Access provided by
London Metropolitan University
Advice from senior nurses on preparing and assisting depleted staff to cope with the months ahead
Nursing staff across the UK are braced for many more months of relentless strain as COVID-19 cases surge once more. Exhausted staff welcomed a brief respite as the pandemic’s first wave eased towards the end of summer, but the let-up was short-lived.
Nursing Management. 27, 6, 8-9. doi: 10.7748/nm.27.6.8.s8
Published: 26 November 2020
With the second wave likely to be accompanied by the usual winter pressures, many nurses are already emotionally and physically spent. Senior nurses have spoken of fatigue and burnout among teams.
Buckinghamshire Healthcare NHS Trust chief nurse Karen Bonner acknowledges a dip in energy as tiredness has set in.
Central London Community Healthcare NHS Trust head of nursing Francis Fernando says many nurses are drained by firefighting and constant demand.
‘You can only be resilient for a certain time. At some stage our health and mental well-being will suffer.’
As he points out, having burnt-out staff is a threat to patient safety.
So how can nurse managers keep their teams motivated and safeguard nurses’ health as the crisis grinds on?
‘We created space to listen and gathered staff feedback to shape our plans for the next few months’
Karen Bonner
Many nurses and healthcare assistants have died as a result of COVID-19, and it has caused serious illness in many more. Staff therefore have real fears for their own safety and that of their families, and managers must acknowledge those fears, says matron Ali Low, of the Westminster Memorial Hospital in Shaftesbury, Dorset.
‘It’s important that they can voice their concerns,’ she says.
Ms Bonner agrees. ‘We created space to listen and gathered staff feedback to help shape our plans for the next few months.’
Mr Fernando says: ‘I would have conversations with nurses and support staff, listen to their concerns, understand where they’re coming from, help and support them, and empower them too.’
As well as informal discussions and team meetings, Mr Fernando suggests clinical supervision, Schwartz rounds and action learning sets should be used as forums for airing thoughts, ideas and concerns.
It’s important to mark the outstanding contribution of individuals and teams during the pandemic, says Canford Healthcare operations manager Caron Sanders-Crook.
Senior managers at Canford, a residential care provider, have used video recordings to express their thanks to staff who have gone above and beyond in their roles. ‘This has been really appreciated,’ says Ms Sanders-Crook.
‘Our chief executive and chief operating officer make welfare calls to home managers, some in person, restrictions permitting, and some via Microsoft Teams. We celebrate what’s working well in the homes and give praise at every opportunity.’
A month-long ‘positivity challenge’ that Canford homes took part in focused on positive thoughts and actions.
‘It’s important that matrons have an open-door policy,’ says Ms Low. ‘Each day before I leave I go round, say goodbye and ask if there are any problems.’
Mr Fernando adds: ‘As head of nursing I would be very visible, and also model the values and behaviours of the trust I’m working for.’
Ms Bonner says she is increasing her visibility at her trust, creating more time to hear from staff through forums and drop-in sessions. She is also encouraging other senior nurses to innovate in supporting and motivating staff.
‘Intensive care unit teams are developing a way to record how long staff are in full personal protective equipment and creating a flag system to identify when they require a break.’
Some staff, such as those from black and minority ethnic groups, may be more vulnerable than others to the threat of COVID-19.
‘We need to ensure that leaders allay any anxieties and concerns,’ says Mr Fernando.
Staff assessed as high-risk should be redeployed or shielded, he says. ‘It’s a nightmare for managers to back-fill the post, but our first priority is to protect the staff.’
This may mean encouraging nurses to take leave if they are at risk of burnout, he adds.
Reviewing work patterns can help identify opportunities for regular rest and breaks, Ms Bonner says.
Ms Sanders-Crook says her workplace has increased the number of admin staff to help with the management of COVID-19 testing.
‘That’s taken some of the workload off the main teams so they can concentrate on service delivery,’ she says.
The company’s marketing team has also increased the number of newsletters sent to residents, families and staff, and the human resources department has clarified for staff what payment schemes are available to support them during the pandemic.
Small, practical steps such as ensuring staff take meal breaks can help them through difficult shifts, says Mr Fernando.
In his previous role as a clinical matron, that often meant stepping in for half an hour and taking over from a nurse who hadn’t had a break.
Nurse managers can’t be expected to be the only ones their teams rely on to get them through the crisis.
Occupational health, psychology support, wobble rooms and trust counselling teams are among the resources there to help. There is also a wide range of resources available via the NHS People website, including a guide on supporting others in difficult times.
Mr Fernando says: ‘I encourage staff to link up with support networks within their trust as a safe space for them to express any frustrations, anger and anything they want to discuss.’
Think about how to steer people to sources of help, Ms Low suggests. For example, many nurses have partners who have lost jobs or been furloughed and directing them to financial support and advice can ease concerns. Consider printing and displaying relevant information for the benefit of those with little time to access emails.
Accountability and responsibility can be exhausting and knowing when and how to switch off is challenging.
Ms Low admits that even when off duty she checks in via her laptop so that when she goes to work the next day she’s aware of what’s waiting for her.
For Mr Fernando, self-compassion is important and making sure life and work are balanced. He tries to model the values he expects of others – seeking support as required, for example, and ensuring he has adequate breaks and rest. Try to keep in mind managers and their staff require the same things, he says.
Ms Sanders-Crook uses meditation to unwind, while care home residents and a supportive team help her maintain her drive.
‘Speaking with residents and hearing that they feel well looked after and safe, and they are still smiling in the face of adversity, motivates me and keeps me grounded.’
Ms Bonner also meditates and uses long cycle rides to switch off. Caring motivates her, as does making sure her nurses are looked after so they can give the best care.
‘My staff motivate me too. They continue to make me proud as we provide care in an ever-changing environment.’
