Self-isolating but still at work: the nurses behind the front line

The COVID-19 pandemic has forced many nurses to forge new ways of working from home

• Many nurses have not been able to continue to work in their usual roles as they need to self-isolate due to their own or family members’ underlying conditions
• Tips for staff and managers about providing support for self-isolating nurses and those in new roles
• Nurses share their experiences, good and bad, of redeployment while working from home

While the pandemic has brought legions of nurses back to the bedside, there are others who have had to step back from patient-facing roles because comorbidities or COVID-19 symptoms in their household have required them to self-isolate.

This has not meant they are unable to play a part in the response to the pandemic; in many cases they are doing jobs that makes the work of those in patient-facing roles easier.

Many nurses are continuing to work despite the need to self-isolate

‘If someone has an underlying health issue, we know they are going to be off for the foreseeable future but they may not feel unwell,’ says Fiona Lawson, a matron in the tertiary neonatal intensive care unit (ICU) at University Hospital Southampton NHS Foundation Trust. After a risk assessment, these nurses can be offered other roles, she says.

Ms Lawson has been seconded to work on her trust’s COVID-19 strategy. ‘We have one senior nurse who is remotely running all our risk reporting and meetings with other staff through Microsoft Teams,’ she says. This nurse can feed back what is being learned from incidents and carry out debriefs.

• RELATED: COVID-19: diary of a nurse in self-isolation

‘For the less senior nurses, managers are finding a way for them to contact new parents, offering their support, for example for breastfeeding, and undertaking psychological risk assessments.’

Self-isolating nurses can work in ways that support those working directly with patients

Other nurses who are able to work in some way have been:

• Organising the rosters – and ensuring their colleagues are not working excessive hours.
• Setting up a drug preparation room, where drug infusions and fluids can be prepared without the staff being in contact with patients.
• Working on staff appraisals.
• Checking in with staff when there has been a significant incident and contacting staff who are on sick leave to ensure they have whatever support they need.

‘Nurses don’t go into nursing thinking they are going to have an easy life,’ Ms Lawson says. ‘They see the pressure their teams are under and want to contribute.’

Many self-isolating nurses who have been redeployed are delighted to be occupied.

Stephanie Cooke, a community nurse with Wiltshire Health and Care, has been told to stay at home for 12 weeks. She is triaging patients who are ready to leave acute care but need support at home – such as equipment or visits from carers, and she’s finding the experience illuminating.

She says she is gaining insight into how the service works, which she otherwise would not. ‘And I would be tearing my hair out if I did not have something to do,’ she says.

Nursing in self-isolation – tips for staff and managers

• Communication with your colleagues is very important for morale and effectiveness so take conscious steps to stay in touch
• Support from your line manager is important. Keep in touch with them regularly and ensure they know what you are doing and how you are feeling
• Talk to your IT department if the technology is letting you down – it’s their job to help you
• Try to keep a routine similar to that you have at work – or indeed a healthier one if you’re not used to taking breaks. It’s too easy to work longer hours and skip breaks when you are working from home
• Be kind to yourself. This is a difficult time for everyone and it is not easy to make the level of adjustments needed. You may feel grumpy, frustrated or stressed, as will many of your colleagues. You may worry you are not as productive as you normally are or that you should be with your team. Try to recognise these feelings for what they are

Coordinating redeployment from home

Felicia Cox has been working from home ensuring nurse colleagues at Royal Brompton and Harefield NHS Foundation Trust in London can be redeployed to the most appropriate role.

Ms Cox, who leads the trust’s pain service, is immunocompromised so has been advised to self-isolate for 12 weeks. ‘It has been interesting and far more complex than anyone could have imagined,’ she says.

• RELATED: COVID-19 has taken me from surgeon to ICU nurse

Working with another senior nurse who has also been advised to work from home, she has been identifying the preferred working area for other staff and making contact with the service manager in that area to find a solution. ‘We have not had a single person in the trust who has declined to be redeployed,’ she says.

She does say, however, working from home can be challenging and she has chosen to drop her working week to four days during this period.

The crisis has meant new ways of working for many nurses

For some nurses, the COVID-19 crisis has meant the balance of their work has had to shift. Natasha Bradley, a district nurse team leader at Mid Yorkshire Hospitals NHS Trust, used to combine operational and clinical work in her role – but because she had bilateral pneumonia last year her GP urged her not to work in a front-line role.

‘You can’t help but feel you should be out there. There is an element of guilt’

Rachel Daly, hospice practice development nurse, who is shielding

Armed with a laptop, she has been able to take on work that would normally have been spread out over the team. This has included incident investigation and updating the social media page.

‘It is tough,’ she says. ‘District nurses are pack animals – at some point in the day we would normally get together to discuss things.

‘Historically, I would have been in the thick of it. I am having to regroup mentally and think about my own health.’

• RELATED: When this is all over, I don’t think things will go back to how they were

Virtual meetings help teams stay in touch

Trudi Archer, who works for Hantsdoc, an urgent care provider in Hampshire, had a long period off work during cancer treatment and then returned to work only to contract pneumonia in January. This has meant she needs to self-isolate.

‘I have been told not to go back to my old job at all,’ she says. ‘I am not able to do any clinical work – I have found it very difficult and at the beginning it was very hard to find a role that worked.’

Now she is involved in strategy, leading on safeguarding and has been putting together a weekly message to staff, looking at key issues such as domestic violence and mental health. Virtual team meetings help her keep in touch but she still finds not being in a clinical role hard and sometimes feels her work is not as important as that of front-line colleagues.  

• RELATED: COVID-19: nurses report feeling guilt over decisions related to pandemic

Those concerns are echoed by Rachel Daly, who works in practice development at Rennie Grove Hospice Care in Hertfordshire and is shielding. She now provides remote supervision to colleagues whom she would previously have supervised in patients’ homes, and has been working on training packages and policy updates.

‘Initially, it was incredibly frustrating,’ she says. ‘You can’t help but feel you should be out there. There is an element of guilt.’

• RELATED: How to escape the cycle of pandemic-induced guilt

Telephone helplines have seen a surge in call volumes

Nationally, some nurses are being redeployed into the NHS 111 service, which has seen an enormous increase in call volumes and has needed nurses to work in the national COVID-19 assessment service.

This work can be done from home and involves telephone assessments and directing patients to the most appropriate source of help.

‘I’m here for as long as it takes. Hopefully when it is over I will go back to my normal role as I have no intention of retiring yet’

Jenny House, adult safeguarding officer, Royal Bournemouth Hospital

However, one potential barrier to working from home is IT. One nurse – who asked to remain anonymous but was having to remain at home because of significant health conditions – says lack of access to her employer’s intranet limited what she could do from home.

‘What would really help my colleagues would be if I could put all the staff off-duty information on to the pay systems, sort out bank staff and chase people for shift swaps, but I can’t do that without access to work’s intranet and for that I need a work laptop,’ she said.  

‘I have years of experience and knowledge but I have to take a back seat’

Matt Daley is unable to join colleagues caring directly for people with COVID-19 – but he is determined to play his part.

Mr Daley has the autoimmune disease lupus. His background is in ICU nursing, he spent 23 years in the military and has worked at Surrey and Sussex Healthcare NHS Trust as a practice development nurse.

He is on secondment to Health Education England working on Nursing Now’s Nightingale Challenge, a global initiative to promote leadership and development training for nurses and midwives.

When he realised the pandemic was coming, he was ready to return to clinical practice – but realised his lupus meant he should not.  

‘It was frustrating – I have years of experience and knowledge and I can’t be there and have to take a back seat. I can’t physically be there with my colleagues so what I’m doing is channelling my efforts by producing leadership development resources, running webinars, considering the implications of the World Health Organization's State of The World's Nurses report and contributing to podcasts for nurses around the world.

‘I’m also involved in a Facebook page that was started by military colleagues that shares ideas, knowledge and support worldwide with about 3,500 nurses.

‘I can give the benefit of time, experience and knowledge through these channels – and deliver more benefit to people by doing this.’

Self-isolating nurses can provide vital support for colleagues

Some nurses have been able to reduce the risk to their own health by avoiding clinical areas in their organisations rather than working from home. At the Royal Bournemouth Hospital, Jenny House, who is 73, had been working as the adult safeguarding officer after stepping down from her role as a matron in orthopaedics.

Since late March, she has been working in a different building providing clinical advice to staff who are worried about coronavirus infection. ‘I feel I’m doing something worthwhile and supporting staff and trying to allay their fears,’ she says.

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Staff worries include what they should do if they are pregnant, whether they need to stay off work if they have symptoms and whether they need to be shielded. Solutions can often be tailored to keep staff safe but sometimes they really want to be at work and have to be told they can’t be, she says. 

‘I really wish I was on the front line,’ she says. ‘I’m here for as long as it takes. Hopefully when it is over I will go back to my normal role as I have no intention of retiring yet.’

Alison Moore is a freelance health writer