By Jessica Stokes-Parish MACN
Early last week, an opinion piece published in The Guardian came across my Twitter feed. It was titled “Diary of an intensive care nurse: are we concerned about coronavirus? The honest answer is not yet”. You can read it here. Now, to be honest, I was pretty miffed. I’m an intensive care nurse, amongst other things (researcher, educator, simulation enthusiast), and I felt misrepresented on a number of fronts. So much so, that I retweeted the journalist’s tweet with the following:
As a nurse, I feel entirely misrepresented in this article. I am not concerned about my leave. I am concerned about:— Jessica StokesParish (@j_stokesparish) March 11, 2020
1) How will the vulnerable in our community survive this outbreak
2) How will our hospitals manage the surge of patients
In short, I AM CONCERNED about #COVID19 https://t.co/THvWuTJ5qb
Like many health care professionals, I have been following the COVID-19 situation quite closely. At first, with only a few thousand cases in China, I thought ‘no big deal’. But as the weeks turned to months, as the spread crossed borders and oceans, I began to appreciate that we might be heading for a pandemic. I began to appreciate that this new virus was approaching with voracity and speed, and we might just not be equipped to deal with it.
Whilst we know that the majority of cases are mild, our vulnerable communities are significantly more at risk. Vulnerable, as a term, is broad – it speaks to those with autoimmune diseases, heart problems, lung problems, those 60+ years of age (which, by the way, is a significant portion of our nursing workforce – 14% according to the 2019 NMBA report) and chronic illnesses. According to the Australian Institute of Health and Welfare (AIHW), a staggering one in two Australians live with chronic illness. According to the data coming out of the World Health Organization (WHO), those with diabetes and heart disease have a higher crude fatality rate (CFR) than those that who do not (Diabetes 9.2% CFR vs 1.4% CFR) (WHO, 2020). Drilling down on this, 6% of Australian adults have diabetes – that’s 1.2 million people with a much higher risk of death or serious morbidity due to COVID-19 (AIHW, 2019). And what about the percentage of those over 60 years of age in our community? 15% of Australians were aged 65 or over in 2018, so we can expect that is a conservative estimate of our current population (AIHW, 2019). And for those 80 years of age and above, WHO reports a CFR of 21.9%. This data reinforces to me the severity of risk to the immunocompromised and older people of our community.
And what about hospitals managing the surge? As we know, many hospitals in Australia began putting protocols and plans in place as early as January this year. Many nurses are involved in this practical phase of preparation – infection prevention service nurses have developed policy, supported education and assisted with epidemiological data. Management nurses are setting up contingency rotas for potential deployments, setting up stocktake plans to ensure staff have access to adequate personal protective equipment (PPE). On the floor, many nurses are brushing up on their donning and doffing, doing simulated drills and keeping up-to-date with the changes in operations. All of these steps are necessary to prepare for managing a surge of patients. But will it be enough? Our international counterparts are showing us that it’s not sufficient. China impressed with their ability to build fever hospitals within a number of days, Italy is forced to select best candidates. What will we do?
Over the coming months we will see our profession tested. We will be sleep deprived, exhausted, stretched and upskilled beyond belief. We might lose a few of our own – there will be tears and anger, frustration and anxiety. In these moments, we must remember to give ourselves moments to debrief, reach out with a word of kindness and support our colleagues through it all. Be proud to be part of a profession that is versatile, skilled, intelligent and creative. You are part of a profession that is essential for our community, turning up even when defeated. This is your moment to be proud of nursing.
About the author:
Jessica Stokes-Parish MACN is a registered nurse, leading surgical outcomes improvement strategy in Newcastle, NSW. She is a practicing intensive care nurse, simulation enthusiast, researcher and educator.