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How older people’s nurses can safeguard their mental health: strategies to cope and support colleagues

The pandemic has been tough for healthcare staff, but there are ways to help maintain well-being

The pandemic has been tough for healthcare staff, but there are ways to help maintain well-being

  • Older peoples and community nurses are exhausted, their resilience stretched by the pandemic
  • How employers and organisations like the Queens Nursing Institute are supporting nurses to process events
  • Managing stress and psychosocial well-being is as important as managing your physical health

The COVID-19 pandemic has undoubtedly been the biggest challenge ever faced by older peoples nurses.

And in many ways, the second wave has been tougher than the first, says British Geriatrics Societys Nurses and AHP Council chair Lucy Lewis. In the first wave, there was a lot of goodwill from the public,

The pandemic has been tough for healthcare staff, but there are ways to help maintain well-being

  • Older people’s and community nurses are exhausted, their resilience stretched by the pandemic
  • How employers and organisations like the Queen’s Nursing Institute are supporting nurses to process events
  • Managing stress and psychosocial well-being is as important as managing your physical health
COVID-19 has been tough for healthcare staff, but there are ways to maintain well-being
Picture: iStock

The COVID-19 pandemic has undoubtedly been the biggest challenge ever faced by older people’s nurses.

And in many ways, the second wave has been tougher than the first, says British Geriatrics Society’s Nurses and AHP Council chair Lucy Lewis. ‘In the first wave, there was a lot of goodwill from the public,’ she says.

‘People made personal sacrifices – I know of two nurses who sent children to live with grandparents in the first lockdown so that they [the nurses] wouldn’t bring COVID back home, but also so that they could be 100% there for their teams.

Lucy Lewis, British Geriatrics Society’s Nurses and AHP Council chair
Lucy Lewis Picture: British Geriatrics Society

‘There was a feeling that we were all pulling together and it was short-term and we just have to go with it. But people are now exhausted.

Nurses have had to draw on different skill sets in the second wave

‘We know we’ve got hope with the vaccines, we know there’s an end in sight, but that doesn’t negate the fact that people are exhausted. This time, people’s resilience has been really challenged.’

Ms Lewis, who is a consultant practitioner in frailty with Southern Health NHS Foundation Trust, says she has seen colleagues drawing on different skill sets during the second wave.

‘There are more younger people in hospital than there were last time, so older people’s wards will have younger people on them, because they are the COVID wards. You’ve got people who’ve dedicated their careers and their specialism to nursing older people who are now looking after people who are much younger.

Community nurses have seen a rise in the intensity of their work

‘That adds to cognitive and emotional load for people because it’s just different – you’re having to take on the personal circumstances of a 40-year-old who has teenagers at home, and the teenagers can’t come in to see their parents.’

Nurses working in the community – such as those in her team – have seen an increase in the intensity of their work, she says. While previously they would have seen patients two or three times before having potentially difficult conversations about escalation plans and whether, if their condition worsened, they would want to go to hospital or stay at home, this is now happening on a first visit.

Tips for mental well-being for older people’s nurses

By Crystal Oldman, Queen’s Nursing Institute (QNI) chief executive

‘It’s still something we do well, because we do it all the time as part of our role, but it’s a conversation that we’re having earlier, especially if you’ve got someone with an acute infection.’

Feelings of stress that are likely among healthcare workers during the pandemic are no reflection on their ability to do the job, according to the World Health Organization (WHO).

WHO guidance on COVID-19 and mental health says feeling stressed is ‘quite normal’ in the current situation, and puts the mental well-being of healthcare staff on a par with their physical health.

‘Our nurses are working hard, but what gives me a huge sense of pride is their ability to adapt’

Jason Cross, nurse team manager

‘Managing your stress and psychosocial well-being during this time is as important as managing your physical health,’ the guidance states.

Jason Cross works for a large NHS trust managing a nursing team that supports older or frail patients who are having surgery. Despite the challenges, his team is holding up well, he says.

‘Our nurses are working hard – really hard – but what gives me a huge sense of pride is their ability to adapt. Some of my team have been redeployed to the community or redeployed to intensive care over the peaks of the pandemic and they have adapted. Yes, they found it hard, but our senior support has been such that we’ve hopefully been able to lessen the long-term impact of that kind of change of working environment.’

Breathing exercise for relaxation

Breathing exercises for relaxation

Next time you feel anxious, take a moment to notice your breathing. Focus on breathing through your stomach so that your stomach rises when you inhale and drops when you exhale. Here is a stomach breathing exercise you can practise for five to ten minutes a day to help you feel calmer:

  1. Inhale gently, lightly and slowly count to four, expanding your stomach as you do so
  2. Hold that breath for a count of two
  3. Slowly exhale though your mouth for a count of six

Source: Wellness Society

Mr Cross speaks at least once a week with any member of the team who has been redeployed, and his employer has also put in place measures to support staff well-being.

‘They set up a wellness centre in the hospital, so in their downtime people can book to spend time on a massage chair, for example, and there are free teas and coffees.’

He says his trust has made efforts to support the mental health and well-being of staff, including a robust occupational health team and additional input from psychology colleagues. There is also an online resource for staff who want additional help, with access to apps such as meditation site Headspace, which has been popular.

Support is easier to offer in larger organisations

Crystal Oldman, Queen’s Nursing Institute chief executive
Crystal Oldman Picture: Kate Stanworth

Queen’s Nursing Institute (QNI) chief executive Crystal Oldman says nurses working in the community or in smaller organisations can sometimes miss out on the support that is easier to offer in hospitals. That has an effect on older people’s nurses in particular, as many are not ward-based.

‘If you’re in a big NHS organisation, employers have been brilliant at setting up support services,’ she says. ‘The challenge is the smaller organisations, like GP surgeries or care homes. If you’re a big NHS organisation you might redeploy or bring in psychologists to support staff.

‘But it’s harder for those in smaller services where you might not even have the building – if you’re a nurse in the community you have a clinic base or a GP base. You don’t have a place to go which is your well-being room, because there isn’t the facility for it, and that’s a very big difference.’

Dr Oldman says the QNI was able to mobilise quickly to support nurses during the pandemic because of systems it already had in place. For example, the QNI’s network for care home nurses began in January 2020, with support from England’s chief nursing officer Ruth May and the RCN Foundation.

It held its first event in February 2020 – just before the pandemic took hold in the UK. Although this was serendipity rather than design, she says the fact that it existed helped the QNI’s pandemic response.

‘From the start we knew that vulnerable people were going to be hit hardest by this – people in care homes, those who were being visited by our district nursing teams,’ says Dr Oldman.

Pandemic emotionally tough for nurses working in the community

‘When the pandemic hit we obviously saw that the impact on hospitals and intensive care units was significant. But at the same time we were thinking that no one was talking about the community, no one was talking about care homes.’

The pandemic was emotionally tough for nurses working in the community with older people, she says, partly because of the sheer numbers of their patients who were dying, and partly because COVID-related restrictions meant that these patients often had to face the end of life without their families being present.

‘Nurses in the community were seeing patients they’d perhaps been caring for over months, or even years, dying very quickly,’ says Dr Oldman.

A masked community nurse talking through things with a masked patient
Picture: iStock

‘That’s very distressing. The patients haven’t been able to see their families, they’ve been isolating. The only person with them during that death is the nurse, and that’s a lot to carry. It’s also a lot to carry in a care home to enable the last conversations that someone is having with their loved one via an iPad or phone because they can’t be with you.’

Leaders need to acknowledge different personality types in their teams

In recognition of this mental and emotional toll, the QNI developed the TalkToUs service offering nurses an appointment with a trained nurse to talk through what was happening and how they were feeling.

Funding this service at a time when the QNI, like other charities, faced severe financial challenges was likely to be difficult, says Dr Oldman, so she set about raising it herself.

‘I was desperate to do something, so on the weekend the London Marathon was supposed to take place I said I would walk around my garden to raise money’

Crystal Oldman, Queen’s Nursing Institute chief executive

‘I was desperate to do something, so I said in April on the weekend that the London Marathon was supposed to take place that I would walk around my garden to raise money. And I did, and another Queen’s Nurse did the same, and between us we raised nearly £13,000.’

According to Ms Lewis, supporting the mental and emotional well-being of staff is crucial. One size doesn’t fit all, she says. ‘As leaders, we need to acknowledge the different personality types within our teams and to understand what works best for those individuals.’

Importance of having a culture of openness and discussion

She says some people may benefit from talking things over and externally processing a day at work that’s been particularly challenging, so it can be valuable to use time at the end of the day or the next day to discuss it. ‘It’s important to have a culture of openness and discussion so that people can reflect on what they’ve done well and what’s been challenging.

Nurses may benefit from talking things over
Nurses may benefit from talking things over Picture: iStock

‘It’s important as a leader to say “this is unusual” and to show a little bit of vulnerability – not that you’re not in control, but acknowledging that actually, this is all quite new, and we’re all learning on a daily basis.

‘We also need to ensure that we ourselves, as leaders, have support networks, peer groups, peer support and coaching, so having internal informal coaching within the team and formal coaching for leaders is important. As leaders, it’s about recognising the additional cognitive and emotional strain on your team, and making sure your communication channels are open and working well.’

Well-being resources

RCNi well-being centre


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