What is your usual role?
I am an advanced nurse practitioner in primary care, working as part of the clinical team. A ‘normal’ day includes prebooked and urgent on-the-day appointments, home visits, medicines management, the action and filing of blood tests, investigations and hospital letters. One day a week I undertake a ward round at a residential care home, which you can read about here.
Throughout general practice, whatever your role, no two days are ever the same. Practice nursing is varied and challenging in many ways, but never in a way that has been brought about by Covid 19.
What work have you been doing during the Covid-19 outbreak?
Covid-19 has meant we have had to change how we ‘see’ our patients and how we communicate; now we are most often a voice on a phone or a face on a video screen. I have only been at my current practice for just over seven months so to many I am still a stranger.
Without the person sat in front of me, I am unable to pick up and act on non-verbal cues. I almost feel like I am doing my job blindfolded. It has been very stressful working in this remote way, providing telephone triage assessment and management, although in many cases it works better than I thought it would. Patients are not having to alter their day to attend an appointment, and neither the patient nor I get stressed about running behind schedule as patients are advised they will get a call in the morning or afternoon.
The situation becomes more acceptable and normal day by day, but what never leaves is the worry of wondering, did I get it right? Did the patient describe their complaint correctly? A video link means you can see but not clinically examine, which is a key part of making a diagnosis. However, a whole plethora of consultations can definitely be managed remotely and moving forward to a post-Covid-19 era, we plan to include and promote telephone/video consultations as the norm if appropriate for an issue that doesn’t require a hands-on clinical assessment.
My weekly ward round is also no longer in person. This has been done via video link, battling with poor signals, freezing screens and delays in transmission. During the ward round, I need my senses to visually see a person’s state of health, to touch, to examine and reassure, to listen to the concerns and worries of each resident and the concerns of the staff who care for them daily – and not forgetting that hunch you get just from setting eyes on someone. Covid-19 has taken all this away and left me only able to look and listen through a screen.
It takes time to get to know your residents and now I am completely reliant on the information given to me by the staff. I have had to think outside the box, ascertain the history through an often pixillated video link and this has been quite stressful at times. This has meant also meant relying on temperature and oxygen saturation taken by the residential home staff and utilising the amazing skills of our wonderful district nursing team who were already visiting the home twice-daily basis to administer insulin amongst other things, to be my eyes monitoring the status of patients. For those that need clinical assessment, they are referred to a dedicated Covid-19 domiciliary team and for this service, we are very grateful.
My role also includes informing relatives about the declining health of their loved ones, putting advanced care plans in place with regard to their care and often this includes admission avoidance and to provide palliative care at home. These are very sensitive conversations that are often difficult for loved ones and most often, where possible, occur face to face where a hand can be held or an arm put around shoulders to provide comfort. Covid-19 has taken this away from me and means these conversations are now only by phone. For a relativem this is very difficult and emotional time already, and adding the fact they can not visit their loved one it makes the phone call emotional for me too.
Why would you say you are a Covid-19 Nursing Star?
To me, all nurses are stars. No matter what is thrown at us, we pull together with our healthcare colleagues to adapt and survive. Covid-19 has certainly thrown what was our ‘norm’ into outer space. This pandemic has made me refocus and use alternative ways of providing clinical assessment and care. I have continued to pride myself on the skill, care and comfort I provide, whilst being handcuffed by Covid-19, this has made me realise I definitely am a Nursing Star.
How do you think Covid-19 will impact the way you work in the future?
No one knows what changes the next few weeks, months and years will bring. In every area of healthcare, there are backlogs of work due to the pandemic impacting on all but essential and emergency care. In general practice that will have wide-ranging impacts – for example, ongoing pain management due to delayed surgery, but I feel the greatest impact will be rise in mental health issues. Models can be utilised to estimate the demand in primary care, but it is likely the impact will not be known until we are dealing with it and likely that services will not be able to adequately provide a timely service due to increased demand, thus increasing the impact further.
On a positive note, Covid 19 has forced us to become a more cohesive, decisive and reactive team. Changes in the way we work and operate as a team have been phenomenal, and these have been put in place within a short time frame where usually this could have taken months if not years of research and audit before implementing.