Caring for Nurses Through the Third Wave

The pandemic changed the trajectory of my nursing career. I had ‘risen through the ranks’ of a large private hospital group in South Africa for the 10 years preceding the pandemic and was based at the group’s corporate office. The pandemic resulted in almost instantaneous change and provided the most incredible challenges. In the first few months of 2020 I shifted gears into a supportive role, but the pandemic increased my yearning for actual patient contact and my need to make a difference where it mattered most. I wanted to do more with my knowledge and expertise. I volunteered to be redeployed to a hospital serving my community at the end of the first wave and stayed there till the end of the second wave. It felt like the best way of serving humanity and my colleagues.

I immersed myself in the messiness and excitement of dealing with a pandemic in a hospital setting – and I loved it! I was in the thick of it almost immediately – working with the team to stop a Covid outbreak amongst healthcare workers. I even took on the additional challenge of standing in for a unit manager of one of the Covid wards when she took ill. Every hour brought another challenge. It was scintillating.

Part of my key responsibilities was ensuring safe staffing for upcoming shifts in all the units. And when patient numbers surged and nursing shortages were critical, I would go home, get some decent food, take a shower, and then come back 2 hours later and work the night as a RN in the Covid ICU. I did this intermittently whenever there was an exacerbated staffing crisis in the Covid ICU, and it is the thing I am most proud of. I had not worked in the ICU for 15 years – the first time I did this I was so nervous. At the end of the shift, I was exhausted, but I was also euphoric because I had done something that was of genuine help and support to the people shouldering the burden of the pandemic. I now work as a relief/agency nurse in the Covid ICU as the third wave builds in South Africa to try and relieve some of the pressure.

We all want to hear that our efforts are enough and that we did not let people down. And it is easy to criticise with the benefit of hindsight. Healthcare in South Africa – with its intertwined and interdependent public and private sectors is a complex system.

One of the laws of Systems Thinking is that There is No Blame.

So according to Systems Thinking there is No Blame for not training sufficient nurses in the last two decades. There is No Blame that the profession struggles to attract younger generations. There is No Blame for the mass exodus of specialist nurses to first world countries that could pay them their worth when exchanged to ZAR. There is No Blame for the lack of distinction and remuneration for genuine nursing expertise.

But the people who must shoulder the implications of this complexity are nurses – and my biggest wish is that this is understood, and that healthcare organisations, government and society begin to truly value nurses and make genuine changes to alter the trajectory of an almost inevitable nursing crisis.

I am increasingly annoyed by the focus on resilience and self-care. As if resilience is a product of the individual and that the individual must work on their own resilience instead of designing a system to be more resilient. And the silent judgement of those nurses who are struggling and somehow “less resilient”. Nurses in in-hospital settings are taking on unsustainable workloads – and because of who they are and the professional oath they have taken, they will keep trying to cope.

And they will only stop when they breakdown physically or mentally.

My practical advice to fellow nurses is balancing your health and wellbeing with the wellbeing of a nation. I have seen too many strong, proud, and resilient nurses crumble under the weight of the physical and psychological burden they are carrying. And they are too tired to tell their own story. As an individual you cannot possibly compensate for the critical nursing shortages.

You can only do what you can do. Look after yourself. You are so precious. You are irreplaceable.

My appeal to those in hospital management positions - please stop thinking that nurses can be driven further to perform. Nurses are tired. Many are burnt out. Please stop thinking they can do all of what they currently do in addition to what was previously expected of them. It is not business as usual. Spend time on the floor – go into units and see what they are experiencing.

Speak with them – ask what constraints you can try and lighten and what barriers you can try and remove. Go be of genuine assistance. And above all show appreciation.