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We know the mental and emotional toll of the pandemic is starting to show- Natalie Greening

Updated: Nov 1, 2021

It is 3am. It is 28 degrees. The multitude of ventilators, haemofiltration machines and harsh lights have driven up the temperatures inside these walls. It is like an incinerator, except that the things inside are all fighting to survive.

Our goggles begin to mist at the edges, condensation from the heat and the beads of sweat that are making their way across the ridges of our brows. Our hands struggle against thick gloves, filling syringes with medicine that will keep you alive.

“I look up, and I see a sea of faceless bodies. Nurses, doctors with no face”

Keep your blood pressure up just enough to try and perfuse your organs. Fight against the huge pressures that the ventilator is creating inside your thoracic cavity, trying to squeeze enough oxygen in to your damaged, virus-ridden body.

I look up, and I see a sea of faceless bodies. Nurses, doctors with no face. Their masks and gowns and visors and hair caps, concealing all. And worse, still, I see a vast room full of patients with no face.

Every one, side by side, face down, prone. An indicator of their level of acuity, and their precarious existence. Somewhere between life and death.

We hear stories of husband and wife, ventilated side by side. We hear that the nurses pushed their beds together so that unconsciously, they could hold hands as treatment was withdrawn. Family call and our muffled voices reassure them through the phone, breathless with the effort of speaking in our masks. They hear monitor alarms in the background and a flurry of activity.

We are here together. But we are exhausted. And as we are confronted with the beginning of a second wave, we know that the mental and emotional toll of the pandemic is starting to show.

Statistics regarding the mental health of the profession were circulating long before Covid-19, with nurse suicide rates and absences due to mental health drawing attention to the critical need for intervention.

The current crisis should be of enormous concern, and we have both a moral responsibility and a duty of care to respond with a sense of urgency.

Heightened public awareness of mental and emotional health presents the opportunity to influence the way that this topic is both viewed and managed in future.

“We have both a moral responsibility and a duty of care to respond with a sense of urgency”

In the wake of the pandemic, as a profession, we collectively find ourselves with the capacity to determine the legacy we leave for the next generation.

As the largest workforce within the health service, nurses and midwives are fundamental in ensuring that services are available to operationally meet public demand.

The executive summary of the Stevenson-Farmer ‘Thriving at Work’ review of mental health emphasises that risks within nursing are far greater due to the nature of the role, defending the need for employers and government to recognise the human cost of poor mental health and the societal and economic impact of such.

The NHS long-term plan is reliant upon nurses being mentally fit and fully supported, and at present we are a workforce under major psychological strain.

The NHS is arguably the most valuable resource in the UK, with its greatest asset found in its staff. With this in mind, supporting the safety and wellbeing of this staff group should be synonymous with both preserving and safeguarding the health service and safeguarding the wellbeing of the wider public.

As we see senior nurse leaders take to the podium and share plans to prioritise the mental and emotional wellbeing of healthcare staff, we feel expectant, reassured. But now we must see them deliver.

We must see new structures to reach those in need and action in the form of resources and support for emergent nurse-led initiatives.

Who is better placed than nurses at ground level, to be the driving force for sustainable change and at the heart of influencing and implementing such?

While the pandemic has brought dire consequences for many aspects of daily life, it should be noted that times of crisis also breed innovation and resilience.

“Inaction would be to do the profession a great injustice and I believe we can and must choose to make a lasting difference”

United by an acute awareness of the increasing pressures facing the wider profession and advocating fundamental change in the way that mental health needs are met, we see several nurse-led projects rising from the ashes.

With a focus upon peer-support, organisations such as Nurse Lifeline remain unique in maintaining their by nurses, for nurses approach.

A peer to peer modelled service, while providing a safe space to decompress and offload, connected by a common experience and shared understanding, also generates the opportunity for staff empowerment and acquisition of skills that are transferable to clinical practice.

Evidence suggests that fostering a peer-supported culture within nursing has enormous benefits for the operational capacity of the profession both in the short and long-term. Unofficial high-level recommendations suggest that a service such as this could be a game-changer for both the profession and the wider health service, with similar models overseas having had an overwhelmingly positive impact.

We hear senior leadership voice that there is no stigma attached to staff seeking support, but we must find practical ways to overcome this barrier.

Could emerging nurse-led services be the answer and go beyond in serving as a catalyst to inspire long-term change?

The International Year of the Nurse and Midwife has not been the year that was anticipated. But we know that an alliance between senior leadership and nurses in practice through projects such as Nurse Lifeline will undeniably raise morale as we confront another challenging period, leaving an unwavering positive legacy far beyond the pandemic.

A one-size-fits-all approach will not suffice, and in isolation we can achieve little. However, the formation of partnerships which support in the operational delivery of mental health and wellbeing projects at ground level are essential.

Costs of absenteeism secondary to mental health issues and the detrimental economic and emotional effects of presenteeism as a result, far outweigh the resources required to develop a sustainable support service.

The CNO’s pledge of 15m to address the mental health needs of the nursing workforce has been encouraging.

We only hope that the voices of those who are risking both their physical and mental health, who perform their duties in full PPE, and who may lift their gaze at 3am to be met with a sea of faceless bodies, are heard, and their opinion is valued.

We have a choice. Inaction would be to do the profession a great injustice and I believe we can and must choose to make a lasting difference.

Natalie Greening, founder and chair, Nurse Lifeline


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