Our COVID experience - staff look back at last two years

REFLECTIONS ON A PANDEMIC

Hope and optimism replace dread and fear for 2022

2022 has brought fresh hope and optimism for the entire world. Plans can finally be made again, family hugged and friends visited. It has been a very long two years of the COVID-19 pandemic for everyone, not least our healthcare workers.

COVID-19 has changed so much about ourselves, our society and how we do things. For healthcare workers, these changes took place as the volume and complexity of their work rose expediently. From virtual appointments and video conferencing, to the embracing of countless digital innovations, healthcare in our hospitals and out in the community has been utterly transformed and done so while under the most severe pressure.

Staff from across the health service have shared with us some reflections of their life during COVID, how their job changed, how they coped with the worst of the pandemic, what they missed most during restrictions, and now. T he images of Bernie Waterhouse receiving her COVID-19 vaccine on December 29th 2020 was a welcome boost at the close of a horrific year for everyone.

Bernie, a Clinical Nurse Manager (CNM) in St James’ Hospital, became the first healthcare worker in the country to get a dose of the longawaited vaccine. More than two years later, she has reflected on the many changes that COVID-19 brought about in her work life, completely revolutionising the delivery of healthcare in Ireland.

“I got so much from our time dealing with COVID-19. It learned more than I did in any other stage of my career and I was so proud of all that we did. It has instilled in us such high-quality standards and patient-centred care,” she said.

“We did what we could to keep patients alive and get them back to their families. And we got great feedback from families who were so grateful to us so we knew we were doing the right things.”

As COVID-19 hit the country in March 2020, Bernie, who was a CNM on a surgical ward, volunteered to work on a COVID medical ward. For her, the first wave of COVID-19 was the most traumatic as staff on the frontline battled an unknown beast.

“It was really tough. The lack of PPE was the worst part at the start. By the second week, staff were dropping like flies and the anxiety around was huge. It was a very tough on everyone psychologically because of the very high death rates that we were experiencing on the ward,” she explained.

“The number of deaths we would see in a year on the surgical ward, we were getting in just one or two weeks. On one

day, we sent five people to the ICU and had two deaths. It was quite overwhelming. Patients were deteriorating so quickly. One lady was eating her lunch at 12pm and was dead by 2pm, completely without warning. And we were seeing that with both young and old people.”

Bernie, like every healthcare worker, was impacted greatly by the lack of touch and physical contact with her patients, particularly as they were dying.

“Patients weren’t able to see our faces and they weren’t able to hold our hands. It was just torture not being able to comfort them as they were so scared and anxious. Facial expressions and physical contact are so important in patient care and that was all taken away from us,” she said.

“We ended up getting lanyards made with photos of ourselves on it so that our patients would know what we looked like underneath all that PPE.”

She said lots of things changed by the time the following waves hit and, despite the volume of COVID-19 patients, the staff were much better equipped to handle it.

“It was all so scary at the beginning. Patients were dying alone because we were afraid to let family in. We just didn’t know if the PPE was going to be enough to protect them. But we have all learned so much about the virus and how to treat our patients. It has made life much simpler,” said Bernie.

The isolation was also a tough side effect of being on the COVID-19 frontline.

“I had one of my staff who was living with her parents and she isolated by herself for four months. The only social integration people were getting was at work.”

She credits her colleagues with helping to get her through the toughest of times during the pandemic, as well as a ‘phenomenal’ multidisciplinary team.

“Everyone showed so much kindness to each other. We were a strong, united team that proved very resilient throughout. The multidisciplinary team were phenomenal. They were so nice and so respectful of nursing. There was no hierarchy at all.”

Bernie said that there are many innovations in patient care that the entire team will be carrying forward.

“Our end-of-life care has been transformed for the better. We now have a Spotify account approved by the Foundation here and we can play a patient’s favourite music to them. One patient recently loved Andre Rieu and he actually passed away listening to him. We also have students in holding their hands while they are dying to help reassure them and keep them comforted,” she explained.

She said that the Hearts for Heroes initiative is another that the staff in St James’ are only too delighted to continue.

Early into the pandemic, the hospital was sent a box of knitted hearts by Angie Fennell, an outpatient of the hospital. Each heart had an identical match. When a patient was dying, a heart would be placed in their hand and a matching heart was given to their family. This gesture brought families closer to their loved ones when they were dying and could not be physically by their side.

“I had families on to me crying, they were just so touched by the gesture. And it helped them to feel closer to their loved one even though they couldn’t be with them as they passed.”

Changes to hospital visits have also been welcomed by Bernie.

“It was obviously tough that patients had no visitors but it’s difficult to think back to the days when we had maybe 50 visitors coming through, children and babies. There is no doubt that the routine ward visits pre-COVID definitely impeded our ability to do our work and mind our patients, never mind the infection control perspective,” said Bernie.

“We have set up visitor pods here outside the hospital to facilitate off-ward visits and I think that is a good way forward. I don’t think I would like the visits to go back to the way they were.”

She said she is happy to continue wearing masks on the wards and out and about in crowded settings.

“Staff definitely feel more protected wearing them and are more than happy to keep wearing them. We’ve seen fewer absences through other illnesses on the wards too.”

As restrictions are lifted, Bernie said she is looking forward to a lot of things.

“It is great to be able to finally meet people again. There are some that I haven’t seen since the beginning of COVID. Seeing people without their masks is also a lovely thing. I have worked with some people that I hadn’t seen out of their full PPE so being able to see their face was wonderful. I have a lot of babies in the family that I haven’t met yet because they were born during the pandemic so I can’t wait for that,” she said.

“It’s just great to be able to meet in bigger groups, go to restaurants and not have to plan everything that you do. I am also a big swimmer and used to go four times a week. I’m only back to it in the last month and it was brilliant. And, of course, holidays are back on the cards. It’s all feeling very hopeful.”

JOHN KELLY, DIRECTOR OF PASTORAL CARE, TALLAGHT UNIVERSITY HOSPITAL

How did your job change during COVID? The pandemic presented me in my role as a healthcare chaplain with new challenges and opportunities. The distressing realities challenged my own abilities and also highlighted the unique contribution of pastoral care in providing end of life care, care for patients and their families and my role in supporting staff. My job changed with the sheer number of COVID-19 related deaths over a period of months and unprecedented levels of physical, emotional and spiritual distress I experienced. Who or what got you through the hardest moments of COVID? Through the pandemic, I witnessed extraordinary teamwork within TUH. This is what kept me focused and energised through the hardest moments. We truly had each other’s backs and kept each other going. Through it all: love, death, fear, guilt, pride, hope, friendship, alienation, and so much sorrow they kept turning up for work and caring for their patients. While working through COVID-19 will always affect me as a person, I refuse to let it define me. I’d like to think it pushed me into wanting more for my patients and colleagues. Are there any changes that you have made in your work and home life during the pandemic that you will be happy to bring forward with you? From a work point there are three areas that are worth holding onto: 1) pandemicera safety precautions that will improve health and quality for vulnerable patients, 2) rest and quiet time for all patients, 3) the use of technology for work meetings will be something to embrace for the future. From a personal point of view, a quieter world along with more reflective days and breaks near the sea or countryside are a must. What did you miss the most during COVID? Throughout the pandemic I missed meeting friends, family and my visits to the swimming pool. I also missed my involvement with a number of organisations where I do some voluntary work. What are you most looking forward to doing as restrictions ease? I am looking forward to taking to the skies again as I feel I only get a break from work when I am out of the country. I am also looking forward to a ski holiday with lots of sun and snow.

SHARON FARRELL, HSELIVE MULTI-CHANNEL OPERATOR

What got you through the hardest moments of COVID? When COVID first came to light I was really frightened. It made me feel that there was a world war with an unseen army. I did not want to speak to close family about my fears as I did not want to worry them or add to their fears. I have a little Yorkshire terrier called Spartacus. I took to talking to him all the time just as if he was a person, he never disagreed or judged me on my fears or feelings. He just would look at me with these brown trusting eyes as if to say this too will pass. He kept me sane. Are there any changes that you have made in your work and home life during the pandemic that you will be happy to bring forward with you? I have found time for me. Certain things in life that I thought important were actually not and my priorities changed. I learned that in my home life everything did not have to be done today - it could wait until tomorrow. I found a calmer me. In my working life I learned that it was ok to step outside the box and not to be scared of taking on new roles. I worked in the same department for over 10 years. I now work in a new department in a completely different role and I have embraced the change and the challenge. What did you miss the most during COVID? Freedom and family. I missed my freedom to travel. I had so much planned for 2020 - I turned 50 that year. When the dreaded 5km lockdown came into place, this was my worst nightmare. I walked my 5k everyday but it was the same 5k. I felt like a gold fish in a bowl going round and around in a circle seeing the same thing. My daughter lives in Canada and I would visit her once a year. She struggled greatly because she was working from home and never got to see anyone. I could not be with her in person to give her a hug. We had many tearful phone calls but we started up the family group chat and we had a quiz night every Friday night. It was these nights that made up for the sad hard times. It was something to look forward to the end of a long week. What are you most looking forward to doing as restrictions ease? I’m looking forward to going to Canada to see my daughter. However, I have come to really like my current lifestyle the way it is. I’m more on the side of what it is I’m not looking forward to. I like my space. Before COVID, people would call in unexpectedly and I would drop what I was doing. After having time on my own I realised that this is not okay. The mask is a great thing - I did not have to slap on a full face of make-up just to go do a grocery shop. My skin is so fresh and clear and the saying ‘I’m having a bad hair day’ nearly became a thing of the past. Family became really close during the pandemic, sons and daughters had more time for their elderly parents even though at times the chat may have been over a fence or through a window. Neighbours once again started to look out for each other communities came together. I hope that this continues and that we don’t get caught up in the rat race once more. Maybe the Government could pick a weekend day in the summer time and we could all get together at a CCSP - COVID community summer party!

HELEN STOKES, GENERAL MANAGER, SELF ISOLATION FACILITY, CITYWEST HOTEL

How did your job change during COVID? I was asked to take minutes of the Management Group that was setting up the HSE COVID-19 Self-Isolation Facility on March 19th 2020 and as a result was asked to join the Team. This resulted in me being assigned as the Operations Manager for the Self-Isolation Facility. When the Project Manager finished up in June 2020, I was the head HSE Manager. We were a multidisciplinary team consisting of GPs, Director of Nursing, nursing staff, healthcare assistants, an admin team and the hotel staff, operating 24/7. Who or what got you through the hardest moments of COVID? Knowing that the Self-isolation Facility was making a difference in relation to the spread of COVID and we helped a high number of people to stay safe. As the surges happened we reached full occupancy quite quickly and had to manage the bed numbers very closely – literally counting available rooms on a whiteboard. When a resident was discharged their room had to be locked for over 24 hours to kill any virus before the staff could enter and turn around. We had to secure translators of many different languages and dialects for residents from Direct Provision. Sometimes we could have a family of five or six people, some positive, some close contacts, and some asymptomatic, and these were often with us for up to six weeks. Having young children being couped up for this length of time, we ensured we had toys, books, extra clothing and outdoor bits (footballs etc) so that they could entertain themselves. Are there any changes that you have made in your work and home life during the pandemic that you will be happy to bring forward with you? I have developed new skills in knowing how to multitask in a very efficient and fast way. I’ve also learned to deal with many diverse groups across the country and have developed a strong understanding of how people have to do without! I now also engage more with all the various staffing groups and have an ‘open door’ policy. Communication is very important. What did you miss the most during COVID? Being able to have some ‘down time’. I was always on call to deal with many different eventualities. I also missed not being able to see my daughter and grandchildren here in Dublin when the lockdown was very strict. The lack of interaction with other family members and friends was also very difficult. During this period my mother-in-law also went in to a Nursing Home and it was a very difficult period for all involved. My second daughter is in Australia and not being able to see her and family has been sad (Skype and Snapchat are great). What are you most looking forward to doing as restrictions ease? Being able to meet up with family and friends and do one-to-one, face-to-face catch-ups; being able to go to a restaurant for a meal and stay out after 8pm. I also plan to visit Australia to see my daughter who is expecting her third baby in May.

DR AUGUSTINE PEREIRA, CHIEF CLINICAL OFFICER AND RCFS WITH RESIDENTIAL CARE FACILITIES.

How did your job change during COVID? The PH role changed overnight in unimaginable ways. From a service largely unknown, to a service at the forefront of the pandemic response in Ireland. From a service that had the odd out of hours calls in a week to a service where the OOH doctors phone didn’t stop ringing. I remember the sleepless nights at the start of the pandemic and starkly remember taking the on call phone off a colleague who hadn’t slept a wink the previous night. What kept us going was the team support to each other. My own role changed in many ways during this time too. As Director of Public Health I scaled up the team in Cork and Kerry to respond to pandemic within weeks working with UCC PH team, health promotion and many CHO colleagues. From March 2020, I moved to some national roles- initially with contact management programme, then PH lead for test and trace working with all the 8 departments of Public Health and latterly clinical lead for HSE Live, the communications division of the HSE. Since October, at request of CCO, I have been at the PH Department in the North East, which had the highest burden of disease and was facing particular challenges including low staffing levels that needed strong leadership to address. Who or what got you through the hardest moments of COVID? The team. I saw such dedication, commitment and selfless service from my team, one which I am truly honoured to be leading. One phrase that rings in my ear is ‘Would you want me to cover this weekend?’’I think the RCFs need our support this weekend, so I shall keep an eye.’ So many times this was repeated ... They say when the going gets tough, the tough get going. Every so often, I have witnessed this to be the case in North East. It felt like there was nothing that could knock us down, wave after wave, we grew stronger. Are there any changes that you have made in your work and home life during the pandemic that you will be happy to bring forward with you? Since we scaled up the team to nearly four times the size since I joined North East or rather nearly 10 times when compared to core capacity pre Covid, we didn’t have office space. Many of our redeployed staff came from across the country, so we quickly adopted a remote working approach. We’ve mastered the art of being effective in our role working from home. A word of caution as we bring that learning into future- ‘work’ shouldn’t encroach into ‘life’, ie maintain the work life balance. What did you miss the most during COVID? My family. I used to travel every fortnight to my wife and son in England. The toughest part was being unable to see my young son grow up due to the travel restrictions and to explain why I couldn’t be there for him. My wife bore the brunt of the caring responsibilities juggling her clinical duties as a doctor on the frontline. What are you most looking forward to doing as restrictions ease? Visiting my family frequently and them being able to visit every half-term as in the past. At work, seeing the smiles on my colleagues’ unmasked faces!

BARBARA SLEVIN, ASSISTANT DIRECTOR OF NURSING, INFECTION PREVENTION & CONTROL AND CPE MANAGEMENTUL HOSPITALS GROUP

How did your job change during COVID? IPC was fundamental in leading and managing the COVID pandemic across ULHG from the early days in January 2020 and this lent to a greater awareness of our role. We up-scaled training for all multidisciplinary sta , including non-frontline healthcare workers. COVID-19 was a fast-moving, evolving situation with rapidly changing epidemiology globally. My role as Group ADON for IPC in ULHG, meant leading the nursing team and being adaptive to these changes in order to respond rapidly. This was especially challenging to maintain confidence among sta , one day we were recommending one thing and the next it was changed again. Often these changes led to stress among sta , increased re-training and education requirements, rewriting processes, and ensuring at all times that there was e ective communication to sta to keep them informed of changes to guidance and practices. Who or what got you through the hardest moments of COVID? The support of and working collaboratively with our wide multidisciplinary IPC team and other work colleagues made even the most di cult days possible. My family are centre to my world and the moments I could grab with them were precious and most important to me. Those moments sustained me over tough days. When it was possible, I swam in the sea and to me it was as if the sea washed away all the stresses of COVID, the perfect antidote. And not forgetting copious amounts of good co ee.

How did your job change during COVID? My job changed in vigilance and in following COVID policy. There were constant updates and policies regarding the pandemic. We had to wear PPE gear into houses at certain times, wear di erent masks, and there was also a shortage of sta at times when they were close contacts or had COVID. There was a generalised fear amongst the public and a few times clients refused me to visit. Staying vigilant for the public’s safety I did not socialise and maintained COVID restrictions personally and professionally. Who or what got you through the hardest moments of COVID? My family, especially my husband and two kids. I am blessed to have supportive friends and colleagues at the end of the phone. It became about the small things that you appreciated like a takeaway, glass of wine and a co ee with a friend (when we could). Are there any changes that you have made in your work and home life during the pandemic that you will be happy to bring forward with you? Despite COVID challenges, there were also some definite positives, great collaboration and multidisciplinary team working, and a fantastic surge in Infection Prevention and Control training and education. Sta now have a greater awareness and appreciation of the importance of infection control and hopefully these practices will remain interwoven when COVID activity has decreased and will lead to improvements in practices at clinical level. Many meetings took place via teleconference and teams which is LEAN and e cient and definitely the way forward. What did you miss the most during COVID? Jokingly, I could say I missed most of 2020 and 2021 as it was all work and all COVID! However, it was the simplest things - not being able to rush in and hug my family when I came in the door from work-and the fear of bringing COVID to anyone’s door. I really missed contact with my wider family and friends, we managed this via Zoom but it isn’t the same. I also missed many great opportunities to celebrate important family occasions but also not being physically present with people who needed some friendly support during these di cult times. I also feel saddened being unable to share in the tradition of funerals of special people that were lost during the pandemic. This is something we do very well collectively as a community and it felt almost alien being unable to do these rituals and traditions that we normally do so well in shouldering the grief of others. What are you most looking forward to doing as restrictions ease? Quite humbly it’s the simple things - hugs! Seeing people’s expressions, smiles and laughs. I am looking forward to creating new memories for my children that don’t involve COVID, masks, and COVID testing. My youngest doesn’t remember life pre-COVID. I am looking forward to a bright, wonderful, free and happy summer in 2022.

COURTNEY CHASE, PUBLIC HEALTH NURSE, CO MAYO

Are there any changes that you have made in your work and home life during the pandemic that you will be happy to bring forward with you? The realisation that anything can happen at any time even a pandemic!! Be grateful and have gratitude for who and what I have. Try to always have a work-life balance. Appreciate the small things. What did you miss the most during COVID? I missed socialising with friends and holidays and seeing my family who live abroad. What are the most looking forward to doing as restrictions ease? I am really looking forward to travelling again. I went to Florida at Christmas to visit my parents. Going to concerts and social gatherings again.

BERNI O’SULLIVAN, LEAD COORDINATOR FOR NORTH MAIN STREET VACCINATION CENTRE IN CORK

How did your job change during COVID? I worked in the ICU in Cork University Hospital for 30 years. I worked in the COVID ICU for the first year of COVID and it was certainly the worst year of my career. It was so sad and so horrible. I felt so bad for the young nurses who were starting off and wondering if things were always going to be so terrible. I was at rock bottom. But then last March, I moved to the new vaccination centre at Pairc Ui Chaoimh as a Lead. Within a month I was so re-energised. It was so fantastic seeing the hope that was around the place, watching the older generation coming in to us dressed up to the nines and with huge smiles. Who or what got you through the hardest moments of COVID? It was definitely my colleagues who got me through the worst days. All the staff at the ICU, not just the nurses, but the doctors, cleaners, porters, everyone had your back. They always recognised when you were at your lowest and would offer their support. Not being able to let families in to see loved ones was horrendous. After doing the video calls between the patient and their families, you were at rock bottom, it was a cruel thing. But the support from colleagues was overwhelming. And of course I have my brilliant family – my husband and two daughters have kept me going too. Are there any changes that you have made in your work and home life during the pandemic that you will be happy to bring forward with you? I didn’t make massive changes but I will definitely continue to wear a mask in a lot of situations to protect the people around me for the foreseeable future. What did you miss the most during COVID? The thing I missed most was family. I am one of eight in my family and I have three sisters that I am very close to. They are in Kilkenny, Galway and Longford so I didn’t get to see them and that was really hard. My daughter is a nurse in Liverpool and she wasn’t able to get home to us at all. It was so tough. What are you most looking forward to doing as restrictions ease? Like everyone, I am looking forward to travelling again. And getting to be with all my family again is a big one. It is great that my daughter can get home to us regularly now from Liverpool.

CHARLOTTE CARTER, CNM 2 ICU, CCU, PORTIUNCULA UNIVERSITY HOSPITAL

How did your job change during COVID? The main change in my role was having to take in to account the bigger picture more than I would have done previously. Due to the focus on ICU capacity within our own ICU as well as other Saolta group ICUs, I needed to ensure that we were able to facilitate all admissions safely which included accepting several patients from other hospitals who were experiencing capacity issues. I was also very conscious of ensuring that non-COVID patients had their needs met as for a while it felt that globally like COVID was the only focus. As well as this we had to implement a variation of new practices in to our department in a short period of time. As a result, ensuring my staff got the neccessary updates on practice, as we learned it from our European counterparts, without overwhelming the staff was a very delicate balance. Who or what got you through the hardest moments of COVID? The ICU team have been amazing. I feel so proud to manage my nursing staff who respect me with my decisions and who trust me for ensuring that the safety of the patients and staff will never be compromised. From a personal point of view, my family have always been incredibly supportive of my career and know how important it is to me, and without their understanding during such uncertain times it could have been so different. Are there any changes that you have made in your work and home lifeduring the pandemic that you will be happy to bring forward with you? At work, I am even more protective of the staff as I am so cautious of burnout and how it has all impacted them in their own lives. I make sure that they know I am there for them should they need anything and will do whatever I can to help them should they need it. As for home, it has made me think of how precious time is. My children are teenagers now who have missed out on two years of experiences which would shape them for the future. My focus now is to encourage them in to as many different things as I can to make sure they go forward in life not being afraid of trying new things and taking every opportunity that is presented to them. What did you miss the most during COVID? All my own family are all back in the UK, and I have not been able to visit for various reasons since COVID began. Before COVID I would could just hop on a plane for a few days, but the restrictions made this process much more complicated. Now that the restrictions are lifting, it will be on the top of my list to book a flight over! I love learning new things, so I am already on the look-out for short craft sessions such as pottery or jewellery making where I can learn new skills either by myself or with my boys. From a work point of view, we are all looking forward to organising a lunchtime get-together to catch up on all the missed conversations in the tea room!