Nobody working in healthcare expected 2020, the International Year of the Nurse and Midwife, to unfold in the way that it has done.
The World Health Organization and every other healthcare body had begun to work on plans to celebrate the unique contribution of nursing to individuals and societies in all parts of the world.
Now nurses are working during a coronavirus pandemic and face challenges that nurses have not faced almost since the time of Florence Nightingale, the 200th anniversary of whose birth falls this year. Instead, community nurses find themselves having to adapt to the stark reality of managing and protecting the health of their communities from the impact of the novel coronavirus.
History has much to teach us in preparation for the current situation. The first district nurses, who were trained by the Queen’s Nursing Institute from 1887, needed to be adept in managing and controlling the spread of infectious diseases. Florence Nightingale was one of the founders of the QNI and she had made her career in fighting disease among the British Army in the Crimea – for as she rightly realised, it was infectious diseases such as cholera that depleted the soldiers’ ranks far more seriously than the wounds acquired in battle.
Many hospitals were founded as fever or isolation hospitals, as the Victorians fought to contain the spread of infectious diseases – particularly smallpox, typhus and enteric fever. During the 20th Century, as the vectors of disease were better understood, huge advances in medicine reduced the impact of these diseases.
Thus in the 21st Century, the caseload of general practice nurses and others working in the community had become refocused on chronic, long-term conditions related to ageing and lifestyle. The coronavirus outbreak has therefore come as a dramatic shock to the whole health and care system.
A shock nurses in the community are dealing with as they fear they may be the last in line for Covid-19 testing and for appropriate Personal Protective Equipment (PPE). The QNI is one of the organisations that have been representing the needs of nurses in the community to politicians and civil servants, highlighting the issues surrounding PPE.
QNI chief executive Dr Crystal Oldman has been actively working to represent the issues facing community nurses at the highest level, and has been in regular contact with the Department of Health and Social Care, sharing vital intelligence from nurses working on the front line. We have highlighted the issue of variation in the understanding of the Public Health England guidance on the use of PPE, including the misinterpretation of the term ‘session’, leading to some nurses being advised to use a single surgical mask for a whole shift, rather than it being changed for each visit in the community.
We also know that nurses are concerned about where to find quick, accurate advice about the correct type of PPE to be used in various settings and also the correct procedure in terms of donning and doffing the equipment. This may be more challenging for nurses who are doing home visits, where it may not be practicable or desirable to put on equipment in the car, or on the pavement before entering a patient’s home.
One general practice nurse told us of her experiences of working from a hospital hub in London that is co-ordinating the ongoing care for patients of 38 practices.
As well as managing physical health, the nurse describes the complex mental health issues facing people whose usual means of accessing services has been disrupted.
‘My patients’ anxiety level, mental health issues have been really challenging. For example, OCD patients who need to wash their hands several times because of their obsessive compulsive disorder now cannot understand why they are being told to wash their hands all the time, as what has been abnormal for them is now normal for everyone. Many of my patients are lonely and have felt even lonelier in recent weeks. They have lost people they cared about and they could not attend their funerals.’
She also talked about the challenges of dealing with an increase in domestic violence and safeguarding over the phone.
The nurse added: ‘It is going to be really hard to get [patients] to engage with services again in the future and l think l need to start thinking of ways l can help rehabilitate them starting now, like getting them to go into the garden and look for butterflies, or listening to the birds and identify the different species. I have to think of something. Nursing is very different now.’
We know community nurses are adapting extremely well to work in new ways but we want to let them know the QNI is here to support community nurses to give the highest quality care to patients, families and carers.
We advise nurses and their employers to follow the advice issued by Public Health Bodies and equivalent national bodies in other parts of the UK where relevant. Nurses can direct their patients to other sources of support during this time, such as the Samaritans.
But the QNI has also created some resources below to help nurses:
- A central resource for the most relevant information for nurses working in the community and primary care, to help manage the effect of coronavirus in various settings. It includes ‘rapid training plans’ that have been developed with Health Education England.
- Specialist advice for nurses who are working with the homeless population, or anyone who is in vulnerable accommodation: .
- A resource page on the General Practice Nurse Education Network website. This also includes ‘rapid training plans’.
- A ‘listening service’, operated by trained Queen’s Nurses, for community nurses to talk to someone in complete confidence about their life and work at the current time.
The QNI will strive to continue to provide the same level of support we have done to community nurses for more than 130 years, since the foundation of the charity by Florence Nightingale and others, which is needed now more than ever.