During the first peak of the pandemic I spoke with a friend who compared covid-19 to grief, “you can’t see it, but it changes everything,” and indeed they are right. The amount of change that has occurred in the NHS since the pandemic started to affect everyday life in March 2020 has been unprecedented. No one should underestimate the impact of covid-19 on their staff. Some staff have been deployed to clinical areas outside of their comfort zone, while others have shielded at home. Many remain in their usual place of work, maintaining a skeletal service, or have welcomed redeployed staff to their already-overwhelmed departments.
Many of our staff moved from working in an outpatient sexual health setting, assessing generally well patients, to in-patient wards, managing acutely unwell and dying patients with little time to prepare. There were skills refresher workshops and e-learning to help staff manage the move to the wards, but little in terms of preparing staff for the emotional impact of coping with deaths in such high numbers.
Some will argue that this is what we signed up for. After all, we are nurses and doctors so of course we have an unfailing desire to help others. This is “altruism” in its truest form. But not all of us within the NHS necessarily feel able to be as altruistic as others, not because of a failing of our own altruistic attitudes, but due to the inherent risks that this unprecedented situation has forced upon us. Colleagues have told me that they have felt torn between carrying out their duties as a doctor and their duty as a parent or primary carer. Their drive to provide altruistic care through their profession clashes with their feelings of responsibility outside of the workplace. With the knowledge that covid-19 can significantly affect healthy individuals, I do not think anyone can say they have not thought about their own death during the pandemic and considered “what if?” particularly in the context of young children—I know that I have.
It has been challenging dealing with the abrupt change from meeting and interacting with patients face-to-face to dealing with the lists of virtual telephone consultations. The loss of reading patients’ behaviours and non-verbal cues has left many staff and patients craving for that more intimate dialogue that takes place between clinician and patient when we consult in person.
In the first wave, within my own clinic approximately 60% of staff remained within sexual health, 30% of staff were redeployed to the wards, and 10% shielded. Almost all staff had returned by the end of August 2020. Due to the fragmentation of our own staff group there was an undercurrent of emotions stirred up during the pandemic which needed to be addressed. Each staff member needed to process their experiences and be able to move on in the new “covid” way of working. We felt the opportunity to have an informal debrief session was essential in bringing staff back together and create some cohesion within the team following significant periods of absence.
The debrief followed a simple format:
- Structured group discussions using the NHS England Debrief template;
- Using discussion points generated from the debrief to highlight the trust values and behaviours;
- Presentation of the mental health and wellbeing resources available to staff both within and outside of the Trust.
The debriefs have allowed the much-needed time for face to face conversation to take place, something which you cannot replace with Microsoft Teams or Zoom. The sessions have allowed staff to regroup as a team and reflect on those values by which we want our NHS services to run.
Staff have had the opportunity to discuss their own experiences in as much or as little detail as they would like in a “safe” place. For some staff the experiences of the pandemic have been an extremely difficult and traumatic time, and for those colleagues I hope these debriefs have provided them with the forum to acknowledge this and to know that there are many services and resources available to support them.
As a manager the debriefs have not only allowed me to reflect on my own leadership skills during the pandemic, but allowed me to take the time to really understand and appreciate the varied concerns and anxieties from staff surrounding covid-19. They have highlighted the importance of ensuring regular risk assessments with staff, but more importantly having regular conversations with colleagues to understand their concerns and manage them accordingly.
The debriefs have provided us with invaluable feedback and knowledge which we can share with colleagues within the Trust so that if redeployment happens again, we may be more prepared.
The general sense of relief that we made our way through the “first wave” of the pandemic has unified us all. That unity binds us in our concerns as we cope with this “second wave.” We take forward the reassurance that we can, and will, deal with it again in a professional and committed manner.
Anna Garner, consultant genitourinary medicine, Manchester University NHS Foundation Trust and training programme director for genitourinary medicine, Health Education England, North West.
Competing interests: none declared.