Nursing in Mind

We’ve created this page to give nurses working across North Central and North East London a nursing-specific view of the resources, podcasts and long-reads available through the Together in Mind site.

This is in response to what we are hearing from the workforce, and we will continue to add more as the situation and your needs change over time.

Want to get involved? Get in touch via nclinmind@tavi-port.nhs.uk to submit blogs, podcasts or to make suggestions.

View transcript

Hello my name is Claire Shaw and I am a Consultant Nurse at the Tavistock and Portman NHS foundation Trust. I’d like to welcome you to ‘Nursing in Mind’. This page of the Together in Mind website has been developed specifically for nurses and by nurses in recognition of the centrality of the nursing workforce in providing care and innovative practice across the board, from covid wards to psychiatric liaison, from being along side our patients to influencing strategic responses, from responding to immediate crises to providing personal care for those at the end of life.

The Tavistock has a long history of reflecting, exploring and supporting those engaged in the raw work of frontline care, recognising the critical importance and meaning of this work for the patients and families who come into contact with our services. In hosting this page we hope to capture some of this, recognising the impact we have upon our patients and also how each of us will be affected by our work with patients and within the teams and organisations that we work for. The current crisis has intensified many of our daily experiences and brought new ones, some positive and others far more challenging. The wellbeing of the nursing workforce needs to be at the forefront of each of our minds, in relation to our colleagues, those we teach, supervise, manage, and in relation to ourselves.

We recognise that many nurses have had experiences that might feel ‘outside’ of their previous working lives. This may mean having risen to unprecedented challenges, having adapted to new roles or using new skills and having implemented significant changes at an operational or strategic level. We know that coronavirus has forced developments, changes and innovations in a way and a timescale that we have not previously seen. Many of us have experienced growth and development in these changing times, but we also recognise that it has brought loss, confusion and anger, amongst other things, to many of us at different points. There is a new mantra, that ‘it is OK to not be OK’, we may hear it a lot, but what does it mean? We hope that the podcasts, blogs and resources in this page will highlight that we are neither one nor the other, OK or not OK, we all have our resources and strengths and we will all inevitably have our struggles and carry some of the weight of our experiences.

We are aware that you may feel inundated with articles, guidance, and resources on wellbeing and coronavirus, but possibly without the resource of time or energy to explore these. We hope that the resources in this page provide a structure and some stimulus to reflect on the impact of the work and to consider ways of understanding, responding and managing the situations we find ourselves in. We hope that the bite-size approach of this page means that it is accessible and that you can digest it one sitting. The longer reads are available to follow up when you can, providing more information in relation to the blogs or podcasts.

To finish with, we would like to offer an open invitation to you to contribute, to shape this page with your own experiences and reflections. If you would like to share something of your work, experiences and ideas either in a blog or a podcast, or to make a suggestion, please do contact us.

Thank you.

Recommended resources

Here’s some tailored blogs, podcasts and resources we think you might find helpful.

Blogs

On not being Wonder Woman

Written by a Mental Health nurse

I am a nurse and I am writing this from home. I am not at the front line of providing physical care. I am not at the immediate interface with patients in crisis. I work from home as my husband is shielding, developing training and resources for staff support and wellbeing. But whilst I am working on this I am also not sitting in the other room with my husband who has recently returned from hospital, nor am I helping my two teenagers who are upstairs doggedly avoiding doing their school work. Neither am I tidying up the mess (and slight chaos) which surrounds me in our busy family home.

It is easy to feel guilty about each and every part of this. That I should keep working very hard, as nursing colleagues on the front line are having to do. That I don’t really deserve time off, or to switch off, as I know some of my colleagues are unable to. I find myself thinking “I’m exhausted!” and then experience a twinge of guilt, thinking of the nurses doing the ‘proper’ work at the frontline and feel that I am not entitled to feel tired. It may be guilt at being at home, guilt at working within mental rather than physical health, guilt at not being a ‘proper’ stay at home mum. I hear other parents say how well their children are doing, settling down with their school work, whilst I hear mine bickering with one another over a background of Drake, as I try to frantically quieten them before another zoom meeting takes place.

I have wondered about this sense of guilt, is it just me? Is it being a working mother? A nurse? A mental health nurse? I don’t think that it is only me (although I may experience it more or less than others) and I do think that there is a relation to being both a working mother and a nurse. I think that there are idealised views of both mothers and nurses, as if either identity automatically means you can provide some sort of perfect care or go selflessly and endlessly above and beyond, with heightened sensitivity to the needs of others. The current pandemic has brought awareness of intense anxiety, fear, loss and need. The pervasive guilt that many nurses including myself seem to experience may be linked to this, a wish to address it, attend to it, to be able to ease it. We feel we should be able to make pain better, to do something reparative, restorative. We can’t do this for the whole of coronavirus, the loss, the pain and distress. But I think we can do it in small, ordinary and every day ways with individuals, our colleagues, our patients, our friends, our families. And I think that maybe that is good enough.

Someone recently sent me a keyring with ‘Wonder Woman’ on it for a playful joke, knowing I was working hard to try and keep everything afloat. A more accurate key ring might have read ‘Fair to middling woman’, or ‘high expectations, thwarted by human limitations’. I work hard and I am conscientious about my work and my family, and to be honest, I’m probably doing alright. The problem is that ‘alright’ gets turned into not good enough, with images of nurses in super hero capes and with superhuman qualities. That, I am not. And I am the one who takes on this feeling of guilt, no one else has suggested it or put it upon me, it is mine to hold on to or to let go of as I see fit. But it is a pity for me, and for many other nurses I know if we soak up this pervasive sense of guilt. I will bring something to the table, possibly now or later, it won’t be providing physical care on a covid ward, but I will be here for nursing colleagues when they may need support or are ready for a space in which to think about their experiences. I will be there when people are looking for a way, a model, a framework, to understand what has taken place. I may also be able to offer something to my patients who experience the isolation and anxiety, but will have a point of contact in their relationship with me. I can role model to my daughters about being a working mother, I can learn about making compromises and keeping hold of values. I don’t think I will be able to altogether lose the sense of guilt, but I am more curious about it and that makes me less driven by it and more able to think about it with others.

Reflections on Zoom sessions in the context of lockdown

Written by a CAMHS nurse

The change from face to face in the room “1:1 counselling and mental health support sessions”, to zoom and telephone sessions happened literally overnight. I, like other nurses, did not have time to digest or to think about the change. However, in the last couple of weeks I have begun to take stock of what it may be like for young people to now have their sessions via zoom.

I realise that for many this has meant letting me know more about their home environment, this in itself challenges patients’ privacy in a zoom session. Often there is a lack of a private space, where they can feel confident that they will not be overheard by other family members. Often too, in these circumstances, the necessary and appropriate boundaries needed for adolescents are not securely in place. It is common for adolescents to have an experience of the lack of boundaries for many different reasons and this can contribute to a feeling of confusion and uncertainty about themselves in relation to others. In my experience adolescents both want and need to know who are the adults both at home and at school and a confidence that boundaries with both be kept appropriately.

It is also often the same young people who tell me that they have not got a laptop /device on which to use Zoom, they may have a phone, but this is not the same….. Zoom sessions can be a reminder to patients of who has what, “the haves” and “have nots” in our society. I am also worried that some families who live nearer to hospitals and mental health resources, maybe able to access face to face appointments more easily. For the families that live in other areas of a borough, the reality and risks of travel on public transport, maybe a stumbling block to access this model of treatment.

The nursing profession has a proud history of challenging social injustices and recognising the relationship between health and ill health and poverty. It is important to think imaginatively about the experience for families in accessing medical support.  As nurses we have experience of knowing the practicalities, stresses and challenges involved, for example, a single parent with several children, travelling on public transport at this time of the pandemic. In some areas of London, the social and disparities are witnessed, when moving literally from one street to the next. If we put ourselves in young people’s shoes, a journey to medical health care can often involve travelling through areas of deprivation, to areas of considerable wealth, from a deprived housing estate to walking alongside a luxury gated community. I am concerned that access to mental health support will be more difficult for those young people whose parents do not have a car, or cannot afford a taxi to bring them to appointments. They will be faced with a choice of using public transport, maybe the tube system, at very busy times of the day.  

For many young people, not having their session at school or the clinic is a great loss, I think we need to be sensitive to this and to acknowledge this within ourselves, with them and in planning their care.

This week I am feeling more hopeful, as I have managed to negotiate a doorstep visit to a vulnerable 15 year, someone who has not left his home since lockdown started. He is very frightened of becoming ill. His mother has asked if I can help access a laptop for him, to help engage with school work. The visit may be an opportunity to reach out to a young person, who has become very isolated at home. I am very glad of this opportunity to visit,  see and speak to one of my patients in a “non-virtual setting”, but also maintaining social distancing.  

Nightmares

Written by a CAMHS nurse

We were in our regular nurses meeting the other day. Discussing the stresses, strains and possible opportunities within these strange, unsettling times.  I was reminded of a time a couple of weeks ago that I had tried to put out of my mind.

I am currently working rotationally part week on site and part week working remotely.  My nursing role includes quite a lot of complex safeguarding and child protection work. As such I am often involved in discussions with distressing content around the abuse and safety of children. Whilst this can be upsetting and at times images can become preoccupying for a time – it is ‘normally’ within the confines of my work and within the physical bounds of an office or a meeting room. When it upsets me, I might talk to a colleague, take it to supervision or occasionally have a cry in my car on the way home. But now my reflective safety nets are not in place in the same way – they are more distant, behind a screen or offered alongside all that the colleague is managing.

I live in a flat with others and so my work at home happens in my bedroom. I thought it was ok but then I started having distressing, shocking and violent nightmares, waking up startled and scared. One night passed with this, I spent the next day working, tried but didn’t want to give it much thought, I put it down to the general COVID anxiety that is invariably impacting us all. But again the next night and the next. I was exhausted but anxious going to sleep for fear of what nightmares my dreams would bring.

On reflection I realised that the distress and disturbance of my day to day work was somehow hanging in the air of my bedroom, my mind associating that room with the most disturbing and upsetting aspects of my job and with less capacity to process them as I usually might. I found this blurring of boundaries intrusive and unsettling, I was angry at ‘it’, feeling that it was making my usual work life /home life balance fragile.

Once I had allowed myself to become curious and realised that this was happening I decided to make some changes. Sleep is crucial to our wellbeing but I was most bothered by my anxiety about what my dreams might bring. I swapped room with a house member for a week for my work, I bought a new duvet cover and I started listening to green noise and wind chimes on my sleep app as I fell asleep. This really helped and the nightmares have not come back.

Separated but United

Written by a CAMHS nurse

Over the last few months I have seen everyone I know separated by the Covid virus and at the same time united in the suffering it has brought. It is a strange paradox that we are all more apart than ever but experiencing the same crisis all together. The disruptions to all our lives are obvious and not in need of being restated here but what I am going to reflect on, is how the situation has changed the nature of my work as a mental health nurse.

Different teams of workers have adjusted to the situation in a variety of ways, as the requirements of their duties allow and the community of health and social care professionals has been fractured, as many of us work remotely, only seeing our friends and colleagues in a wall of Zoom or Skype windows. Many of us have felt the sense of control and influence we have in the lives of our vulnerable clients, eroded by being only present for them over a phone call. Through this, a sense of insecurity and isolation has affected many professionals deeply. On top of that, many among us were already feeling pushed to the edge by challenges in our personal lives, which also now exist in the context of Covid.

In my role as CAMHS specialist for several local authority-based teams of social and youth workers, I provide consultation to the staff, on a group and individual basis, where there is concern about mental health. Toward the beginning of the quarantine, I noticed that I was being contacted more frequently to talk about the professionals own mental health and to talk with them about their own thoughts and problems.

I thought about this with my supervisor and they reflected that many people outside our own profession, are not sure, what it is we really do. There is an understanding that we deal with the mental health problems and we are where those thoughts go. This may have been what has led many to talk with me in this way, not to get guidance on how to deal with their patients, but how to deal with themselves.

 I don’t see this as a misreading of my role by them, or as anything I am not prepared to do. I have worried about some, as there has been some real profound distress expressed to me, that has made me both care about and respect deeply, the staff that I work with in these teams but I have also felt supported by professionals close to me, who have shared this burden.

That is my uplifting conclusion on where we find ourselves; failed by structures but supported by each other as people. I do not call any specific structures to task, there are too many systemically to even start. But it is my long held belief that the best good we can do in the world, is to lift up and protect the people around us, and I have seen many teams and individuals around me commit to this action, as a response to the Covid crisis.

Beam me up Scotty

Written by a CAMHS nurse

Nursing is an embodied experience. In my experience of both general and mental health nursing, it is about doing things with and to other people, in an agreed and consensual way. To physically or mentally help and care for them, being alongside, being able to see them, touch them, feel them, relate to them and they to you, whether it’s in physical care and or mental health care, in terms of nurturing someone’s mind, alongside their body.

In watching the BBC2 COVID program about the Royal Free the other evening, a moving documentary about the momentous work being undertaken by all the hospital staff,  I was struck by how nurses were dressed, particularly those in the ITU, as if astronauts in full PPE, hot, uncomfortable,  dehydrating and causing of sores to the face and claustrophobia within the mind.. and yet and yet, they were able even through the touch of a latex gloved hand, to soothe and comfort, seriously ill and in some cases dying patients.

It made me think about the discombobulated experience of working in mental health, in a remote virtual way through Zoom. There is an intensity of what you see, the eyes and face of the person you’re looking at, a sense of intrusiveness there and in relation to the circumstances in which they are looking at you, into their bedroom or some other part of the house, where they have perhaps managed to find some privacy and quiet from a rather full house of children and/or other adults.

But there is also the lack of direct gaze and eye level contact. If you look into the lens, you don’t see the person but if you look into the persons eyes, they see your eyelids. The level of your device either reveals a very large forehead, or the internal anatomy of your nose. You are delving into me and I into you, in a way that one would normally only experience physically with a sexual partner, lying in bed or close up. Yet here you are experiencing it in a two-dimensional way with patients, whom you want to be emotionally connected to and yet you can feel emotionally remote from because of the sense of the screen and the world of distance between you and them.

As social animals we have evolved our abilities to home in on non-verbal cues, that allow us to regulate our social and emotional intimacy. Here there is a loss of body language, a loss of smell, a loss of the sight of limbs and nuanced movement, that would have in an ordinary way in a meeting room been present. A disembodied experience without touch but with emotional contact, connected with the emotional resonance of the person you are meeting with. In an ordinary way there is a need in our brains to find a form of regulation based on physical presence and addressing non-verbal cues, in all their rich cultural manifestations, brain to brain, body to body and the use of the misfit when it occurs, to understand something of what is going on in the relationship with the other; in their relationship to themselves, others and to you. Here often the loudest misfit is what is going on in your mind, which cannot easily make sense of what you are seeing or experiencing. The experience of the presence of the absence of the other, disrupting intimacy and stimulating a searching, that is taxing for our minds. Indeed, exhausting and a source of Zoom fatigue.

Here you struggle to hear, as it can sound as if the other is talking underwater, or through space and of course in space no one can hear you scream, a point memorably made in the advertising for the first Alien film. You are left to guess at times whether the silence is poignant and meaningful, and or the buffering of the system, yours or theirs, with perhaps an anxious check at the speed check, within your system. Is it functioning adequately or not and a sense of guilt that it might not be and in any case your attention is now elsewhere and there’s a further loss of contact in the context, of already diminished contact.

There is of course also their intrusiveness into your/my world, what they see, what’s on view, of what they see behind you and what they imagine they see. A sense of voyeurism on the part of both, that is perhaps both sought but in the same moment guiltily avoided. There is the sense in which we think we join with them, but in many ways they join with us and enter our world, our personal-interpersonal world both visually in the moment but as ghosts, who continue to haunt, worryingly and sometimes malevolently the spaces we see them within, once they have left. Work and home life can become mashed together with a falling way of boundaries between the two, that affects you and your family.

There is also not the distance between sessions or meetings in the ordinary way, in which you might see someone back to waiting room or say goodbye on the doorstep and walk down the road. You leave them in whatever state they are in, as you leave the meeting and managing and being aware of this is important, as you regulate the end of the session, as they are left at home alone. But they equally leave you in whatever state you are in, as you attempt to process something of their experience and yours, but all too often and too quickly beam into another hyper-real virtual world, with either another patient, or into a meeting with colleagues. All too often there is a salami slicing and connectedness between Zoom meetings…no walk down the corridor or down the road.

The sense of leaping between virtual worlds, where in fact you remain in the same space, has a disorientating quality and I’m reminded of Star Trek and the often-used phrase “Beam me up Scotty”, to rescue people from disastrous encounters in foreign lands, on other planets. However, in one episode, a malfunction in the transporter a room, results in two people being amalgamated in a hideous way, as they arrive on the transporter deck, having been beamed up. Far from rescue, they were a hideous mix of each other.

There is a sense in which moving so rapidly from one meeting to another,  leaves a whole host of feelings, thoughts and emotions from one setting, mixed up in the other, as you arrive either with another patient, or indeed with colleagues, whom you may have seen recently in another world but now in view again, in their same world but in a different context. Whilst Zoom provides temporal flexibility and a sense of no limitations on distance and space, it also can lead to a lack of sensory integration and absorption of experience, without the process of filtering, a sense at times of disinhibition, inhibition and invasion of the sense of self, in a virtual world

There is a sense of otherworldliness about Zoom meetings, in this way a sense of hyperreality but yet a distancing disconnect, in a way that the brain and mind finds hard to fathom. Adjusting to seeing and nursing patients in this hyperreality, requires a time to catch up both with the experience in the moment but equally with the strangeness of this context of nursing care in the longer term, if this is not to be the new abnormal normal and we risk losing the skills and artistry of Nursing, as an embodied experience.

Moodswings

I have been reflecting on and noticing patterns in my mood over the past few months.  Prior to the Covid situation becoming a pandemic I was often in conversation and dilemas with people about how serious things were, how much do we need to prepare, what we need to do.  As the weeks went on it quickly became apparent that the situation was very serious and we needed to take action.  This led to many weeks of planning and constant change as rapidly the situation changed nationally.

Personally, as a child and adolescent mental health nurse, I was consumed with guilt at not doing more on the ‘front line’, but recognising my skills were not necessarily best placed to support there.  Rationally I recognised that what I was doing to keep the service I manage going was enough.  The restlessness and helplessness I felt made it difficult for me to allow myself any down time, I experienced sleeplessness and mood swings that impacted on my home life.  Once I was able to reflect and name the guilt I felt and express it I was more accepting of how I felt.   I found ways I could offer support in more ordinary ways, being there to really listen to people’s experience as this was so important in a world where being in the moment was getting difficult to sit with. 

As the lockdown came and our service began to be delivered remotely I recognised the increasing exhaustion I felt and the weight of containing, managing and supporting not only our clients but also their families and the wider network.  As a manager, attending to staff psychological wellbeing feels increasingly important to attend to but it is also difficult to really gauge in the current circumstances.

I have learnt to take lots of deep breaths, be kind to others and to myself and pace myself……this is a rollercoaster and a marathon all in one.

Podcasts

View transcript

Hello. My name’s Jon Creedy, I’m a mental health nurse and work at the Tavistock and Portman NHS Foundation Trust. This podcast will focus on ‘being good enough’, looking at both what this means and where this concept comes from. I’ll address some of the factors that can threaten the belief we have in ourselves as clinicians, and will explore how we can stay in touch with the idea that we are indeed good enough.

The global COVID-19 pandemic has seen a seismic shift in the landscape, having an immense impact on our working lives and beyond. Healthcare systems worldwide have been forced to quickly adapt to continue delivering essential services. At times of such uncertainty and change, the external and internal pressures we experience intensify. It’s then particularly common to question one’s own capability to meet expectations, and therefore all the more vital to hold on to ‘being good enough’.

The work of paediatrician and psychoanalyst Donald Winnicott on ‘good enough’ parenting provides helpful clues as to the importance of this concept. His work focussed on the start of life, and on the significance of the parent-infant relationship on child development. Initially, the primary care-giver, often the mother, devotes herself to the infant child, striving to meet the baby’s every need. As time goes on, the mother adapts and is no longer wholly attentive, but continues to provide a safe, nurturing environment, allowing the infant to experience some distress and frustration, only small amounts at first but progressively more. The mother comes to find a balance between being too good and not good enough, which allows for healthy developmental processes in the baby.

There are parallels between the mother’s challenge to find the “good enough” position and the challenge nurses face with their patients. Both involve learning to tolerate “not knowing”, but seeking to understand. In both, the carer aims to be attuned to another’s needs. It’s necessary to adapt, to an ever-changing, developing presentation. Both must allow for and tolerate distress in those they care for. The aim must not be for perfection, as this is counter-productive and damaging. Holding these things in mind in our work will help us preserve a sense of being good enough.

Recognising the pressures and expectations we face and seeking to understand how they impact us is similarly important. External pressures and expectations are felt from our environment: from individuals – colleagues, managers, patients and their families, even our friends and loved ones; from the systems in which we work – complex and inter-connected, target-driven, and imperfect; and from the important position that healthcare holds in society, particularly so with the NHS in the UK. This external pressure is likely to be more keenly felt at the moment, when the spotlight has shone brightly on healthcare workers and their necessity, and when the common, and arguably unhelpful, rhetoric is of the frontline, sacrifice and heroism.

The internal pressures and expectations we face come from within ourselves as individuals and from within the group dynamics in which we work. You may recognise some of the following examples as pressures and expectations that you place on yourself: to be infallible, never making mistakes; to know what to do and how to do it; to be unconditionally caring and compassionate; to persevere and keep going. It’s a useful exercise – either individually or in your team – to consider what we expect of ourselves. We may realise that these are neither realistic nor achievable, that this is not what is expected of us from others. Currently, we face so much external uncertainty, that identifying these aspects of our internal functioning, giving ourselves space and time for reflection as individuals or in groups, is especially important. This can safeguard against unmanageable stress, disillusionment and burn-out.

To retain our belief in being good enough, let’s bear in mind the nature of the work nurses do. In the book “The Unconscious at Work”, which examines individual and organisational stress in the human services, Vega Zagier Roberts writes that, “those in the helping professions inevitably and repeatedly encounter failure in their work with damaged and deprived clients”. What’s more, nurses regularly have intense, emotional contact and use their self as a therapeutic tool – we empathise and are compassionate, when faced with distress and with situations that we cannot simply fix. This work evokes powerful human emotions – fear, joy, anger, guilt, despair and hopelessness.

Given this, it’s valuable to examine the motivations we have for choosing caring work. The positive feelings it engenders – that we’re helpful, worthwhile, or even powerful – may nourish and drive us. By putting ourselves forward as instruments of change, of healing, we may be unconsciously hoping to confirm to ourselves that we’re good enough. Consider a scenario where you’ve assisted the recovery of a patient, preventing further suffering or death. The feelings that are evoked by such “success” can be deeply validating and rewarding, telling us we are “good enough” as a person. On the other hand “failure”, or even limited success, may be taken as evidence of one’s inner deficiency, and feel intolerable. Seeking to uncover or recall our own deeper reasons for choosing challenging emotional work, especially at times when we feel particularly tested, is a powerful tool in holding onto our sense of “being good enough”.

As I come to the end of this podcast, I’m hoping this has provided some time, space and food for thought about how we self-evaluate and can remain ‘good enough’. I notice that I’m asking questions of myself: “Is this good enough? Will this be listened to and help anyone? Is this essential work at the moment?” I feel a ripple of anxiety and in response remind myself that this is a natural reaction to uncertainty. There are no simple answers, but to try and find balance. Thank you for listening.

View transcript

Lisa: Hello, my name is Lisa Younge and I’m an IBD Nurse Consultant at St Mark’s Hospital, and a Project Manager for IBD Nursing at Crohn’s and Colitis UK. I’m here with Lucy Metcalf, IBD Lead Nurse at King’s College Hospital, and Alex Hall, Gastroenterology Nurse Consultant at Homerton Hospital. And we’re reflecting on how IBD nurses managed our advice line services in these unprecedented challenging times, hopefully offering some useful insights and advice. As with many other people living with underlying conditions, those living with inflammatory bowel disease (IBD) were understandably concerned about what the Coronavirus means for them, and as the majority of IBD services across the UK provide on demand access for people, advice lines were understandably often the first port of call for many.

So Lucy, can you describe how that was for you?

Lucy: For IBD patients, especially those on immunosuppressant’s, it caused high levels of anxiety, but it was also a time when we were also experiencing personal heightened anxieties. The initial guidance changed regularly and for patients, it was a really very confusing time. Even prior to the lockdown, the government’s messages were confusing, telling people that anyone who requires the flu vaccine because of medication or their diagnosis was to self-isolate. This immediately meant a very sudden increase in phone calls and emails to the IBD team, at a time when our own teams were being redeployed to the wards or ITU (Intensive Treatment Unit). The information early on was all about anti-inflammatories and reducing your outcomes in regards to IBD. This meant even a few patients just on metallocene became alarmed and wanted to stop their own medications.

Alex: Yeah, and there was no clear government guidance for us as experienced nurses working in our specialty. We are used to coming up with plans for care and treatments and it was very difficult to realise and admit that we didn’t know the answers. Let’s face it, this is a pandemic affecting the world, a situation that none of us had come across before.

Lisa: Absolutely. So Alex, what impact do you think that that had on you?

Alex: The first thought was to give out the right advice, the government had sent out this blanket advice regarding shielding, and patients wanted personal advice, which was difficult at the time, and due to the number of increased phone calls, the fact that services were usually manned, and managed by a number of nurses, and due to redeployment we are only often one person manning the phone. At times, it felt like we’re not providing a satisfactory service and I was very nervous about missing patients who were actually clinically unwell. However, we made a plan of action within the department with the consultants, and once the BSG had published their guidance, it was much easier. In addition to the patients it was a worrying time for us. My team had been redeployed, I felt extremely guilty about them working on the wards at times with restricted PPE and working with extremely ill patients. And they in turn afterwards told me about how guilty they felt about leaving me holding the service together. We’ve done a lot of debriefing and often open dialogue has helped since they have returned to the department, but I think it’s really important. It’s been a stressful time for everyone.

Lisa: And Lucy, anything to add?

Lucy: I think I would say exactly the same as Alex, it was, it was just very challenging knowing what to tell people.

Lisa: It did certainly feel like a very challenging time. In fact, the national reporting to IBD services estimated that over 80% of services did see their advice line contacts increase by at least 50%. And around a quarter actually reported an increase of up to 100%. And as you say, during a time when the people manning those services were also depleted for redeployment. So what sort of steps did you put in place to try and mitigate against this? Lucy?

Lucy: We changed our voicemail. We also changed our email auto response. So patients, if they emailed in, firstly, they had to say if they were unwell, we had to resend it with ‘I’m having a flare’ in it so we realised who was unwell and who was just asking questions. I was very lucky that one of our consultants actually wrote this whole crib sheet so we could send it out automatically as well. So some of the questions that patients were asking they were automatically answered those questions without even having to wait for me to necessarily reply to them. Alex, what about you?

Alex: Yeah, we put a long message on the answer phone and emails very similar to you, Lucy. And I think once the BSG had published their guidance signposting to the Crohn’s and Colitis UK and other agencies was the way we managed it.

Lisa: Yeah. I also think it’s important to recognise that as a speciality, inflammatory bowel disease does have a well-functioning community spirit. So, for example, we have a closed Facebook page with RCM nurses, and that has over 500 members. And I think it always allows peer support and sharing of practice. So can I ask what role, if any, do you think that this might have played in the current climate?

Alex: I think the IBD Facebook page and links with other IBD nurses meant actually we weren’t alone and the general consensus was found about how to interpret the government guidelines and BSG guidelines. I mean and how people were putting them into action. In addition, the network itself was invaluable, being able to access support for patients stranded out of area who needed to be seen for treatment or monitoring. It really demonstrated the value of networking.

Lisa: Of course, yeah, Lucy, anything else to add?

Lucy: I think it was exactly the same, you know, finding out what other people were doing, peer support was really important for people in the same position. And I think you know, we all found it very challenging, so it was good to hear that you weren’t alone.

Lisa: Alex, you thought a little bit about some of the general frustrations, the whole episode, do you want to elaborate a bit on that?

Alex: It was a frustrating time when we had to change the working patterns quite rapidly. We were trying to keep patients away from hospital and in situations when you may have wanted to physically normally see a patient you couldn’t and sometimes had to treat patients quite blindly. And we didn’t go into nursing to have such a hands off approach, we are used to physically seeing patients and discussing the plans of action. However, in some ways, it was good that they had increased communication with GPS and we were able to build much stronger links. I’d often phone the GP about one patient and ended up discussing another patient. I think generally people are much more willing to cooperate, we’re able to change the way we work to provide services quickly from face to face to telephone clinics almost overnight. And this generally worked, although it’s definitely not quicker and often means more telephone appointments to follow patients up on investigation and responses to treatments.

Lisa: Yeah, absolutely. Finally, both of you, any tips or tricks for anyone who’s listening on how to practice our own self-care during times like this? Lucy?

Lucy: I think for me, it was about just being as honest as you can with a patient. You know, I think they come to us asking for answers and telling them what to do. And I think being honest and saying I don’t know, is actually okay, even though it doesn’t feel right for us to do that. I think it’s absolutely, you have to be honest with patients to tell them how you are. I think for me, it was a very stressful time during the COVID pandemic, but I didn’t feel stressed because of that. I think I felt probably more stressed since it, I don’t quite know why and it may be that you know, I’m worried that perhaps I’ve missed things and I haven’t given people the right information. But at the time, I think for me, it was just getting on with the job and just doing what we could do.

Lisa: Yeah, Alex?

Alex: I totally agree with Lucy, I think, honestly, and since COVID, it feels more stressful, funnily enough. I think we just have to be honest, we don’t know, sometimes we don’t know the answers and we’re used to having the answers. But I think in the era of duty of candour, it’s the best pathway to be honest with patients.

Lisa: Yeah, absolutely. And honest with ourselves as well. So yeah.

Lucy: Absolutely. True.

Lisa: Many thanks, then to you both for being so honest and open about recent challenges. So we’ve been discussing the impact of the recent Coronavirus situation on nurses working specialist roles, particularly in inflammatory bowel disease, but possibly across the board, and this has been while we have been supporting our patients virtually and it is for the Nursing In Mind podcast. Thank you for listening.

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Recently I was with a group of nursing colleagues and we were discussing their particular experiences of nursing at the height of the COVID pandemic. One nurse in particular, spoke with despair about feeling utterly stripped and bereft of any sense of being an effective nurse, he had seen so many patients die, he had felt so helpless that wondered whether he actually justified the title of being called a nurse.

I could see that my colleagues were nodding in some sort of recognition of what he was saying and the quality of his despair. So I asked him to say a little bit more, and he started to describe a particular patient he had been a key nurse for, and this patient unusually had been on the ward for over three months. In that length of time he had really got to know this woman, he had got to understand her he thought, he had provided her with comfort along with his colleagues, she had become quite a known patient on the ward because of the time she had spent there. He had known what had made her comfortable, what she liked to eat, what she didn’t like to eat, what made her irritable, what made her slightly more hopeful, he cajoled her, he tried to revive the life in her and accordingly on many occasions she did appear to be close to recovery, but then, as is often the case with a patient suffering COVID, there would be a very sudden unexpected and catastrophic decline in the state of health. But because she had recovered many of these dips in her health there was a consensus in the ward that she would probably make it. And then one day he turns up for an early shift and he is told the awful news that she had died very suddenly in the night. “What a waste of time!” he exclaimed, it was a shocking thing to say but it was authentic, and I knew that his colleagues understood exactly what he meant. We acknowledged that very painful and angry state of mind, when one’s efforts, one’s real hard dedication seems to have been worth nothing and that’s what nursing COVID patients often leaves the nurse with. It is a particularly cruel aspect of this type of nursing and this type of illness.

But I thought that it might be helpful to think what else was behind that anger and that sense of futility and we started to think about a sort of intimacy that does play a part in nursing patients who are not going to respond to a care plan or to a medication but who are inevitable there to die. It is a cruel travesty, in terms of nursing, to feel that there is nothing actively, there is no process, there is no procedure that is going to make a significant impact and you are left being a human being, ok with skills, with experience, but ultimately you are one human being with another person, with another human being who is dying. And we thought about the exceptional experience of doing that on behalf of society, being there with the patient at the most extreme point in their life and then inevitable death, and we thought about why it is so difficult in the quietness and in the space of being able to reflect, why is it felt so difficult to appreciate that might actually be a terribly important aspect of nursing. To really be with the patient, with their agony, with their despair, with their hope, with their irritability, that the being with all of those different things that one patient can bring, all those confusing and complicated things that the patient brings with them, that being with is implicit in the nursing role, and perhaps it is difficult for us as nurses to acknowledge it because it doesn’t get measured, it is not included in the care plan, it is not something that we easily can describe, but it is there in what we do and in being with the patient who has exhausted all of the doctors initiatives and skill and experience, it is down to the nurse to be with that patient and to do something that no one else is able to do, to watch, to feel, to be with and to witness.

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Hello, my name is Pam Smith. I work at the University of Edinburgh. I teach nursing students and research the emotional labour of nursing, the topic of my podcast. I have thought about emotional labour every single day since the pandemic began … whether in conversations with students, friends and family, listening to the radio or my own reflections with ‘Nursing in Mind’. 

I first heard about emotional labour in a study of flight attendants in the 1980s by sociologist, Arlie Hochschild, who developed the notion of ‘emotional labour’ to describe the emotional component of work (smiling, friendliness, kindness) as a paid requirement of the job. She defines emotional labour as ‘the induction or suppression of feeling in order to sustain an outward appearance that produces in others a sense of being cared for in a convivial safe place’ (Hochschild 1983, 2003:7). 

I first studied the emotional labour of student nurses learning to care in different ward environments (Smith 1992, 2012). The leadership style of the sister or charge nurse to set the emotional tone was key.

As one student put it:  ‘Sisters are critical because of their influence on staff nurses. They in turn influence how the students work and on the way they feel, their morale’.

Sisters’ influence was reflected in this patient’s comment:  

The nurses have been brilliant. They are such good listeners. To give yourself a chance physically you need to have the emotional side there helping you.

Although it is recognised that nurses work in high stress environments, there is little research to determine the nature of their emotional labour.  Following conversations with intensive care nurses we undertook a project to explore the nature of their work and their support strategies to reduce stress and burnout (Smith et al. 2013).

The nurses recognised and used the language of emotional labour to describe and reflect on the emotional intensity and complexity of their work. Here are some examples which may resonate with your own experiences.

They described work as fulfilling, Satisfying,  Rewarding; Intense, Stressful; Turbulent, Frustrating; Humorous, Fun; Emotional, Caring; Tiring; Anxiety-provoking; Safe,  helped or hindered by good skill mix; adequate staff numbers; sufficient or lack of time and available equipment..  (Reminiscent of the PPE debate at the height of the pandemic) .  

Emotional impact on work and emotion management

Nurses said the uncertain environment of intensive care required high levels of emotional labour which had an emotional impact on their work requiring them to manage their emotions. This is how they did it.

I mean I think it is we have got to stay cool and calm. You have to act very calm as if you’ve no problems.

You have got to suppress your emotions ….because you may have four people die in a day … and you have to try and suppress how you are feeling but it has to be very difficult actually.

Emotional tone, experienced leadership, team and peer support:

Nurses were supported by the emotional tone of their leaders, team and peers who played key roles in supporting them to remain engaged and effective in their work.

Nurses said there is a feeling that ‘you have to get on with it’ but‘the important thing is the ‘togetherness’ of thewhole team ….  if you have got a good team that shift will run and no matter what is thrown at it, you will get through it.

Need for debriefs

The nurses said they needed immediate ‘debriefs’ following distressing events

One nurse said: If you have had that kind of (difficult) shift I do think it is quite helpful just to sit for half an hour not being on shift any more but just being …

Another nurse said:  We just had a chat in the coffee room about it, just went through events and just off-loaded that way really.

Home and work boundaries

Nurses also spoke about twelve hour shifts which blurred the boundaries between home and work

When you go home you then don’t want to be a burden … you have to almost stop that feeling before you go home because you don’t want it to enter into your home life. We have got to say to ourselves once we leave the door we leave the door.

Some reflections

Emotional labour gives a language to recognise, support and manage emotions especially in uncertain times when high levels of emotional labour and support are required. There have been many inspiring accounts of nurses and carers thinking of creative ways to communicate at a distance to help ‘the emotional side’ of very sick and dying patients isolated from families and friends. Nurses also told me how recognising ‘the emotional side’ helped them to be kind to themselves, taking frequent breaks, talking to on-hand counsellors and finding helpful online resources such as mindfulness (RCN 2020) and self-compassion (Neff 2020). 

The pandemic has revealed just what nurses and carers do but it also reveals the urgent need to address extreme inequalities such as in the care homes and among Black, Asian and Minority Ethnic (BAME) communities, many of them health and social care workers. As lockdown eases let’s keep the light shining on nurses and carers to value and protect their emotional labour of care.   

References

Hochschild AR (1983/2003) The Managed Heart: the commercialisation of human feeling. Berkeley: University of California Press

Neff, K.D.(2020)  Self-compassion.org

Royal College of Nursing (2020) COVID-19 (Coronavirus) and your mental wellbeing

Smith P (1992) The Emotional Labour of Nursing: How nurses care. Basingstoke: Palgrave Macmillan

Smith P (2012) The Emotional Labour of Nursing Re-visited: Can nurses still care. 2nd Edition. Basingstoke: Palgrave Macmillan www.palgrave.com/nursinghealth/smith

Smith P, Kean S, Ritchie D, Ramsay P and Dunlevie J (2013) Nursing at the Extremes. End of Project Report, University of Edinburgh

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Hello, my name is Claire Shaw, I am a Consultant Nurse and Psychotherapist working at The Tavistock and Portman NHS Foundation Trust. I am going to be talking about making mistakes in clinical practice, thinking about what happens next to the individual and the team. 

I thought the area of making mistakes was particularly relevant at this time. It’s an issue for all of us, we all get things wrong at some point, it may be that we have overlooked something important, that we hadn’t thought through the consequences of a decision, or maybe that we acted outside the realms of our experience or our training. I’m going to talk broadly about mistakes that are commonly made, the occasional clinical errors made by otherwise sound, thoughtful, competent clinicians.

Einstein told us that a person who had never made a mistake, had never tried anything new. We have all been in a time of great flux, many of us have been called to work in new ways, in new roles, undertaking new skills and in new teams or services. Within this newness we are more likely to make a mistake.

Mistakes at work can have a profound impact on nurses, on all health professionals. The literature identifies that making an error as a health care professional can leave the person experiencing a sense of guilt and shame, feelings of burn-out, of moral distress leaving them ruminating and reliving events, feeling unable to sleep, or to talk about their feelings. At the extreme, we know that people can fear the loss of their careers, and of their homes as a result.

I thought it might be helpful for us to think about what happens after the mistake has been made? Why does it affect us? We have all made mistakes and we will have experienced this differently. Why is this?

As a starting point, there are several more clear-cut factors that we can identify: The seriousness of the mistake and its consequences for the patient, team and organisation increases the impact; more experienced clinicians generally experience lower negative impact; and external stresses such as a bereavement or divorce can reduce an individual’s resilience at that time.

We have thought a lot about the idea of ‘expectations’ in our work with nurses, trying to think about the external expectations (those from others) and the internal expectations, those we place upon ourselves. We may feel that the public idealises nurses, see us as flawless, caring and all knowing, in the current covid climate nurses have been heralded as heroes. We may feel that our organisation expects us to be perfect, that there is no room for ordinary imperfections that may lead to mistakes. We may feel that our patients place themselves trustingly in our hands on the understanding we won’t fail them. We may have expectations of ourselves, either consciously at the forefront of our minds, or unconsciously deep within us, this varies for each of us. We may consciously strive to get things right, to know, to understand, to be perfect. We may feel that we’re not very good, that we’re a hare’s breadth away from a mistake most of the time. Unconsciously, for example, we may have a sense that we are alright, good enough, or we may have a deep sense of being inadequate, disappointing.  These feelings about ourselves are unique to us and often based on much, much earlier experiences of ourselves in relation to others. These experiences affect how we ‘talk to’ or think about ourselves, you know the “it will be alright, come on, you’ll be OK”, or the “you idiot! How could you do something SO stupid”.

When something goes wrong, our relationship to the world around us and to ourselves comes into sharp relief. As does our ability to keep connected with the everyday reality around us. Some people may feel that they are seen as failing, as useless, feelings that they have towards themselves that they may feel are those of the charge nurse, the ward manager. The ability to see the reality of the situation becomes impaired with distress, a minor error is experienced as completely disastrous, concerned colleagues experienced as critical and judgemental. Others may struggle to recognise that they have even made a mistake, instead blaming their colleagues, the patient, the organisation.

At this point things can become rather polarised. The idealistaion that I mentioned just now comes with a flip side, that of denigration. Nurses may be perceived as idealised heroes, and swiftly and unknowingly make the transition to the denigrated version of a ‘stupid nurse’ one who does not care. Sometimes individuals who have made a clinical error come to feel as if they are the only ones who could or would have made a mistake, as if the team has become clearly divided into ‘mistake makers’ and ‘perfect nurses’. Comments such as ‘oh poor you’, ‘how could she have done that!’ suggest that the other person is different to the speaker. They are saying “Thank god I’m not like you, a person who makes mistakes!”. It is a defensive divide,   splitting of good nurses and bad nurses, we all know who’s who. It leaves a weighty burden to carry for the supposedly ‘bad’ nurse who made a mistake, who may feel very bad, above and beyond the original error. It also means others nurses are protected from the uncomfortable, anxiety provoking reality that they too could have made the mistake, that any of us could and will make mistakes. It’s a hard reality to bear, to know that we are all capable of getting it wrong at times.

So what is needed? What supports the individual to bear it, to keep connected with their good work as well as bearing knowing about a mistake? What enables a team to be interested and to learn from mistakes, rather than feeling it is only about the failure of one individual, of one team. I will briefly touch on two main points that we know can positively impact upon individuals, that of the immediate response from others and that of work place culture.

The literature suggests that relationships and the opportunity to talk with work colleagues can have a positive impact. This makes sense, it may give the person the opportunity to voice their thoughts and fears, to sound them out. It lets the murky doubts see the light of day and hopefully be met with a more reasonable reality. It can enable them to be in touch with the reality of others (they too may ‘admit’ to having made a mistake at some point), they may not feel persecuted or criticised but supported. It can help to have an external reality check on themselves, they haven’t become a ‘terrible nurse’, but a good nurse who has got something wrong. We know that not talking, trying to be self-sufficient, has a negative impact on recovery. This is something we need to be aware of, either with colleagues who may attempt to be self-sufficient, or in incidents where, in order to follow post-incident protocols, people have been instructed not to talk to others and also in these days of working from home and self-isolation.

I’m not sure if you may have seen the ‘still face experiment’, but it always comes to my mind when I think about how people are responded to by colleagues or by the organisation at a time of distress. In brief a very young child is engaged in interacting with their mother, a responsive interplay between the two of them. At one point the mother turns away and turns back, but with a blank, unresponsive face. The child’s distress at being unable to get through to her increases as she attempts to make contact with her mother, without success. It is painful to watch, but something of this shift to a blank face resonates with the way colleagues and organisations can respond to individuals in the wake of an error. The key and most troubling aspect is when the response becomes a formulaic process, un-attuned and unavailable to the distress and anxieties of the individual. The individual may give up on trying to get through.

I am not suggesting that staff are children, nor that managers are parents. Clinical errors can stir up anxiety in both, the interaction I have just described, may take place (unhelpfully) in different parts of the organisation. And not out of ill will, or inability, but possibly out of anxiety at the situation, out of a preoccupation with reports, datex, incidents reviews, deadlines, outcomes. But when this happens, and I think it does happen, it can leave individuals feeling that the other can’t or won’t help them.

This takes us to the idea of a supportive workplace culture, something which is identified as reducing the negative impact on the clinician after an error has been made. The recovery trajectory is like to follow the same pattern with either a supportive or non-supportive workplace culture, the key difference is that it significantly reduces the initial impact. So, if we think of two nurses, each working in a non-supportive or supportive workplace, they would both have to follow the same route to recovery. We could visualise one being at the bottom of a mountain, the other at the bottom of a gentle hill. Both have to traverse the ups and downs of the land in front of them, but one has to climb higher, work harder, has a more extreme experience, based on their starting point.

So what is a positive work place culture in this context? There are obvious factors, such as the support and availability of senior staff, a non-blaming culture, recognition and acceptance that mistakes can happen, that mistakes are framed as opportunities for learning and developing, identifying what individuals and teams can learn and change. We know that best practice includes people receiving full information about the response to the mistake and to the next steps that will take place, and being supported with this. Having the opportunity to express not only what happened (in terms of a factual account), but also recognising the impact of the error and the consequences can be helpful. This requires a responsive colleague/manager, not one of the blank faced kind, but rather someone who can contain some of the fears and anxieties that the incident may have stirred up.

To end with, I think that we are mostly very familiar with the processes of responding to clinical errors or mistakes, the protocols, reports, reviews and action plans. I think we are less familiar with thinking about the impact on the individual and the team. At a time when many of us are working in new ways, we have had fantastic opportunities to learn and to develop, but we are also more likely to have got something wrong at some point. The way each of us responds, matters. We have the potential to support one another, to be interested and to learn.

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This week we have celebrated International Nurses’ Day 2020. It was fantastic to see nursing receiving such a high profile across the press and notable that the nature of the press coverage has started to change and the way nursing was represent showed an markedly more realistic and varied image of a nurse in 2020. 

As many writers have already pointed out, 2020 was intended to be the global year of nursing and midwifery, with a huge global campaign through Nursing Now to raise the profile of the essential role that nurses and nursing leadership plays in global health. Coronavirus has meant the campaign and the celebrations have not been able to progress as intended, but ironically the virus has gone some way to achieving their aim. 

The coronavirus pandemic has undoubtedly raised the profile of nursing across the globe and that perhaps is a silver lining in what might otherwise be seen as a rather dark cloud over recent weeks. 

However, the Chief Nursing Officer for England, Ruth May, did still have to stress in her speech on Nurses’ Day, that nurses are not heroes, as still commonly portrayed, but highly skilled professionals whose contribution to global population health needs to be recognised, valued and acted upon. 

What is made refreshingly clear from the media portrayal this week is that nursing is a widely varied and ever-changing profession, career and role. The BBC portrayed nurses working with older people and in the community. We saw nurses locally at the Royal Free and Barnet Hospitals depicted in an incredibly powerfully documentary on TV responding with courage and agility, along with the whole hospital team as the pandemic surged through North London. We know that at the same time clinical nurses, nurse managers and clinical educators across the country were similarly thinking on their feet, flexing services, rapidly training and mobilising colleagues into unknown areas in the face of an unknown epidemic without wavering. 

Nursing Now, the global campaign, launched a film to coincide with Nurses’ Day created with the royal family which showed the full range of nurses working across the globe: From mental health nurses working in the Caribbean, to children’s nurses working in Malawi, and nurses in Sierra Leone applying their learning from Ebola to fight the coronavirus. 

Florence Nightingale whose 200th birthday we celebrated on Nurses’ Day, in her writings, was clear that nursing is both a science and an art. She writes that is it is possibly the finest of fine arts because rather than working with clay or canvas, the nurse works with a human being across the full range of their experience of life. 

Florence Nightingale was also clear that to be a nurse is not an easy choice and it involves significant hard work. In order to maintain ones enthusiasm and passion and to thrive through a lifelong nursing career, requires that we hold on to the things that drive and motivate us, which draws on both inner strengths and external sources of energy in our outside lives. The support of family friends and colleagues and a workplace that values us, engages, supports and develops us. For me that passion is like an internal light which needs to be kept charged with energy from these sources to remain burning bright.

American nurse theorist Jennifer Jackson writes about the four different kinds of labour involved in nursing. First the physical labour of tending to the patients’ needs, providing physical care over the period of time, the many miles walked around a hospital or community visiting patients and managing nursing across different departments. At the moment working in PPE or using virtual media whilst trying to build an interpersonal relationship, all of these demand significant physical labour.

Jackson also talks about the cognitive labour of nursing – the assessment of need, analysing data from various different data sources, hunches, juggling between paying attention to the patient and observing the impact that other people and their environments on them and using all of that data and processing it to make decisions about care and intervention. 

Organisational labour is the third kind of labour Jackson talks about. The work of caring for the individual patient or working as a nurse educator, researcher or manager within the context of the whole team or service, as part of a bureaucratic organisation: the juggling between the demands of one person and another, one part of the service and another, in order to achieve the best outcomes for all.

Finally, and perhaps most widely written about, but often not paid much attention to, is the emotional labour of being a nurse. Being besides our patients and out nursing colleagues, sharing their experience and helping patients them with the impact of ill-health or changing life circumstances and supporting them to adapt or recover and supporting those in our teams and services to engage in this emotional work too and to achieve their own full potential as nurses and professionals.

Thinking about nursing in terms of these four different types of labour helps us to understand its complexity and the skills it requires but it also helps us see the potential toll of our remarkable profession on us if left unchecked.

To be able to continue to thrive as nurses we need to work in an environment that has structures, processes and systems which support us, so that our labours are as effective and fulfilling as possible, rather than wearing us out. But we also need to draw on our own personal resources to remind ourselves why we do this, what inspired us to become nurses in the first place and to ensure that we engage in those activities that bring us new energy and enable us to keep our inner light shining.

This week the public were encouraged to shine a light in celebration of nursing.  Today and every day as you go about your work as a nurse on your own and with other nurses, don’t forget to engage in activities that ensure that you keep your own light shining, and that you support others to sustain their energies to keep their lights shining too. 

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Hello there, my name is Nicky Lambert. I’ve been asked to put together a few thoughts for student nurses at this very strange time that we are going through. I think when you start a course as a student nurse you assume that things will smoothly go ahead, you’ll go from module to module, placement to placement, and you’ll come out the end and you’ll have received your goal. One of the really interesting, exciting, scary, fabulous, weird things about nursing is that you can’t predict what will happen. No two days are the same and certainly no nursing journey, no learning journeys, is the same.

I think what I wanted to say to you was a story that I heard when I was a student nurse, and it was something that really stuck with me and it was about the anthropologist Margaret Mead being asked what she thought were the first signs of civilisation in the culture. I think people assume you’re going to talk about wars or axes or clay pots, and what she said was the first sign of civilisation in ancient culture was a broken leg that you could see had healed and she was saying in any situation if an animal breaks its leg, it can’t get food, it can’t hunt and an animal just doesn’t survive a broken leg usually long enough for the bone to heal.

What Margaret Mead was saying was that a broken femur that healed is evidence that somebody was there with that person, somebody stayed with them, somebody picked them up when they fell, carried them to safety, tended them, helped them to get recovered. Helping someone else through difficulties is where civilisation starts, that’s where we are at the moment. We are certainly in a difficult situation, not easy to see how it will turn out at the moment, there will be lots of changes.

The learning journey that we thought we were all on is probably going to be quite different and it’s an opportunity to grow and learn and more importantly it’s an opportunity for us to be together.

So the reason you want to be a nurse, to help other people, to serve the public, to be part of a team, all those things are still same. I think when I first started as a nurse I wanted to learn and grow and be challenged and certainly that’s what these times are bringing us.

So just a few thoughts for you. One is: prioritise your own self-care, make sure you’re rested, make sure you’re eating properly and prioritise your family and your loved ones. You can’t keep drawing on your resources if you don’t have any, so treat yourself with the compassion and respect that you treat the public and that that will help you going through this time.

Also be aware that your colleagues are there for you, your lecturers in college and your peers and even service users and the public will be there to support you. You are doing a really important job, at a very difficult time, people recognise that and I think nurses, your colleagues, really respect you stepping up. If it’s something that you can’t do, if you can’t step up through health issues and through family issues, the other thing I would say is please don’t feel bad. That’s the reason we work as a team, we each have a time and a place to act. This is a long, long game. Do what you can. Support others where you can and step back when you need, to that’s why there’s so many of us and that’s why we stand together. So I hope that’s helped and I would say as well is – thank you.

External websites and related resources

RCN – Nursing: Wellbeing, Self Care and Resilience Guide – Visit the webpage

Free wellbeing Apps available for all NHS staff – Visit the webpage

RCN – What we can all do to help identify and prevent burnout among nurses – Visit the webpage

Kings Fund – Leading in a crisis starts with acknowledging your own feelings – Visit the webpage