Our third interview with NHS workers about their situation during and after the lockdown.
Where do you work? What does your work and workplace look like?
I was a student nurse towards the end of my training and as such I was asked if I was willing to take part in an “extended placement” meaning I would stop most of my academic work and primarily be assessed on a longer than normal placement, up to 6 months. During this placement I was paid at a band 4 rate, normally student nurses work goes unpaid, and was counted in the numbers, normally student nurses are supernumerary but this is often a fiction.
I decided to take place in this for several reasons. One I wanted to finish my training and not doing this would only delay that, two I would get paid for what I was going to be doing anyway under normal circumstances and thirdly I wanted to help. It’s important to recognise though the additional pressure that was put onto student nurses to step up in this way, other students in other healthcare professions nearing the end of there training where given the option to do similar things but only student nurses, as I understand it, where in the position where if they didn’t it would delay qualifying. I know that for many of my course mates this was a very tough position to be put in, I had long talks with some of them about this risks taking part could put children and vulnerable family members in verses the finical problems not taking part and delaying qualifying would create. I think it’s clear this different treated of nursing students is connected to the fact that compared to other healthcare workers e.g. doctors and pharmacists, nurses tend to be women and working class.
I was placed in the Emergency Department of the hospital I had most of my practical training in, this is also the place I will be working when I start properly as a registered nurse. However for the first two weeks I worked in another area, a ward who’s staff had been first relocated and changed from a surgical ward to a COVID step down area, patients where also sent to us to die when it was judged to that ICU was not suitable but who couldn’t stay in ED any longer.
The ED had been completely reorganised taking over neighbouring parts of the hospital, which where in less use due to COVID, in order to create hot and cold version of each area e.g. minor injuries, majors, triage and rustication. Ironical this meant that the ED for the first time since it was built had the amount of room it need to function. It’s worth mentioning that my hospital is one the largest in the country and contains several specialist departments which means patients get sent here from out of area and it was based one co-workers estimates probably had significant amount of the hospitalised COVID patients in the country come through our door, due to proximity to a hotspot and ours been chosen as the hospital in out area most would be funnelled through. On a given shift there can be 30-40 nursing staff on shift, if staffing was good and most staff work 12.5 hour shifts.
What happened when the Covid-19 pandemic started becoming public knowledge? How did your co-workers talk about it? What did management do, health and safety or otherwise? Where people happy with that?
As a student I was only brought into the work force two week after things became serious but from what I was told by the my co-workers the first two weeks where chaotic and for many deeply upsetting. I was told about experienced nurses who had worked in in ED for years breaking into tears and fights with doctors over which patients where suitable for DNARs.
By the time I arrived things had calmed down and generally where working smoothly, mostly. My hospital generally had a good of PPE due to being on the largest, it got what it needed. One issue was that for an extended period we ran out of the necessary equipment to test respirator masks. Mostly the steps we took where things as healthcare professionals we’d have to do any way a lot the time, some parts also involved making sure patients where in the right area, hot or cold, which was not help by some forgetting to mention they’d had a dry cough for 3 days until they’d been in the cold area for 2 hours. We also had to stop family members coming in with a few exceptions which at times made our jobs harder and at time easier. Some things however felt like theatre such having to go to a different part of the hospital to socially distance for handover, when 5 minutes later we’d be on the shop floor where we can’t socially distance form each other or patients.
One point of difficulty was chest compressions, Public Health England’s guidance was that it wasn’t aerosol generating but the Resuscitation Council’s guidance was that it was. ED followed the Resuscitation Council’s guidance and the rest of the hospital went with Public Health England’s guidance. This meant that if a patient went into cardiac arrest if I wasn’t wearing a respirator mask all I could do was pulling the emergency bell and attach the defib pads. One hand I think this was the right decision but at the same time emotionally it didn’t feel right and because of the difference in what ED was doing and what the rest of the hospital was doing would the hospital have my back if I did that and patient died? Many of my co-workers expressed the same concerns to me.
What happened with the amount of work and the number of workers during the lockdown? Did you have more work to do? Did you have new tasks to do? Did management have a plan for this or did you have to improvise?
I’ll let you into a dark secret here at the start, at least once the initial chaos was over, the work load got lighter in terms of numbers of patients but at the same time more intense in terms of the care those patients needed. There area couple of reasons for this: firstly people where just scared to come into hospital and so lots of people that should have come to ED didn’t, a lot of them did turn up weeks later when it was to late for us to do anything about their stroke, MI or injury and some just died; secondly the people that needed some kind of medical attention but didn’t need to be in ED mostly stopped for a while, it’s important to note that many of these people present at ED because they don’t have accesses to any other healthcare services and due to the difficulty getting GP appointments during COVID I worry about the long term effects of this; thirdly less people where working or going out so less people where being injured; fourthly we finally had enough room due to taking over other sections of the hospital.
All this means that for the first time time since it opened the ED was operating at capacity rather over capacity. Also all the patients where ones that needed a higher level of attention, so work didn’t get easier but you didn’t have to keep track of 20 things just 10 but those 10 where often more intense.
What happened to the general conditions during the lockdown: wages, working times, shifts etc.?
They stayed similar to before shifts patterns where the same, working time where the same, pay remained the same, except for student nurse who where being paid for the first time. All holiday was cancelled at the start of lock down. A big difference was the reintroduction of the 4 hour rule e.g. all patients unless there’s a clinical reasons need to be moved within 4 hours or ED gets fined, this rule was removed because there where to many patients in ED and not enough room in the hospital for it to be possible until COVID most elective admissions.
Did relations between co-workers change during that time? The relationship with management? The relationship with customers, patients, other members of ‘the public’? If so, how?
Relations between stayed similar although we did become each others main social outlet besides the people we lived with, I know it help me deal with lock down. Relations with patients stayed similar although now we had to police there social distancing and mask usage. With regards the general public there was a lot of frustration towards people that where making our jobs hard by not taking social distancing and lock down seriously, I had a lot of conversation about the reasons people might not be able to and the factors such the governments weak response which would effect how people perceived lock down. A lot of us felt patronised by the clapping but we also enjoyed the takeaway people sent us, it made a shit night where several patients died or got harassed a lot better.
Did many people went off sick? If so, how did management react? How was work done with less staff?
A lot of people did, management expected it to happen and where generally able find people either internally or via agencies to fill the gaps.
What were the main conflicts during the lockdown? How were they solved or not?
There was disagreement about this and that new measure but the main things where pre-existing stuff. Frustration over shift patterns some people always working in one area, some of the “non-registered” staff not getting the specialist pay rate which would reflect what they do in ED.
Did the union play a role?
None that I saw.
What was better at work during the lockdown? What worse?
Less patients and often better staffing.
Worse not enough of some equipment for both the hot and cold areas this never coursed any problems but it easily could have. Needing to constantly take off and on PPE and although it’s not as bad as anti-mask people like to make out 12 hours in a mask and full PPE sucks.
Has the source of income of your household changed? Benefits? Other jobs? Other ways to make money?
I had a lot more money than normal several of housemates had less/none and some had the same as they could work form home. Overall it was okay as we could support each over.
How did your household cope with childcare during the school closure? Did family relations change?
There a no children in my household. I know it was a big issue for a some of my course mates.
Did you take part in or used mutual aid groups or other charities during lockdown? What about your workmates?
I took part in mutual aid at the start of lockdown but I quickly stopped having the time to play a big role in it. None of my co-workers to my knowledge used or took part in any but there was a stock of food an toiletries for people to take in the staff room.
Has management announced that certain changes will stay in place? What are they? How do workers think about this?
The ED is permanently expanding in size, people are generally happy about this but worried about staffing them long term and the distance they are form the main department.
Have there been job cuts or have new people been hired?
There’s always jobs in ED.
What do people discuss about the Covid-19 crisis? How do they see the government and the lockdown? What do they think about the future?
Generally people think the government fucked around and that lockdown should have started earlier. There often wasn’t a good connect between the governments failures and there frustrations with the public. Plus it generally didn’t develop into a clear vision of what would have been better.
Was there any discussion about ‘what is essential work’ and its position in society?
It felt like a joke we know we’re essential pay us better, get us the equipment we need not just for COVID but generally.
Do you think workers at your workplace come out of this stronger or weaker? As a group?
Hard to say I think its been bonding experience but also everyone is worn out and they where exhausted to start with.
Have you discussed the uprising in the US against police violence at work? What do people think?
People thought it made sense in the US even if they disagreed in the “violence” but had mixed understanding of the situation
Do you think the uprising has relevance for the situation in the UK? At your workplace?
Yes I have to deal with the police in work, often they’re the people that brining patients in the midsts of mental health crisis someone needs to be there when there’s a risk of violence the police only make things worse though and often in my view make what would have been a peaceful situation into an aggressive one. However sadly often my co-workers only see the end results and not how the police create it.