The second wave After a year spent fighting COVID-19, NHS nurses are running on empty

On 11 March 2020 the World Health Organisation declared the COVID-19 outbreak to be a global pandemic. A year later, the UK is beginning to see light at the end of the tunnel, but the danger is far from over. And after months fighting the pandemic's second wave, the health team is at breaking point.

UNISON’s national nursing officer Stuart Tuckwood reflects on the experience and speaks with colleagues on the frontline.

Stuart Tuckwood

Before working for UNISON, I was a nurse in a critical care rapid response team. So when COVID-19 became a national health crisis in 2020, I offered to go back into the NHS to provide cover and help my colleagues. What followed was a year of intense, fearful, sometimes heart-breaking work for everyone involved.

Having survived the first wave of the pandemic, we spent the autumn watching with fear as COVID-19 infections started to rise again. Our hope that the worst had passed fell away with the leaves from the trees. Intensive care staff – nurses, healthcare support workers and doctors – were full of dread, knowing the hell they had already battled through once and desperate not to go through it again.

Unfortunately, that’s exactly what they had to do.

Victor Tapah

“Imagine you have a car, and you’ve driven it until the tank is empty,” Victor Tapah, UNISON steward and critical care nurse, tells me. “But you are still driving because you can’t afford to stop. This is how the second wave of the virus makes me feel. After the burnout, fatigue and trauma from the first wave, we never had time to refuel.”

Victor joined the intensive care unit (ICU) at Royal Papworth Hospital, in Cambridge, shortly before the pandemic erupted, having only recently qualified. Nasia Psariadi, a Greek nurse at nearby Addenbrooke’s Hospital, previously worked in theatre recovery but was redeployed into intensive care in March 2020 as patient numbers climbed. After just one day working alongside a regular ICU nurse, she started to care for severely sick people who required ventilators to survive.

Nasia Psariadi

“The ICU nurses were amazing. I was never alone,” Nasia recalls. After the first wave subsided, she decided to remain with them: "I wanted to help those who had helped me at the most difficult point of their careers.” And as the second wave gathered momentum she faced up to the prospect of now being the one to support other ICU volunteers.

At the same time, she admits, “It was difficult knowing we would have to go through this again.”

As Christmas and household-mixing passed, the numbers of sick people admitted to intensive care units became a deluge. Hospitals expanded ICUs into theatres and spare ward areas – stretching their trained staff more thinly and supplementing them with other nurses, volunteers and support from the military. All of the regular ICU staff I’ve spoken to have expressed their gratitude for the help they’ve received from colleagues. But supervising so many other staff whilst caring for their own patients takes a drastic toll.

On my first night working in the second wave I strived to learn quickly – desperate to pick up what I needed in order to care for my young patient without the need to overly bother the ICU nurses. The second night I also helped them to run their blood samples and to wash and clean their patients. By the third I was supporting the volunteer doctor alongside me, who hadn’t worked in ICU in years.

Meanwhile, a relatively junior Filipino nurse marshalled the room, to support us and make sure our patients were monitored and cared for properly. The nurse in charge appeared at our bedsides to check we were OK and offer advice.

The skill on display was incredible; through layers of PPE, I particularly marvelled at the more experienced nurses who juggled so many different advanced treatments at once.

Victor’s ICU is a specialist centre that offers ECMO, an advanced form of cardio-respiratory support, and he has had to manage this treatment for several patients while administering medicines, providing personal care, monitoring his critically unwell patients’ observations, and much more besides. Victor now oversees volunteer nurses and doctors far more senior than him – in intensive-care, he has to support them. “I feel like I’ve been a nurse for 20 years,” he says. “But the thing is, you need to support each other, you need to lead, you need to cope.”

© Royal Papworth Hospital NHS Foundation Trust

In normal times, the level of sickness and dependency of an intensive-care patient means they should have one ICU nurse dedicated solely to their care – but this ratio has slipped, by necessity, during the pandemic. Many nurses have told me how they have felt ashamed and guilty about not being able to provide the best care, for example by maintaining oral hygiene and changing wound dressings regularly.

“It’s impossible to care properly for three or four ventilated patients,” Nasia tells me. “We just focus on keeping them safe and alive, so their bodies can beat the disease.”

ICU staff also have to deal with the pain of families who are separated from loved ones critically ill with COVID-19. My colleagues see that distress every day and work hard to ease it the best way they can.

“We have letters from families that we print out and read to the patients, to tell them they are not alone,” says Nasia.

Adds Victor: “We try to update families and sometimes organise video calls, via the family liaison team. Although it’s very emotional, and painful, because patients cannot respond to their loved ones and you can see the families in tears... Imagine what it’s like to call a family when their loved one has passed.”

Dealing with death caused by the virus has become too common. In the bed across from me one night the treatments can go no further; a nurse switches the machines off and talks softly to the young woman as she slips away. On the other hand, the joy and relief when someone recovers is shared by all. I once saw a young man ready for discharge pull his surprised nurse over for a huge hug as he cried.

I’ve never felt as tired as I did after just my third night; coming out of the PPE was like coming up for air and I slumped in a colleague’s office while I came round. Back in my room I had to lie down for a half hour to ease the pain in my legs, before I could rouse myself to shower. The chronic exhaustion of doing this work, fighting this virus day and night, was telling on all of those around me, who did this every day.

“I am so drained, I want this to be over,” says Nasia. She couldn’t sleep properly for a month, waking with nightmares in which she ran out of crucial medicines for her patients and couldn’t get help. A number of the nurses I spoke to, through our masks in the middle of the night, told me they couldn’t go on any longer; they would leave when they saw the pandemic was over. Some already have.

So where can we go from here? How can nurses and ICU staff recover from all this and find the strength to deal with what comes next?

Victor’s family live in Cameroon. He struggles to pay the rent in Cambridge and is distressed that when his father recently fell ill, he couldn’t support them. “You’ve done everything you can – you’ve put your life on the line – but at the end of the month you look at your pay packet and you’re struggling to make ends meet. I’ve questioned my job. What’s the point if I can’t look after my family?”

And he adds: “You cannot advise nurses to seek help, to look after their psychological well-being, while ignoring their financial well-being.”

Says Nasia: “I think so, so many nurses are going to quit nursing after this. So many people are going to leave ICU and go to easier jobs, and so many others are going to leave altogether.”

There have been claps, Spitfire flyovers, Royal visits and grand statements in Parliament, but nothing other than real change will satisfy the nurses and ICU staff who have been through this. The knowledge, skill and devotion they have shown has been extraordinary and they cannot be expected to do it again. Many will walk away unless it is shown that they are properly valued and respected.

“It’s so unfortunate it took a pandemic to show people how important nurses are,” Nasia concludes. The public overwhelmingly supports all NHS staff and believes they deserve a pay rise; so far the government has shown no sign that it, too, understands the value of what they have achieved.

One Team 2k: Give all NHS staff a decent pay rise

Words: Stuart Tuckwood

Images: Marcus Rose

Design: Demetrios Matheou