Emergency Department staff take solace in ‘Coffee and Vent’ sessions at Devon hospital

Dr Annette Rickard, Consultant in Emergency Medicine

When the global pandemic hit the UK, NHS emergency teams knew their challenging jobs were about to get harder.

Staff that work in the Emergency Department at University Hospitals Plymouth NHS Trust (UHP) are no strangers to working in a high-pressure environment.

As the largest acute hospital and major trauma centre for the South West Peninsula, they could anticipate what was coming. For many clinicians across the UK this was a terrifying time.

“The problem was perceived before it had really hit us. We know emergency medicine is hard at the front door.”

The Trust’s Clinical Psychologists, Counsellors, Occupational Health and Organisational Development teams came together to help. They wanted to provide psychological and practical support to those experiencing difficulty or mental health crises.

mug of black coffee on wooden table

There was also a need for early intervention to protect the workforce from psychological distress and the potential for sickness absence that could put further pressure on the service.

From the resulting multi-pronged strategy, one of the projects implemented was a safe space for colleagues to talk.

Dr Annette Rickard, Consultant in Emergency Medicine at UHP said that in normal times, she would be able to invite close colleagues who were struggling for a coffee and chat. As Covid-19 made that impossible, she set up a virtual space to talk, in an informal setting. The virtual ‘Coffee and Vent’ sessions were launched.

Annette said: “The problem was perceived before it had really hit us. We know emergency medicine is hard at the front door. We know that frontline staff are at risk from burnout and PTSD. My first job was to publicise the virtual invitation into my space for a cup of tea and chat.”

The resulting conversations were a great success. 20, one hour-long Coffee and Vent sessions took place between March and October 2020, with varying numbers of attendees from just five people, up to 20 participants.

Helping to facilitate the safe discussion was Staff Counsellor Natalie Ashley, who helped hold the space and support people if they became upset or distressed. The Trust lead for Safety Culture and Psychological Safety, Matt Hill – with experience of working in the Emergency Department – was also on hand.

Staff Counsellor Natalie Ashley

Annette explained: “I gave a pre-amble at the start of each session for the benefit of any newcomers, stating that this would have been an actual coffee at my house where people could relax and chat about whatever was on their chests, or just enjoy coffee and listen to colleagues.

“You could say anything you liked. If people had any concerns about safety they could escalate those to an Emergency Medicine Consultant.

“Using the private chat function, we were able to signpost people directly. We had all sorts of conversations, sometimes related to Covid, and sometimes not.”

Themes discussed included work rotas, managing time for non-clinical work, team working and how to avoid silos, communication and leadership, and how to manage ‘post-COVID extraordinary effort fatigue’.

Image of online group chat

Annette added: “It was an opportunity to talk about issues where we could affect change within the department, but some of the conversations were just about listening.

“Some of our colleagues were at home with Covid at the time, some were shielding and feeling isolated, and it was a way of connecting us all.

“Many colleagues become regulars at dialling in, and it was particularly popular with the last rotation of doctors.

“The psychologist that joined us on those calls has become a friend of the Emergency Department and has been able to reach out to individuals on a more personal level. It worked really well.”

Comments from participants:

“The last group I found extremely beneficial especially after you all left, I had a sort of unofficial counselling session with Natalie, which I really appreciated.”

“Great session today and well hosted. There were some really interesting points in the conversation. I really liked the talk of teams and huddles and how they build connection and have practical benefits. I also liked the way the leadership behaviours were identified and recognised as being helpful. These are incredibly powerful.”


 “Truly everyone is a legend and we need to keep that respect for each other, we are the ones who need to clap for each other.”

“We have the best ED in the world with the best people in the world. We are the only ones who can make it a better place for all of us.”

 “Great session, really well hosted! I am keen and happy to be part of future sessions. Really interesting themes that definitely need attention and thinking about by us and the wider Trust.”

“Thank you and love you all amazing people. It will all be over soon and history for our children to learn from. Keep the ED family together”

For more information about support for NHS staff visit: https://people.nhs.uk/

Further reading:

NHS People guides and bitesize learning

Click here to visit the University Hospitals Plymouth Support Hub.

My experience: St John Ambulance volunteer at UHP

There are lots of people from different organisations who make up the extended #1BigTeam at University Hospitals Plymouth (UHP). Abby Williams is an Emergency Medical Technician (EMT), trainer and assessor who has been part of St John Ambulance for nearly three years. St John Ambulance volunteers have been helping out at UHP since July this year supporting the Emergency Department at Derriford Hospital and helping to transfer patients.

Abby Williams volunteering at UHP for St John Ambulance

“I joined St John Ambulance while I was at university studying to become a teacher. I love volunteering and being able to help people and I understand how important it is to know first aid. St John Ambulance does all of the above. Like most people at St John Ambulance I joined as a first aider and progressed through the roles to EMT, which means I have a wider scope of practices and can now crew ambulances through St John Ambulance. I also work with the training team, which brings my love of teaching and first aid together. Recently, along with a colleague, we’ve been busy training a new course to allow members to volunteer in hospital. This is where my experience at UHP comes in handy.

“Normally at this time of year, I would be offering first aid support at large events. Since lockdown these have obviously all been cancelled, which has been really odd. COVID-19 has meant that we have been able to support the NHS by going into hospitals, like Derriford, which has been an amazing experience. 

“When we are doing a shift at Derriford, we arrive and introduce ourselves to the Nurse in Charge, saying hello to everyone else on the way. Once they know we are there we have a look and see if there is anything we can do straight away such as any call bells going off. We are able to offer a huge range of skills such as observations, personal care, providing tea and coffee. We also support transfers to other parts of the hospital. One of the most important things we do is give time to the patients. The Emergency Department gets really busy and there is always loads to do. We are happy to spend time talking to the patients, which is wonderful. No two days are the same and this keeps us on our toes! 

“Outside of volunteering for St John Ambulance (most members of St John Ambulance are volunteers and hold full-time jobs) I am a primary school teacher and work for a local charity that helps special children. I like to keep busy, however, and during the summer holidays most of my time has been spent volunteering with St John Ambulance and supporting the NHS.

“The role has certainly changed over recent time, but it has allowed us a more diverse experience and I’ve learnt loads about medical terminology and been able to enhance my skills. It’s a change being stood in a hot Emergency Department rather than a field when it’s pouring down with rain! 

“The experience of working in the Emergency Department has been brilliant. I’ve learnt so much and have enjoyed every minute whether it be putting skills into practice or simply having a chat with a patient. The Emergency Department staff do an incredible job and have been so welcoming and made us feel at home. 

“The diversity of the role is certainly one of the best bits. I also love the fact that even when the Emergency Department is really busy, we are able to spend the time talking to patients, reassuring them and making their time in the Emergency Department that little bit better. 

“For me, as a teacher, school is starting in September so the time I am able to give will be reduced. I hope to be able to do a few shifts on the weekend. I’ll also continue to train our members to enable them to support the NHS in hospitals and ensure they are ready for events when they start again.”

My COVID experience as a student nurse

Hannah Graham was in her third year as an adult nursing student on placement as an Aspirant Nurse. Read her reflections below:

My COVID placement was on a green ward on Level 12 where thankfully the impact of COVID was less than has been experienced in other areas of the hospital. The obvious challenges of learning to work while wearing a mask, gloves and apron were there, particularly during the hot weather, but I felt grateful to not have to wear the level of protection that others were wearing in higher risk areas.  

I was shocked at how the pandemic was affecting other areas of health and wellbeing that I hadn’t considered before. I was particularly struck by the number of young people experiencing mental health crisis and parents at breaking point with all normal support structures either non-existent or running differently to normal. I found this challenging as on the ward there was little we could do to help these young people other than keep them safe during their admission. COVID has deepened my understanding of the importance of young people being at school and accessing support services in the community, not only for their education and personal development but also for their mental health and wellbeing. 

The second event that challenged me was when a young child came onto the ward in distress. The mother and father were both in masks and couldn’t console the child. The mother reported that she didn’t think the child could recognise her with a mask on and this was causing her child distress. The mother removed her mask and almost straight away the child began to settle. This really challenged my view on the impact that PPE may have on young children and their ability to form attachments and trust. I guess this is something we will only know the true impact of in years to come as these children grow and develop.  

While my placement threw up challenges that I wasn’t expecting it was one of the most rewarding placements I have had so far. It was an emotional roller-coaster but the sense of togetherness amongst staff was overwhelming. The welcome and support I received was amazing and, considering the pressure that staff were under, having been working in this environment for a number of months now I am incredibly thankful.  

At first I thought we were the unlucky cohorts of students having this thrown into our training but looking back on this I believe that the opposite is the case. We have had learning opportunities that cohorts before us and after us may never have. I honestly feel this placement has shaped me to be a better nurse. 

Thank you everyone at Derriford! 

My experience: Supporting people with Learning Disabilities and Autism

Photograph of Jill Singh

My name is Jill Singh and I started with the Trust as an Associate Educator: Learning Disabilities and Autism in April of this year. Following a successful bid to The Burdett Trust; a plan was put in place to improve the Trust’s LD training program. This included more use of co-trainers and a temporary Associate Educator post; which I was recruited into. Training in these areas is currently voluntary but will soon be mandatory.

It has definitely been interesting starting a new job in the middle of a worldwide pandemic and it helped that I knew the people in the Learning Disability (LD) Liaison Team and Derriford Autism Service really well beforehand. I have worked alongside the Trust since 2010 as an Independent LD Advocate and run the Derriford User Group.

My new role involves supporting the teams to review and develop their training frameworks and facilitate face to face training with staff. When COVID hit we had to rethink our plans so I learnt how to shoot and edit films so we could still offer sessions in a safe way. I have recorded one hour sessions with Saoirse Read and Kate Bamforth and two six minute clips with Dave McCannon our co-trainer with a LD so we could still have user involvement with follow up workshops.

Like many members of staff I have had to master MS Teams and have become an administrator on ESR and OLM so I can book colleagues onto courses. We will be coming around the wards with promotional posters advertising dates for our sessions between September to December. Tiers 1-2 are covered in a short e-learning presentation and quiz and Tier 3 is a MS Teams session.

In the New Year we hope to offer Masterclasses exploring different themes. For more information on any of our sessions please contact the teams, look on our StaffNET pages or check our team Facebook accounts @DerrifordT  and @DerrifordAutism

Jill Singh
Associate Educator Learning Disabilities and Autism

Me, Covid-19 and Nursing – not nursing!

AliciaWhen I was six, I had to have my tonsils removed. Since that day, I have always wanted to be a nurse. The sister who looked after me had such a kind face and manner, a crisp uniform with a hat and waist buckle belt. She made me feel like she cared, like I was worth her time and I looked up to her. I knew she was who I wanted to be.

Cut to February 2003, I’m starting my training to become an adult trained nurse! This wasn’t easy and it took me longer than I expected to get my Diploma, but when I finally achieved it, I was so proud. I had reached my life-long goal to date and was in for the long haul.

My first five years were spent in adult neuro intensive care. During this time, I cared for a pregnant lady with a brain injury, who went into preterm labour. After a c-section, the neonatal sister brought her new son down to visit whilst she was still sedated and on a ventilator. There was so much equipment on wheels – incubator, ventilator, pumps, you name it – it was there. But the sister was so calm, kind and baby oriented amidst the chaos. I did not know what was happening, but I was fascinated by this small baby nestling up to his mum’s chest to try to breastfeed, mouth wide open. So much so, I asked the sister: “are any jobs going where you work?”

After I finished my four nights with his mum, I visited the Neonatal Intensive Care Unit (NICU) educator, enquiring about how to get a job. Low and behold a job became available a couple of weeks later and I jumped at the chance. Shortly after I left Neuro ICU, to join the NICU team.

Fast-forward to March 2020. I have completed my special care module, Qualification in Speciality training, mentorship training, joined the transport service and became one of the first of three Enhanced Neonatal Nurse Practitioner’s (ENNP) at the Trust

Then suddenly, Covid-19 starts to appear on the news. At first I thought nothing of it, it’s just a bad case of flu. I have actually had a strain of coronavirus before, and despite making my asthma flare up and landing me a short stint in hospital, I got over it and lived to tell the tale. Why should I be worried? I’m a nurse – I’ve been through worse.

The risks to asthmatics were like nothing we’ve seen.

Then the stories started to flood in. The risks to asthmatics were like nothing we’ve seen. I didn’t want to be a ‘vulnerable person’ but according to the news, the government and risk assessments, that’s exactly what I am.

So now I am at home. Not working as nurse, transport or as an ENNP. Instead I am shielding to protect myself. This hits me hard. Harder than I could possibly imagine, more than any the other issue I’ve have had to deal with. I’ve survived cancer, pregnancy loss, family loss, asthma. But Covid-19 knocks me down in a way I never expected. Since childhood, I have always helped, saved, cared for strangers and loved ones and now I can’t. I’ve got to do what lots of nurse’s struggle to do – care for myself, put myself first. I was not prepared for that.

The guilt was overwhelming and at week six, I crumbled.

Watching the news, reading about it online, hearing it all on the radio as I ‘worked from home’ made me feel guilty – guilty for not being able to help, guilty for not being part of the team (I was asked to return back to adult ITU to prepare and care for the potential patients that would arrive, but I couldn’t), guilty for not being there to support my co-workers, friends and family. The guilt was overwhelming and at week six, I crumbled.

When I participated in the British Association of Perinatal Medicine (BAPM) Covid-19 webinar, my emotions were running wild. I realised I needed support as all this was taking a toll on my mental health. I reached out to my line manager and the NICU Senior Sister, spoke to the mental health Covid-19 support team and I broke down – toxic guilt had taken over and I needed to open my eyes to the truth.

The mental health team were amazing, set me back on track and made me see that I am still a nurse, will always be a nurse – as long as I look after myself. I had to let go of the guilt, I was not working but I was still saving lives and my own. I was not going to become a statistic; I wasn’t going to put the strain on the NHS and pressure on the ITU team and ONE day I will be able to return to my team back on NICU.

I was honest with my manager and NICU sister, a small support group was created with our unit mental health support lead, allowing for others to speak up honestly and freely. The guilt it seems, was felt by us all and we were all adjusting to it differently. But together, we stayed safe, we stayed strong and we are still able to care, nurse and look after those who will need us when we come back.

Hopefully sometime soon, I can be back doing what I love the most.

So, I am at the start of week 15, completed many, many packages of e-learning, written some guidelines, attending meetings, a REaSoN training course, completed rotas, kept myself busy with tasks shared out by my colleagues who are still practicing. I have learned to forgive myself for not ‘nursing’, but I am still a nurse, now with more IT and management skills then before, and hopefully sometime soon, I can be back doing what I love the most.

Covid-19 might always be around, but so will nurses, ENNPs, ANNPs, doctors, physios, cleaners, carers, psychologists, occupational health colleagues, radiographers, managers, the police, the fire officers…the list goes on and on. For we are all part of one massive team, one massive family, always working together, saving lives and our own.

Stay safe,

Alicia Donovan
Enhanced Neonatal Nurse Practitioner

 

Visit the Staff Support Hub here:
https://www.plymouthhospitals.nhs.uk/support-hub

Support hub graphic

 

 

 

My experience: Working from home was like being alone in a storm, but now I have the right support in place

Ria

Ria George has been working from home since March as part of the Operational Resourcing team

Like so many others I began working from home in March once the government announced a national lockdown.

It all seemed very surreal. Since our return from Christmas and New Year leave our office had been watching the unfolding disaster from China and monitoring the daily increase in infections. We discussed how terrible it all was, but not really acknowledging the impact it may have on us in the UK. As the days progressed and things got steadily worse with outbreaks spreading, instead of the light-hearted chit-chat in the office there was the realisation that this was going to affect us and thoughts soon turned to how were we going to cope and navigate through this.

Throughout February and the beginning of March, our team (Operational Resourcing) were busy getting things in place for when things got real. Adding additional absence reasons for national reporting and monitoring, additional training and support for staff, manning the Sickness Hub and so on. Every evening watching the 5pm government update from our mobiles in the office wondering what the impact was going to be and how we could be ready to react.

By mid-March the majority of the floor had started to work from home already and the once bustling office was already eerily quiet with fewer and fewer staff in every day. We had been getting things in place in order for the team to work from home and still provide the service we needed to, then the announcement came about lockdown. The open-plan office environment disappeared and was replaced by my laptop and a spare monitor I borrowed from my other half set up on a camping table in my lounge.

The first few days were exciting, this was a different experience and it was so nice not to worry about the traffic and finding a parking space or deciding what to take in for lunch. Excitement soon turned into a feeling of anxiety, pressure, stress and worry. There was so much work to do it was very difficult to switch off and walk away.

I found myself often working past my normal office hours into the late night, desperate to get things done. But the longer I worked the more and more work kept coming. I would clear one email and it would be replaced by five more, it was so demoralising. With the pandemic getting worse, I couldn’t sleep through worry about work outstanding and about friends, family and colleagues . I felt lost and that everything was out of my control. Not only was I trying to navigate my own thoughts and feelings while trying to work but I also had the kids to reassure and support with their worries, anxieties, and of course, the dreaded homeschooling. Then there was the dog! Wanting to be walked and played with at every opportunity just because we were all suddenly home.

Even though I am part of a team I felt like I was alone in a storm and that we weren’t connected to each other. There was so much going on around I couldn’t see a way out of what felt like hell. Then we started talking, using the MS Teams platform. I soon realised that we were all feeling tired, worried, anxious, exhausted, and that really helped. I wasn’t alone in this, although I couldn’t physically see my colleagues in the office we were still all part of a team, experiencing similar issues. We weren’t in the same boat but we were riding the same storm together! Daily team catch-ups started to happen and this gave us the platform we had been missing to check in on each other and offer the help and support needed from a work point of view and on an emotional level too.

Talking about our own challenges helped me to realise that it’s OK to work my hours and then switch the laptop off and walk away as I would in the office environment. Once I got my head around this, I was then able to support my colleagues in realising we only have one pair of hands and a set amount of time. I realised it is OK to switch off when we need to and to get that balance of work/life in place even while working in a slightly different way.

Now I have the right support in place and I am not so hard on myself, working from home is a more positive experience. Still with kids and pets as a challenge, but more positive on the whole. I have set up my computer and screens (collected from the office) correctly on the dining room table so I am ergonomically safe. I am more productive and find myself achieving more things in my working hours than I would in the open plan office.

Instead of being worried and anxious about how we move forward and emerge stronger, I am excited about what changes the future might hold and, based on our experiences and what we’ve learnt over the past few months, the opportunities that await.

– Ria George

My lock down blog: Imogen Paterson

Imogen Paterson

Imogen Paterson, Digital Transformation Team

Like most, lock down started very quickly for me. I remember the office was suddenly very concerned with its progress. We were pulled off the wards and confined to the office. I had a cough so was a COVID suspect (since cleared of all charges thanks to an antibody test). Other members of the team were off sick but I was the first to experiment with working from home. So along with my cough I went home with just a few bits, my laptop and my mouse. Things quickly spiralled and after a brief stint in the NU building all of my colleagues were working from home too.

 

Imogen Paterson Picture2It was a very very strange thing to get used to. Getting up for work and going to the kitchen to sign in. It was very difficult in the beginning to stay focused and to feel like what I was doing was actually needed and making a difference. The daily team catch ups definitely helped in those first few days/weeks and I am still very glad that we still have them. It helped maintain that we were all in this weird new world together. I still miss all their faces and it isn’t quite the same chatting on MS teams but we are getting better.

Sitting at an awkward table with a dining room chair can be a challenge but I do feel very lucky to even have that as so many colleagues have to make do with much worse conditions. I am also very lucky to still have a job and when WFH is getting to me a try and remember that.
Imogen Paterson Picture3
In true Digital Transformation style I have set up my own work board. It is still a work in progress but I am trialling using it to try and give my work days more structure and to see things to look forward too. Plus it’s helping me to remember to put the bins out!

When inspired I try and do a little bit of art. Whether painting, drawing or just colouring in something fun I have printed off. This helps to use a different part of my brain and switch off for a bit.

I have also been keeping a work COVID sort of thing in OneNote. Just noting down things we have done as a team. The weird and wonderful things we have been asked to do for team meetings like picking a song for a team BBQ post COVID or decide what kind of tree we would be and why! It is lovely to look back on some of the things we have been doing as a team to keep sane and silly.

I have been lucky to visit the hospital a few times for some projects which was just brilliant. I was really reluctant to do this to start with and I put it off. I felt very anxious about going in but couldn’t tell you why. But when the team needed volunteers I just offered myself up and I am so glad I did.  Engaging with staff and seeing what’s going on in there has been really great. It helped me keep focused on what I was doing and gave me a break from the kitchen office.

Imogen Paterson Picture4As the hospital starting moving towards a new normal and projects are starting to move towards a more definitive plan I am getting excited about how our team is going to be back helping out. It doesn’t look like this working from home business is going to be going away anytime soon but I feel much better about juggling working from home and also working in the hospital (most of the time).

Imogen Paterson
Digital Transformation Team

My COVID experience: ‘Re-awakening’ by Sascha Von-Lieven-Knapp

June 08b

Occupational Therapist, Sascha has reflected on her experience as part of the COVID rehab team with a powerful piece of writing titled, ‘Reawakening’.

I walk towards you – barely moving, tethered to tubes, bags and lines.

You need help to breathe – to stay alive.

Even your voice can no longer be heard – a tube sits in your windpipe.

You look at me with tired eyes.

You cannot move under your own volition; your hands are swollen, your body moved by others.

Exhausted, surrendered to an alien environment; not able to question your surroundings and actions of those caring for you.

Unable to make your needs known.

This is heart-breaking.

You – a person with friends, family and part of a community.

You – a decision maker, a person with choices and views.

You are alone. You are vulnerable like a new born.

You depend on others to stay alive – to guide you through.

But you are not alone.

There are kind, caring and highly skilled people around you. They monitor, look and listen out for change – any gesture, noise and expression – even the look in your eyes. They are your parents, your confidantes. The people who clean and feed you and give your medications. Who persist. Who worry for and with you. Who encourage you.  Who commit to doing their utmost – through despair, disappointment and set-backs onto a path they hope leads to re- emerging as a sentient being; a decision maker, a voice, leading a fulfilling life.

Who will you to survive.

I wonder – has your world crashed? You must have been so ill to come here. Did you feel panic when you could no longer breathe? Did your life drop into a black hole for a while – not being conscious for days on end?

What was it like to slowly wake up – feeling pain and discomfort; in a ‘science fiction’ like environment – bright lights, connected to many tubes and surrounded by telescopic arms mounted full of bleeping monitors. Unable to communicate – not quite knowing what happened and maybe with very bad dreams you couldn’t get out of or explain to yourself. And all of us in gowns, aprons, gloves, masks and face shields. How very frightening that must have been.

But you are emerging.

You are aware of where you are; you become familiar with the people around you and recognise their names. Your body and mind recognises routines and distractions. You remember who you are and where you’ve come from. You know that you are an important part of a ‘whole’ and that you are loved and missed. That people care. You can make your needs known. You can speak with help.

There are new people to see you now: You sit up and are hoisted into a chair. You can visit a lovely garden with help: fresh air, colour, flowers, smells and sounds of normality. You are encouraged to rehab – stretch your mind, increase you resilience and stamina, even sit on an exercise bike! You are becoming more independent and are able to sip a drink – even ask for a favourite coffee. You can brush your own teeth!

It is exhausting and hard work. But you can.

You are moving on, you are progressing.

You are becoming ‘YOU’ again.

I meet you again many days later – to see you walk toward your family, being ‘clapped out’. There will be more work for you but you are leaving us to go HOME.

Amazing and utterly moving. I don’t really know you – but I am proud of you.

Not everyone made it through – this horrible invisible COVID fiend has taken you. I hope you are all in a better space – you will not be forgotten.

I feel privileged to work in a system that offers free healthcare when you need it most; a sometimes maddening Goliath of a health-machine – but driven by a plethora of human hearts.

My shielding experience: Going from working on the ward to never leaving the house

lisaLisa has worked as a nurse at University Hospitals Plymouth for over 25 years. Due to a medical condition she has been shielding at home since lockdown began. She has been keeping a video diary of her experiences – both professional and personal.

In the short video below, Lisa explains some of the hard realities of shielding, from the boredom and isolation to the fear of eventually having to leave the house – and the risks that entails.

In this longer video, Lisa shares some of her wider experiences of shielding at home and how it has affected her professionally going from working on wards before lockdown to now running clinics through computer screens. She talks about some of her frustrations and missing her patients and colleagues, but also how she has embraced technology to make the best of things.​