The Queen's Nursing Institute (QNI) has always offered a range of support to community nurses. Last year, the charity expanded this support with a new listening service for all registered nurses working in the community and social care. The TalkToUs telephone listening service was set up in the first weeks of the COVID-19 pandemic, in the recognition that community nurses were coming under unprecedented pressure in work and home life and would benefit from additional support.
While the pandemic has affected everybody in the UK, its effects have impacted most directly and severely on health practitioners, who see the effects of the virus on patients both in hospital when acutely ill and in the community setting, where end-of-life care has doubled and long COVID is emerging as a long-term condition. Working patterns have been disrupted and care pathways have had to be completely rebuilt at scale. In the first waves of the pandemic, many nurses were redeployed, often into fields of practice of which they had limited previous knowledge or experience.
The QNI trustees and staff team were, and continue to be, very concerned about the mental and emotional toll of the pandemic on the health of nurses. The media has tended to focus on intensive care in hospitals, but the contribution of the community sector has to a large extent been overlooked, particularly in the national media. Nurses working in the community and social care have taken on a huge extra burden since the start of the pandemic, but this is still not widely reported or appreciated in the mainstream news.
Charities such as the QNI are there to provide a lifeline to all community nurses. The TalkToUs service was established to provide a confidential, independent, compassionate and understanding ear, for all nurses in the community, primary care and social care, as well as to signpost to other sources of support. We will not turn any caller away and have supported nurses working in intensive care, too.
Nurses have now worked under pandemic conditions for well over a year, and they have lived under various national and regional lockdowns at the same time. In short, they have had no respite either at work or at home, and this is the case for community nurses as much as for their colleagues in hospitals. Every individual will have been affected by the pandemic differently, and some have found their personal and professional circumstances particularly challenging.
Concerns about the mental and emotional health of nurses have grown during the third wave and lockdown of the pandemic; while it lacked the shock character of the first wave, its length over the dark winter months made it seem remorseless. The impacts on health and wellbeing are likely to be long term, lasting far beyond the duration of the pandemic itself.
It is the duty of all employers to protect staff wellbeing and to ensure workloads are manageable. The TalkToUs service is not a substitute for open communication and support within the workplace, which should always be available from managers and colleagues. However, if a team is permanently overstretched, working overtime to manage the most urgent cases, this may lead to a permanent state of stress, which is likely to lead to burnout. In this kind of environment, there is a real risk that, without proper support, people will leave the profession.
Establishing TalkToUs
The QNI was fortunate in that one of its staff had extensive experience in setting up and managing telephone helplines, so we already had the expertise in-house to draw on for the creation and development of the new listening service. We also had staff members-Queen's Nurses-who would be able to staff the service. After some discussion within the staff team, we decided to call the listening service ‘TalkToUs’ to emphasise its informal and inclusive nature and to encourage people to contact us.
TalkToUs is a way for nurses to be able to reach out and communicate with others, in complete confidence and, if needed, to ask for help. We do not offer professional counselling; rather, this is a safe space where people can talk and reflect about their own experiences and feelings at this time. This could include home as well as professional life, as many people are experiencing domestic disruption as well as challenging conditions in the workplace. It is envisaged that the service will continue to operate long after the crisis period, as need arises.
Good communication and listening skills are at the core of what it is to be a nurse. All of the Queen's Nurses working in the new programme are themselves experienced community nurses, so they have an understanding of the kinds of challenges that others are likely to be facing. All have received training in the provision of a confidential listening service and can signpost to other sources of help as needed. The QNI's listeners have now been taking calls from nurses for over a year, and the feedback we receive is consistently positive.
Reluctance to seek help
Many people find it difficult to talk about their thoughts, feelings and experiences and may be encouraged to manage their feelings internally. Nurses, too, may be reluctant to talk and share the issues that are affecting them and may struggle to articulate the effects that working during the pandemic is having on them. They may hesitate to access support services such as TalkToUs, but there is strong evidence that opening up, talking through and reflecting about personal and professional challenges is beneficial, in the short and longer term.
To give a personal example, Lucie Bradby, my grandmother, worked at Dewsbury Hospital in West Yorkshire for much of her lifelong career in nursing. Among the people she cared for in the years following World War Two were former soldiers who had contracted malaria on service in the Far East. Despite the best nursing care, it was not possible to save many of those lives with the medical knowledge available at the time, and my grandmother spoke movingly about nursing them, many decades later. However, people of her generation were strongly encouraged to maintain a ‘stiff upper lip’ and were not encouraged to share their feelings.
More recently, a QNI colleague has spoken about the experience of nursing people in the early years of the HIV pandemic in the 1980s. Many of these people died a traumatic and premature death in the years before anti-retroviral drug regimens were developed. These are just two examples of how nursing in challenging circumstances can have a profound effect on the emotional health and wellbeing of practitioners in the longer term.
There are a number of blogs on the QNI website written during the pandemic that may aid personal reflection. A recent one was related to Dying Matters Week, where Queen's Nurse Catherine Best wrote thoughtfully on this subject: https://tinyurl.com/294ejs7p.
Practical information
TalkToUs is not restricted to NHS staff-nurses working in the private sector, charities, hospices, care homes and other settings are encouraged to contact us. It is not an instant access phone line. In order to arrange a call, nurses first need to send an email to talktous@qni.org.uk with their phone number and a suitable time to call. A member of QNI staff will then respond to arrange a mutually convenient time to speak. For more information, visit the QNI website: https://tinyurl.com/3fttz268. Thus, TalkToUs is not a crisis line, but the Samaritans are available for urgent calls on 116 123.
Information about other support offered by the QNI, including grants for people whose income may have been affected by the pandemic, can be found on the website: https://tinyurl.com/v2fyumbc.
COVID-19 Healthcare Support Appeal
In 2021, the QNI received a major funding boost for the listening service from a new charity, the COVID-19 Healthcare Support Appeal (CHSA), part of the Royal College of Nursing Foundation. The CHSA is a time-limited charity set up to support health and care staff across the UK who have been adversely affected by the pandemic. The CHSA's work is focused on three areas of need: emergency aid and hardship, psychological support and recovery and resilience. The CHSA is helping people working in all health and social care professions, from doctors and nurses to hospital porters, administrative staff, ambulance and care workers, healthcare assistants, housekeepers and community workers. More than 5000 health and social care workers have already benefited from CHSA support to help them through the impact of the pandemic.
Before beginning its work, the CHSA brought together people from across the health and care professions to help map the sector and identify areas of greatest need. This exercise informed priority areas for funding and provided targets to guide grant-making. The CHSA's trustees agreed that a key objective would be to reach those most in need and disproportionately affected by COVID-19, including those in lower salary bands, people from a black, Asian and minority ethnic (BAME) background or people in vulnerable groups with an underlying health condition.
The CHSA Board meets regularly to review applications and makes grants to organisations giving vital financial and psychological support to frontline health and social care workers battling the crisis on the frontline. CHSA also funds projects that seek to strengthen resilience in the longer term. For more information about the charity's work, please visit: https://tinyurl.com/4w34h59h.