Lasting impact: nurses reflect on Covid four years on

“I have one message for you,” Mr Johnson told the country. “Stay at home.”

Millions watched this broadcast from their homes and proceeded to do just that, while nurses and other health and social care staff carried on tackling the devastating first wave of infections.

Ahead of the fourth anniversary of the first lockdown, Nursing Times spoke to nurses from across the profession about their memories of 2020 and its lasting impact on them.

Will Nicol

Social care nurse Will Nicol described a calmness before lockdown that changed as soon as the first Covid-19 outbreak happened in his workplace.

“It was pretty calm before lockdown – we heard of anecdotal cases here […] but you weren’t seeing it for yourself,” he recalled.

“There was a preconceived notion that it wasn’t going to hit us as hard as it did. Then when the lockdown hit and we had an outbreak very early on and that’s it, it really hit home.”

As a nurse specialising in dementia care, at a care home in a small town near Glasgow, Mr Nicol had a front-row seat to some of the darkest sights of 2020, as residents fell ill with a then-largely unknown illness.

“I remember thinking: ‘Oh my god, how are we going to deal with this?’,” Mr Nicol said.

There was a common understanding among staff that they would just have to make do until Covid-19 was better understood, he continued.

One particularly difficult memory for Mr Nicol was when a woman wanted to say goodbye to her father before his death, but he could only facilitate this through a phone call.

“When the call ended, I just sat in there listening to him breathe,” he added.

“That horrible, rattly Covid-chested breathing and coughing were the only noises in the room and I remember thinking, this is the hardest thing I’ve ever done as a nurse. Four years later, nothing’s come close to that.”

Mr Nicol described an almost omnipotence of Covid-19 in his life at that time: “We were living through it and then going home and seeing it all on the news.

“That anxiety never, and can never, really go away for me. Even now, when Covid comes up, the hairs on the back of my neck stand up.”

Even in rare moments of quiet in the care home, Mr Nicol said Covid-19 would not go away.

He recalled the atmosphere during breaks, when it was limited to two people in the room at once: “Normally […] you can chill out and you can decompress a little bit.

“You’d just normally chat about like, what you did at the weekend. Those conversations were gone because you didn’t do anything at the weekend, you just stayed in the house and watched the news.

“Your break was either you were sitting in the room, chatting to [a colleague] about trying to help them through the experience, or you were both trying to call your family.”

Reflecting, Mr Nicol said that the first lockdown was probably “traumatic” for all those working in health and social care and still affected him now.

“It’s not something that goes away very easily and there are times I pause and think about it, to consciously try and process and deal with it,” he said.

Emily Gilhespy

“Covid just upended everything,” said Emily Gilhespy, an intensive care nurse at a hospital trust in the North West of England at the time of the outbreak.

“The whole world, what you were used to, the environment in which you’re used to working, just completely changed when we had our first [Covid-19] patient.

“That, for me, was probably the most poignant memory more than the lockdown. That moment marked a significant change in our work environment and how we were going to be functioning in our lives for the next year or so.”

Ms Gilhespy said that, before long, nurses were struggling despite a public perception of them as invincible and infallible superheroes.

To challenge this, she photographed nurses on the frontline of the pandemic.

The project hoped to capture the emotions and reality of the toll Covid-19 had on them.

“A lot of media portrayals at the time about how nurses were operating on the frontlines of the pandemic felt a bit incongruous with the realities of it,” she said.

“They didn’t touch on the human aspects of the fact these were individuals expected to go into work to face incredibly difficult and challenging environments.”

Laura Fox

Laura Fox, a senior intensive care sister when Covid-19 hit, was one of the nurses Ms Gilhespy captured in her project in full personal protective equipment (PPE) during the height of the pandemic.

Speaking to Nursing Times now, Ms Fox compared the pandemic with a storm.

Just before cases ramped up in her hospital, she said there was an “eerie” calm in the large ward that had been cleared for the patients.

What followed was so intense that she could scarcely remember any exact details.

“It was a blur, it was all a blur,” she said. “It just happened […] and you think to yourself: ‘Did we really do that?’ It feels very surreal now. As though it never happened.”

Caty Hollis

Caty Hollis was bedbound with Covid-19 when the first lockdown began but was back at work as a nurse at Marie Curie Hospice, Bradford, not long afterwards.

She noted that the hospice was “so short” on staff but the worst change was the fact that visitors were no longer allowed.

She said: “The distress that caused to everyone was the main difference, apart from the practicality of wearing all the PPE and everything that entailed.”

These issues, Ms Hollis noted, meant staff felt communicating with people at the end of their lives was less personal and harder.

“The pandemic period was the hardest thing I’ve dealt with,” she said. “It’s not the nursing that was hard. It was the mental and emotional strain, it was the extra stuff.

“We’re used to dealing with people dying. It was the lack of contact with their loved ones. It’s still with me now. I can’t say how terrible it was.”

Marlene Johnson

“Whilst I was hoping [lockdown] would give us a breather, I don’t think it actually did,” said Marlene Johnson, who was, in 2020, the head of nursing for renal, haematology, oncology and palliative care at St George’s University Hospitals NHS Foundation Trust in South London.

She added: “Our hospital was frantic, we were moving people around wards, around departments. We were extending [the intensive care unit].

“Suddenly, we had to increase the capacity to be able to take our really sick patients.”

Ms Johnson said she was particularly worried about the potential of missed care for non-Covid-19 patients: “Our renal patients […] still needed that treatment, and we had to create a pathway for them so we could continue to dialyse them but also keep patients safe. We couldn’t turn them [away].”

She said patients with cancer, sickle cell and other long-term conditions were similarly impacted.

As a leader, Ms Johnson recalled having to juggle these concerns with firefighting in areas becoming overwhelmed. She was the bearer of bad news to some nurses, informing them they would be redeployed to areas outside of their specialty.

“There were times I was asking nurses to do things that I knew they weren’t happy or comfortable with,” she said.

She recalled having to tell nurses in non-Covid-19 wards they would not be supplied with full-body PPE, against their requests.

At other times, she had to tell nurses inexperienced with intensive care that they would be redeployed to those areas.

“I would come home sometimes feeling really quite burdened, quite burdened with information that I had to pass down,” said Ms Johnson.

As with other nurses in management positions, Ms Johnson said she tried to assist with lower level, hands-on clinical work where possible to alleviate her colleagues who were swamped and exhausted.

“There were times I was asking nurses to do things that I knew they weren’t happy or comfortable with”

Marlene Johnson

“I had to get up to speed with lots of things,” she recalled.

Ms Johnson said that the atmosphere on the ward was tense, but that everybody supported each other where they could.

For her, personally, Ms Johnson said faith helped keep her going: “It wasn’t necessarily everyone’s thing, but I knew at times I went to an area of the hospital with other nurses who had the same faith, and I’d ask: ‘Should we pray together?’.

“That was really well received by lots of staff […], to encourage and to strengthen each other.”

She added: “I remember being really touched once by a nurse who was from a completely different faith. He said: ‘Would you pray with me, Marlene?’

“I did and I thought, that was the measure of his faith and his fear, that he was willing to reach out to someone else in a different faith to pray with him.”

Nicole Lee

Nicole Lee, a nurse at Mid and South Essex NHS Foundation Trust at the time of the first lockdown, remembered being expected to do the impossible: training intensive care skills in redeployed nurses, which would normally take months or years, in a matter of days or weeks.

Ms Lee, whose normal role was burns clinical facilitator, also assisted in the set-up of the NHS Nightingale Hospital London at the ExCel centre.

She recalled being expected to do the impossible there, too: “The phrase ‘Can’t be done’ very quickly became ‘It can be done, what are we going to do about it?’.

“I learned some resilience I didn’t know I had.”

While the emergency period of Covid-19 has ended, Ms Lee noted ongoing pressures in the NHS and was also concerned about rising levels of abuse against nurses.

Jess Sainsbury

Jess Sainsbury, an adult and mental health nursing student at the University of Southampton at the time of the first lockdown, said she burst into tears when she heard that her cohort would be drafted in to help on the frontline.

She said the fear of the unknown – of what they were going into, about their registration – was what shocked her and others in the same position.

As then-chair of the Royal College of Nursing (RCN) students committee, Ms Sainsbury campaigned to ensure deployed students had some degree of say over where they went and what work they would be doing.

She, personally, was deployed into a mental health crisis team in Southampton.

“For a while, we felt we were anticipating what they called at the time the ‘second wave’ of Covid – the mental health wave where services would be overwhelmed in a few months’ time,” Ms Sainsbury said, recalling what work was like at the time.

She said that, amid the challenges, some positive changes to practice and working conditions happened out of necessity and stuck afterwards.

“Student advocacy and representation kind of happened in silos before”

Jess Sainsbury

Along with NHS England and the Florence Nightingale Foundation (FNF), Ms Sainsbury helped push for wider access to clinical supervision for nursing staff in her RCN role.

“We had been talking about clinical supervision for 30 years in nursing, so that was definitely a positive,” said Ms Sainsbury, who now works for FNF.

Student nurses also gained a stronger voice nationally, she noted.

“Student advocacy and representation kind of happened in silos before […], but what we had to do was reach the masses of the student body, so we all had to work together,” she said.

“It kind of brought those groups together. It also made [senior national nursing figures] listen to what the students were saying, that was a big positive.”

Lucy Jenkins

Former critical care matron Lucy Jenkins recalled her entire department at Homerton Healthcare NHS Foundation Trust, East London, cheering when a consultant announced that a lockdown was about to start.

Like many nurses across the country, however, she quickly noticed that lockdown was not an instant saving grace.

“We didn’t see the effects straight away and we were still getting overwhelmed,” she said.

“It was horrific and it ramped up in such a short moment of time. It was particularly frightening because, though wave one was shorter in length, there was the sheer unknown.

“Our [infection] numbers went from a couple to our wards being at full and quadruple capacity. People were dying, our colleagues were coming in sick.

“We were intubating colleagues on our unit.”

Ms Jenkins said she was “convinced” she was going to catch the disease and that it would kill her, and that her husband – a paramedic – shared the same fear.

That, combined with having no idea when it would all end, stuck with her throughout the emergency period.

She recalled something of a “Blitz spirit” between colleagues at the time.

“I don’t like this phrase, but it’s a good way to explain it,” she said.

“I’d walk through the staff room and see these junior nurses looking absolutely shell-shocked. But there was this overwhelming sense of duty”

Lucy Jenkins

“We had that, and people were very supportive.

“People would fall down emotionally, but others took it in turns […] to pick someone up.”

She recalled a “shell-shocked” look on her more junior colleagues’ faces at times during the emergency period.

“That is a distinct memory,” Ms Jenkins said.

“I’d walk through the staff room and see these junior nurses looking absolutely shell-shocked. But there was this overwhelming sense of duty and we needed to just do what we needed to do.”

However, she said there were “pockets of positivity” that came out of that time.

She remembered a junior nurse arriving to work upset about not finding basic groceries in the supermarket – but people began to drop items off for free in response.

Ms Jenkins said moments like that had a special place in her memory.

She added that the resilience shown by the health workforce and increased recognition for her speciality was a positive. “It put critical care on the map a bit,” she noted.