Nursing Opinion

Leading from the frontline: specialist nursing in the pandemic

Micheala Russell, Specialist Nurse, PJ Care

My role as Specialist Nurse at PJ Care gives me a wide area of responsibility ensuring that the specialist clinical and nursing needs of all our residents, and in particular new admissions, are met fully.  This has proved particularly challenging over the last year as we have dealt with a whole range of new issues that we couldn’t have dreamt of before the pandemic.

At PJ Care we implemented many new rules and protocols right at outset of the pandemic, including a ban on inter-unit movement.  Prior to this I would have spent time on every unit during a typical week, assessing the needs and dependencies of the residents as well as visiting new residents prior to admission to ensure we could meet their specialist neurological needs fully.  Then almost overnight this had to stop and we had to find new ways of ensuring everyone’s often complex and challenging needs were met in full.

We look after individuals with a neurological condition, either a progressive condition such as young-onset dementia, and other illnesses like Huntington’s Disease, or people with a brain injury.  Our residents have diverse and different needs, sometimes behavioural, and with many physical and occasional mental health dependencies.  They need specialist care and accurate and detailed assessment and care planning; this is where I come in to make sure these are in place from the beginning of their journey with PJ Care.  But how to do that without being able to visit and meet the new resident?

PJ Care created a Management Group with all the leaders from different areas across the company, this has met online using Teams every single day since the middle of March last year – including Christmas Day!  This ensured that we were able to meet the challenges of the pandemic, ensuring we had enough staff, enough equipment and most importantly enough PPE.  They reviewed our in house protocols daily successfully ensuring the safety of both residents and staff.  And using this I was able to stay updated on the situation on our different units and when dependencies changed, I could make adjustments and react quickly ensuring new admissions were appropriate and we had sufficient nursing and care staff to meet the needs of our new resident.

But how do we know what those needs are, without being able to visit?  This has been my biggest challenge; the complex needs of our residents mean a simple telephone conversation with a busy ward sister in the hospital is rarely enough to fully understand what their requirements are.  The majority of hospitals and care homes have been incredibly helpful using video links so either I or one of my team could speak with the new resident, as far as possible, they have copied reams of notes and emailed them through so our specialist Multi-Disciplinary Team can have a full overview before admission.  We have had to rely on the knowledge of the nurses currently caring for the new resident and have had to ensure we ask all the right questions beforehand, so we have everything we need to produce a safe and supportive care plan before they arrive.

We have reviewed and revised our pre-admission paperwork, improving our risk assessments to the point where we now may never need to visit for a pre-admission assessment (although a face to face assessment is undeniably the best way).

Finally, I then had to ensure that the new resident was COVID free on admission, challenging hospital management that just wanted to discharge without any testing.  The hospital needed the bed and didn’t want to delay discharge, but we have to protect and from the start of the pandemic we simply refused to admit anyone without a negative PCR test.

Its been a challenging year, but throughout we have kept both our current and new residents as safe as possible and ensured they all received the car they needed, so despite the extra hard work, the challenges and difficulties along the way, it has been incredibly fulfilling and there is nothing as rewarding as knowing you are providing he best quality of life to someone who could not get it before.

 

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