Nurses in the time of COVID-19

Did anyone else’s heart sink or eyes roll just a little at the naming of the new NHS Nightingale Hospital in East London – the Nightingale name soon to be replicated in a number of locations around England? Scotland, at least have named their hospital after Scottish nurse Louisa Jordan.

Until the last week, nurses have been virtually absent from the political discussions, policy development or media broadcasting.  Nurses have been denied a seat at the table when the purchase of ventilators and PPE was discussed – yet they have more sustained contact with patients than anybody else.

It took the bombshell, dropped calmly by RCN general secretary and chief executive, Donna Kinnair at Question Time on 2 April 2020, that the numbers of nurses dying in the UK from Covid-19, was not being counted, for nurses to be noticed at all. As a result, next day, the chief nursing officer, Ruth May appeared for the first time at the daily Covid-19 press conference. Her appearance, again calm and respectful of all healthcare workers, brought a refreshing change from the usual wartime talk of battles, fights and Dunkirk spirit.

Until this point, the lone nursing voice in the field has been that of Nicki Credland, Chair of the British Association of Critical Care Nurses (BACCN) and a Lecturer in Critical Care and Advanced Practice at the University of Hull. Not afraid to speak truth to power Ms Credland, has said, she doesn’t think government understand that nurses do more than ‘make tea and pat you on the head’. I don’t think they understand that it is a safety critical profession’, she told me.

The conversion of the Excel Centre in East London into 4000 beds with supportive services in just nine days, was remarkable. A fantastic feat of modern day logistics. For this reason, if no other, the naming of the hospital is fitting - there is no doubt that Florence Nightingale would have been up to the task of designing a hospital of this size and mobilising a workforce to fill it – estimated to be some 200 people per 42 bed ward, including ancillary and support staff.

Florence used mathematical modelling and drawings to illustrate the effect of infectious diseases as well as battlefield wounds on soldiers in the Crimea. She also played a large part in the design of St Thomas’ Hospital in London - where the prime minister, who has coronovrius is currently being cared for. At a time when germ theory was still not fully understood, she recognised the importance of design for improving hygiene and health and calculated the dimensions and efficient use of space in hospital. She proposed full-height windows at specified intervals in the wards, with the beds set between to encourage ventilation and allow air to circulate without creating draughts. She stipulated that clean and dirty areas should be separate so food and clean linen were stored at the ward entry with washing and sanitary facilities at the other end. The so-called Nightingale wards.

But it was not for any of these reasons that her name was taken in vain for the new Covid-19 hospitals; it was because of the sentimentality about nursing that her name invokes among politicians and the media.

Nursing has a hugely rich history but so little of it is chronicled or appreciated outside of nursing academic circles. That and the fact that virtually all nurses over the last 100 years have been women, adds to their invisibility.

It is to raise their profile, celebrate their skills, their commitment and their sheer importance in this pandemic, that I am chronicling their experiences for record  If you are a nurse, whether at the frontline of patient care, delivering education and training to nurses or developing policy, please get in touch with your stories, via this website, via twitter @Claire_Laurent or email me at: claire@clairelaurent.co.uk

#nurse #COVID-19 #Nightingale #criticalcare #RCN

Celebrating history; fighting for a future

Westminster Abbey was packed with nurses, many were in the superbly uniformed ranks of service men and women but there were also nurses from every civilian rank and file: care support workers through to the chief nursing officer for England, Professor Jane Cummings.  The woman next to me was limbering up with gentle humming under her breath, familiarising herself with the hymns in the service sheet. The ladies the other side of me and all around were chatting to each other and some were calling out as they spotted old friends. 

This was my first time at the annual service to commemorate the life of Florence Nightingale. Speak it quietly but I’ve never been a huge fan of Florence and have always felt she has been heralded in the public eye to the exclusion of some other pretty amazing nurse leaders (Mary Seacole, Edith Cavell, Ethel Bedford Fenwick, to name a few).  But, as I am writing a book on the Rituals and Myths in Nursing, I was intrigued to witness this ultimate ritual in the nursing calendar: the celebration of Florence’s life.

As you will know, Florence was known as the ‘the lady with the lamp’, during her work in Crimea, and a lamp is kept in the Florence Nightingale chapel (yes really) at Westminster Abbey. The lamp was carried in procession by a Florence Nightingale Foundation scholar Sandra Mononga and the Lamp party was escorted by student nurses and midwives from Edinburgh Napier University, dressed in white uniforms and hats. The ceremony involves a series of processions through the Abbey to celebrate nurses who have served and continue to serve. First off were the Chelsea Pensioners – taking part in memory of Florence and her care of the troops – their predecessors – during the Crimean Campaign. Honorary officers of the Florence Nightingale Foundation were followed by the masters and warden of the newly formed Guild of Nurses and after that were a stream of nurse representatives from the many and varied corners of nursing and the armed forces.

The service is supported by the Florence Nightingale Foundation (a ‘living memorial to Florence Nightingale’). The service is held as close as possible to 12^th May – Florence’s birthday and now International Nurses Day. This year there was a bit of a clash: for the ceremony was held on 17^th May which coincided with RCN congress, both huge events in the nursing calendar. The story has it that the RCN president, Cecilia Amin, had to hotfoot it down from Congress in Liverpool to attend the hour long ceremony at Westminster Abbey.

Of course there were more than enough nurses to go round for both events with plenty others still on duty. According to Statista the statistics portal, there are 675,000 nurses in the UK and that doesn’t, as far as I can ascertain, include the armed services. Yet, still wards and services are short staffed.

For me, the clash of dates brought into focus the very different facets of nursing and nurses. On the one hand at Congress nurses were fighting to be heard by politicians and public alike: concerns about pay restraint, loss of real term income, nursing bursaries and shortage of skilled nursing care in every aspect of the health service. Whilst at Westminster Abbey, nurses were celebrating the art and science of what makes nursing good, away from the daily grind of long hours and poor reward. 

Whilst Labour leader Jeremy Corbyn and Lib Dem leader Tim Farron appeared at Congress to promise the kind of basic improvements in pay and conditions that nurses are desperate to see, the Conservatives saw no point in being targets for metaphorical if not actual egg throwing. The Tories know that the public still does not grasp how poorly recompensed nurses are and that the power to change this and how the NHS is regarded lies with their vote. And perhaps even politicians could see the hypocrisy in attending an event to celebrate the very foundation of nursing when as leaders they appear so unconcerned for the profession's future?  

Nurses’ pay has been relentlessly held back. The 1% cap is eroding nurses’ pay now and in the future. It is the reason that nurses are using food banks, no more complex than that. This, together with an overall shortage of nurses, downgrading of posts, loss of the nursing bursary and a political failure to actually care, means we are headed to months of disruption and potential strike action amongst a dedicated long suffering workforce.  My guess is that the politicians will ride it out, just like they did with the junior doctors. Short term success, being the only show in town because that sets the scene for longer term demise of a service that people will only value once it has gone.

As the woman next to me in the Abbey launched into the first hymn with a deafening but fortunately, tuneful voice, I realized that in reality these two celebrations were one and the same: Congress being the current vociferous call for action protecting the ancient bedrock of nursing, the history of which was being celebrated in the Abbey, both reminding us of the values and commitment of nursing’s predecessors and the fight that is on for its future.