Analysis

Long-COVID and the support nurses need when returning to work

Nurses share their personal experiences of managing recovery and making adjustments at work

Nurses with long-COVID share what they have learned about managing their symptoms and making adjustments at work. Plus advice for managers of nurses with long-COVID

  • Pacing your return to work if you have long-COVID – tips from nurses who have lived experience
  • Advice to nurse managers about supporting staff who have chronic symptoms following coronavirus infection
  • Know your rights regarding pay and time off if you have long-COVID

Three times a week, Salli Pilcher drives from her home in a northern corner of the Lake District, pulls on a wetsuit and takes the plunge in one

Nurses with long-COVID share what they have learned about managing their symptoms and making adjustments at work. Plus advice for managers of nurses with long-COVID

  • Pacing your return to work if you have long-COVID – tips from nurses who have lived experience
  • Advice to nurse managers about supporting staff who have chronic symptoms following coronavirus infection
  • Know your rights regarding pay and time off if you have long-COVID
Nurse Salli Pilcher uses wild swimming as one positive way to cope with long-COVID symptoms
For nurse Salli Pilcher, wild swimming has been one positive way to cope with long-COVID symptoms Picture: John Houlihan

Three times a week, Salli Pilcher drives from her home in a northern corner of the Lake District, pulls on a wetsuit and takes the plunge in one of the deepest – and coldest – lakes in England.

It’s a ritual she has maintained for the past year. And while the prospect of swimming in freezing water may not be for everyone, for Ms Pilcher, wild swimming has been an essential part of managing symptoms of long-COVID.

Diverse, fluctuating symptoms of long-COVID

‘It’s amazing. You go in the water and it just decompresses your body,’ says Ms Pilcher, associate director of nursing at North Cumbria Integrated Care NHS Foundation Trust.

962,000

people in the UK were estimated to have long-COVID as of 1 July 2021

(Source: ONS)

‘It takes the nerve pain away and for me the relief lasts anything from a few hours to a few days.’

Long-COVID is the umbrella term for symptoms that last more than four weeks after COVID-19 infection, including pain, brain fog, anxiety, depression, breathlessness and chronic fatigue.

The symptoms can be wide-ranging and, for some patients, fluctuate between periods of remission and relapse.

Some 962,000 people in the UK were affected by long-COVID as of 1 July 2021, according to figures published by the Office for National Statistics.

Salli Pilcher also finds tai chi helpful
Ms Pilcher also finds tai chi helpful Picture: John Houlihan

Ms Pilcher has been living with long-COVID symptoms for more than a year, after developing COVID-19 in March 2020.

‘I had three weeks off work, but I went back too early, probably because of self-induced guilt. I’m a senior nurse and I wanted to be with my team.’

Symptom management

In addition to nerve pain, her symptoms have included muscle ache, breathlessness, brain fog and fatigue.

To help manage her symptoms, Ms Pilcher now works flexible hours, including starting earlier to combat the effects of fatigue. Her trust has supplied a height-adjustable desk that enables her to work standing up, because prolonged sitting causes her pain.

‘It’s really important you don’t go all out on an activity and then crash. If I had known about that in the beginning, I would have made much more progress’

Salli Pilcher, nurse

In addition to painkillers and support from a pain clinic, Ms Pilcher has found exercise, including tai chi, helpful.

‘My whole right side becomes tight, from my shoulders to my toes, but tai chi softens the body back into a natural alignment. It also helped with my mindfulness and breathing.’

Pain-relieving activity

And then there is the wild swimming. The practice – swimming in rivers, lakes or natural pools– grew in popularity when public pools were closed during lockdowns.

‘The wild swimming came about as we were, like every family during lockdown, looking for what we could do locally,’ Ms Pilcher says.

Long-COVID podcast: Salli Pilcher’s advice on self-care in recovery

‘We bought a kayak but I couldn’t get in it because of the nerve pain. So I started to swim alongside my son and nephews and I realised quite quickly I didn’t have any pain in the water, so that was really amazing.

‘I did it twice and then I went on Facebook to ask if anyone fancied wild swimming and one of my friends typed back immediately. I asked when and she said “15 minutes. I’ll see you up the valley” and that’s it – we’ve swum three times a week right through winter, nearly a year now in the deepest and probably the coldest lake in England.’

Ms Pilcher says she is able to manage her symptoms, but wishes she had paced herself in the early days of recovery.

‘It’s really important you don’t go all out on an activity and then crash,’ she adds. ‘If I had known about that in the beginning, I would have made much more progress.’

My 6 tips for nurses affected by long-COVID

Salli Pilcher’s advice to aid recovery and symptom management:

  • Seek occupational health support early on
  • Understand that relapses will happen
  • Keep an activity diary to pinpoint what triggers symptoms, and learn how to manage them
  • Be open to all treatment options
  • Pace yourself
  • You may find mindfulness and breathing techniques helpful

Take it slowly – why pacing yourself is so important

Like Ms Pilcher, Sam (not their real name), an emergency nurse practitioner working in the south of England, knows the challenges long-COVID presents.

£20 million

Funding announced for in July 2021 for 15 studies aiming to improve diagnosis and treatments for long-COVID

(Source: Imperial College London)

Sam almost died from a pulmonary embolism after contracting coronavirus in January 2021 and as a result was signed off work for four months.

Sam struggled with breathlessness and a lack of energy when off work, and began a phased return to work in April.

‘I was working four hours a day, which is half my shift, five days a week. It was hard, but I just put it down to being off work for four months.

‘One of the main difficulties was the late-to-early shift turnaround. By the third week, I went up to working six hours a day and I couldn’t cope.’

‘I have a colleague who also had COVID, and we often give each other pep talks and support’

Rachel De Silva, nurse

Sam spoke to an occupational health professional, who suggested working three shifts a week instead. The shift changed has helped, but Sam is struggling with mental health issues. ‘I am quite apprehensive about returning to work full-time. My partner, GP and line manager have also expressed their concerns.’

Psychological fallout and the need for ongoing support

Nurse Rachel De Silva, who developed COVID-19 in May 2020, was off work for three weeks but has been left with symptoms including dizziness, fatigue and headaches, which can last for days.

Nurse Rachel De Silva, who developed COVID-19 in 2020
Rachel De Silva: ‘Access well-being support and don’t be afraid to talk about symptoms’

Ms De Silva manages the headaches with migraine medication, takes regular screen breaks and says her trust has been supportive.

Although she manages the physical symptoms, she says the psychological impact has been challenging. However she has found a coping mechanism in peer support.

‘I have a colleague who also had COVID, and we often have informal chats and give each other pep talks and support.

‘You need to give yourself permission to think about what we have all been through, access well-being support and don’t be afraid to talk about it.’

Measures in the workplace to aid recovery

Ms De Silva’s employer, North Tees and Hartlepool Foundation Trust, has introduced a number of initiatives to support staff with long-COVID.

Any staff member who tests positive for coronavirus is sent a confidential email asking them about their symptoms and signposting them to support at work.

The trust’s long-COVD clinic is open to staff with a GP referral. With the employee’s permission, the clinic liaises with occupational health to discuss whether any workplace adjustments would aid their recovery.

‘A lot of nurses are pushing themselves to get back to normal hours when they aren’t ready’

Sharon Aldridge-Bent, director of nursing programmes, Queen’s Nursing Institute

Staff are encouraged to take breaks and use staff rooms, and the trust is in the process of setting up a long-COVID support group.

Trust occupational health lead Denise Jones says: ‘It is important staff have the ability to chat to people to explore symptoms and know they are not alone.’

Advice for managers – how to support a team member’s phased return

A nurse manager checking in with a staff member
Checking in with staff is essential Picture: iStock

NHS Employers guidance suggests a phased return to work could help support staff with physical, emotional and cognitive aspects of their role. Measures may include:

  • Working from home (when possible)
  • Reduced hours
  • A more flexible working pattern, for example three longer days instead of five shorter days
  • Regular and longer breaks
  • Reduced caseload, and fewer cognitively demanding jobs if the staff member is experiencing brain fog
  • Discussion of redeployment opportunities
  • Regular check-ins with the employee to ensure the working pattern suits them

(Adapted from NHS Employers guidance)

Attitudes of colleagues and reasonable adjustments when returning to work

Sadly, not all nursing staff have such positive workplace experiences.

Queen’s Nursing Institute director of nursing programmes Sharon Aldridge-Bent says many nurses with long-COVID are struggling.

‘Rest and recuperation must be central to the decision to return to work and there must be funded and supported time out for all staff’

Nicola Lee, RCN national officer

‘The biggest thing we are picking up is that those with long-COVID do not always have sympathy from colleagues,’ she says.

‘In addition, a lot of nurses are pushing themselves to get back to normal hours when they aren’t ready.’

Breathlessness, nerve pain and brain fog are common symptoms of long-COVID
Breathlessness, nerve pain and brain fog are common symptoms of long-COVID Picture: iStock

Guidance from NHS Employers states full sick pay will be paid to staff on NHS Agenda for Change (AfC) contracts for any COVID-19-related absence. In addition, any sickness absence related to COVID-19 should not be counted for the purposes of triggering sickness management policies.

RCN national officer Nicola Lee says nurses must be given the time they need to recover before returning to work.

‘For nursing staff, rest and recuperation must be central to the decision to return to work and there must be funded and supported time out – not limited to annual leave – for all staff, regardless of where they work.’

She urges employers to make reasonable adjustments to help those who feel ready to return – particularly, but not limited to, flexible working arrangements.

‘Until long-COVID is classified as an occupational disease, anyone unable to return to work shouldn’t lose out financially’

Christina McAnea, Unison general secretary

‘Proper mental and psychological support services also need to be available to all nursing staff including healthcare workers in independent health and care services.’ she adds.

Sick pay and return to work: your rights

Full sick pay is paid to NHS Agenda for Change staff for absence related to COVID-19.

If you are making a phased return to work, such as flexible or reduced hours, you should receive your normal pay.

Under the Equality Act 2010, long-COVID may be considered a disability. The act defines a disability as a physical or mental impairment that has a substantial and long-term detrimental impact on ability to carry out normal day to day activities.

(Adapted from NHS Employers guidance)

Recognition of long-COVID as an occupational disease

19 July 2021

Final social distancing measures in England were lifted
(Source: Cabinet Office)

And what about nurses with long-COVID who are not yet ready or able to return to work?

The All-Party Parliamentary Group on Coronavirus has made repeated calls to the government to recognise long-COVID as an occupational disease – defined as a chronic ailment caused by exposure to workplace hazards or work activities – and to set up a compensation scheme for key workers.

Classifying long-COVID as an occupational health disease would therefore pave the way for affected staff to be able to claim benefits and compensation. The cross-party group of MPs says a long-COVID compensation scheme should mirror the Armed Forces Compensation Scheme, which provides immediate and continuing financial support for service personnel injured in service.

The matter is being considered by the Industrial Injuries Advisory Council, but the body has warned the decision could take up to a year. As a result, the all-party parliamentary group on coronavirus has called for interim compensation arrangements to put in place.

Unions including the RCN and Unison have backed the calls for the classification. Unison general secretary Christina McAnea says: ‘Until long-COVID is classified as an occupational disease, anyone unable to return to work shouldn't lose out financially.

‘Employers should be sympathetic to staff and do all they can to support them, including adjustments that allow them to continue working wherever possible.’

Visit our well-being centre

Further information


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