The Queen’s Nursing Institute (QNI) has published a major new report on the effect of the Covid-19 pandemic on the UK’s nursing and residential homes.
In May and June of 2020, a survey of the QNI’s Care Home Nurses Network was carried out by the QNI International Community Nursing Observatory (ICNO) to understand more about the impact of Covid-19 on the Care Home Nurse workforce within the UK. This survey was launched in the early weeks of the pandemic in response to grave concerns about the safety of the workforce and the gaps in provision that it was facing. The survey responses confirm that for the majority of respondents, the pandemic has been a very challenging experience. They indicated that their work and wellbeing has been worse or much worse than at normal times, during the survey period.
Having to accept patients from hospitals with unknown Covid-19 status, being told about plans not to resuscitate residents without consulting families, residents or care home staff, lack of guidance on issues like personal protection and issues of poor access to pay if they became ill were some of the major issues the care home workforce faced during March and April 2020.
While two thirds of respondents said they ‘always’ had access to appropriate personal protective equipment (PPE) and most others said that it was usually available, a small minority were not provided with PPE and had to improvise, by obtaining it themselves or by making it. The need for appropriate PPE in care homes is of critical importance in staff and resident safety: 21% of respondents said that their home accepted people discharged from hospital who had tested positive for Covid-19.
The majority of survey respondents found it easy to access hospital care for their residents when this was required; however, a substantial minority found this difficult or very difficult. Additionally, a substantial number found it difficult to access District Nursing and GP services, which are universal parts of the National Health Service. In addition, many indicated that they were not able to access essential training from other health professionals at this time.
Some respondents refocused work to consider how they could improve on their approach to end of life care. Worryingly, some who responded raised serious ethical and professional concerns, for example GPs, Clinical Commissioning Groups and hospital trusts making resuscitation decisions without first speaking to residents, families and care home staff or trying to enact ‘blanket’ ‘do not resuscitate’ decisions for whole groups of people.
Dr Crystal Oldman CBE, the QNI’s Chief Executive commented: “The care being delivered in a home can at times be as intensive as in a hospital – in particular for end of life care – and it is hugely skilled work. As the majority of respondents to this survey indicate, the people living in their care homes need a combination of support for complex physical and cognitive needs.
“Overall, as would be expected, the picture presented is of an extremely stressful and anxious period for professionals working to care for and protect their residents. The positives represent a silver lining to this cloud and there are numerous testaments to the skill, dedication, professionalism and teamwork that Care Home Nurses have displayed in 2020. In addition, this brief insight into the experiences of the nurses provides an opportunity to consider and plan for the support systems that may be needed in the anticipated second wave of Covid-19.
“More needs to be done to understand the effect of Covid-19 on the workforce and residents in care homes. Urgent attention must be paid to the sector if the workforce is to withstand the additional demands of the pandemic, particularly in planning, guidance and employment practices.”
Professor Alison Leary MBE, Director of the ICNO and Professor of Healthcare and Workforce Modelling at London South Bank University commented: “It is clear from this survey that the care home workforce has faced very challenging issues. Many have felt unsupported and their wellbeing has suffered. We need to support this workforce to face the challenges ahead.”
Key findings of the survey include:
- 70% (114) of respondents were Registered Nurses (RN) and 28% (46) were managers. 78% of respondents were over the age of 45 (128).
- Most respondents reported caring for older people (97, 60%) with just under a third reporting caring for a mixture of residents of different ages and needs (48, 29%).
- 66% (107, 66%) of respondents reported always having appropriate PPE while 2 (2, 1%) of respondents reported never having access to the appropriate type and quantity of PPE during the first three months of the pandemic (March-May 2020). 75% (123, 75%) reported that their employer had provided all their PPE.
- During March and April 2020, 34 (21%) reported receiving residents from the hospital sector who had tested positive for Covid-19 in hospital.
- 70 respondents (43%) reported receiving residents from the hospital with an unknown Covid-19 status during March and April 2020.
- 54% in total of respondents reported it was easy or somewhat easy to access hospital care with 25% in total reporting it somewhat difficult or very difficult during March-May 2020
- In terms of accessing GPs, 67% reported it was easy or somewhat easy to access GP services with 32% reporting it somewhat difficult or very difficult.
- 23% reported it was easy or somewhat easy to access District Nursing services with 33% reporting it somewhat difficult or very difficult during March to May 2020.
- 71% reported it was easy or somewhat easy to access end of life medication/services for residents who required it, with 12% reporting it difficult or very difficult.
- When asked if arrangements had changed in terms of decision making around do not attempt cardiopulmonary resuscitation (DNACPR), the majority responded “no” (95) that there had been no changes. Five respondents stated they had made no changes to practice as continuous review was normal practice.
- 16 respondents reported negative changes which they found challenging such as “blanket DNACPR” decisions, or decisions taken about resuscitation status by others (GPs, hospital staff or clinical commissioning groups) without discussion with residents, families or care home staff or that they disagreed with some of the decisions on legal, professional or ethical grounds.
- 39 respondents reported Covid19 as a positive focus for change in talking about end of life care and a discussion of practice or ceiling of care, for example, moving to a recommended summary plan for emergency care and treatment (RESPECT) process or a reason to initiate conversations around dying and residents’ wishes.
- Around 20% of responses reported positive or mixed sentiment around the experience of working through Covid-19, for example pride in their colleagues or new workforce opportunities. 80% of responses reported very negative experiences.
- 56% felt worse or much worse in terms of their physical and mental wellbeing, while 36% reported no change.
- Only 62 respondents stated that they could take time off with full pay, while some felt pressure not to take time off at all (15).