Covid-19 - March 2020 has been the most challenging time in my Mental Health Nursing career

"There will undoubtedly, be lessons to learn from this, but the time for reflection has not arrived yet."

Mental Health Nurse Consultant, Laura Woods, discusses how the mental health service is changing in the face of the current pandemic, and the impact its having on her own mental health.

Topics covered in this article

Introduction

How my job has changed as a result of Covid-19

Thinking on our feet

Everything feels new and unknown

Patient safety is our primary focus

How Coronavirus has affected me personally

Comments

Introduction

I have been working in frontline mental health services for over fifteen years, I am used to change, I am used to crisis, I am familiar with distress and emotional pain, it’s my job.

Some would argue it is what I am best at, holding another person’s anxiety, listening and supporting them until they are ready and equipped to move forward without me by their side.

But the last month has, without a doubt been the most challenging time in my career to date.

I was away on holiday when the news broke about the Corona virus, now known as COVID-19. Detached geographically and emotionally, I watched the news unfold.

Perhaps a natural psychological defence, I reassured myself with thoughts of “just like the flu” or “we have an excellent healthcare system” but as the time progressed my daily routine and work as a Consultant Nurse in the NHS has become unrecognisable.

How my job has changed as a result of Covid-19

My usual day consists of clinical work with patients in a secure hospital and prisons, leadership meetings, teaching at universities and providing supervision to nurses.

Overnight that changed.

The meetings all converted to skype, emergency planning meetings were initiated, and a growing sense of anxiety descended across my service.

Working in forensic mental health, my patient population often experience a feeling of being detached from the outside world.

Detained under the Mental Health Act, their lives are restricted, internet access can be monitored, contact with family members observed and leave to the community supervised.

My first job was to communicate with them all, openly and honestly about what was happening in the wider world.

A balance of transparency and not being alarmist, I attended the wards and listened to their fears.

Nationally, guidance was changing daily, and we soon had to inform all our patients that visits from family members would stop and leave to the community would also be suspended.

Thinking on our feet

I have always said the main risk in any mental health inpatient setting is boredom.

It was time for us as nurses to think creatively, be flexible and recognise we were entering exceptional times.

We have been working as a team to come up with solutions for our patients.

Occupational Therapists have quickly and effectively created activities on the wards, gym equipment has been moved to the garden areas and access to outside spaces have been increased.

We ordered more iPad’s for the units and set up video visits for family and carers and psychologists have been offering their sessions via skype.

The landscape is changing on a daily basis with new national and local guidance, so my role is to keep up to date with every piece of emerging evidence and cascade, the best I can to colleagues.

As a Consultant Nurse I am fortunate to have links to other nurses across the country and I sit on a national committee for psychiatric intensive care and low secure units.

This has been invaluable during this time, sharing clinical cases, management plans and best practice.

I never thought as a mental health nurse I would be developing isolation plans for patients, creating emergency training packages for community nurses who may be re-deployed to inpatient settings, and ensuring the hospital have enough Personal Protective Equipment (PPE) to deal with COVID-19 patients.

Everything feels new and unknown

An area unique to mental health is thinking about how we will manage and nurse patients who are acutely mentally unwell and who have COVID-19.

There have been amendments to the Mental Health Act, new legislation allowing nurses to enforce isolation and daily national debates about what PPE to wear if we have to restrain people.

It is a constantly moving landscape, fraught with ethical, legal and moral dilemmas.

Everything feels new and unknown.

My every day has become a service briefing call at 10am, then responding to each situation as they arise.

The best analogy for how I feel is that of the swan, my feet frantically paddling under the water, whilst I try to maintain a sense of calm and normality for my patients and staff.

The hospital feels quiet most days, with many other professional disciplines working from home.

We have no admin support, no psychologists on site, no daily safety huddles and no managers walking the corridors.

It is nursing staff and patients.

There is a sense of “togetherness” which, having not experienced before provides some reassurance and strength for us all.

For us in mental health services there is pride in our general nurse colleagues who are working every day in ITU and critical care settings.

I’ve heard mental health services share embarrassment at the Thursday national clapping at the NHS or reports of “imposter” feelings as they get their free cup of coffee.

But what I do know and what is becoming increasingly real is the impact this pandemic is having on the whole system, every corner of healthcare, every contact with patients.

No service is unaffected.

Nurses of all disciplines, in all settings are preparing to work frontline, whatever that frontline looks like.

As a mental health nurse, I do not have the skills or expertise to manage the complexities present in ITU, but I know I and my mental health colleagues are a cog in this machine.

Patient safety is our primary focus

It would be impossible and unjust to write about how COVID-19 is affecting my work without writing about the staff who are working every day in this current climate.

We talk, often, in my work about resilience, the ability for us to manage complex emotional traumas, to hear emotional pain and contain distressing feelings.

We have structures in place to manage our own psychological well-being on a day to day basis including clinical supervision spaces and reflective practice sessions.

Right now, more than ever these structures are invaluable, however the time given to them is fragile.

Patient safety is our primary focus, the wards are short staffed, nurses are busy, and priority is given to the basic daily tasks of keeping the inpatient units running safely.

I try each day to ask how my colleagues are doing, a simple check-in, a break off the unit, some biscuits for the team.

The whole country feels anxious and for me, it is important to acknowledge that nurses are not immune, we require PPE for our emotions and wellbeing as well as our bodies.

There have been many comparisons made with “war”. I am unsure yet if this is a helpful comparison, but what I do know is that there is no “right” or “wrong” way of getting through this time.

People manage stress and anxiety in different ways.

Some staff are tearful, others curter in their communication.

Some nurses feel overwhelmed, whilst others arrange to stay in hotels and be onsite for days on end.

There will undoubtedly, be lessons to learn from this, but the time for reflection has not arrived yet.

Currently, it feels like each day, we do the best we can, for our patients and for ourselves.

How Coronavirus has affected me personally

On a personal and professional level, I am finding it tough.

I am a nurse, I am registered with the Nursing and Midwifery Council and I have discovered that at a time of national and global need, I appear to have an inherent sense of professional duty.

As a single mum I made the decision to take my son to live with my sister 200 miles away.

The tension of professional responsibility and motherhood became too much with 9pm conference calls and 14-hour days.

Our daily facetime calls keep me going and I miss him a lot.

I feel tired a lot and the daily structure has changed.

I notice my own mental health and how important it is for me to de-stress with phone calls to friends and colleagues.

There is a new found connection with nurses and all working in healthcare and an odd detachment to those in my life who don’t.

It is unclear how long this will continue to take over my life and work, but it has reminded me how effective, resilient and committed nurses are.

Comments

Danielle, Mental Health Nurse

"So I read this and when she said she felt like an imposter, I completely agreed.

These past few weeks I have felt like an imposter, “not a real nurse” and quite simply not good enough because I am a mental health nurse and not a general nurse in ICU and that lovely meeting with my neighbours made me feel the same, a fake, an imposter and ‘not a real nurse’.

However, we are still nurses.

We still did a degree course at uni, completed 1000s of hours in placements and theory work.

We are still registered nurses and recognised by the NMC.

We are still trained in emergency and life saving first aid.

We are still going out and seeing patients that have both mental health and physical health issues and providing holistic care to the patient and their families/carers.

We are still supporting those with covid19 symptoms.

We have had team members off work with symptoms, we still have colleagues in hospital testing positive.

We may not be in ICU and monitoring patients on their death bed, on ventilators and trying to bring them back into good health.

But we are helping those with complex needs, severe and enduring mental illnesses.

From the person with bipolar who is now experiencing a manic episode brought on by the stress.

The person with OCD who is struggling with the thought of the world being unclean and contaminated and increasing their rituals.

The person with anxiety that is experiencing debilitating and intrusive thoughts and panic attacks.

The person with depression that is now feeling increasingly lonely, isolated and is experiencing a worsening in their mood.

The person with suicidal thoughts that are now fighting even harder to stay alive in these scary and uncertain times.

The person with schizophrenia who is relapsing because they have been missing their depot appointments because they are scared of contamination.

The list goes on... We may not be keeping people physically well when compared to our fellow colleagues, but we are certainty trying to help them stay mentally well which will in turn help their physical health and overall quality of life.

Mental health nursing isn’t about just talking, it is about holistic care, reading in between the lines and guiding them into recovery.

Advocating, protecting and helping them in all aspects of life and this doesn’t stop because of covid, if anything this is increasing our demand and pressures, we are increasingly fighting against this just like the general nurses are.

Let’s not forget about those nurses on inpatient Psychiatric wards.... who are ‘not real nurses’ but still looking after those that are covid19 positive but are too mentally unwell to be on a general ward due to their risks to themselves or others needing to be managed in a secure setting.

We may not be fighting this in general hospitals, but we are still fighting it.

We are still exposed, still taking preventative measures.

Still separated from our friends family and loved ones.

We are still nurses and for that I am proud."