As a Macmillan lead cancer nurse at University Hospitals Coventry & Warwickshire (UHCW) NHS Trust in Coventry, Carole Bailey is used to supporting her nurses any way they need, whether that’s emotional, clinical, or administrative. She’s a mentor and a friend to the 50 cancer clinical nurse specialists in the hospital, who support patients and their families across 20 cancers. Her goal is to ensure the highest quality of cancer nursing throughout the Trust, to help the nurses improve the patient experience and quality of life, and to ensure that they focus on outcomes from the National Cancer Patient Experience Survey.
“It’s a partnership,” she said. “I work with everyone if it benefits spreading the word about cancer and ensuring patients are supported.”
That role took on a whole new meaning in recent months as the COVID-19 pandemic swept England, just as it did the rest of the world.
“We started hearing what was happening in China and Italy in February,” Bailey said. “Then the cases started coming in mid-March. My main focus was ensuring that all our patients and their families continued to feel supported.”
Her hospital was ready, she said. They had time to prepare, including training the nurses and doctors and stockpiling personal protective equipment (PPE). They reached out to the independent, sector using their facilities so that cancer treatment and care could continue, and the hospital-maintained patient and staff safety by ensuring that suspected COVID-19 and confirmed COVID-19 patients were separated from other patients.
She credits the smooth transition from “normal” times to COVID times with the collaboration between the three Trusts in the area and the independent sector. . It’s collaboration and effective communication and having that culture in your organization where people don’t mind dropping what they normally do to do something to support another area that’s so important.”
The teamwork and unity of staff throughout the hospital enabled UHCW to manage the early surge without becoming overwhelmed.
New Ways of Working
When COVID hit, the Coventry-based Macmillan Cancer Clinical Nurse Specialist Teams knew it had to revamp its processes and they were determined that any changes would have the patient experience as its core foundation.
They quickly instituted new ways of working, such as providing virtual clinics and access to a dedicated phone line for patients and their families through the Cancer Information and Support Centre. Not all patients, of course, wanted or could even use telehealth. “Some need those face-to-face conversations with a healthcare professional to feel reassured,” she said.
Flexibility is key, Bailey said. “It’s about providing the right information at the right time for that individual patient.”
Cancer doesn’t stop because of COVID, and at UHCW the focus has remained where it’s always been: on the patient. “We continued providing chemotherapy and radiotherapy,” Bailey said, with patients receiving the same doses although sometimes over a shorter time period to minimize trips to the hospital.
Social distancing was and still is practiced everywhere, including the infusion rooms, where chairs are spaced at least two meters apart, and all staff wear PPE when in the clinical areas.
As with many cancer centers around the world, some non-essential surgeries were postponed. However, Bailey, said, those decisions were made not by a single doctor, but by a multidisciplinary team that met weekly. The staff also moved some surgeries to the independent sector when needed.
Overall, Bailey said, “we continued to provide cancer services but in a different way.” And while it may not have felt exactly the same for patients, “we tried our hardest to provide them with the support they needed and to ensure they felt that support.” In other words, she and the rest of the team did their best to ensure that patients didn’t feel marginalized as the world turned its attention to COVID-19.
“It’s about reassurance,” Bailey said. “Not just about the virus but that we’re not forgetting about them,” she said. “We make sure that just because they’re out of sight doesn’t mean they’re out of mind. The nurses continually reassure the patients that they are still very much in our thoughts.”
Maintaining Calm in the COVID Storm
The hospital also paid special attention to the needs of its staff, who put their lives on the line every time they turned up for work. For instance, they opened the clinical psychology clinic, which typically only served patients, to the staff and encouraged them to visit. “The staff has such great anxiety and fear of COVID-19 because it’s everywhere,” Bailey said.
And yet they remain strong and resilient, she said, embracing the challenges and emotions of the COVID-19 pandemic – both the surge they experienced and the continued infections – with dedication and exemplary expertise.
Bailey herself used her background in emergency medicine and palliative care, plus her long history of hospital-based nursing, to cope with the COVID stress without burning out. “I’m used to providing support to people and happy and willing to provide the support,” she said.
“I’ve always been very self-aware,” she said. “I’ve always known when I’ve had enough.” She has a good friend at work, and they support each other throughout all situations. She also praises her own manager as “extremely supportive. Still, she said, “I leave the hospital and it’s very good to switch off. By the time I’m in my car, I’m thinking about what to cook at tea.””
In the end, she said, “we all have our anxieties and fears about COVID-19, but we’re here to do our jobs helping cancer patients and as long as we do the hand washing and have appropriate PPE, then I’m very happy to come into work and support our push to try and tackle COVID-19.”
As England’s lockdown begins loosening, she and her colleagues have begun planning what she calls the “restoration.” “We have to get back to functioning,” she said. But she knows that the cancer care of the next months and possibly years will look different. “ ‘Normal’ is never going to exist with us again. This virus is going to be with us for some time,” she said.
So, the hospital is reviewing which changes benefited patients and the Trust and should continue. “I think we will be doing more telehealth for our follow-up patients,” she said. It fits with the NHS’ ongoing initiative to focus on patients living well and beyond cancer with person-centered follow-up pathways.
And no matter what comes next, her personal mission will never change.
“It’s stepping out of your comfort zone and looking at your values and saying, ‘This is what I should be doing for the greater good of patients in this hospital.’”
“I’m a nurse. It’s what I do. I care and support.”
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