Scott Hamilton, Associate Improvement Advisor, was deployed back to the frontline as a nurse on a COVID-19 ward. He describes what it’s been like to manage the fear, connect with family and appreciate the many things that nurses do to make a difference.
On 17 February this year, I joined Healthcare Improvement Scotland’s Acute Care Improvement Portfolio as an Associate Improvement Advisor. Having completed the Scottish Improvement Leader Programme, I was excited to get stuck into my new improvement role at a national level.
Then, just a few weeks in, COVID-19 happened.
I’ve got over 20 years’ clinical nursing experience, from working in acute admissions at the front door to focusing on practice development, quality improvement and clinical teaching within older peoples’ care. I thought I’d seen plenty of what life throws at the NHS. I remember the SARS and flu outbreaks in recent years, but both now seem like a storm in a teacup compared to this. It is astonishing to see the speed with which this virus affects people, particularly the elderly.
Mentally, emotionally and physically demanding
Once the scale of the problem became clear, I was keen to go back to my previous team at the Royal Alexandra Hospital (RAH) in Paisley to help. Very quickly the ward I was on, ward five, became a designated COVID-19 unit.
The past 12 weeks have been the hardest challenge of my career.
When our first COVID-19 patient came in, my colleagues and I were anxious about what to expect. We were – and are – learning new ways of working in a new environment, all at speed and on the hoof. And it is demanding work. We’re dealing with situations we wouldn’t have thought possible. For example, in usual circumstances, we would be looking for oxygen saturation levels of 96-100%, but now we are accepting lower levels like 88-94% or occasionally even lower. Patients seem to do OK on that and it blows your mind as a clinician. But it is taxing mentally, emotionally and physically. We have to concentrate constantly on keeping ourselves safe by following the guidance on how to don and doff personal protective equipment (PPE) and keep it in place. The frequent hand washing is causing me some skin problems, and 12-hour shifts are something I’ve not experienced since 2008.
“I’ve got over 20 years’ clinical nursing experience, from working in acute admissions at the front door to focusing on practice development, quality improvement and clinical teaching within older peoples’ care. I thought I’d seen plenty of what life throws at the NHS. I remember the SARS and flu outbreaks in recent years, but both now seem like a storm in a teacup compared to this.”
Thanks to previous work by the Scottish Patient Safety Programme (SPSP), we are used to using the National Early Warning Score (NEWS) to help identify deterioration in patients. The system remains invaluable in clinical settings. However, In COVID-19 patients it is more about how the patient looks at a particular time based on their NEWS score. There is no broad standard for everyone – it is much more focused on goal setting and getting the right parameters for each individual’s care. We need to maintain existing standards and guidance and develop a complementary new rulebook for COVID-19 patients, because it’s so different.
Teamwork is outstanding
There is one thing that has remained very much the same, though – the teamwork. I work in a multidisciplinary team including nurses, student nurses, consultants, junior doctors, physios and occupational therapists. Thanks to a combination of strong leadership, teamwork, compassion and camaraderie, we’ve become tight and slick! Everyone has an essential role in dealing with COVID-19 patients, whether we are helping them overcome viral fatigue, connecting them with loved ones using technology (usually tablets) or treating various complications that they may be dealing with. The team is phenomenal – they are my NHS heroes.
This experience has shown us that when the motivation is there, amazing things can happen in a short space of time. There has been no adoption curve – everybody is moving in the same direction at the same time. It’s amazing what we can do. Frontline staff have been supported to be innovative and creative and the whole team has been able to contribute. I think we’ll need to re-scope the landscape – for example, treatment for older people looks different now. There has been so much invaluable learning and the NHS has done a tremendous job, now we need to keep sharing and spreading that learning.
“Everyone in my team has an essential role in dealing with COVID-19 patients, whether we are helping them overcome viral fatigue, connecting them with loved ones using technology or treating various complications that they may be dealing with. The team is phenomenal – they are my NHS heroes.”
Connecting with others
My wife Elaine, who is also a nurse, usually works in Practice Development however, due to the pandemic she has returned to work in the Queen Elizabeth University Hospital Intensive Care Unit. We’re working different shifts so we make the most of the one day a week when we can spend time together as a family, along with our three children.
Usually, you could describe our life as “pedal to the metal”, week in and week out. Lockdown has led us to reflect on what’s important in life and we have been spending our family time playing board games and walking outdoors together. We appreciate that time together a lot more now.
My two boys both had birthdays during lockdown. Our youngest, Matthew, turned 10 and had a virtual party on Zoom. Using the internet has been essential to connect all of us, not just with each other but with the wider world so we can do things we took for granted before. For example, both my mother in law and sister in law have both used NHS NearMe for medical consultations. For me, it’s meant I can learn from my Healthcare Improvement Scotland colleagues through a webinars that share learning from those using the service. It’s been interesting to see these things from both sides.
This experience has made my introduction to Healthcare Improvement Scotland interesting, to say the least I can’t wait to get back to that role, but I would not change the experience. I’m so proud to be a nurse. The leadership, teamwork, connecting patients and their families – it’s all the little things that nurses do that make a difference to patients, families and the whole NHS team.
Scott Hamilton is an Associate Improvement Advisor with the ihub’s Acute Care team.