The UK is now enduring a devastating third wave of the COVID-19 pandemic, and the overwhelming burden on the NHS continues. It is clear from the headlines and social media that frontline workers are persistently feeling the physical and emotional impact and reality of this ongoing crisis.
At the time of writing, the number of new positive COVID-19 cases and the number of people who have died within 28 days of a positive test are decreasing (UK Government, 2021). However, the fight against this virus is not over. Hopefully, the lockdown stay-at-home guidance and the huge drive of the national vaccination programme are starting to reduce these numbers further and provide the glimmer of hope that we have been waiting for.
Although this is good news, working in the community during the pandemic has had, and still does have, its risks and challenges: personal protective equipment (PPE) shortages, staff shortages, rapidly increasing caseload numbers and the potential of contracting COVID-19. Managing these types of challenges is embedded in district nursing intuition; district nurses begin risk assessing as soon as they step through the patient's door, and COVID-19 has added a whole new dimension to this. This includes hospital avoidance, which is a huge part of community nursing work. Nurses are having difficult conversations with patients and their families about acute and chronic care management, while strongly considering the serious risk of contracting COVID-19 outside their home environment and the associated implications. We often experience the devastating reality of losing some of our patients if hospitalisation cannot be avoided because of COVID-19.
Despite the emotional and physical toll, the community nursing workforce is hugely resilient, and community nurses are adaptive and rise to meet the needs of the service and the complexity of the work. In our London borough, the district nursing service has contributed to vaccinating housebound patients and supporting care homes with managing COVID-19 outbreaks, and it has provided district nursing presence in the local hospital to facilitate discharges and reduce the pressure on secondary care services. On top of these extra demands, normal work carries on, and now, more than ever, community nursing is a huge support for housebound patients, as it is a source of social interaction for those isolated, lonely people who are separated from those most important to them (King's Fund, 2016).
As the 1-year anniversary of the first lockdown looms, I reflect on the experiences that my colleagues and I have been through: the despair, the tears and memories of those who were taken too soon. However, I also recall the moments when we feel we are making a difference, the camaraderie and, ultimately, what we are overcoming together.
I find myself writing this editorial after posting a photo of myself on Twitter in my uniform, in the snow between patient visits. I did not expect much engagement with my post (if any!), but the online nursing community have overwhelmed me with their recognition and support.
The truth is that I was simply doing what community nurses do every single day: providing essential nursing care to people at home to reduce unnecessary hospital admissions, whatever the weather.