The Changes COVID Has Made To My Job As A Practice Nurse

“Remote working, which was never in my job remit, became 'a thing'. Never had I thought I would be taking a laptop home and plugging in and reaching out to my patients from my dining room table.”

An anonymous Practice Nurse spoke to us about the effect that COVID-19 has had on her role.

Topics covered in this article

Introduction

Initial Changes

Remote Working

The Future

Positive Outcomes

Introduction

The COVID-19 pandemic had a profound impact on everyone's life.

Primary Care certainly was no exception.

Sudden and reactive change was essential and care delivery changed within a matter of days; walk-ins became a thing of the past.

Suddenly, we were working remotely, calling patients, relying on photos to assess, and using IT advances online to manage consultations.

As a practice we were faced with enormous pressure to maintain care delivery whilst it seemed the whole world was shutting down around us.

As a team we had to find all our strength to support each other, reassure each other, pull together ideas and resources to move forward and manage the needs of the patient population in the middle of the pandemic.

Initial Changes

Routine Practice Nurse appointments in March 2020 fell dramatically, the need for routine blood tests, routine cervical screening, child immunisations, wound care for example weren't being booked.

Patients’ anxieties grew attending for appointments.

The appointment screens never looked so sparse.

This led to complications, there were concerns about unmet needs.

Patients were told to stay at home, new NHS England guidance informed by Public Health England to maintain infection control standards meant emphasis on remote working unless clinical need indicated based on triage and assessment.

The appointment system required re-shuffling to accommodate cleaning time and donning of personal protective equipment (PPE) between each patient.

Patients were screened to make sure no COVID symptoms were present before they entered the building.

Efforts to contact patients prior to the appointment or sent an SMS informing guidance were also necessary.

Remote Working

Remote working, which was never in my job remit, became 'a thing'.

Never had I thought I would be taking a laptop home and plugging in and reaching out to my patients from my dining room table.

Managing chronic disease reviews continued to be a necessity but the challenge to continue to review long term conditions remotely without blood tests and without seeing the patient had to be managed.

Triaging to safely postpone bloods and develop a new re-call system was necessary.

District Nurses continued for urgent requests only so this impacted our work within the clinics.

Referrals to district nurses were largely on pause.

We had to balance requests based on urgency and review and re-call at a later date.

Re-structuring our appointment systems to minimise patients' time in surgery and deliver more of the consult over the phone was adjusted.

Where there was no waiting room pressure, we found phone consultations were quicker as notes could be written during the consultation reducing administration time.

Guidance via a traffic light system by our CCG helped guide our practice, we had capacity to continue with cervical screening and immunisations.

Reaching out alone and checking in with our most vulnerable patients and identifying basic needs shopping, family/friend support, and assessing vulnerability formed part of the consult and it was quite simply all the patient needed at times.

Ultimately, it formed new ways of working, thinking outside of the box identifying need holistically shaped a new relationship, respect and thank you's became a big part of the conversation.

Suddenly we were lifted, during the storm, patients became increasingly grateful, thankful, and respected us simply contacting them and reaching out.

The Future

Moving forward, it seems there is huge potential to continue working remotely, a reduction of face-to-face consultations seems sensible in light of the on-going nature of COVID and the risks it poses especially to our most vulnerable patients.

In collaboration with the reception staff and Clinician booking an appropriate appointment based on risk and need is identified.

Being able to reach out to patients hard to access and providing a more convenient approach to booking has been a positive.

The offer of choice as to how patients want their needs addressed has also proved to be a benefit to most.

Patient safety and infection prevention measures continue as a priority at a local level to continue with the level of protection, (PPE, screening of symptoms prior to entering and cleaning continues) remain in practice.

As a team we are all reassured by the continued measures.

Positive Outcomes

What was to come in the last 7 months was the enormous expansion to our already massive immunisation programme, whilst of course continuing to operate as a Doctor’s surgery.

In light of the work pressures, pulling in extra overtime, delivering an extensive immunisation programme not to just our practice but to the locality called for a magnificent teamwork approach.

There was elation we were able to pull together to provide a wide scale service and to make history was the icing on the cake.

Despite all that came from the pandemic, we pulled it together, the team adapted with professionalism and efficiency.

We adapted with resilience and responded remarkably and the love of what we do was magnified.

Change in Health Care occurs daily, keeping up with advances in Health Care, responding to the government and public health directions almost daily and the enormous effort of pushing out COVID-19 vaccinations has been incredible.

I do think the health service adaptations to change has been a positive moving forward challenging our mindset to being able to adapt on another level.

As a team we have never been stronger than we are now.