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Nursing

A&E Covid 19 Story Week 7

Changes to the NHS

This week I have noticed firsthand some of the changes to the NHS that Covid has brought about. Firstly, for most of the week I have been working with the non covid patients who come into A&E. These are the patients who present to A&E with no Covid/respiratory symptoms or temperatures and signs of infection. These people are triaged straight to the non covid side of the department. 

These patients have been steadily increasing in number over the past few weeks. Whereas when lockdown started, perhaps due to the #stayhome (or now #stayalert) message being promoted to the public, there were very few patients coming in. However the illnesses and accidents requiring emergency care such as heart attacks, strokes and mechanical injuries are still happening. This lead to NHS England’s Medical Director making a public announcement. He encouraged people to attend the emergency department when needed.

During this period, as Covid patient attendances decrease and non covid patients increase in numbers, there is an uncertainty of how A&Es and wards across the country need to change and adapt again. This would be to ensure minimal cross contamination so inpatients aren’t put at risk of catching the Corona Virus.

To adapt to the pandemic hospitals are changing to have Covid and non covid areas. I.e. there may be a ‘Covid ITU’ where the normal Intensive Care Unit is situated and a ‘non covid ITU’ in i.e. a theatre recovery area.

Patient Flow

As the patient numbers are changing week by week it has thrown many things into question. For example, if the designated areas can now fit the size of the population they are treating. It is also a tricky problem to solve. This is because after having people with Covid in, these areas will need to be kept empty long enough to be extensively cleaned. This is so it would be safe for the non covid patients.

The intensive cleaning involves many steps. Firstly, removing and replacing the curtains. Then, wiping down all surfaces and walls with disinfectant and disposing of any items left in the room. This is usually unused ECG stickers, unopened cannula packets and untouched dressings. Additionally, if these areas were switched back too quickly to ‘clean’ spaces, it might mean there wouldn’t be enough spaces to treat the Covid patients if the prevalence of Covid hospital admissions spike again.

Accident & Emergency

Where I work in A&E, the changes to the NHS are very visible as the entire department has been rearranged. The non Covid majors patients are treated in the small cubicles that under normal circumstances are used for minor injuries. For example, used for people who need stitches, casts, and wounds dressings. These cubicles are not as big as the standard majors cubicles. These are equipped with a cardiac monitor, a trolley and a patient table.

The nurses looking after the Non Covid Majors patients have to work in a small number of cramped clinic rooms that weren’t designed for majors patients. The environment feels overcrowded and chaotic. For example, it makes simple tasks like getting a hospital bed into the room, difficult due to space. Someone may require a hospital bed in A&E due to being in a wheelchair and not being able to transfer to the height of a hospital trolley or requiring a bariatric bed as the A&E trolleys would not fit these patients.

Redeployment

Additionally, another change the NHS has had to adopt is the mass redeployment of staff. Services like childrens ED’s and speciality clinics are getting relocated. I personally know a lot of stroke and paedeatric nurses who have been told at a few days notice that they will now work at a completely different hospital. This is miles away from where they currently work. This has meant lots of staff have had to sort out temporary accomodation. Staff in management roles have had to leave half way through their current projects/workloads for inductions at totally new trusts.

Redeployment is not always as easy as it sounds. For many, it means going through the stress and hassle of learning new IT systems, acquiring new access badges and getting to know a totally new site or even job role. It means teams who know each other well being pulled apart and has left nurses unsure of what they are allowed to do in their new role specification. (The RCN has a useful advice page if you are going through redeployment here). 

Redeployment has meant the relocation of many specialist nurses and doctors. A lot of whom were about to commence/were mid way through training for a speciality role. They have been since asked to move to places such as emergency departments and ITU’s to support the staff with the projected strain on the NHS that Covid was thought to bring. A close family member of mine, who usually runs a podiatry clinic, has been supporting the district nurses. She has been taking some of their visits to change dressings and give medication. Although this has been difficult and a lot to get used to, she also reports it has been a refreshing change from the usual workload!

Teamwork

The feeling of teamwork and the liberation of being able to ‘pull out all the stops’ to support frontline services has been quite incredible to behold. It has been very useful to have extra staff around to help out when needed and I have felt very supported by this.

Sadly though, the cost of this short term relief has been great. Elective theatre lists have been placed on hold which has left patients with cancer waiting for their operations. It has meant, patients with osteoarthritis that stop them walking have been in debilitating pain. These are just two examples of the people that will have their lives affected by the changes to the NHS and the measures necessary to ensure the NHS would be able to cope with the Corona Virus. Post Covid there will need to be changes brought about to control the after affects of this pandemic, such as an increase in theatre capacity to clear the now massive backlog of theatre waiting lists.

Concluding

This post was not intended to be overly negative and cynical, only realistic and reflective. Whilst this has been a time of great tragedy and suffering, which we must not forget, there are also many things to be thankful for this week. For example, passing the peak of the Corona Virus and the relieving of some lockdown measures. I am extremely proud of my colleagues, friends and family members who have all acted and continue to act so bravely. I know my parents, like many around the world, have been so worried about me, themselves and the people they love of course, and they continue acting bravely. 

There have been large amounts of support available at work. A wellness centre to came to visit with socially distanced activities such as yoga and group support sessions. I have also had a therapist visit the department and taken part in a mindfulness session. Myself and other staff found it to be very stress relieving. 

Its easy to feel overwhelmed at the prospect of facing more long term social distancing, increasingly difficult working conditions. Especially as more changes happen to the NHS and there is a rapid crumbling of summer plans. However the mantra of taking it ‘one day at a time’ helps me here! I hope it helps others too. 

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