Nurses are beginning to be recognised as they should
As NHS Nightingale London goes on standby, returned nurse Christie Watson shares stories of sadness, courage and hope from the frontline
Outside the main entrance to NHS Nightingale London there is a statue, The Dockers Sculpture, made in memory of ordinary working people, like us. There is much courage here, and across the entirety of the NHS, at the moment, but there are no heroes. These women and men are ordinary people who happen to be doing extraordinary jobs. We are fragile, tearful, afraid, and we are human.
Today is International Nurses’ Day – reason to celebrate, but also a good time to reflect. The need for critical care nurses has been one of the most significant challenges of this crisis, even with the thousands of clinically retired nurses, like me, rejoining the temporary Covid-19 register to help. Finally, nurses are beginning to be recognised as they should be: as safety-critical, highly qualified and experienced practitioners.
The Nightingale is now on standby – since the last patient left on May 6, clinical staff are returning to their trusts; to friends and colleagues who describe being brought to their knees by this first wave of the coronavirus. Remaining staff have been deep cleaning and preparing a clinical model, and all the documentation needed to reactivate, should a second or third wave happen (“when”, my colleague points out, “when”). Like all critical care units across the world at the moment, there has been light and dark here, hope as well as sadness. And it is probably not at all what you imagine.
About half a mile long, the hospital takes at least 15 minutes to walk across, and has a central boulevard the width of a motorway – I have never experienced anything like walking on to the critical care unit here.
Donning and doffing are magicalsounding terms you might expect to
A recovered patient kept asking: ‘They built a hospital while I was asleep? Blimey’
find in a Harry Potter book, but in Covid-19 critical care, these are the most important words of all. A donning nurse outside the ward helps us put on our PPE before we enter a vast, haunting space, akin to something from an apocalyptic film: high warehouse ceilings, strip lighting, alarms and echoes, and patients in rows, desperately unwell, hooked up to every kind of machine imaginable.
A patient’s relative once described critical care to me as a spaceship. This is like another planet entirely, with everyone covered head to toe in PPE, from small mask to Darth Vader-visors. At our busiest, there were 32 incredibly sick patients – which is around the size of a large intensive care unit. We never got above 54 patients in total, and frankly, we’re all relieved about that. The idea of caring for the 4,000 patients it was built to scale up to, in extremis, in this setting is chilling.
Intensive care consultants and senior nurses from around London have been invited to visit, check and see if we’ve missed something, could be doing something better. They, like us, are baffled to find a fully functioning ICU in a warehouse, where staff deliver, overall, safe and quality care to the sickest of patients. “That, there, is an intensive care unit,” a UCLH intensivist points out. It seems obvious, yet it doesn’t seem possible.
Upstairs in the management offices, teams have been working 100-hour weeks to get things right – with daily forums to which everybody is invited (there’s a flat hierarchy) and during which lessons are learnt from the day before, and from staff on the ground. Change happens fast, and consequently patient care improves every day. For those who have worked in the system for decades, the current speed of process and lack of bureaucracy across the entire NHS feels liberating, and it feels right.
At the back of the management room is the team described to me as the jewel in the Nightingale crown – the Family Support and Liaison Unit, made up of nurses, SNODS (Specialist Nurses for Organ Donation), GPS and FANYS (The First Aid Nursing Yeomanry, an all-female team of volunteers who specialise in communicating with families after the worst things imaginable; terrorist attacks, for example, or the Grenfell Tower fire). This team make the most difficult calls to families, they facilitate family visits for patients at the end of life, and they have worked so hard to make that happen in this challenging environment.
Because really, although the message from higher up the food chain is that the purpose of the Nightingale and other ICUS is about saving lives, there is a wider purpose of intensive care at this time: compassion. To provide compassionate care to all patients and families – and each other – during the Covid-19 crisis is a measure of our humanity, and how we should be judged.
On the way out of the ward, past the doffing area – where sweaty and contaminated kit is removed slowly, lest something splashes or touches – there is time to breathe, and read a board of messages from patients and their families: “We love our dad. And we love you too. Thank you”; “To all the team. Thank you for working so hard to get him back to us”.
After a 12-hour day or night, this may be the first pause to think about our own families. Members of the spiritual team are on hand, 24 hours a day. The patients, families and staff all need support. There is chatter, and sometimes laughter, and every single day, there are tears.
Two weeks ago, a patient was well enough to come off life support and was sitting up and talking in the Step-down Unit. The nurses had to
I hear nurses say they’d love generous donations to go to those in real need
explain to him that he had been sick with Covid-19, and had been put on a ventilator, and that while he was asleep, he was transferred to the Nightingale for intensive care. “They built a hospital while I was asleep?” he kept asking. He was a chatty man, but quiet a while then. “Blimey.”
Nursing has taught me there is always hope. But this International Nurses’ Day, as well as celebrating, there perhaps needs to be a shifting of mood. I hear nurses – grateful for the generosity and the free food they are receiving, I’m sure – say they’d love donations to go instead to those increasing numbers in real need.
And I wonder if the time for clapping has passed. It’s easy to understand, this longing for community, as well as wanting to support those in front-line jobs. Perhaps now, along with holding the Government to account about PPE, a minute’s silence, or the lighting of candles, shining a lamp, is the thing.
Today, as well as celebrating our profession, we will also pause and mourn for our nurses – and all frontline workers – who have died from this awful, awful virus. We must think of their families, and of our own. We must think of ourselves, and what these experiences might mean for those of us who make it.
This search for meaning has only begun; survival is just the beginning.