‘Success is not final. Failure is not fatal. It is the courage to carry on that counts.’
I recall with a great sense of clarity the first moments when coronavirus hit the headlines. As much as I hoped that it would amount to nothing, there was a part of me that diligently followed the World Health Organization's daily updates and epidemiology reports with concerning pessimism. It quickly transpired that the coronavirus was not merely one that would have minimal impact and carry on its jolly way. Sure enough, what started as an epidemic with pandemic potential soon evolved into a global pandemic that, as we now know, would change the world as we knew it.
Human beings, as a species, do not like change. We are creatures of habit and become increasingly unsettled when a stimulus (be it external or internal) jars with our status quo, our homeostatic balance, our equilibrium. That said, the riots and violent scuffles that played out in supermarkets throughout the UK were testament to our inability as a species to cope with a sudden disturbance to normative convention.
Despite there being no evidence of coronavirus causing illness that would prompt the need for a worrying amount of toilet roll, shelves quickly emptied and volatile scenes were witnessed in the aisles of stores the length and breadth of the country. These emotionally charged scenes evidenced our inability to cope. We could not, at that moment, slow the virus's progress. We could not stop it. We were not in control. As a result, people took charge of the situation in any way that they could and, in the form of bulk-buying toilet roll, found a way of regaining control. Fast forward just a few weeks and as people became accustomed to hearing about COVID-19 and as they got used to queuing outside supermarkets, maintaining a 2-metre distance, the shelves slowly refilled. Toilet roll was once again in ready supply. Violent scuffles had subsided. Why? Quite simply because we, as a species, had adapted. We learned a new status quo. Indeed, if one were to read the nation's response to COVID-19 alongside Elisabeth Kubler-Ross's change curve, it was clear how a forced detachment from a status quo resulted in resistance, exploration but then eventual acceptance of a new normal. A new way of living. A new modus operandi.
A call to action
Swansea University was swift to act. Monitoring the fluidity of the ever-evolving situation, the university made the decision to move to online learning and closed its university buildings. I'll not deny that this concerned me. The only time I had ever seen the like was as a child when snowstorms and blizzards forced closures of schools. While at the time this triggered a sense of excitement at an unexpected holiday filled with snow fights, sleds and frozen hands, closure of university buildings meant something quite different.
Sure enough, within weeks, the Nursing and Midwifery Council had liaised with higher education institutions throughout the UK, formed an emergency register and appealed for student nurses to opt in to COVID-19 clinical placements. As the Chief Medical Adviser to the Government, Chris Whitty, updated the country on a daily basis and as the death toll continued to rise, the Prime Minister pleaded with retired nurses, student nurses and nurses who had left the profession to return, opt-in and help the NHS. We were in the midst of a global pandemic and the NHS quickly felt the strain of the pandemic's burden.
Ironically, 2020 was meant to be the ‘Year of the Nurse’ and now more than ever was the country (and we as practitioners) going to realise what that truly meant.
Opting-in dilemma
When the email dropped into my inbox asking me to consider opting in to an elective, extended clinical placement, I felt conflicting emotions. As I said in my video diary, to consider anything other than opting in was not an option. I remember discussing the potential ramifications of the virus with Elaine Jones, my academic mentor, shortly before face-to-face teaching was disbanded.
I recall detailing to her how, if student nurses were sent into clinical practice, it would be an excellent learning opportunity to develop our skills. I was certain that Swansea University would not put us in danger. Now the COVID-19 placements have come to end, I stand by that assertion. I remember thinking to myself, ‘I am a future nurse. I have a professional responsibility and duty of care to my patients.’
I also realised, however, that I had a duty of responsibility to my family. Aside from being a student nurse, I am also a husband, a son, a brother and an uncle. I think my decision to opt in hit my husband, Pete, the hardest. Pete will not mind me sharing with you that he lives with anxiety and, in the run up to my placement, his shoulders weighed heavily with the countless ‘what ifs’ he had played over and over in his mind. Quite simply, Pete was worried that I would die in clinical practice and was scared that I would one day go to work and never come home.
As the news headlines began to report that nurses were dying on the ‘front line’, I received calls and messages from my mother and sister forbidding me to go into clinical practice. A part of me felt excited at the prospect of getting to witness, first hand, what nursing in a pandemic meant. A part of me felt selfish and guilty for wanting to opt in but a greater part of me knew that it was morally (and professionally) the right thing to do for me. I have spoken to Pete in the past about my desire to do humanitarian work as a nurse in the future and promised him that I would keep myself as safe as possible. This seemed to allay his fears and concerns. He was coming around to the idea and feeling increasingly reassured and comforted.
And then, Swansea University lost one of its nursing lecturers, Brian Mfula. For many of us, Brian's death hit home and made us understand the gravity of the situation, as well as the fragility of life. For many, Brian's death was the first personal link to coronavirus. It is no exaggeration when I say that Brian's death devastated me. Less than 2 weeks previously, he had taught us on Zoom and reassured students that the university would keep us as safe as possible. Brian was such a kind and generous man. I learned a great deal from him, and his death confirmed one thing: coronavirus spares no one. A few days later, I sat at my desk and wrote goodbye letters. You know, just in case.
The realities of clinical practice
Returning to clinical practice as a student nurse was a welcome reprieve from the monotony of lockdown. It allowed me the opportunity to feel useful again. It gave me purpose. Returning to practice also helped me rationalise what COVID-19 meant on the ground. In stark contrast to the emotive and sensationalised media reports, it was reassuring to witness, first hand, how the hospitals were coping and what coronavirus meant practically and logistically on a day-to-day basis.
The hospital had, seemingly overnight, altered and I remember thinking how the accident and emergency tent at the front of the hospital evoked in me wartime images of temporary Red Cross shelters helping the sick and injured in their hour of need. It made the Prime Minister's call for nurses even more chilling and I had images of him proclaiming to the nation, ‘Your NHS needs you’.
As far as my clinical placement was concerned, I could not have asked for a better team, environment or experience. Doctors, nurses, physiotherapists, healthcare support workers, domestic staff and even the patients themselves seemed to appreciate how we must be feeling and welcomed us with (socially distant) open arms. There was a great sense of camaraderie felt across the board and between disciplines. At times there was a very real sense of collective angst, but even this seemed to do nothing other than to bring the team closer together.
While I learned a great deal clinically and, without doubt, developed professionally as a nurse, my COVID-19 journey has been an overwhelmingly personal one. This journey has, I feel, impacted upon and enhanced my clinical and professional development, but it also allowed me the opportunity to grow emotionally. Enhanced infection control procedures can be taught and learned. Interventions and treatments can be taught and learned. What cannot be taught, though, is how we, as individuals, will react emotionally and physically to the unseen burden of a pandemic. I include my patients in this.
The fluidity and constant evolution of the virus meant that we were all learning about its impact at the same time. It was a learning curve for us all—nurses and patients—in the thick of it together. There were occasions when we simply did not have the answer to a patient's or relative's questions and, as I was quickly reminded, honesty and transparency were (as they always have been) the most reliable tools of our trade. Deep down, our patients or relatives have a greater respect for the nurse who admits that they do not have an answer right now but that they will endeavour to find out. If, of course, an answer exists.
Reflections
Since the beginning of my nurse training, I have kept a reflective journal. There is something rather cathartic about seeing, concretised on the page before me, thoughts and feelings that were, until that point in time, abstract, intangible emotions. Night after night, I would return home from placement and write. Some evenings I would write for hours in an almost desperate attempt to make sense of what I had witnessed, or what I had learned. In many respects, my journal became my therapist, my confidante, my non-judgemental sounding board of how I was coping.
In readiness for this final reflection I re-read my COVID entries. It was intriguing to note that a greater portion of them contemplate the human condition in the face of a pandemic—the thoughts, fears, hopes and sometimes despair of my patients and their relatives. My entries taught me about not just the ability to survive a clinical placement in a pandemic, but also how to survive, more profoundly, as a human being. There were family and friends who were not able to say goodbye. There were anxious relatives on the end of a phone wanting to see and touch their loved ones. Humanity had been deprived of the one thing that lies at its heart: the ability to make a connection with loved ones. Often, we were the bridge between the two. It was the responsibility of the frontline staff to allay fears and anxieties, reassure if possible, and keep those channels of communication open and hope alive.
I feel extremely proud and privileged to have been able to complete a clinical placement during the COVID-19 pandemic. It is no exaggeration to say that we have witnessed, first-hand, history in the making and it is a story we will tell for many years to come, if not for the rest of our lives. I would like to thank Swansea University for keeping us safe and Hywel Dda University Health Board for working tirelessly to ensure we had what we needed to do our jobs to the best of our ability. I would like to thank the people with whom I worked in unprecedented times and often in extremely pressured environments.
Finally, I would like to thank the patients, families and relatives with whom I journeyed along this path: thank you for entrusting me with your care and for teaching me so very much about what it means to be a nurse, but also what it means to be myself.