Moral injury every day

Seeing people suffering from illness and injury in itself can be distressing enough, but that is the nature of nursing and part of its challenges. But every day I see more than that – I experience moral injury seeing people sitting in hard chairs in the waiting room for hours because there is no emergency department (ED) cubicle to make them comfortable. I see them lying in corridors with no privacy, waiting for a bed in the hospital that might yet be hours away. And I see them again when I come back in the next day, still in the same place.

Each moral injury chips away at my knowledge of what good and safe care is. The hospital is ‘full’ day after day. Safety is put at risk once the bed occupancy rate rises above 85%, according to the British Medical Association, but the NHS has been above this level for many years and some trusts are regularly above 95% in winter months.

For many, the pandemic was awful. I worked 60-plus hours per week during the early weeks of the first lockdown in the department ‘hot zone’, treating the sickest known or suspected COVID-19 patients in full personal protective equipment (PPE) for ten-hour stints.

I was unable to take off the PPE because there was no one to cover patient care (many of my colleagues caught COVID during wave one, and many were deemed at risk so not allowed to work in the ‘hot zone’), or not enough PPE to allow me the luxury of stepping out for a drink. That sort of effort takes a toll on the best of us.

Staffing has taken its toll too. We are more than 47,000 nurses short in England alone, according to data from NHS Digital, and there is no quick-fix because there is also a global nursing shortage. ‘The NHS and social care face the greatest workforce crisis in its history’ is the verdict of the House of Commons health and social care committee.

I did the unthinkable

I do not blame colleagues in my department or my NHS trust. They do what they can with what they have and are amazing for it. But, at 4.30am that Wednesday morning, thinking about the past ten years and wondering if I have it in me to carry on delivering care for another day, let alone another month or year, with no sign of improvement for months, it became clear. I don’t.

So I did what had, until then, been unthinkable. I admitted I must leave the role that I love, leave the department I have given my all to for 14 years, and in went my resignation.

Since then, I have received more than 250 comments from friends, family, colleagues and current and former nursing students, giving me their support. Even patients and relatives have commented on social media and in the local press expressing their concern for my well-being, thanking me for what I did for them.

Why did I tweet about it? Why did I give what was an emotionally challenging interview with BBC radio the next day? Why am I even writing this opinion piece? I’m not sure I know. Maybe it was that little voice needing to be heard? It is saying that emergency care is broken, and if I don’t do something, I will be too.