Impact of COVID-19 on NHS clinical nurse specialists in mesothelioma
Clare Gardiner on behalf of the Mesothelioma UK Research Centre – Sheffield
In August 2020, the charity Mesothelioma UK undertook a survey of its front line clinical nurse specialists (CNS’s), to explore the impact of COVID-19. Mesothelioma UK clinical nurse specialists are based in NHS hospital across England, Scotland and Wales. They have worked tirelessly through the first 6 months of the COVID-19 pandemic to support patients, minimise the impact of the pandemic and adapt services to ensure continuity has been maintained as much as possible.
The survey was designed to capture data from CNS’s on the impact of COVID-19 on patients and their families, and also to capture the challenges that nurses and their clinical teams were facing. The survey was circulated in late August 2020 to 25 mesothelioma CNS’s, responses were received from 20 of the 25 nurses contacted. Responses were returned by email, anonymised and collated. The survey had 18 questions, 13 of which requested narrative responses. Responses were categorised to establish emerging themes and results relevant to this inquiry are summarised below.
Most challenging/saddest issue
When nurses were asked about their ‘most challenging or saddest issue’, many nurses described the lack of face to face contact with patients. There was also concern that the lack of face to face contact meant patients were not adequately assessed, communication skills and training could not be followed, bad news was not delivered as well over the phone and it was much harder to build up a relationship with the patient and their family.
Providing good end of life care was found to be one of the most challenging/saddest issues faced by nurses. Patients being denied the ability to spend time with loved ones and a lack of visitors at end of life was found to be challenging with 6 nurses describing difficult situations such as: “Looking after patients in hospital when they were near end of life and visiting not allowed” and similarly: “Lack of face to face contact and the amount of patients who have died in hospital without seeing their relatives and not being able to review on the ward at the beginning of the pandemic.”
Nurses also spoke about the effect on them personally. One nurse wrote; “It has had a real impact on me – more than anything has I think throughout my career. Sometimes I felt I couldn’t have another one of those conversations – that I didn’t have anything left.” Another nurse described how she just felt she was continually delivering sub-standard care: “It has been difficult to deliver bad news over the telephone and it’s made me feel that they are not getting the support they deserve.” Another spoke of the difficulties they faced with reassuring patients, when they were facing their own anxieties: “Having to try and give reassurance and support about coronavirus when there is little information and you are feeling anxious about it yourself.”
Guidance and resources for nurses
The survey asked the nurses if they had the guidance and resources necessary to meet the needs of their patients. The lack of UK wide advice, it being different in each country and the frequency of changes made it hard to keep up to date, to offer advice and follow the guidance. However, useful sources of information included their own NHS trust, government websites, Mesothelioma UK, NHS England, Cancer Research UK (CRUK), Lung Cancer Nursing UK (LCNUK) and Cancer One Voice. One nurse described the value of supportive colleagues and organisations: “The support of my Meso UK colleagues in clarifying issues and guidance especially in the beginning when things were changing so rapidly was invaluable.”
Support from line managers and their own NHS trust varied with some saying support from their line managers was very poor. Limited access to PPE and lack of confidence in the guidelines about who should be wearing it caused concern initially. Access to IT equipment to be able to work from home was identified as an issue.
Personal impact of COVID-19
Finally, the survey asked about any other COVID-19 related matters or issues. Some nurses described their own feelings of exhaustion and anxiety: “Staff [are] feeling exhausted and morale is low”. Nurses wanted the effect of the COVID-19 pandemic on them personally to be acknowledged. Morale has been affected, clinical teams were tired and at times nurses struggled to provide the support needed to patients when they had their own personal and family COVID-19 journey to manage. One nurse highlighted the personal impact thus: “Coping with other people’s anxieties and emotions when mine have been low”.
Despite this the nurses generally felt that the way the NHS responded to the pandemic was positive and the public support of key workers was heartening. “I think the way the NHS pulled together and responded to the pandemic was really amazing and the public response to key workers was heartening.”
This survey of a small group of clinical nurse specialists in mesothelioma highlighted a number of issues related to workforce stress, burnout and resilience during the COVID-19 pandemic. These included difficulties with new ways of working, personal anxieties and worries, and feeling unable to provide patients with the care they needed. Support from colleagues and other organisations was invaluable, and the public response was encouraging. However, the ongoing impact of the pandemic means morale is low and greater acknowledgement of the impact on nurses is required.
 The Mesothelioma UK Research Centre is based in the Health Sciences School at University of Sheffield and is funded by Mesothelioma UK. https://www.sheffield.ac.uk/murc