I find it hard to recall the names of my patients, but I am thankful I recall their faces. Recently, through the COVID-19 pandemic, these recollections are more chaotic than I have known them, which I attribute to patients being nursed so closely together by so many colleagues. One patient, however, stands as the clearest of my memories and my reflections on the extraordinary and humbling achievements of teams since meeting him are the reason for my writing.
Henry* was 32. I am 32. His flatmates were at home, suffering with milder symptoms, his parents lived abroad. Henry was ill for seven days before needing hospital treatment, then two more days before needing a ventilator, where I met him. I felt anxious for him: where usually we can predict recovery and understand if treatments are effective, this virus does not play by our rules. At the end of March, in a scary week of bad news, on an ever-busier unit in which we had ceased to ask “how will we do this?” (knowing instead that we would simply do all we could), Henry was liberated from his ventilator. I tried not to cry, knowing that it would steam up my visor and called his Mum to tell her the good news.
We had helped Henry: nurses, doctors, physiotherapists and many others. But in the context of an overstretched critical care unit, we had no choice than to be more than our name badge or registration implied. I delivered the necessary physiotherapy, but I also restocked trolleys of consumables, sourced additional pillows for proning and created a makeshift storage system to prevent nasogastric feed from spilling into the handover room. It doesn’t matter to the ICU patient whose job it is and when a critical care nurse is caring for 3 patients, it’s close to irrelevant. There were other things I could have done, but while I had the time to learn, I did not have the agency or permissions to acquire those skills.
More staff were enlisted, drawn from every corner of the healthcare system, but while fitting the clinical model I felt sorry for those who were “at-sea” in critical care.
“I’m a surge nurse and I usually work in sexual health, I don’t know how to suction.” He practically apologised for being there.
“Hello, my name is…I’m an HIV registrar and I haven’t been on ICU in 7 years.” She also wasn’t comfortable.
It was not the possession of a PIN, GMC number or HCPC registration that enabled the agile response of teams. It was a willingness to learn from each other and then to carefully to step outside role boundaries and do what was needed. Working alongside brave colleagues operating outside their comfort zone encouraged us to support each other and care for patients in ways not normally considered to be within our gift.
As a master craftsman is observed by and teaches an eager apprentice, there is an expectation that she too, will one day wield her tools with great skill. In critical care, I am watching masters work and I am learning, but I cannot take on their skills (or lighten their load) because my number cannot be found at the NMC or GMC. What’s more, there is no interprofessional education space in which to explore overlapping skill matrices and unearth new synergies to create more efficient clinical models.
Regulatory bodies and education systems exist to ensure that patients are surrounded by competent professionals, but the potential of our workforce is unduly limited by their territorial nature and siloed funding. Professional pride should be celebrated, pushing us to excel amongst peers but it gets in the way of sharing hard-won expertise.
The urgency of a pandemic offered almost no time for creative thinking but we now have a relative reprieve and so a chance to reconsider the limits of professional scope. Can we now create a space for interprofessional learning, where trust and respect are born and where clinical skills and clinical reasoning is shared between our brilliant professional tribes? Might this be key in mobilising a more efficient and agile workforce, better prepared for the next wave?
I’m praying that a second wave doesn’t come, but ahead of the next busy day on the unit, our patients will move us to re-examine our limitations, professional and otherwise. The boldness and adaptability of those I worked alongside during the COVID-19 peak was a product of the urgent needs of patients, pushing us beyond the comfort of our conventional roles. It is also a testament to our willingness to learn and adapt to that need. However, the boundaries of professional identity and tired clinical models confine the impact of our learning. We must re-assess the limitations they impose in light of what the future will require of us. We can identify those who are willing and well placed to learn new skills, but in order to unleash this agile workforce, our professional bodies, regulators and educators must loosen the chains.
*Name has been changed.
This blog was originally published in the Health Service Journal.