Nursing in a pandemic, suddenly finding yourself on a pedestal, and life in a Nightingale hospital with Dorcas Boamah
Illustration by Sarah Harvey. This is Dorcas on her first day at the Nightingale, London – the marks on Dorcas’ face are from her PPE.
I’m not good at thinking on the spot. I like to consider everything that could possibly go wrong for a very long time before doing anything ‘big’. However, this year, I’m getting faster. I’m trusting my instincts, and committing to things.
I don’t think it’s just me. This year, I’ve seen people come to rapid conclusions over questions they’d been grappling for a long time. Stay or go? Buy or sell? Have a baby, don’t have a baby? They’ve decided. And what’s more, they seem confident in their decisions.
Maybe living in sudden, unforeseen circumstances – like a pandemic – can have the effect of making your values, what you really want, clear. That knowledge was probably there all along – but with the comfortable padding of predictable, everyday life stripped away, the bones of the matter emerge.
Dorcas Boamah is the second nurse I interviewed this summer. She volunteered to work in the NHS’s temporary Nightingale hospitals, which are dedicated to treating COVID-19, after watching a news item about it on TV.
As you’ll see, what seemed like an impulsive decision was actually one underpinned by her longstanding beliefs about what being a nurse means to her. I also learnt about what some of British Airways’ pilots and cabin crew have been getting up to while all the flights have been grounded…
“ Just seeing the vast amounts of patients that you’re seeing, you can feel really overwhelmed. Especially when you can relate to them. ”
Dorcas is a clinical nurse at the Royal Free Hospital in London, where she specialises in intestinal and nutrition issues. This year she volunteered to work at the temporary Nightingale Hospital in East London. This meant isolating herself for over six weeks from her family, living in a hotel, and working in a field hospital that is usually a conference centre.
Olivia Gagan: When did coronavirus first enter your consciousness? When did you first become aware of it at work?
Dorcas Boamah: February. Before February, everyone was just living their life. I was going to work eight 'til six, nine 'til five. At work we have something called the 'ground round', which is basically when people meet, and talk about current issues. So we were talking about what COVID-19 is, and how it could affect people. A few weeks down the line, we were in lockdown. It was mad.
Olivia: So it hit, and you ended up working at the Nightingale Hospital in East London for six weeks. How did that happen?
Dorcas: Initially, I heard the whole initiative on telly – I think it was on Channel 4. They were talking about these makeshift hospitals they were building to relieve some of the pressure from hospitals. And I was like, this seems like the sensible thing to do – a place where everyone will be in the same boat. But I was also thinking, I will be protected at the Nightingale. I will have the right PPE. Because in the sight of the media, they will have to do things right there.
Olivia: Because a lot of hospital workers have not had the right PPE for this.
Dorcas: Oh, yeah. Before I went to the Nightingale, I literally just had a surgical mask for treating a COVID-positive patient. No visors whatsoever. No one really knew what they were doing. Everyone was just doing your best. You would feel very unsafe.
When I saw the news, my manager was off sick, so I went to her manager and said, “Hey, I saw this thing on the news. If you have any emails about people stepping up, I'm really, really keen. I want to go.”
Olivia: And it happened – they placed you there. It sounds good on paper – ‘I'll get the right PPE, I'll have a place to stay where I'm protected, and my family is protected from me,’ that all makes sense. But on a personal level, it must be tough completely distancing yourself from your family. How did it feel deciding to go?
Dorcas: I called a couple of friends who were like, what are you doing Dorcas? My brother's fiancée was saying, please, please don't go. And I said, I can't. You can't be a nurse and not step up. It's like being in the army and there's a war, and saying I don't want to fight. And wherever I go as a nurse, I will be surrounded by COVID-19. This is our new normal now. I was hoping would be protected – using the war analogy, you wouldn’t send someone to war without the right equipment. But it wasn't an easy choice at all.
I remember leaving home and I was crying. There's been a lot of sadness with not seeing my family, but also real fear about the unexpected, and what I was actually going to experience. I also felt fear of not being able to be in the right community – in the sense of not being able to build friendships or having someone there to talk to.
Olivia: The whole nature of the Nightingales, where staff are being pulled in from hospitals all over the place, means you likely won't know each other. Is a bit like the first day of school – thinking ‘who are all these people, and are we going to connect?’
Dorcas: Yeah, exactly. ‘Can I be vulnerable with them?’ Especially when your emotions are all over the place.
Olivia: How do you connect with someone else when you are just coated in PPE? When you work right now, you're wearing a visor, you're wearing a mask, you're literally covered in plastic. I imagine all the usual ways you build empathy and communicate with someone – your eyes, your voice, touch – they've all gone out the window. Have you changed the way you communicate to mitigate that?
Dorcas: For sure. I would say a lot of nurses are really good communicators anyway. Especially when communicating with an unconscious patient – I think it's all about compassionate care, isn't it? When I’m on the ward, for example, and someone has passed away, I’m still talking to the person. I guess a lot of us are used to doing that – talking to someone who is not ‘there’ – whether they’re unconscious, or have passed away. I think a lot of nurses just find it easy.
I had never worked in an ICU (intensive care unit) setting, but whether unconscious or not you give them the respect needed. It’s part of holistic care.
Olivia: When you have patients that are still conscious, how did you change the way you communicate with them? You've said you and the other staff have to shout at each other sometimes to hear each other from under your PPE. How do you make someone feel cared for, when a nurse could look quite intimidating if you're covered in a visor and under gowns and masks, and they can't hear your voice very well?
Dorcas: The thing with a lot of Covid-19 patients, is that they’re intubated [where a person is fitted with a breathing tube and is placed on a ventilator, so they can’t speak]. But even though they are intubated, they may be able to hear you. Some can still feel touch. So even though it was a loud place, and sometimes you can't hear each other, I was tactile. I made sure if I was talking to them, I touched them, just so they knew I was there. I think communication in an environment like that is really difficult, but I did use a lot of physical touch. Hands on the shoulder mainly.
It’s difficult – if that person normally doesn't like those things, I would never know. But I'm sure if you're in a situation like that, you would want touch as like a reassurance thing, so you know you're not alone, that there's someone there. Using a really still voice helps. And being close, near their upper torso and just talking to them. Stroking someone’s hair when they’re distressed can help relax them. It’s about providing that reassurance they’re not alone.
But when you leave and you're walking home, and you reflect on what happened in the day, you are quite saddened by what you’ve seen and what is going on around you.
Olivia: Did you feel there was more concern about staff wellbeing at the Nightingale than is usual?
Dorcas: In nursing, there's something called 'donning on'. It’s the idea that when you put on your nurse’s uniform and your PPE, you are taking on a role – you basically change into a nurse, because you've just ‘donned on’. And then there’s ‘doffing off’ uniform – where you're releasing, you're taking all that stuff off basically. So, there was a lot of conversation about how when you don on – when you take on the persona of a nurse – it's really important to check within yourself.
Actually, how am I feeling today? Am I really up for looking after that patient? How are my emotions? Do I need time out? Then with the concept of doffing off, you’re thinking about how you’re feeling after being in that place. Have you seen something that you need to talk to someone about?
I think it's a good concept to use, because a lot of nurses, we can tend to be robots. You go in and you go out, and you don't check your inner feelings. There were days where I needed a timeout. I needed to get out of the unit and I was confident enough to just be like, actually, you know what, I need some space. It was OK for me to take about an hour out.
You can get really overwhelmed by everything. Just seeing the vast amounts of patients that you’re seeing, you can feel really overwhelmed. Especially when you can relate to them. A lot of the patients were from an ethnic minority. I am seeing a lot of people from Asian and Black communities. Being a Black woman, I could relate, especially when the statistics are all against us. I think the thing that really made me realise this was my second week. I saw forty patients at that time. Just two were from a white, Caucasian background. And I was like, oh my days. This could be me. This could be my dad. You do have that fear, but then you bounce back and I think nope, I'm here for a reason. I just need to do my bit, you know, come in, do my bit and leave. I could never sit at home and not help.
Olivia: But that comes with a cost, right? You must be so wired after a shift. ‘Cause you've input so much information. You've had to deal with so much. This sounds like a really cheesy question – but how do you unwind after a long day at work? How do you disperse that level of adrenaline?
Dorcas: You don't. I don't think you can. On Nightingale shifts, before I slept, I would be awake for a long time just because I still had adrenaline going. It felt like I was always on. Maybe I could fall asleep at like 2AM, but then I have to wake up at 6AM if I'm working the next day. On my days off I’d go for long walks and sometimes I used music as therapy, to relax me.
Olivia: In the press, the Nightingales get described as field hospitals – which is a war or a temporary hospital. Working in that kind of hospital environment, the purpose of it is different to a normal hospital. The layout is different. It's all being done on the fly. How does the lack of structure and predictability affect how everyone works together? What happened to the traditional work hierarchies? Did they stay in place?
Dorcas: A lot of the hierarchy was flat. Well, it was to begin with. Obviously, you know who the consultant is, you know who the matrons are, but the mutual respect was really flat. There was no, "I'm the matron: you need to do this." Which I totally loved. But once people started to feel stress, you could see hierarchies start to form again. People were so stressed that they needed to put their feet down.
But I would say it is one of the best hospitals I've ever worked in, in terms of the relationships that I built. I wasn't my normal Band 7 nurse there [OG: nurses are graded and paid in bands, with ‘Band 1’ being the lowest, and Band 9 the highest grade). I was a baby nurse again. Who basically knew nothing. We were all like that. So because of all the uncertainty and everyone being from different hospitals, everyone was so lovely. I had never experienced this amount of care towards each other because in hospitals, people can be unreasonable, I tell you!
Olivia: What do you think caused that? Do you think it was like this sort of wartime spirit of like, ‘We're all in this together. We all have to go through this’ kind of thing.
Dorcas: Yeah, I think so. I think there's an attitude of, ‘We all have to pull together. No one knows what they're doing, but we're gonna do this.’ I think it was that behaviour. Actually prioritising being supportive of each other, because everyone is feeling the stress. Everyone looked after each other really, really well, to be honest.
Olivia: Do you think there are lessons that can be learned from that, from the Nightingale and that experience that could be applied to nursing going forward?
Dorcas: Definitely. I gave a little feedback with my team when I got back to my normal job. I was just talking about how, before COVID-19, staff wellbeing services weren’t really publicised in the hospital. If I wanted to know who to go to for help, I wouldn't know. Now that obviously COVID-19 is here, and we're all still in it, we're talking about it more. At the moment though, a lot of the talk is around mental health apps for support, because no one is really available to talk to. Whereas at the Nightingale, you could actually go and talk to someone face to face.
Olivia: Like a counsellor, or a therapist?
Dorcas: No, we had volunteers from British Airways – the pilots and the cabin crews. They were there if you wanted a chat. They didn't need to have a response or the answers. They just needed to listen. Because you know, they're not going to have the answers to all of this, to be honest. None of us do. We had St John's Ambulance on site if we felt physically sick, but the emotional side of things, it's about being able to just vent what you needed to, and having someone just actively listening. You could just dump this emotion.
And then separately, the hierarchy in a hospital is really clear and sometimes a bit too much, to be honest. Maybe to make it better as a workplace, people need to be really open and welcoming, and not just put on that armour of, ‘I'm the corporate manager’, or ‘I'm the matron’. I don't know how that could change, because it's been the structure of the NHS for years. Maybe the people in the higher positions could be a bit more friendly. Some of them are. But I guess also, they're human, and stress affects them too. Do they have someone that they can talk to?
Olivia: It sounds like stress and adrenaline are impacting everyone within the NHS at the moment.
Dorcas: Yes, and being tired. And when you're tired, you start destructive behaviours and coping mechanisms. I remember when I was in the Nightingale, I felt tired all the time. I was always...I wouldn't say ‘on edge’, but I was quite emotional, because you know, you've seen a lot. So you go into your coping mechanisms, like eating junk food every day, that kind of thing. That might be just being snappy with someone. Or not talking to people, or just going to bed and crying.
Olivia: Which long term, is no way to live.
Dorcas: Definitely not. So when I came back home from the Nightingale, I booked myself into a retreat centre. I went away for three or four days by myself, just to reflect, just to dump all this emotion. And I was able to come back and just go back to my normal job. If I hadn’t done that, I'm not sure how I would have been able to go back to my normal job and behave like nothing happened.
Olivia: Maybe it created like a bridge between the two, just a bit of space in between.
Dorcas: Yeah. I've got some of the girls’ numbers [who I was working with at the Nightingale] and I've been checking up on them.
Olivia: The perception of NHS workers in the media has just exploded. I feel like nursing as a profession has gone from being something people really weren't that interested in, to suddenly, you know, there was clapping for carers, there are ‘Thank you NHS’ adverts everywhere. How has it been to experience that as someone on the inside, suddenly having this newfound level of interest and respect in what you do? Has that been weird, or has it been appreciated?
Dorcas: My emotions have been up and down about it. Before COVID-19 happened, on the news they were talking about unskilled workers, and nursing was named as a part of that [OG note: This is evolving, but from 2021 anyone who earns under £25,600 and does not have an education to the equivalent of A Levels could be classed as ‘unskilled’ under UK immigration and employment law. Some healthcare workers will be classed as unskilled].
That was just a couple of weeks before COVID-19. And now it's like, you want to put us on this pedestal? Calling us ‘heroes’? Personally, to start with, I was quite annoyed. I was thinking, all the health professionals, we've all been working really, really hard. And no one really paid any notice of it, to be honest.
Olivia: I think calling someone a 'hero’ can be quite isolating and dehumanising as well. You shouldn't be expected to take on the mantle of being able to save the world and do extraordinary things all the time.
Dorcas: By calling someone a hero, you're made to feel like you need to really step up – because if people are calling you a hero, then you can't fail. It's not a great word to use, to be honest.
I guess initially, a lot of NHS people, we were quite annoyed by the lack of recognition until COVID-19 happened. Does it have to take something life-threatening like this to recognise the jobs that people do, and give them praise?
But – it has been nice to feel very appreciated. Now, if I tell people that I'm a nurse, they're like, "Oh my gosh, well done!" I never used to have that. Even among my own family. My mother always was proud, obviously, she's my number one fan. But my siblings all went into finance and corporate roles. My brother, who never really shares anything on Instagram, is now sharing pictures of me, telling everyone "my sister is a nurse!"
Olivia: In terms of your experiences over the past six months, what have you learned about what humans need to feel cared for?
Dorcas: The great response you can get through physical touch. When you touch an unconscious patient sometimes, and they move their head or something, you know they can actually feel you.
I've always used compassionate care towards patients, but with COVID-19, there's been a lot of focus on families, too, because it's not typical that you can't visit someone in hospital. I’ve realised the background work with families, to reassure them and give them that support that they need is really important.
Olivia: I guess good communication is a massive part of holistic care, isn't it? You can bandage someone up, but if you're not telling them what's happening, or you're not telling their family what's happening and why, there's a big opportunity missed to care for people in a different way.
Dorcas: Exactly. For families, who are at home feeling super anxious, super scared, who is going to reassure them? Families can call [the ward], but if you’re wearing PPE, you can't really be patching phones and whatnot. That communication is really broken at the moment. So I think the importance of communication has been a really, really big thing.