Nurses with long-COVID: why pacing yourself when back at work is essential
Staff struggling to recover from coronavirus need a return to work that is sensitively managed, or they face risk of relapse
- Many people who had COVID-19 are reporting wide-ranging symptoms they seem unable to shake off
- A nurse explains what she has learned from her experience of long-lasting symptoms
- Read the latest advice on how to cope if you’re returning to work
Growing evidence suggests that some people affected by COVID-19 experience symptoms for weeks and even months after the initial infection.
of 545 nurses in a Republic of Ireland study who had recovered from COVID-19 experienced post-viral fatigue
(Source: Irish Nurses and Midwives Organisation)
Given the numbers of nurses who have had the virus, it is likely there are some in the profession struggling with symptoms that are persisting, including breathing difficulties and fatigue.
Nursing staff have higher prevalence of SARS-CoV-2 and antibodies than doctors
Research at one large NHS trust suggests one in seven nurses and healthcare assistants who took part in the study has had COVID-19.
The study, at Oxford University Hospitals NHS Foundation Trust, involved the testing of 9,809 symptomatic and asymptomatic staff volunteers for SARS-CoV-2 and antibodies to the virus between April and June. It found 14% of the nurses and HCAs tested showed evidence of having COVID, compared with 12% of junior doctors and 7% of administrative staff.
And, according to Public Health England, around 10% of people who have had mild symptoms COVID-19 and were not admitted to hospital have reported symptoms lasting more than four weeks.
A number of hospitalised cases reported continuing symptoms for eight or more weeks following discharge, PHE adds.
Long-COVID encompasses a wide range of lingering symptoms
This phenomenon, which has acquired the name ‘long-COVID’, covers a large range of symptoms, including respiratory, heart, liver and kidney problems, fatigue, mental health issues and stomach upset.
Of the 7,068 members who responded to the organisation’s survey, 9.2% (646) said they had tested positive for COVID at some point.
‘I have never experienced anything like this before. While I feel I am recovering slowly now, it has taken a very long time’
Jane Ireson, nurse recovering from COVID-19
Some 65% (355) of respondents who had tested positive said they were still experiencing post-viral fatigue, according to the survey, which was published in July.
In September, RCN director of nursing, policy and public affairs Susan Masters said the college was becoming ‘increasingly concerned’ at anecdotal reports of the long-term nursing workforce, and the wider impact on the public and patients.
In a blog post, she said the RCN was calling for more research to be carried out on Long-COVID.
As nurses, we need to be kind to ourselves and show empathy to each other
One nurse who has had long-term symptoms is Jane Ireson, a nurse specialist in gestational trophoblastic disease and a National Institute for Health Research doctoral fellow based in Sheffield.
She became ill with COVID-19 in March, just before lockdown.
Ever since, she has had fluctuating, relapsing symptoms, in particular, extreme exhaustion, chest pain and breathlessness. She is 42 and before having COVID-19 was a regular runner and cyclist.
‘I have never experienced anything like this before. While I feel I am recovering slowly now, it has taken a very long time.’
One lesson she has learned from the experience is that nurses must put their own health above their desire to get back to work.
As someone previously fit and well, she was keen to get back to work to assist in pandemic care.
‘There is definitely a sense of people not being believed, or listened to – this is very difficult and isolating’
A number of people hospitalised with COVID-19 reported continuing symptoms for eight or more weeks following discharge
(Source: Public Health England)
‘When I first fell ill I felt I could be really useful as a front-line worker who has already had COVID-19.
‘I hastily volunteered for extra shifts and to work at the Nightingale Hospital,’ says Ms Ireson, who has co-founded an online patient support website for people affected by long-COVID.
‘I felt a real pressure to help because of everything that was going on. Making yourself step back is very hard.’
Scepticism in the workplace about people with long-lasting symptoms
She urges other nurses to respond sympathetically when a colleague is coping with long-term effects of COVID-19. The wide range of potential symptoms, their potentially cyclical nature and the fact many people did not receive a COVID-19 test when they were initially ill means there can be some sceptisim towards them, she says.
‘There is definitely a sense of people not being believed, or listened to,’ Ms Ireson says. ‘This is very difficult and isolating for the person affected.’
- RELATED: Long-COVID: what nurses need to know
Nurses returning to work should calibrate increases in their activity levels
Returning to work can be fraught with difficulty for someone struggling with long-term effects of COVID-19.
Many people reporting their experience in online support groups say the exertion of starting work again causes them to relapse, with symptoms returning quickly.
This seems to be reflected in advice from the Royal College of Occupational Therapists (RCOT), which counsels individuals to be gentle with themselves, to take plenty of rest, and to only increase activity levels gradually.
Many commenting on social media support groups, including Ms Ireson, have found pacing helpful, particularly with the crushing fatigue that many people describe.
This means spreading your limited supply of energy throughout the day, and breaking activities down into smaller tasks.
Prioritise, delegate, and yes – procrastinate
The RCOT recommends prioritising what has to be done that day, considering what can be given to someone else to do and putting some things off to another day.
The NHS Your COVID Recovery website gives advice on coping with the physical and mental health elements of recovery, including persistent cough, fear, anxiety, low mood and cognitive problems, as well as exercises for coping with breathlessness.
Long-COVID and return to work: 5 tips for nurses
- Be gentle with yourself, recovery can take longer than expected
- Increase activity levels slowly and take plenty of rest
- Use pacing to support recovery
- Consider a phased return to work and contact your occupational health department if there is one
- Be understanding with colleagues struggling with symptoms after COVID-19
Employers must not penalise nursing staff struggling to recover
The RCN says nurses who are affected need support from employers as our understanding of the long-term effects of COVID-19 continues to evolve. And nurses shouldn’t lose out on sick pay if they experience long-COVID.
It says it expects employers to provide long term sick pay and leave arrangements to give nursing staff and their families the peace of mind that their incomes will be protected should they become ill with COVID as a result of their work, including any long term impact.
of the general population who have had a mild case of COVID-19 reported symptoms that persisted beyond four weeks
(Source: Public Health England)
A college spokesperson says: ‘The RCN’s starting point is that nursing staff should not suffer financial detriment as a result of COVID-19 absence, and they must be supported when returning to work.
‘Governments and employers should ensure nursing staff have the support they need.’
The RCOT says that a phased return to work can be helpful for people affected by ongoing symptoms and post-viral fatigue.
Phased return to work should reflect the need to manage fatigue
‘Phased return works best when it is planned with your manager and, if you have one, your occupational health department. You may need a fit note from your GP. Try to avoid returning to work too soon and without the adjustments that you need to manage fatigue,’ the college says.
The RCN wants arrangements to be put in place to support staff returning from COVID-19-related sickness during phased return to work. This support should include risk assessment and consideration of the potential for home working.
Ms Ireson agrees that employer support is important.
‘A lot of nurses will have had COVID-19 because they were exposed to it at work, and if they are unlucky enough to get ongoing symptoms they need support from their employers and colleagues.’
Erin Dean is a health journalist