Six months into the coronavirus pandemic, a group of general practice nurses (GPNs), with the Twitter handle @WeGPNs, and Ellen Nicholson, the chair of Royal College of Nursing GPN Forum (@RCNGPNForum), held a joint tweet chat to gain feedback on the impact of COVID-19 on nurses working in general practice.
Main challenges
Early on in the pandemic, advising patients about their at-risk category took a lot of time and energy. There was a rapid move from face-to-face to virtual consultations, which proved a challenge due to mastering the technology and overcoming a lack of non-verbal cues during consultations. Other nurses experienced difficulties with internet coverage and patients struggling with technology. Nurse-patient relationships have changed too:
‘Yes we have adapted to using technology, but we came into nursing to see patients and hold their hands. This has been emotionally difficult.’
Barry Clark, GPN, Oldham A rapid move to virtual consultations has been challenging for some
Adapting to change
Adapting to the pandemic has been rapid. Hot hubs were quickly established to see potential COVID-19 patients:
‘At one point there was me and one GP left and we managed to turn an old surgery into a hot hub.’
Janet Gower, Advanced Nurse Practitioner, Cambridgeshire
Roles changed quickly too. Just 11 months after entering general practice, Gary Mitchell became the lead nurse at a ‘hot hub’ for suspected COVID-19 patients. He views the experience positively – as a potential career development – rather than negatively.
While some struggled as guidance was slow in the early months, other practices were proactive, with personal protective equipment and oxygen saturation monitoring stations in place, while keeping routine immunisations and screening going:
‘I'm personally doing nearly 30 routine smears a week over 3 days’ Anon,
GPN North of England
With demand an issue, some have tried out group consultations. Others, having to work from home for various reasons, have undertaken roles remotely, such as triage, diabetes and family planning reviews, flu season planning and smoking cessation clinics.
Team relationships
Working without breaks and fresh air has led to stress and poor sleep. Some have taken their stress into the home, some found ways to support each other virtually and others have had support from online forums.
It has been a testing time for relationships and team working, with some pulling together and others starting to fray.
‘The pandemic has brought our PCN nursing team closer together, we are working more cohesively, are more supportive of each other and share ideas and aspirations more freely.’
Rhiannon Scott, Head of Nursing, Dorset.
Other nurses reported that they were ‘left to get on with it’ and seen ‘as an afterthought’. Relationships with GPs became strained where nurses were directed to do the riskier face-to face consultations, while GPs worked at home. This has impacted on morale, with some reporting colleagues leaving primary care for other roles.
‘GPNs talked of their indomitable spirit and their versatility and resilience in the face of adversity.
Positive developments
In one primary care network, a home visiting team of nurses, doctors, health care assistant and administration/co-ordination has been established quickly to support shielded patients.
Webinars with secondary care colleagues breached some of the historically difficult divide with general practice, as clinicians began to learn about the virus together.
Pharmaceutical companies have been keen to offer support with free online training and information that can be emailed to patients.
The move to telephone and video consultations has offered more convenience to patients who work/attend school or may find it otherwise difficult to attend. One particular benefit has been asthma reviews, where symptoms that patients were just living with have been better managed.
Despite the negatives, including what the nurses described as the ‘bad press’ of backlogged routine work, GPNs talked of their indomitable spirit and their versatility and resilience in the face of adversity.