Returning to practice to provide critical care for COVID-19 patients

Associate Professor Pam Nelmes first stepped into Plymouth’s Derriford hospital as a student nurse in 1982, joining the team in the Intensive Care Unit (ICU) 4 years later. Currently leading programmes focused on emergency and critical care at the University, Pam describes nursing as a privilege and her return to ICU as ‘like going home’.

Professor of Leadership in Nursing Bridie Kent has been an ICU nurse and clinical academic for more than three decades, and held senior positions such as Interim Executive Dean in the University’s former Faculty of Health and Human Sciences. On research sabbatical when the outbreak began, she quickly realised she could be more useful to the NHS by being back in clinical practice in hospital.

Here, they describe what it has been like returning to ICU during the pandemic, sharing advice for newly registered nurses and students entering the workforce early to support the NHS.

This global pandemic has really raised awareness of the work of nurses. 2020 is the Year of the Nurse and Midwife, and what a year it has been.

As registered nurses returning to practice, we are not dissimilar to our students, who experience a range of feelings when going to a new placement. In fact, our third-year nursing students, working as part of the COVID-19 response, are probably more comfortable in practice than we are.

The clinical education we received as part of our return to practice has been superb, preparing us very well to provide safe clinical care. Students are themselves receiving induction and clinical education, and it is wonderful to be working with them side by side. While we know many of the people in the critical care team, as previous or current students, colleagues and friends, we don’t underestimate how daunting it must be for students less familiar with the people and teams they are joining.

The students may be fearful, but we hope they know they are not alone. We also felt fear stepping into the unknown and particularly the new ‘red zone’ ICU for the first time.

However, all the team have looked after us so well and their support is amazing. They have coped so well with all our questions. Students also remain part of their programme team, with access to all the support, guidance and pastoral care on offer. 

Another challenge we faced was wearing PPE. This is a critical layer of protection for ourselves and our patients, but we are not used to wearing it, and the barrier it puts between us does impact on our ability to communicate and connect person to person. Normally, our patients and their families get to know us very well and can see our smiles and non-verbal support. 

So, while PPE is a vital and necessary addition, it requires some creative solutions to ensure human interaction continues. Every time we go into the red zone, staff check that our gear is on correctly and then write our names and role on our backs. Everyone looks so alike when dressed in PPE.

<p>Pam Nelmes, ICU nurse around 1990</p>
Then and now: Associate Professor Pam Nelmes, ICU nurse, 1990
<p>Pam Nelmes</p>
<p>Bridie Kent old square</p>
Then and now: Professor in Leadership in Nursing, Bridie Kent as a newly qualified nurse
<p>Professor Bridie Kent&nbsp;</p>

Keeping connected with home is really important for patients, especially as they can’t have visitors currently.

Increasingly, we have been using patients’ mobile devices to play messages and videos from their family and friends, playing music from their own playlist, as well as connecting with families using tablets and iPads live, in real time. That reassurance from familiar voices or faces is so important, particularly when the patient is in ICU.

Our nursing students are experts at enabling wider patient engagement and the use of communication technology. We are confident they will thrive, use their skills, and indeed be leaders in this respect.

Ultimately, the important things remain the same. The need to offer person-centred care is no different during the pandemic than it was before. It is obviously busy, but the work of a critical care nurse still requires the same level of skill, professionalism, talent and humanity.

In the South West, we seem to have managed capacity very well. However, as we remain in a ‘critical period’, we recognise things may change, particularly if the area receives an influx of visitors when the lockdown is lifted. It’s incredible that ICU capacity has more than tripled at Derriford, with many people (ourselves included) ready to step in where required. If demand for ICU beds does increase then the additional facilities will be brought into use. These will take us back to our ICU roots, with the use of paper charts and multi-coloured pens! 

There is no doubt this virus is really nasty and it hits hard. The sickest patients are looking at months to recover, and in that respect we are incredibly fortunate that Derriford Hospital is nationally and internationally recognised for its focus on critical care rehabilitation. This is thanks in no small part to the tenacity, vision and energy of our ICU nursing colleague Kate Tantam and the #rehablegend campaign, through which she and her team have developed and shared rehabilitation resources.

A highlight for us both, as nurses returning to ICU, has been the opportunity to accompany patients into the ICU ‘secret garden’ with the rehab team.

It has been so uplifting to see patients’ reactions as they experience fresh air, see blue skies and beautiful flowers after many days or weeks in ICU.

Nothing short of inspiring and amazing.

A message to our students

To all nursing students who are able to ‘opt in’ to practice as part of the COVID-19 response, remember you are incredibly well prepared for this. You have studied hard and worked many hours in practice, under the supervision of healthcare professionals, and in a wide range of settings. We are confident that you will bring a fresh perspective, leading to new and more effective ways of working as we establish a new ‘normal abnormal’.

We hope you will have confidence to enable change, and feel your contribution is valued. Transition from student to qualified registered nurse has always been a challenging time. We don’t underestimate how this challenge is heightened during a situation none of us have faced in our professional careers, not even those of us who have been qualified for many decades. However, we are one big team, and we are delighted to be in this team with you.