NHS services are running on sheer goodwill and teamwork

Coronavirus pandemic proves that better staff retention across health and social care is critical

Critical care nursing is at the epicentre of the COVID-19 global pandemic.

As we face another surge in infections and hospital admissions, COVID-19 highlights the expert, highly educated, technical, safety-critical nature of nursing in an intensive care environment.

Sadly, it has also laid bare significant workforce issues.

Nursing shortage and lack of focus on skills in critical care redeployment

At the beginning of the pandemic, many of us voiced concerns about the wider nursing shortage and how this affects critical care nursing provision.

Concerns were raised about being able to deliver critical care nursing to increasing volumes of very sick patients with no additional workforce.

‘We have seen the influx of patients, requiring a significant increase in ICU bed capacity but no corresponding increase in critical care nurse numbers’

We were hugely grateful to our colleagues, both non-critical care nurses and other healthcare professionals, who were redeployed to support increasingly over-run intensive care units (ICUs).

However the redeployment plans of those early months did not prioritise the mobilisation of staff with critical care skills.

Opportunity was missed to capitalise on NHS returners’ specialist expertise

An analysis of how staffing was handled during the first wave found the drive to encourage staff to return to support the NHS did not identify effectively those with critical care expertise.

That meant people with these vital skills were not mobilised as they could have been during the first peak of admissions.

‘ICU nurses are experiencing psychological trauma, some reporting post-traumatic stress disorder symptoms’

So what has this meant for critical care nurses?

ICU staff experiencing physical exhaustion and psychological trauma

We have seen the influx of patients to ICUs up and down the country requiring a significant increase in ICU bed capacity, all with no corresponding increase in critical care nurse numbers.

• Critical care nurse-to-patient ratio redefined in second wave

This has led to critical care nurse-to-patient ratios being stretched to the point that staff working under such continued pressure are physically and psychologically exhausted.

It is becoming increasingly clear that ICU nurses are experiencing psychological trauma, some reporting post-traumatic stress disorder symptoms.

There is significant staff sickness, which compounds the already stark situation.

• Coronavirus vaccine implementation: all you need to know

NHS is being powered by goodwill and professionals’ sense of teamwork

Despite the recent approval in the UK of three COVID-19 vaccines, putting in motion the largest vaccination programme in the history of the NHS, we know this pandemic is far from over.

Figures from NHS England show there were 30,758 patients with COVID-19 in NHS hospitals in England as of 8am on 10 January. This is compared with the 18,974 inpatient peak during the first wave recorded on 12 April 2020.

All the while, the NHS is trying to continue business as usual where possible.

However, staff can only be stretched so thinly, they have a tipping point and sadly many have reached it.

Yet again we find ourselves relying on their goodwill. If it wasn’t for the strong teamwork ethic that binds the NHS together I fear the situation would be even worse.

• 2020 – a year like no other for the world in general and nurses in particular

To critical care nurses I say: you are extraordinary. You have been faced with a situation that those who work outside of ICU will never truly understand.

I sincerely hope this pandemic will teach those with political power of the absolute need to protect our workforce, not just in critical care, but across the whole of health and social care.

Simply put, without its staff there is no NHS.

Related articles

• Critical care nurse-to-patient ratio redefined in second wave
• Coronavirus vaccine implementation: all you need to know
• 2020 was a year like no other for the world in general and nurses in particular

Nicki Credland is senior lecturer and head of department for paramedical, perioperative and advanced practice at the University of Hull, and chair of the British Association of Critical Care Nurses