It’s not new for clinical staff to be working under extremely taxing conditions. But what is happening now is a quantum shift from anything clinical staff have encountered in previous winter months – difficult as those times might have been. It’s almost as if descriptions from last winter belong to a previous era – BC. Before Coronavirus.
From a psychological perspective two factors stand out. First, although prior to this pandemic there were undoubtedly situations where clinicians could be at risk of being physically harmed by their patients, these risks although real, were relatively rare. Covid-19 changes all of this. GPs and nurses whether working in the community or in hospitals, run a significant risk of catching the virus from their patients. And not only catching the virus- but also potentially taking it home to their families.
With tragic stories online of the death of nurses and doctors from countries across the world, it’s impossible for clinicians not to feel vulnerable. Without a shred of doubt, the lack of adequate personal protective equipment exacerbates this situation; committed as clinicians are to caring for their patients, they are understandably frightened that they or their families could suffer as a result.
The second way in which the current pandemic is different from previous winter pressures is that staff are finding themselves tasked with carrying out tasks for which they may feel desperately ill prepared. Of course, this has always happened to some extent, particularly at transition points when a clinician steps up to a new level of responsibility or when there are significant staff shortages.
But currently, given the urgent need to treat the exponentially increasing number of acutely unwell patients, this lack of preparedness is reaching new levels. Whether it’s the premature elevation of final year medical and nursing students into clinical roles, bringing recently retired clinicians back to work or deploying clinicians from other areas of practice to work at the frontline, the overall effect is that significant numbers of staff may feel unsure whether they have the correct skills to give their patients the care that they desperately need.
It’s too early to know whether the new range of measures brought in this Monday will flatten the curve to the point that the NHS avoids being stretched to breaking point. Too early to know whether the field hospital in the Excel Centre, or promised shipments of ventilators and testing kits will somehow mean that clinicians are spared having to see sicker patients die in order to offer life-saving equipment to others who have a better chance of survival. I have no doubt if shortages lead to clinicians having to make these decisions over and over again, that the psychological toll on them will be heavy.
So what can clinicians do to protect their mental wellbeing during a pandemic? One thing is essential, and that is the power of connecting with colleagues. I’m dismayed when I hear from clinicians who have been told that there is no time for staff to come together, to discuss what has happened on their shift, to de-brief, laugh, cry, or raise a concern. And I’m delighted when I’m told, as I was yesterday by a GP in Tower Hamlets how they have instigated twice daily ‘huddles’ in her practice; whilst still maintaining a safe distance from each other, and with those self-isolating or working from home dialling in, they talk about the patients they’ve seen, what has worked well and things that need to be done differently. Feeling connected – an integral part of the team – isn’t an optional extra at times like this. It’s a basic work hygiene factor. Like washing one’s hands.
The power of connectedness was emphasised in an article in yesterday’s BMJ written by Professor Neil Greenberg and colleagues. Greenberg, a specialist in military mental health, highlighted a number of things that can protect the mental health of staff during the pandemic including: proper psychological preparation so that staff have some idea of what they might have to face; team leaders regularly bringing staff from all backgrounds together, to discuss the practical and emotional challenges; briefing the providers of regular staff support about the kinds of difficulties that staff may present with and senior managers keeping a close eye on junior managers who may feel overwhelmed by the scale of their new responsibilities.
Isn’t it paradoxical? The social isolation that we are all experiencing has a vital role to play in slowing the spread of the disease and hopefully preventing the NHS from becoming totally overwhelmed. But in order for clinicians to be able to meet the psychological demands of Covid-19, social isolation from their colleagues is the last thing that they need. Enabling clinicians to feel connected to their colleagues will help them manage the inevitable stresses of the extraordinary work they will be undertaking in the coming weeks and months. Connectedness is key.
Biog of author
Dr Elton specialises in career counselling. After completing her first degree at Oxford University, she obtained a fellowship to the University of Pennsylvania where she completed a masters in Educational Research. She then returned to the UK and did a PhD at the Department of Academic Psychiatry, University College London Medical School. Since 1998 Caroline has worked in medical education including setting up and running an NHS funded careers support service across 70 hospitals in London. In 2014 she left the NHS and set up CPD – Career Planning for Doctors – a specialist career consultancy for the medical profession. In 2018 her book Also Human: the inner lives of doctors was published by Penguin/Random House in the UK and by Basic Books in the US.