In ‘normal times’, nurses’ accounts offer insights into how staffing and time pressures hamper the care of dying patients, – but in this extraordinarily challenging year, so many more issues have been added into the mix.

The term ‘barrier to care’ became literal this year, with universal use of personal protective equipment (PPE) now essential. This was singled out by 33% of the almost 900 survey respondents as the biggest factor getting in the way of care of dying patients.

This year’s survey has personal resonance for me because I lost my dad in April, at the height of the first wave. I recall a hospice nurse telling me that giving care from behind PPE was ‘just not how we do things’. And yet, somehow, this nurse managed to do an outstanding job of making dad as comfortable as possible.

In common with nurses in this survey, those caring for my father had to ask some painful questions of relatives – in our case, which of his four children would see him. I don’t know who this was more awful for, us or the staff.

Nurses who sat alone with patients with COVID-19 in their final hours told the survey they felt they absorbed the emotions of the death and had to shoulder that ‘huge responsibility’ on behalf of families. So as we contemplate the shifting phases of this pandemic, we must ask what can be done to protect nurses’ well-being.

In a welcome move, NHS England and Improvement has pledged rapid access for staff to mental health services. There are a number of national, local and virtual services specifically for nurses, which we will continue to promote via our free-to-access COVID-19 resource centre – look out for an article on this soon.

The ongoing challenges will mean staff must continue to draw on the support of colleagues and teams. As nurses know all too well, this comes at personal cost, which employers and governments must do all they can to minimise.

See analysis page 51, news page 7 and rcni.com/COVID-19