I listened to a call with senior leaders in a trust a short while ago; they were inevitably, talking about an increased demand on their services, due to the rapidly increasing numbers of very unwell patients with Coronavirus. It was both humbling and reassuring to listen to them talking not about themselves, but about maintaining a focus on patient safety and the challenges for staff who continued to care, to turn up, to cope when faced with reduced staffing because of illness, not always being able to deliver the care they wanted to deliver and a fear of the 'what if?'
They looked tired; they were not having days off and were working long hours. Every senior leader was more concerned for their patients and the impact on more junior staff than on themselves. I remember saying at one point it was unimaginable.
Once the call was finished, I reflected a little. Was it unimaginable? Certainly the scale of difficulties is unprecedented and there has not been no comparable situation since Aneurin Bevan, launched the National Health Service at the Park Hospital, Manchester, in 1948. No doubt it is a serious situation, but what about the challenges faced by staff, did we ever have similar? How did we learn to cope and stay well? Did we learn to cope? My truth is that we did sometimes face our own challenges and stresses. Despite being fairly recently qualified, I was once the senior nurse on a week of nights on an intensive care unit when twelve young patients died during my watch. It was beyond hard and sad, but so much more so for the families who had lost their children. I knew we had given our all to our young patients and I knew nothing we could have done would have changed the outcome; that didn't stop the pain and sadness. I can picture some of them still; a child who had been resuscitated after a near drowning, but who was too brain damaged to sustain life, a tiny premature baby born wrinkled and covered in downy hair whose lungs were too immature to cope despite her best efforts, a teenager who had been knocked off their bicycle and a child with a severed spinal cord caused by a non-accidental injury. It was certainly a difficult week and we all spent time coping in the best ways we knew how. We supported each other and were kind if someone needed to disappear to the office to get something out of their eye; we had good support from the night sister and from other parents.
I looked at the MIND website to see what suggestion they offer for maintaining mental wellbeing and building resilience. Some of the suggestions feel very obvious, but I think we had more support structures and behaviours built in, than perhaps staff have now. Staff helplines can be very valuable, but probably not as effective as stopping off for a hot chocolate with the lovely nurses' home receptionist, Mrs May.
We lived with people who understood. Our neighbours and housemates were fellow healthcare professionals who understood the level of anguish: If we met for a toasted sausage sandwich, in the refectory, after a difficult night shift, nobody so much as blinked if someone was crying; we were surrounded by those who understood and empathised, we had a safe space to offload. I wonder how many now cycle home to an empty flat and have to cope with the sadness in isolation? Nurses homes had their restrictions and limitations, but for young people coming to terms with the harsh realities of healthcare, they also offered a safe and supportive haven. They were also very easy living, with none of the stresses of rogue landlords or dodgy neighbours.
We trained in a very small cohort, or set. There were about twenty-four of us starting out, and twelve who eventually qualified. We knew each other incredibly well. We were a close knit group (those final twelve have a WhatsApp group even now, nearly forty years later). We recognised when someone was unwell, not coping, unhappy or coming to the decision that caring for the very sickest of children was not for them. We offered support, we listened, we knocked on doors if we hadn't seen someone who we should have seen. We stood beside anyone who had made a mistake or been in trouble and we allowed those who decided it was no longer for them to make that decision, knowing we would not sit in judgement.
How well do you know the people that work with you and for you, I wonder? Is there unconditional support and understanding? Is there a safe space to offload?
MIND also suggest having hobbies and finding a balance in your lives, in order to build resilience. Exercise and pets help too. (That photo is our beautiful Dalmatian, Franky).
How much pressure do staff feel to work additional hours because of staffing shortages and increases acuity or demand? Thinking back, we had a degree of protection from excessive hours. There was much less flexibility in our shift patterns, which undoubtedly had drawbacks, but it also meant we all arrived and finished at the same time. All grades of nursing staff finished their shift together which meant we could go for that sausage toastie and we weren't usually pressurised to stay beyond our contracted hours. There were times, of course when we were asked to stay for a particular reason (such as a member of the next shifting having phoned to say they would be a little late). Sometimes, we chose to stay and sit with a family, as their child came to their life's end or to see that a child we had taken to theatre was returned safely to the ward. Usually though, we finished our shift fairly shortly after we were rostered to do so. That meant we could plan our evenings and commit to activities outside of work. Our hospital even put on regular filming of new releases in the lecture theatre and had numerous social activities. I wonder whether the more flexible shifts and reduced staffing numbers have increased pressure on staff to do extra. So often as a regulator, I hear, "We never use agency, but cover between our own staff". That may have benefits in terms of costs and continuity, but how much pressure does that put on staff? How tired do those staff have to become before they cannot work safely or until their mental health suffers and they need to take extended sick leave? How do you encourage work-life balance?
Healthy eating is another aspect of sustaining mental health as well as physical health. I am probably not the best placed person to talk about this but, again, looking back, we had ready access to a choice of hot meals, hot drinks, ice cubes and usually had breaks planned in that meant we could go to the refectory or use the ward kitchen to make a coffee and beans on toast, if we were reluctant to leave a student in charge for too long. I can't imagine many hospitals nowadays allowing nurses to serve tea as a sit-down occasion for staff and families on a weekend. It was a good time for parents to ask those questions that there never seemed a right time for, to share their fears and to get to build trust between staff and families. It was certainly more than 'just a cup of tea'.
I hope that the Guardians of Safe Working Hours are tenacious in ensuring that junior doctors have access to reasonable food and drink when they are on call. I know from those fairly recently qualified that they are not always supported to report breaches and missed breaks and that they often go entire shifts without a drink. If you work with junior doctors, do you make them a drink ever? What about of it's not a ward junior doctor but one on call across the hospital at night? Do staff in your care home have facilities to heat food of their choice, or to eat undisturbed? Is there a fridge where staff can keep a salad they have brought from home?
So many staff in so many services are coping under incredible pressure. How well do you support each other?
The MIND website is a good place to start when thinking about how best to support staff with sustaining mental wellbeing.
How to Listen by Samaritans is a recently published book that provides an opportunity for readers to learn about listening and offer support to those around them. Possibly a resource worth investing in.