a rest Front-line nurses need opportunities to work elsewhere for a while, if possible. A month in a vaccination clinic, COVID-19 swabbing clinic, research project or audit team perhaps
  • Book of condolence When a patient died on our unit we wrote their name in a book with messages by staff who knew or nursed them. It wasn’t used by everyone, but it helped some
  • Crafting Many mental health support groups recommend taking up a craft as a form of stress relief and to instil a sense of accomplishment

The emotional pressures on nurses today are all too familiar

Today, the volume of death and suffering seen by those nursing patients seriously affected by COVID-19 is similarly traumatic.

Then, like now, many of us couldn't tell our family and friends what we were facing at work because we didn’t want to worry them.

Public health information reflected some of the gloom surrounding the AIDS epidemic Picture: Alamy

We knew they might be fearful of catching HIV from us, just as now they may be fearful of catching coronavirus.

Back then, we hid where we worked from relatives and neighbours. Our colleagues became our families.

Yet, although we knew they understood our pain, we wouldn’t always tell our colleagues how we were really feeling because we didn’t want to burden them with our grief and sadness when they were already drowning in their own.

Then we began to get burnt out. Ways of coping began to cause harm. We supressed our feelings of sadness and stopped feeling much at all.

Relationships became strained – partners pleaded with us to leave our jobs because they were afraid we might catch the virus and infect them.

It went beyond the sadness of losing patients, it got personal. Our own bereavements built up. Some of our colleagues died too.

Nursing friends reach out to offer mutual support

I can see these things happening again.

Yet even though HIV and AIDS felt huge at the time, it is true that certain groups of people were disproportionately affected. The COVID-19 pandemic is bigger and can affect anyone.

Many of us will get it. Most of us won’t die of it, but we don’t know how our bodies will respond until we contract the virus.

‘I know some of you feel like cannon fodder, some of you want to run away and not come back. You didn’t sign up for this’

My nursing friends have been reaching out to each other to offer support.

Many of us have children and grandchildren. Some of us have underlying health conditions. All of us are older and all of us are scared.

It is unsurprising that, despite wanting to support our colleagues and look after our patients, we sometimes hear a voice telling us to stay home and protect ourselves and our families.

Yet we can’t even verbalise those thoughts because we are expected to be ‘heroes’. The public has put its faith in us.

Self-care and support for nurse colleagues

As a veteran nurse of the HIV epidemic, I'd like to offer my support to all the nurses working on the front line today.

I know some of you feel like cannon fodder, some of you want to run away and not come back.

You didn’t sign up for this.

Be kind to yourselves, take your breaks, leave on time, and switch off where you can.

Reach out to your colleagues and don’t be afraid to admit how you feel: we can be there for each other.


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