Inside NHS Nightingale: a nurse's diary
Head of nursing in medical specialties Fiona Hamer volunteered at the Nightingale Hospital London and describes a typical shift there
- Volunteer nurse stays at nearby hotel and shift starts at 6.30am and ends at 8.45pm
- Welfare and management teams offer motivation and support
- Teamwork is vital as the work can be demanding and tiring
The Nightingale, a critical care temporary hospital, was created in just nine days at London’s ExCeL centre in response to the COVID-19 pandemic.
Guy’s and St Thomas’ NHS Foundation Trust head of nursing in medical specialties Fiona Hamer, who volunteered to work at the Nightingale, describes what it is like to work a shift there. This account was written before the announcement that the hospital is being placed on standby, with all patients moved elsewhere.
6.30am I walk across from my hotel room to the scrub area to change with my colleagues. We discuss the day ahead and prepare each other mentally.
7am I request sizes of scrubs and change in the scrub area and lock all my clothes away. It feels like leaving normality behind when entering the hospital site.
7.15am I walk into the main hospital building and am greeted by the wonderful welfare and management teams offering motivation and support for the day. I sign in, social distancing in place, and collect my personal protective equipment (PPE).
7.45am Start the don process of putting on PPE with the help of colleagues, making the hard look as cool as possible.
‘With personal protective equipment your sight and hearing is affected, which can be frightening at first’
8am Attend a briefing from the nurse in charge about the top five safety requirements for the shift and find my allocation for the day. At this point we all find our work colleagues and introduce ourselves.
8.15am I walk into a ward and collect and place my visor on, ready for work. The hospital is huge and daunting at times, and with PPE your sight and hearing is affected, which can be frightening at first.
8.30am Take handover for four patients with an ITU nurse, another registered nurse and the care support worker. Then we huddle and make a plan for the day.
9am The day starts with safety checks of all equipment and patients to ensure everything is safe and in working order.
Physical observations are taken and documented on the biggest paper sheet you can imagine, as well as the observations relating to the ventilator. These are recorded and discussed with the doctor or ITU nurse if anything is concerning. We check that the nasogastric tube (NG tube) and endotracheal tube (ET tube) are at the level they should be and check NG feed absorption and document the results.
9.30am Blood gases are taken after trying to don another set of gloves and another apron, which is a difficult task in itself.
Blood gas is taken to a machine for analysis and again results entered onto an observation chart and reported if abnormal. I start washing my patient, noting skin damage on the chart and on the computer.
10am Have to stop what I’m doing as I’ve noticed that the patient’s oxygen levels are dropping to an unacceptable level and continue to drop. I call for help. Patient’s cuff in ET tube is not fully inflated so the doctor inflates and suctioning is performed. O2 levels improve. It’s a frightening experience for a non-ITU nurse but I deal with it calmly and we are able to improve the situation.
‘One of the patients becomes distressed by the suctioning, so I alter the position and monitor’
11am It’s already observations time again so these are retaken and documented. At the same time the medications are alarming, so I change the syringe pump and note another medication is about to run out.
I abandon hourly obs and meds are signed out and replaced. I continue washing the patient and check back and turn the patient again. This takes a whole team as well as an airway staff member.
11.15am Back to observations and over to patient two, where a care support worker completes observations for me as well as blood gases. I suction patient one again as there are secretions. The care support worker provides eye and mouth care for both patients.
11.45am I draw up and prep more medications for both patients to ensure replacement at all times. Patient two is washed and turned by the turning and washing team.
12pm Obs time again. Repeat in both patients. Blood sugars two-hourly in patient one, so I perform and alter insulin as per regimen. A doctor alters parameters on the ventilator and stops one of the medications to monitor the patient’s condition. The physio has been to see patients to monitor chests and informs me of suctioning needs. One of the patients becomes distressed by the suctioning, so I alter the position and monitor.
1pm The nurse next door asks me to help with the Bair Hugger (a non-invasive device that can accurately and continuously measure a patient’s core body temperature) as their patient’s temperature is low. I put it on the patient and explain what we are doing – I always talk to the patients, even when they’re not conscious. The patient answers me and I jump a mile! He is awake and I had not noticed. The patient laughs and keeps laughing all day about it.
Oh yes, obs time again. Comes round so quickly… Blood gases are taken and all documented. One patient needs insulin altering, but both are stable.
‘Wearing PPE for this amount of time is hard, hot and painful at times’
1.30pm Break time and I am ready for it. Wearing PPE for this amount of time is hard, hot and painful at times. I hand over my patients and ask the turning team to turn both patients, then go for a much-needed drink and snack.
I sit in the comfy chairs donated to Nightingale and smile at the beautiful posters made by children and the comments board with messages from families. I chat with colleagues and welfare people, who are always available for support.
I also speak to my husband on the phone to check in and say hi. Being away from him is hard. He is my support.
2.30pm I return to my patients to be told one of them has deteriorated while I was away and another patient on the ward has become terminal. Families visit the patients in full PPE, supported by the amazing families' support teams.
My patient is now okay after physio and an increase in some medications and oxygen levels. I take handover so the other nurse can go on a break. Five minutes later, while I’m monitoring my patient, the patient opposite is having a line changed and alarms are ringing so I go to see what’s happening.
The patient is not being ventilated. I do the arrest call and staff arrive. Emergency equipment is used until the problem is solved. The patient stabilises after ten minutes and my anxiety levels return to normal. The nurse in charge checks to ensure I’m okay. The support is amazing in and out of the ward.
‘I chat with the patient who is now awake. I had cared for him when he was so sick. It is emotional for me to see him well’
3.30pm Luckily the care support worker completed the 3pm observations, ensuring the other patients are safe – great teamwork. I check all my other patients and all are okay – medications are running appropriately and all fluid balances are up to date and correct. The other nurse returns from break and I hand her patients back over.
4pm Chest drain to be removed by a new doctor, overseen by another doctor. It’s removed and I monitor the patient, talking to them the whole time.
4.30pm I have a chat with the patient who is now awake. I had cared for him when he came in and was so sick. It is a delight and emotional for me to see him so well. He is so grateful for the care he’s receiving and his second chance at life. This is an emotional time for me and is motivation to continue providing care at Nightingale London. Good things are happening here.
5.15pm Guess what? Yes, obs time. Here we go again. All okay – phew. I change medications that are running out and check the NG tube placement
5.30pm Blood gases are taken, analysed and reported back. Gases on patient one are slightly abnormal so I report it and the doctor comes to see the patient. The ET tube is slightly misplaced so the doctor comes and alters tube placement, and tapes are changed and chest X-rayed.
6pm Patient gases are repeated after 15 minutes. All stable, but we’ll need to repeat again in two hours. Obs again on both patients and a decision is made to prone patient two. I wait on the prone team for this and prepare the patient and complete a safety checklist and stop feed and insulin. In the meantime, I make sure all stock is stocked up, making life easier for the team.
‘The palliative care nurses and one of the doctors bring round handmade hearts with a note for each patient’
6.30pm I hand over and take my second break. Again, huge relief to get out of PPE and have some thinking time. I eat a hot meal and return to the ward.
7pm The care support worker has completed all obs and blood gases. Not sure what we would do without them. Medications and results are checked in both patients.
The palliative care nurses and one of the doctors bring round handcrafted hearts with a note for each patient. The exact same hearts have been given to their relatives. What an amazing idea. I read the message to both patients and give them their hearts.
‘I’m exhausted, but proud of my achievements for the day’
8pm Obs again, and time to ensure everything is up to date, all relevant bloods are taken, documents are complete and medication lines are changed and dated. I ensure replacement meds are available for night team and turn patients, including head turn for patient proned, and ensure they are clean and comfortable.
8.30pm I hand over to the night team using aide-memoire and show all relevant documentations. I say goodnight to my patients and ensure all team members are okay and thank everyone for their help.
8.45pm I change out of PPE, drink fluids and wash my hands. I walk with colleagues to scrub area, get changed and then walk back to hotel while we debrief. I’m exhausted, but proud of my achievements for the day.