Hi, my name is James and I’m a registered mental health nurse. For the past year I’ve been working across three wards in an acute mental health setting just outside of London. Initially I was working on an all female ward, but the strain that Covid put on the NHS caused on resources and staff, forced us to reduce our capacity. As such we’ve now condensed to have two mixed gender wards.
In mental health nursing, one of the first concepts that we learn about is unconditional positive regard. Put simply, this is the belief that anyone is capable of positive change. Our patients frequently don’t see any light at the end of the tunnel, any hope that things could change for the better. Which is why it is so essential for Nursing Staff to keep this glimmer of hope alive for them when they aren’t capable of seeing or believing it for themselves.
Recent global events have made staying true to this value so much harder, for staff and patients alike. We’ve all faced disruption in some form or another, as staff we’ve been separated from the ward and teams that we know and trust. Our patients have endured further constriction in a setting that is already fraught with restriction. Visits by family’s and loved ones have only just begun to return for those unable to leave the ward due to their status under the mental health act. Even these visits are few and far between and heavily regulated. Any capacity for leniency or making exceptions has disappeared.
Life on the ward is very different now. Many workers deemed unessential, like activity staff, chaplains or even advocates are unable to come and visit, to break the monotony of life within a small ward. New patient are confined to their bedrooms for the first few days of their admission while staff wait for Covid results to come back. Most importantly, the staff members who are interacting with them in their time of crisis are often wearing face masks, losing the most important form of communication, facial expression.
Further to this, patients who are recovered to the point of being ready for discharge are faced with impossible choices to make. Housing associations and step down placements are at capacity, community services are severely limiting face to face visitations and family homes they could have returned to have become unviable due to loved ones shielding.
Our patients who experience psychosis or delusions of another nature have been influenced by the events unfolding on the television each day. Many tearful individuals have told me that they believe that they are to blame for the pandemic, and that the guilt is killing them. Similarly, patients with religious, conspiratorial or outright racist tendencies have openly expressed their support for the virus in the communal areas of the ward, claiming that it will purge the world of sin, or that this is the first step in an apocalyptic plan
So how do overstretched and under resourced staff members hold hope that their working conditions, and more importantly, their patients can improve now? It is entirely unclear when we will be able to get back to “business as usual” or whether what we considered to be normal will ever be a state we can return to. I wish there were easy answers to these questions. For their part, hospital management have attempted to be as transparent as possible about ongoing plans for the unit, and what support staff can expect to receive, but we are all aware that there is no magic wand to fix these problems. As would be expected, the already high turnover of staff has increased further, and long-time staff have elected to take an early retirement.
For my part, I have been truly inspired by the students who continue to come and work diligently on the ward in these difficult times, who continue to care and develop their skills despite not being paid to be here. Their courage and commitment gives me hope the next generation of nurses. As for the permanent members of nursing staff, it’s undeniable that a tole is being taken on us. The policies we work with change on what feels like a weekly basis, each time we enter the ward it feels as if we’re walking into the unknown and the inevitability of staff burnout feels close at hand. But through all of this, we have rallied together to take care of each other. No matter how overwhelmed we feel, we still turn up on time and leave our personal baggage at the door. We take the time to look after each other, whether that be a debrief after a bad shift, covering duties for each other to make time for our breaks or bringing in a coffee round and treats to share in the morning. No amount of pressure will stop us from trying to bring laughter, smiles and love onto our ward each day.
As hard as it gets I still hold on to my fundamental principle, my belief that all my patients are capable of making meaningful recoveries and improving their lot in life. This past year has made an already difficult job feel impossible to achieve, and while I’m still hopeful, achieving a good standard of care in services as they’re currently structured becomes harder and harder each day.