My job

COVID-19: returning to work as an ICU nurse is scary, but it’s a privilege too

A nurse’s experience of returning to clinical practice to help the NHS cope amid the pandemic, after a 25-year break 

Image of an intensive care nurse in a theatre
Picture: Helen Jones

After a 25-year break from clinical practice, where I’d mostly worked in intensive care nursing, I had been hankering after a return to clinical work for some time.

I joined my local trust’s nurse bank in January and had been working in endoscopy. 

When the COVID-19 pandemic hit, it seemed obvious I should find out whether my rusty intensive care skills could be useful to my local trust.

Returning to intensive care after a long break was daunting  

Volunteering to step up and work in intensive care felt like a very big move after such a long break. But the staff on the unit welcomed me with open arms.

I reported for duty, put on scrubs and was orientated to the unit. The first part of the brief induction was a ‘fit test’ for my personal protective equipment (PPE), which involved putting on a face mask and a hood.

An aerosol was then pumped into the hood and I had to move around and pretend to talk to a patient. The aerosol has a bitter taste and if it gets through the mask, the wearer can taste it and know that the PPE is not working properly.

‘As the day went on, the gravity of the crisis hit me. I felt tearful and had to go out and call a friend for reassurance’

It took seven minutes to test the mask. I felt reassured when I took it off and instantly tasted the bitterness from the aerosol. I learned to ‘don and doff’ the full PPE, undertook simulations to correctly place patients in the prone position and refreshed my knowledge of how to manage cardiac arrest.

The principles of good nursing care remain constant

As the day went on, the gravity of the crisis hit me. I felt tearful and had to go out and call a good friend who is a former nurse for reassurance. The next day I was allocated to work with an experienced intensive care nurse, who I shadowed while caring for a patient.

My return to intensive care has taught me that the principles of good nursing care are timeless and constant, and regular and effective communication with patients and the multidisciplinary team (MDT) is as important now as it ever was.

I was pleased that I clearly remembered key elements of the role – checking oxygen and suction, the ABCDE approach, checking lines, the thorough cleaning of all surfaces and the humdrum need for regular restocking.

Technical aspects of the role have changed very little; the ventilator settings are the same as they were on my last intensive care shift in 1990, as are the hourly checks that frame the routine of the day.

Technology has changed since the 1990s – but some things stay the same

Positive end-expiratory pressure and tidal volume settings remain the same but are on smaller, more sophisticated ventilators which have additional specifications. The vital signs displayed on the monitors are now far easier to read, and the pumps are more sophisticated; programmed with the name of the drug to be administered, they have built-in settings that prevent the patient receiving a bolus of a drug, such as potassium.

Taking samples from the lines – arterial and central venous and peripherally inserted central catheter lines – was very familiar to me, but there are limits to my scope of practice. I am not taking on the extra responsibility of administering intravenous medication, for example, as I need the time to build up my competence and confidence.

‘The joy of coming off shift is the same, knowing that however difficult it was, you have done your best and made life better for the patient’

The doctors and nurses still work in a warm and flexible non-hierarchical team, and the most important people are still the housekeeper and ward receptionist who hold the team together. MDT members such as pharmacists now play a more central role, and I really enjoyed learning from the physiotherapist.

Communicating with patients remains a priority

One of the things I do miss is the huge old charts at the end of the bed, which we used to fill in with coloured pens. These have been replaced by digital systems which record everything and have built-in checks to minimise risk and improve patient safety – and they take a bit of getting used to. 

There are also some wonderful new and practical inventions, such as ways of securing nasogastric tubes’ label lines, and boots that can be worn to help prevent deep vein thromboses. But the importance of talking to patients has not changed, nor has the need to help them understand what is happening to them.

The joy of coming off shift is the same, knowing that however difficult it was, you have done your best and made life better for the patient. The brilliant, immediate job satisfaction – that hasn’t changed one bit.

Returning to work has been scary – but I don’t regret it

For those thinking of returning to nursing at this time, it’s a big and scary decision. But so many parts of the nurse’s role are constant and will be familiar to you, and your nursing colleagues will welcome you as part of the team.

I won’t deny that I am scared about what is to come and how I will cope, but it’s a privilege to be able to help NHS colleagues during this time of crisis.

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Kim Tolley is a bank staff nurse