This week’s blog is written by Lynn Craig (Twitter: @phd_scphn; LinkedIn: https://uk.linkedin.com/in/dr-lynn-craig-412b76147). Lynn is a nurse, currently working in a North East Clinical Commissioning Group as the Strategic Clinical Commissioning Lead. Her portfolio includes Ageing Well, Enhanced Health in Care Homes, Falls, Frailty and End of Life (Palliative Care). Lynn is proud to be a Florence Nightingale 2021 Emerging Leader scholar.
We all need to be resilient to cope with the challenges of nursing and healthcare provision. In this blog I will reflect on working in a pressured healthcare system and what it means in relation to resilience. This is particularly important at a time when many nurses and other health care providers are at breaking point.
As a nurse of 36 years, I have experienced many changes in healthcare, driven by changing NHS policy, organisational form and function, internal reorganisations, and front-line service delivery. Never have I experienced such change in NHS form and function as we move from Clinical Commissioning Groups to new Integrated Care Systems (NHS England 2021) during a time when the NHS is under unprecedented pressure. This system wide change is ploughing ahead as we emerge from wave three of the Covid 19 pandemic. The last time the NHS faced such massive impacts was probably at its inception, post world war 2 with the ‘Spanish flu’ pandemic still in living memory.
Widespread fatigue, exhaustion and low morale is endemic across the whole health and social care system (Mehta et al 2021, De Kock et al 2021). Healthcare staff in hospitals, community, hospices, care homes and the independent sector have all worked throughout the pandemic. There has been no ‘down time’ to recover and reflect. As we move from Covid 19 restrictions to business as usual, the potential for a reduction in workload and pressure is unlikely. The NHS is working hard to bring down waiting lists, maintain essential elective and non-elective activity. Hospital, emergency departments, urgent treatment centres and ambulance trusts are all under unprecedented pressure – see for example: https://bit.ly/3AdXdta; https://bit.ly/3lmyRa2. This bleak picture, is with a backdrop of expected autumn and winter pressures. Alongside this there is the need for flu/Covid 19 vaccination campaigns to address waning immunity and a resurgence of flu, which was less last year due largely to the beneficial impact of Covid 19 restrictions.
Is this too bleak a picture? No. I think this is realistic and honest. But it is not all doom and gloom. Within this context there are examples of amazing dedication, hard work and resilience from nursing and other healthcare staff.
But where do we get our resilience from? Several studies have recently explored resilience for healthcare staff in context of the Covid 19 pandemic (Health et al 2021; Sumner et al, 2021). Undoubtably part of our resilience is intrinsic, this is our own inner ability to adapt and bounce back and considered to be the physical and psychological characteristics possessed by individuals (Heath et al, 2020). Some resilience is experiential, mechanisms we have learnt through experiences, good and bad, that we can draw on when things get tough. Some resilience is environmental, and in this context, I mean where we live, where we work and who we work with. Resilience is a complex phenomenon and it cannot be redacted from the behaviour of individual parts of the wider system. As such my own resilience impacts on and is affected by the wider context in which I live and work. Sumner et al, (2021) found that personal factors including the presence of meaning in life, and resilient coping styles are associated with more positive welfare outcomes in healthcare staff.
We say there is a need to ‘be kind’ in these stressful and challenging times. For me, kindness starts at home (i.e. in the workplace). Fundamental to my resilience is the need to have emotional support, trust and stability, and kindness provides me the foundation of my resilience. The importance of having a meaningful life, treating everyone with equal dignity and respect and being kind to me, enables me to be kind to others. This is a simple concept in complex times, but one I think all healthcare staff can relate to.
De Kock, J.H.et al (2021) A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-10070-3. Accessed 2.9.21
Heath, C.et al (2020) Resilience strategies to manage psychological distress among healthcare workers during the COVID-19 pandemic: a narrative review
NHS England (2021) https://www.england.nhs.uk/integratedcare/what-is-integrated-care/. Accessed 2.9.21
Mehta, S.et al (2021) COVID-19: a heavy toll on health-care workers. 9, 3, P226-228, March 2021 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00068-0/fulltext. Accessed 2.9.21
Sumner, R. C. & Kinsella, E. L. (2021) Grace Under Pressure: Resilience, Burnout, and Wellbeing in Frontline Workers in the United Kingdom and Republic of Ireland During the SARS-CoV-2 Pandemic. https://www.frontiersin.org/articles/10.3389/fpsyg.2020.576229/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Psychology&id=576229 Accessed 2.9.21