Submitted by Rachel
Intensive Care Nurse
My alarm goes off at 6:00am but I have already been up for hours worrying about the day ahead. I get up, shower, eat breakfast, and put on my game face for the day. Each day I leave the house, my fiancé tells me he is proud of me but I can see the look of concern in his eyes – he knows how much I am struggling, despite my efforts to reassure him that I am fine while trying to convince myself too.
On my arrival to work, I put on my scrubs and go to the coffee area where I am greeted by the happy smiling faces of my colleagues – our smiles are our mask, behind them we are all tired, emotionally drained and near to burnout. This is the calm before the storm, our safe haven and precious moment of normality before the shift begins.
I see my colleagues preparing themselves for the day ahead, each one with a positivity and motivation to see the day through and help the patients that need us at our best. It’s in these moments that I count myself lucky to work with such an amazing group of people.
ITU nursing is based on the foundation of one nurse to one patient due to the high level of attention and oversight needed to effectively care for the critically ill. Today I am allocated two ventilated patients. The unit is ordinarily made up of 12 critical care beds and today they are all full.
The influx of critically ill Covid patients has overwhelmed the unit and we have therefore increased capacity by eight additional beds, which are also full. This has become our ‘new normal’.
My patients are both in the extra capacity Covid area, meaning that I have to work my 12 and a half hour shift in full PPE. We joke that we are putting on our armour, but that is exactly what it is. It is protecting all of us from the virus as we work and provides us with reassurance that our loved ones will also be safe when we get home.
This takes us between five and ten minutes and starts with a full-length gown, one pair of surgical gloves, a tight fitting facemask, a hair net, a visor, and a second pair of gloves. By the time we have finished we are already hot and do not know when we will next be able to have a drink and a well needed break. We check each other’s PPE, make sure we’re safe, give each other a reassuring look and enter the Covid area.
We already know that we are short staffed, so we are apprehensive about the challenges that lie ahead. I take handover from the night nurse and my concerns become a reality, as one of my ventilated patients has had a very difficult night and is now on 100% oxygen due to a sudden deterioration. He is waiting to be reviewed by a doctor while my other patient, who is seemingly doing well, remains on the ventilator but is off sedation and is requiring a lot of reassurance due to his delirium and confusion. I take a deep breath and start my shift.
I start by assessing my deteriorating patient and ring the doctor to inform them that I have made some ventilator changes to stabilise him, but they still require an urgent review. During this time, my colleague informs me that one of her patients is
deteriorating rapidly, needs support for his breathing and the doctors will be coming in to ventilate him immediately. Despite how busy I am, I know that she needs my support, so I help her to get ready for the procedure and then help the team to ventilate him. Once the patient is ventilated the realisation hits, as it often has during the pandemic, that we are further outside of our normal nurse to patient ratio – we are pushed beyond our limits and juggling multiple life and death situations. We are stretched and stressed but we know that our patients need us, so we remain calm and continue.
The doctor has now come to review my deteriorating patient and decides that the only way to improve his situation is to prone him, which involves turning the patient on to their stomach to improve their breathing. Due to the complexity of critical care patients this requires a skilled team of people. The plan was for them to come in an hour, which gave me just enough time to have my breakfast; it is now 12:00pm.
Coming out of the Covid area and taking off the full PPE provides the much-needed relief that we all long for. These 30 minutes give me time to collect my thoughts, eat some food and drink some water, although not too much because I don’t want to risk needing the toilet as soon as I have to go back. I feel refreshed and ready to go back into the Covid area to prone my patient.
Back in my PPE and back in the Covid area, I am happy to find that theatre and recovery staff have come to provide help and support for the rest of the shift. I cannot express enough how grateful we have been for the support provided by our colleagues throughout the hospital, all leaving their normal work environment to selflessly enter an extremely challenging and demanding situation. This is representative of the spirit of the NHS and the country during this time – everybody coming together and helping each other. The proning team have also arrived and have performed the difficult task of proning my patient. Thankfully, we see an instant improvement, which fills us all with hope and relief now that the patient is more stable.
With my patient showing signs of improvement I now need to care for my other patient, who is currently being looked after by one of the assisting theatre nurses. Seeing this patient reminds me that he was only where my other patient was weeks before, requiring high levels of oxygen and also having to be proned. However, he is now much improved and we are in the process of beginning to wean him from the ventilator. The contrast between my patients highlights to me that our hard work pays off, and seeing them get better provides great satisfaction and a much-needed boost. It is these glimmers of hope that help to maintain our optimism during these difficult shifts and through what has been the most difficult time in our careers. It reminds us why we became nurses and why we keep coming in, even when we are feeling at our limit.
Clinical caring is, however, just one aspect of my shift, with another large part being to connect patients and their loved ones while visits were suspended. This for me is also the most challenging part of my day, as there is no training that can prepare you for the emotions felt when listening to relatives desperately pleading for their loved ones to get better, knowing that they cannot be there to provide the comfort of a held hand, a kiss on the forehead, and a familiar face. For my proned patient, I held the iPad to his face and listened to his family sing to him, tell him about the football results, tell him about their day, and express hope that he would be back with them soon, throughout which he was sedated and unable to respond. I found this extremely distressing to see, however, I put on a brave face and reminded myself of the importance of these calls for the patient and their family.
As the end of the shift draws closer, I hand my patients over to the night team, thankful that the patients are more stable than when the day began. I thank my team and remind myself that, although the day has been extremely challenging, we have looked after and supported one another, we have provided the best quality care we can to our patients, and are hopefully one shift closer to the end of the pandemic.