(Opinion piece written in September 2021)
The shortage of HGV drivers has interested me greatly. The public out-cry, the governments eagerness to change visa’s, offer short term contracts. Yet according to the Royal Collage of Nursing we currently have an estimated shortage of 50,000 Nurses in England and Wales. Of the nurses we do currently have, a number are unlikely to be able to travel into work unless the petrol crisis eases. What does 50,000 vacancies even look like? How can this be equated? And what does this actually mean for patients, our non-nursing NHS colleagues and services. I’ll tell you. Of course, it means we are stretched, we are tired, we are doing not only our own jobs but that of our absent colleagues too. So, for a patient this can mean the difference between being given prescribed medicine, or being helped to the toilet. Having a hot meal or a hand held while in pain or dying. It can mean having a blood test or being helped out of bed, being escorted for a procedure on time or updating a worried relative. We can’t be in two places at once, we can’t do multiple people’s jobs at once. But with the nursing shortages only predicted to increase how will we as a profession survive? But more importantly how as a nation, as a society will we survive without our nurses?
Daily I question how can we continue to deliver the care we are highly trained and educated to do so. I have never in my 20-year nursing career seen such low morale, such burnout, such apathy. We have had the hardest 18 months of our careers, we have seen the most horrific sadness, loss and human fear. We were at the epicentre of the pandemic, the beating heart of the NHS. We were clapped, we were sent gifts, children wrote us thank you cards, our parents and partners, our children all proud. We nursed the world through the trauma of the pandemic. Only now when the pubs are open and the buses are full are many of us accepting that we too are traumatised. We have spent 18 months living on adrenalin and determination. We had the camaraderie of our colleagues, the sense we just had to keep pushing through, get through the next few days/weeks. But now our reserves are low, our bodies ache and our minds are full of the heartache of the pandemic.
I enter a ward on my rounds as Clinical Site Manager. A nurse sits at the desk, her make-up slightly smudged around her eyes, her hair un-neat in a bun on her head. She looks like she’s been up all night, she has. It’s 11am, she is one of the only 3-night nurses from the night shift. A night shift that usually has 6 qualified nurses rostered to work. She tells me she has not finished her notes, the legal account and prof of the care she has given. It’s 11am she finished her shift at 08:30. She tells me through a yawn that she is back at 19:30 hours for another shift.
Later a ward Sister calls me, she reports that the night shift only has 4 nurses for her unit. A 48 bedded unit, where normally 12 nurses are allocated to work. The Sister has put the shifts out to agency, she has texted her own staff, she has asked other wards to help. But nowhere are they spare nurses, my job at the end of my shift will be to move nurses from already understaffed wards. I will rob Peter to pay Paul. I will try my hardest to make the hospital safe, or as safe as it can be.
I say good bye to Julia, she has been an NHS nurse for 9 years. Today is her last shift, she is returning to Spain. The UK no longer has the appeal it once had, many of her nursing friends have already left. Orla a nurse on the ward next to Julia is also celebrating her last shift, she is going home to Ireland, she hasn’t seen her family for almost 2 years. She has no job to go back too. Brexit, Covid both driving our nursing workforce away.
I am called to assist a nurse who is crying. She has been hit by a psychotic patient. The patient is unwell, it is not his fault, however he has hit 3 nurses already, he only has a mattress on the floor as he threw the bedframe at the security team. He is very unwell, psychotic, he is not of sound mind. He is waiting for a mental health bed, he has been waiting for over 72 hours. Currently he is being nursed in a medical area alongside the elderly, the vulnerable, those that cannot get themselves out of bed. Although in a side-room he has run into the 6 bedded bay on a number of occasions, once without clothes. Behind the scenes one of my team call again to enquire about his bed in a mental health facility. On his 5th day in hospital, he gets a bed, it is 75 miles from his home, his family, his community, the very things that he will need on his road to recovery. I now have to navigate him safely into the secure ambulance for the almost three-hour journey. The nurse who I was originally called to visit has taken the rest of the week off, she is shaken, nervous, afraid, exhausted and bruised.
Today I hold the emergency response bleep, so I attend the crash calls. A man 52 is struggling to breath, he has Covid, he hasn’t been vaccinated. I don’t ask why; I’ve heard too many excuses. Besides, it doesn’t really matter now, whatever his reasoning Covid has won. We advise he calls his family, says goodbye, I can’t promise we will ever wheel him back out of ITU. I am in full PPE, a mask so tight it will leave a mark for the following hours. It feels like March/April or Christmas last year. A river of bodies, some on their fronts, the loud sounds of ventilators breathing for the almost corpses. Not one of these people have been double vaccinated. Not one.
A nurse sits in the corridor as I leave, I have doffed on my PPE, I sweat with the heat. She sits on her heals, her back against the wall, weary her face red from her mask.
‘You ok?’ I ask.
‘No, I just don’t know how long I can do this for. I’ve had enough of giving everything, giving everything for nothing. I’m looking after 2 ventilated patients on my own. We once had surge nurses to help us, but they have all gone back to their old jobs. I just don’t know how long I can do this.’
‘I know. I think we all feel like that.’ I can’t think of anything else to say to her, I can’t promise her it will get better. I can’t see how it will get better.
She tells me she wants to see her family, she wants to travel down south, but she’s scared, even though she is vaccinated, even though her family are, she is still surrounded by Covid. What if she takes it home, what if she gives it to someone? I have no answers, I have no reassurances for her.
So here, a tiny snapshot of what the NHS nurse’s crisis looks like. Nurses leaving the profession, leaving the country. Nurses staying for hours after their shifts unpaid. Nurses broken, exhausted, doing the job of not just one but two or three absent colleagues. Where is the public outcry? Where are the demands to pay us more, increase training packages, why is this not on the front cover of every newspaper? Why is the lack of lorry drivers dominating our fears?
We lose our nurses; we lose the beating heart of the NHS. We lose our nurses; we lose the humanity and dignity in illness. Illness that can at any time strike any one of us.