The arrival of COVID-19 in the United Kingdom (UK) ripped through lives and the healthcare system, leaving a trail of immeasurable suffering and loss of life in its path. As part of the emergency response, nurses have been among those on the frontline to provide care during the pandemic crisis, being one of the largest workforces within the NHS (Buchan et al, 2019). This included children and young people's nurses, who demonstrated psychological flexibility and emotional resilience as they continued facilitating positive parenting behaviours with caregivers during COVID-19 and beyond (Coyne et al, 2020). The COVID-19 pandemic has led to significant changes in maternal and newborn healthcare delivery, among other areas, as data are collated and resources evolve (Barrero-Castillero et al, 2021).
Nursing associate apprentices are among those who work in a variety of settings within the scope of their generic role (Nursing and Midwifery Council [NMC], 2018a), meaning that they had first-hand experience of the complexities and challenges involved in providing care during the COVID-19 pandemic. Exploring these patient encounters could provide invaluable lessons to inform the development of nursing practice and general future pandemic preparedness. This article provides brief accounts of frontline patient care as experienced by nursing associate apprentices at the University of Wolverhampton.
Nursing associate apprentices
The Department of Health announced the development of the nursing associate role as a strategy to address the nurse workforce shortfall in England (Willis, 2015). Currently, the UK is facing severe nurse shortages, with large numbers leaving the profession each year (NMC, 2017), over 40 000 vacancies remaining unfilled and a 96% drop in European Union nurse registration because of Brexit fears (Davies, 2017).
The introduction of the nursing associate to the nursing family aims to bridge the gap between the registered nurse and the healthcare support worker, thereby improving patient experience at the bedside. While debates on the value of the nursing associate role to health and social care will continue for some time to come, the positive impact they are having on patient outcomes has already started to emerge. In their report, Introduction of Nursing Associates Year 2 Evaluation Report, Health Education England (HEE, 2019) reported on how trainee nursing associates are making a greater impact to patient care and service delivery as they develop new skills and competencies. Furthermore, by becoming more skilled and confident with working across various settings, trainee nursing associates are bringing additional capacity and experience to service delivery, benefiting both colleagues and patients alike.
With the emergence of COVID-19, nursing associate apprentices, like all other nursing students, faced changes and challenges to their practice and learning.
HEE (2017) has highlighted rising public expectations of healthcare delivery in the Nursing Associate Curriculum Framework. Educators have a fundamental duty to facilitate creativity, and to help empower and provide inspirational leadership so that students feel they can embrace the opportunities within the nursing profession.
‘Nursing associate apprentices … had first-hand experience of the complexities and challenges involved in providing care during the COVID-19 pandemic. Exploring these patient encounters could provide invaluable lessons.’
‘When COVID-19 first arrived on the news, we were all anticipating if and how this virus would affect our lives. I never imagined the impact it would have on our patients in care homes. It had been reported that the government was not testing for COVID-19 in March 2020 prior to being discharged to a care home. Testing did not come into effect until 15 April 2020’
During the first and second wave of the pandemic, the teaching team at the University of Wolverhampton supported nursing associate apprentices through weekly online group forums in addition to personal tutorship. The forums provided a unique exposure to the challenges and opportunities that different nursing associate apprentices faced, particularly for those that were redeployed to a different clinical area away from their usual place of employment. Despite the widely documented difficulties students reported in gaining new knowledge and skills, these nursing associate apprentices shaped their world view thinking and crafted their own philosophy, professional values and beliefs.
Amy Darby's experiences
I am currently in my first year of the Nursing Associate Apprentice course. My host setting is on the neonatal unit and I have been here since September 2019 when I started the course.
Parents who have a baby on the neonatal unit already feel helpless, they are worried and scared of the unknown (Bliss, 2020), never mind the additional worries surrounding the COVID-19 pandemic. It was such an anxious time for everyone, the staff, parents and students like me.
The COVID-19 outbreak has meant that restrictions of visiting and contact with their new baby have been imposed (United Nations Children's Fund, 2020). This really caused upset, as not only were parents having babies who were already poorly during a pandemic, but they were restricted to one parent a day for visiting so parents could not share this journey together. This was heart breaking for me, even more so when parents had to self-isolate, or a baby tested positive, so their babies had no visitors for up to 14 days.
As a nursing associate apprentice, I believe my role is to deliver high-quality safe, patient care at the bedside to facilitate a positive patient experience. This experience has taught me that I am much stronger than I believed I was, and I think it will definitely make me a better nursing associate and more compassionate to others.
Laura Williams' experiences
While working during COVID-19, the one thing that I noticed throughout was that everyone worked together as a team. It had removed the hierarchy structure, it no longer mattered what pay band you were anymore, we were in this together. For the first time in the 10 years that I have worked for the NHS, patients were keeping their doors closed to us, not wanting us in their home through understandable fear of cross infection.
My role changed daily and varied in tasks. Sometimes I would be assisting on domiciliary visits with the diabetes podiatrist or I would be in a multidisiplinary team foot clinic. As a team, we had to educate relatives on how to undertake dressing changes safely and recognise signs of infection and when to seek help. My knowledge from university came into play, it aided me and kept me practicing safely and effectively as per The Code and my Nursing Standards of Proficiency (NMC, 2018a; 2018b).
Working during COVID-19 reiterated the importance of emotional resilience and we still managed to make each other smile and laugh in very stressful times. Lecturers from the university whom I had built a professional therapeutic relationship with during the first year still offered support to us every week via zoom. They offered me a listening ear when most needed, which helped me do my job at the best of my ability at a difficult time. Nursing associates gave the COVID-19 patients the bedside care they deserved, held their hands in the final moments when nurses could not and I personally would like to thank each of my fellow nursing associates for all their hard work during COVID-19 but also for the hard work in the aftermath.
Ann Spooner's experiences
I am currently in my first year of the nursing associate course, based within a community nursing team where I have worked for the last 3 years. We visit people's homes, including care home settings.
When COVID-19 first arrived on the news, we were all anticipating if and how this virus would affect our lives. I never imagined the impact it would have on our patients in care homes. It had been reported that the government was not testing for COVID-19 in March 2020 prior to being discharged to a care home. Testing did not come into effect until 15 April 2020 (Panjwani, 2020).
There were a high number of residents that had tested positive in these homes, having a major impact on both my colleagues and me. At times, we felt we were losing the battle; people were dying in front of us, visitors were being denied access to their loved one and residents were often confused and frail, having little understanding what was happening. I felt useless.
It was decided in the community that one designated nurse would attend these care homes, as they were visiting positive patients. This was to help prevent the spread of the virus by reducing the risks of cross infection. When it came to my turn being the designated nursing associate undertaking this role, I found it challenging, as you felt alone and vulnerable, especially as colleagues were going off sick with COVID-19 symptoms. I kept wondering would it be me next – and yes it was. We worked collaboratively with the care home staff ensuring we supported each other in these challenging times.
Proactive swabbing of all residents and staff has since been started to prevent and control further outbreaks (Harper, 2020) and stricter guidelines have now been put in place by the government on care homes (Gov.uk, 2020) to prevent these large outbreaks. This experience has taught me the importance of strict infection control procedures and to treat everybody as if they were positive for the virus.
The role of the nursing associate is a new and emerging one and they must find their way and create their own narrative within the world of health care practice (HEE, 2017). These brief stories, which provide a snapshot into this new emerging practice, have raised a new consciousness in the form of intuitive knowledge within practitioners who are discovering their own stories, and a richer understanding of the world in which they are beginning to practise and influence. Sharing these narratives has provided a means for others to witness and engage with their stories (Cousin, 2009; Frank, 2010), helping to raise awareness and a deeper understanding of the nursing associate role. One apprentice described a feeling of greater autonomy and recognition from within clinical teams, which allowed her to be more confident in making decisions. They highlighted how as a healthcare practitioner, you can feel isolated, challenged and frightened in these unprecedented times. However, by using effective communication, teamwork and interprofessional collaboration, the nursing associate apprentices have applied their skills, knowledge and behaviours to demonstrate their ability to deliver high-quality care at the bedside.