IN THE DÁIL this week, Labour leader Alan Kelly said that healthcare workers were facing into “a perfect storm” this winter.
His comments come amid concerns that the effect of Covid-19 will combine with the usual seasonal pressures to create an even more challenging scenario in Irish hospitals.
The HSE has said that there are currently “3,500 and rising” Covid-related staff absences from work, either from positive tests or close contacts.
The HSE’s chief clinical officer Dr Colm Henry says that the hospital system is currently able to cope with the “surge” in Covid cases but that the pressure on ICU is forcing the cancellation of some planned procedures.
Henry and other senior HSE management figures have praised the work of healthcare workers during the pandemic, with CEO Paul Reid saying this week that they have been “phenomenal throughout” .
As a result of the clear pressure the hospital system is under, we asked healthcare workers to get in contact to share their experiences of the pandemic and their concerns for the forthcoming months.
Here is what they told us.
One nurse speaks about the stress of dealing with dozens of patients.
“I’m a nurse with over 25 years experience on the frontline. The idea of a difficult winter looming is a myth, it’s unbearable all year around. Maybe when I was a student in the 90s the summers were considered lighter but not anymore. Staff are leaving constantly and none of the newly qualified nurses want to stay. The workload is impossible and overwhelming physically and mentally. There are people who work in lofty towers who criticise us when we don’t get our paperwork completed, yet they bailed on frontline work because they’re not able for it. Can you imagine how frustrating this is?
Last December, I worked a shift with 35 acutely ill and dependent patients with only one other qualified nurse. Our staff were either positive for Covid or a close contact. Our sick leave is never covered. Every hour another patient or staff member was coming back positive. I had chest pain from the stress and was out of breath from running around trying to cover all the work we had to do. I wanted to vomit when I got home. But the inevitability of another similar day tomorrow forces you to have a word with yourself and just do it.
“The demand from the public is extremely difficult to deal with. The ratio should be 1 nurse to 4-6 patients but we are dealing with one nurse to 12-17 patients. Imagine going into Tesco and the manager is behind the tills, stocking the shelves, answering emails/calls, ordering stock, sorting out staff duty and staff problems and still has to have time and patience to talk to people.
People say they can see you’re understaffed but that doesn’t stop the relentless and often unrealistic demands. If you ask most nurses, they will say the relatives add an awful lot of stress to their already stressful day.
“Where I work, there is often a mix of patients, medical and surgical. There are violent and disruptive patients. Vulnerable patients. Dying patients. Very acutely unwell patients who need ICU. Very confused patients. Psychiatric patients who need medical care so are not accepted to a psych unit. The shift starts at 7.30am and is due to finish at 8pm.
“We miss our breaks and still don’t finish on time. There is always something that will wake you up at 2am and you end up texting the night staff asking them to help you out even though they too are overworked.
“I have loved nursing since I started at age 19. It has brought so much to my life but at this stage of burnout, pain and anxiety, I have to admit I’m thinking of leaving. As heartbroken as I would be to do it. It is now 12 hours of torment.”
Another nurse speaks about the pressure on ICU beds.
“I am a staff nurse on a busy trauma ward. Our ward always had good levels of staff prior to Covid as it was a lovely place to work, we loved our job even though it was a busy ward to work on. As we stand now, we’re drowning. The nurses who have worked there for years are all burnt out and many have left in the past few months.
Their experience and knowledge is an indiscernible loss which is impossible to replace. The few of us that are left are being pulled weekly to cover other staffing holes throughout the hospital.
“The patients are getting sicker and more complex, patients who require HDU or ICU beds are being kept on the wards as there just are not any beds available for them. I have managed two patients in this situation over the past week, an impossible task when they require one-on-one nursing and you have a whole cohort of sick patients to help. It’s not sustainable and things are going to get a lot worse before they get better.”
The pressure to return to work after Covid is an issue that was raised.
“I work in a hospital in the south of the country. I am actually currently self-isolating because I am Covid positive. I unfortunately acquired it in the workplace along with a few other healthcare colleagues. One of the perks of the job I guess.”
There have always been hospital pressures and there always will be. I find it doesn’t matter how many beds a hospital has because it’s never enough. And the more beds hospitals get the demand goes up with it.
“I consider myself quite lucky that I haven’t caught Covid until now. Although I have to say I wouldn’t like it again. I’m suffering with severe headaches and nausea. On Saturday I could smell and taste very clearly. By Sunday morning I was unable to smell anything. I was lighting wax melts around the house to find something that I could smell but I got absolutely nothing.”
I am a bit apprehensive to return. Will I feel well enough to return? Or will I just have to suck it up and come in and help my colleagues. Staffing levels are at an all-time low. Outbreaks on wards are causing several healthcare workers to test positive for Covid causing a serious shortage. Putting those who are fit for work under more pressure and causing burnout. The regular reminder from patients that we as frontliners should be expecting a token of gratitude from the government for our sacrifices to me feels quite offensive. Maybe it’s just me but you cannot put a monetary value on the work we do.
“We deserve to be treated with respect and should be offered the help we need. We are no good to our families if we are burnt out. A little token of gratitude would be nice but at the end of the day it will never fix the big problem that we have. And that’s burnout.”
One healthcare worker writes about the fear of bringing Covid-19 home and infecting loved ones.
“Working face-to-face with new admissions of Covid patients and those admitted has been mentally and physically draining. This has resulted in healthcare workers contacting Covid while enduring the mental aspect of the pandemic which has induced fear and uncertainty for the future.
Going home drained and risking passing on the virus to your loved ones, which is dreadful for any single-parent or anyone who is in direct contact with patients. No counselling has been provided for the healthcare workers that were and are victims of the pandemic. Conditions continue to be stressful because we are put under pressure to return to work while coping with the after effects of post-Covid symptoms and stress.
“I myself have suffered severe anxiety, depression and other stress related problems yet I go to work with a smile while worrying about what winter will bring with the numbers going high again.”
A nurse says little has changed since the beginning of the pandemic.
“This last week has drained myself and my colleagues, we feel we have nothing left to give. We have had more outbreaks and now are changing back to a Covid ward.
We understand that the restrictions need to be lifted and this helps us not being so isolated but the staffing in the hospital is horrendous. We are just expected to keep getting on with it. We get no extra help, senior management make decisions and don’t even communicate to our line managers, we are losing amazing nurses. We have been forgotten about.
“Cancer surgeries cancelled, patients being rushed out of hospital today to prepare for Covid again. I am in nursing 17 years and exhaustion isn’t even the word, we are so scared for our patients, the healthcare system is on its knees.
“Honestly the lack of recognition for what we have done is more than hurtful. It’s 21 months later and for us nothing has moved on. We still are the last people to see a Covid patient take their last breath, we are still the ones telling bad news to family, we are still the ones putting our lives and our families at risk. Everyone has been affected by Covid but for us this hell continues and it’s breaking us.”
An ICU doctor who has worked in a number of hospitals during the pandemic seeks to explain the knock-on effects that one or two extra Covid patients in ICU can have.
“Hospital/ICU admissions don’t fully reflect the current state of affairs. ICU wards are typically not designed for numerous infectious patients. For example, my last hospital had a nine-bed ICU, with only two of these beds being ‘isolation’ beds. i.e. negative pressure rooms.
“Once there were more than Covid patients in that ICU, the entire unit had to be closed to non-Covid patients, and re-classified as a ‘Covid ICU’. But then where do the non-Covid ICU patients go? Usually to the High Dependency Unit, or the Post Anaesthetic Unit. These units are not designed to care for the needs of an ICU patient.
Additionally, to create space in these units, the knock-on effect is that other services in the hospital must be curtailed. Elective surgery, outpatient appointments and endoscopy are all cancelled. Besides the obvious impact on patient care, this also impacts on medical training with widespread difficulties reaching training targets reported.
“ICU has always been a busy and stressful specialty. A benefit of the early lockdowns was that non-Covid ICU admissions were at an all-time low. Nowadays, we’re contending with a rise in Covid patients as well as normal ICU admissions (car crashes, traumas, high risk surgeries, overdoses, organ failure, sepsis etc). Considering the relative lack of isolation beds, our resources are stretched extremely thin even though our Covid ICU stats aren’t as high as previous waves of the pandemic.
“I would ask readers to be conscious of the fact that it only takes 2-3 Covid patients in an ICU to start a domino effect resulting in the widespread cancellation of elective activity. This, all in a system with famously long waiting lists.”
Another nurse speaks about her belief that the profession is becoming less and less of an attractive option for young people.
“As of the 1 October 2021 a newly qualified nurse in Ireland earns a basic wage of €15.33 an hour, there is a notice in the window of my local McDonald’s recruiting for jobs paying up to €15 an hour.”
“To qualify as a nurse, one must complete a four year Bachelor of Science Degree, the sole specification for the job advertised by McDonald’s is that the applicant must be over 18 years of age. I’ve no doubt that the job in McDonald’s would be hard work, but are the employees risking their lives everyday? Are they carrying the stress that if they don’t pick up on something quick enough a person may die? Are they afraid that if they make one error they could be struck off the register and no longer have a career?”
I’m fascinated that the government still expects people to choose nursing as a career. I’m genuinely intrigued to see how they expect the health system to survive? Nurses on the ground are already hugely concerned by perpetual staff shortages. The youth are no longer choosing nursing as a career, and who could blame them.
“Overseas staff which we have traditionally leaned heavily on to fill the abundant vacancies are no longer choosing Ireland to start a career given the ever increasing cost of living. Nurses near retirement age are getting out as soon as they can afford to after the last two years.
Honest to God I’d love to know what the plan is? The healthcare system is imploding around us. Certainly from talking to fellow nurses across the country, pandemic aside, the undercurrent of dread of what’s to come is palpable amongst staff in hospitals nationwide.
Speaking during Thursday’s Covid-19 media briefing, HSE CEO Paul Reid said that the current rate of Covid-related absenteeism within the HSE was “3,500 and rising” and was “putting huge pressure” on staff within the system.
He said that staff have been “working relentlessly” throughout the pandemic and that their efforts “don’t go unnoticed any day by any of us in management in the HSE”.
During the briefing, The Journal asked Reid and the HSE’s chief operations officer Anne O’Connor what supports are in place for staff who have suffered mental health or other impacts as a result of burnout.
In response, Reid said:
We acknowledge the massive pressures that our teams have worked through, four waves, a cyber attack and they’ve been phenomenal throughout it all. We’ve been putting in a range of supports, all across the services. Employee assistance programme supports, mental health supports, physical well-being supports, mental well-being supports and that’s part of our ongoing supports throughout the system, and that is through the winter as well. We’re really conscious of the pressure levels, the anxiety levels that are in our teams and we want to acknowledge what they’ve done and we will provide all the reasonable levels of support that we can.
O’Connor also outlined supports that are in place and acknowledged that when it comes to frontline staff there “aren’t a lot of options” but for them to attend work.
“You may recall earlier in the pandemic we developed our psychosocial framework and part of that was about staff and we have an enhanced employee assistance programme. But there is no doubt that this is very difficult and winter will be very difficult and our staff are under huge pressure,” she said.
Unfortunately when it comes to clinical frontline staff, there aren’t a lot of options when it comes to needing that staff at work, so our priority is to try and ensure that we can support them. We have a range of initiatives there but it will be difficult.
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