First published Dec 8th 2020
So this year was supposed to be full of so many celebrations but has instead been full of so many sad stories. This time last year none of us could have anticipated what was to come despite stories emerging I am sure we all thought it would pass us by without too many of us affected and replaced with more discussion on Brexit, government antics or the latest royal scandal! However quite quickly 2020 became the year of the nurse for so many other reasons.
As always we did what we always do, step up and put our patients first. Some returned to practice to assist where they were able, and some postponed retirement or plans to change careers as they soon realised the importance of our roles. We were clapped on a Thursday, something I found almost embarrassing as my small role in healthcare currently didn’t feel worthy really – as a bank nurse in a chemotherapy service, I was lucky to be in rather a protected role, risky like all but on the spectrum compared with ITU very low.
Despite this, we had our own challenges in oncology. The unit I work in is private and as such many patients come to us as options are open to them that wouldn’t necessarily be open to them in the NHS. We have many overseas patients and many who have advanced cancer following the palliative route for treatment or accessing a clinical trial to add some quality of life or added time. We like many units though had to face difficult questions. Many of these patients who were having treatment for advanced disease were not being told that treatment may stop. I remember before it was official that these conversations were occurring, one lady coming to the unit under my care. I knew she had had extremely good scan results but was unaware of the conversation her consultant had had to have with her. My initial comment to her of ” your scan results were fantastic” were met with tears as she explained the conversation she had just had and the realisation that all this hard work to keep things at bay may now be destroyed by the fact that treatment had to stop. Her risk was too high in a world of Covid – benefit of treatment v’s reality of outcome should she contract it. Other patients travelled back home whilst flights were still occurring laden with some of their oral chemo where appropriate but knowing we would unlikely see them again. It was a grieving process for us as well as them – the harsh reality of the uncertainty of the current times. These were the days before PPE and isolation / Red zones, patients were only tested when arriving symptomatic and they started arriving as such daily from the second or third week. Whilst the contingency planning was put in place and processes decided upon patients still had to be cared for, we quickly put temperature checks upstairs of the unit when patients arrived so as to avoid them coming to the unit if potential C-19 but the reality was they had already been sitting in waiting areas with staff and patients …
I remember one chap arriving for his pre chemo chat – something which is done in our counselling room off the unit. He appeared fit and well ( despite the cancer diagnosis ) but as the nurse did his pre checks he disclosed how he “just hadn’t felt right” for a few days and had had a persistent cough for a couple of weeks. He put it down to his disease and the sooner he could start treatment the better. My colleague quickly realised the potential risk, professionally removing herself from the room, escalating and taking the appropriate steps. In that moment he realised what she was realising herself and before going to the isolation ward, set up literally in hours, asked the nurse to call his daughter so he could speak to her. The phone call was so emotional as everyone with him in person on the phone realised this may be the last chance to say everything they wanted before events took over a medicalised process. Terrifying for my colleague also, when his test came back confirmed as positive. All of us still thought he would be ok – he hadn’t started treatment yet so his risk was no higher than Mr Public, he was relatively young, no additional health concerns and we thought had been diagnosed quickly with few physical symptoms. But as this disease has shown us, the cruel nature of it is the little preparation and over the period of 48hrs he deteriorated rapidly eventually dying with only strangers holding one hand through full protective gear and holding his phone in the other so his children could speak to him one last time. This was the horror even in our “low risk” unit – terrifying.
Over the next couple of weeks we had a consultant test positive and most of her patients, colleagues having to shield and others testing positive so isolating – workforce potentially being the biggest risk if it continued at the same rate. As we are part of a larger private network, units could be amalgamated and staff joined, with some units shut and other roles being joined so staff could be reallocated where able. For me personally, something I hadn’t even considered would be an issue, was that due to the staff juggling and the workload changing as patients stopped treatment or returned home, the organisation had to make the financial decision to stop all bank work. Having managed private units in the past, I saw it coming before the team did and understood the decision. But it was rather odd to be unable to work there at at time when nurses were needed more and more!! The team were angry – they felt let down and that it was short sighted but to be honest I was little relieved having that decision taken from me. Previously when I was out of work due to the NMC issues, I was angry and impotent at my choices being taken away from me. This time it was so different and to be completely selfish I was relieved that I no longer had to travel into COVID land and could retreat to the security and safety of my family safe in the knowledge I wasn’t going to bring the virus home with me.
I kept in touch with colleagues – missed them loads but did not miss how busy they were. Hearing of one of the sisters seriously ill with COVID was a wake up call on how different it could have been and how lucky I was to be able to step back this time. I applied to track and trace, seemed perfect as would be able to do it from home. Not sure what it was like for others applying but considering they were supposed to be desperate to get people on board the process was ridiculous. I was ready to work immediately and yet weeks went by sending paperwork, talking to different stages in the process, promises I woudl hear soon. I eventually did get cleared 2 and a half months later to be told literally 36hrs later whilst waiting for my e-learning to come through, that they were stopping recruitment! Paranoia did kick in a little bit, an after effect of NMC process which occasionally rears its head… was this because of my history… were they just being polite but actually wouldn’t recruit a nurse who had been struck off even if she did win at appeal?? I had to push those thoughts aside, could not spend time thinking about them anymore – I was in a positive place after a very long time not being so, so had to tell myself it was nothing to do with that just another process that took too long.
After a few weeks following the T&T debacle, the phone call came, as I knew it would, to see if I could help out on another unit for some shifts. I gladly did , the team were lovely and welcomed me straight away, where I have been doing bank shifts ever since. A different cohort of patients so less exposure to the pandemic and this time everything was in place to minimise the risk even further – weekly testing of staff and testing at every appointment for the patient. For me my COVId experience was relatively safe again.
One aspect which hasn’t changed in this year of the nurse is the work with NMCWatch. The pandemic has brought more excuses for process taking even longer and sadly we are starting to see referrals which can be related to working through a crisis. The good news though is that more people are hearing about us and earlier on in their investigation. We officially formed as a Community Interest Company (CIC) in January so this year has been about bedding the processes in and tightening up on how we do things, getting more people on board to help with the work and trying to get ourselves respected for what we do. The reality is that the process will always be there and will rarely be perfect but we can do our bit to help our colleagues and peers to get through it with dignity and hopefully some professional career options that may not have been open to them without our involvement.
The year for me, personally, has been about getting back to basics, hunkering down with family and slowing down the pace of life a bit ( well wish!! ). My father was seriously ill in the summer which brought it’s own challenges as daughter became carer and advocate and at times parent to him! That in itself made me realise that I am good at what I do and reaffirmed that nursing runs through me, it won’t leave me even if not working, the ethos and belief systems are fundamental to who I am. In turn as difficult as this was, family dynamics and all it did help me regain a bit of my spark in regards to my work. ehDad’s illness also helped me realise just what a nightmare this really is for those hospitalised and those left at home worrying. We were lucky with dad, his hospital allowed 1 visitor per day for 1 hour and actually they would often let you stay longer. It still was frustrating to have to negotiate his progress via telephones with teams that constantly handed over to each other rather than having one person coordinating. We also had the issue of Do Not resuscitate order thrown into the mix, which at the time I thought I understood as appropriate but now reflecting back have concerns about as dad was at his lowest, did not have us there to advocate for him and wanted to give up. Once through and back home, there was no way he would have made that decision now, which made me realise how vulnerable the elderly are now more than ever and need advocating for so much better than they do get currently. Without an advocate life on the wards involves a lot of luck.
Other reflections – how I feel about my work…Prior to my dad’s illness, covid and everything else that this year has brought the spark had gone out well and truly when I went through the NMC process and I really thought I would never get it back, nor wanted to. There were many days when I made myself go in rather than because I truly wanted to, the necessity to pay the bills was the only driving factor. When I initially returned to work it was because financially I had to, but if I could have afforded to walk away I would have done. I also would not have been able to do so had I not had such a supportive employer and team around me – vital for anyone’s professional recovery post NMC. Now, as we come to the close of the year I have learnt that despite it all I am really lucky to be a nurse. Nursing will always give me options, unlike many are finding post pandemic
( whenever that may be ), I do love it when I am here but equally it isn’t my everything anymore which isn’t a bad thing.
Ironically as this year of the nurse comes to the end I find myself on the other side of the bed. A simple walk with the dogs has turned into a fracture of Tib/Fib and I am blogging from my bed waiting orthopaedics to tell me what time I am going for my op!! This is my 4th fracture in 5 years and the realisation that I may still feel as young as I did when I started my nursing career, I really am not – osteoporotic, menopausal and breaking!!! I am encouraged by the nurses I have met in the few hours I have been here thought. Both my A&E nurse and the night nurse tonight are newly qualified and we have had great chats about training and working – both give me hope that the ethos is there still. .
However as my bones are screaming out at me and the last conversation has finally confirmed, this is the year of an old nurse – they were both born the year I qualified !!!!!
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