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Connecting, learning and reflecting through COVID-19 – Ruth McDowell

Hi, I’m Ruth. I’m a District Nursing Sister in the Magherafelt District Nursing Team.

I always wanted to be a nurse. I never considered another career. As a child, I was always fascinated with hospitals. I entered the world of caring from a young age at 17 when I commenced the role of care assistant in a local nursing home whilst I studied for my A levels. I went on to study nursing at Queen’s University Belfast and began my career as a staff nurse in Belfast City Hospital.

Despite wanting to be a surgical nurse, a job shortage at the time resulted in me taking up a post in general medicine and I have remained in that area of nursing. I briefly moved to Antrim Area Hospital’s admissions unit before accepting a community nursing post close to home. Incidentally it was with the team of nurses who had cared for my late grandmother only two years previous and had inspired me to pursue a role in community care. I was delighted to work with such an experienced and professional team of staff who readily welcomed me into their world.

When I commenced work as a community staff nurse in December 2012, I felt I found my ‘niche’. I love meeting patients in their own home and following their care journeys, whether this involves nursing them back to good health, supporting them with their chronic illness or providing end of life care – each journey is so personal and individual. I feel it is a privilege that as nurses we are granted access into the patient’s own home and have the opportunity to develop a rapport with the individual and their family and carers to facilitate holistic, quality, person-centred care.

I qualified as a District Nurse last summer and progressed to a District Nursing Sister role in October 2019. This was the perfect opportunity to implement the theories of leadership that I had learned during the completion of the Specialist Practice Qualification in District Nursing, whilst getting to grips with this new job role. The Nightingale Challenge was also a great opportunity at an ideal time, to progress as a leader within my own role. It gave the time to develop networks with other nurses and midwives, observe leadership within the Trust, and reflect on this in order to implement it into my own role. There were clear goals laid out and a schedule of events where we could network and avail from learning opportunities that may not have presented themselves otherwise.

‘Anticipation of great change…’

Taking on my new role and entering into the Nightingale programme took place against the backdrop of increased concern about COVID-19. There was anticipation of great change upon us and curiosity over how it would impact us as individuals. I had been greatly enthused about the fact that 2020 was dedicated as ‘Year of the Nurse and the Midwife’. Finally, our profession and vocation was to get the recognition it so readily needed and deserved and I was passionate to be part of a collective, global effort to promote the professionalism of nursing, and in particular District Nursing. Unbeknown to me at that stage, nurses and midwives would quickly observe what has been our greatest challenge yet in our lifetime and the stage was already being set in a very real arena of how we would exemplify our professionalism to a global audience through our actions in a rapidly evolving climate. The COVID-19 pandemic has impacted significantly on this journey. Events were cancelled; ‘Zoom’ became a meeting method. As nurses, we faced the continually evolving demands of a global pandemic, a phenomenon that we have never experienced in our lifetime. However, I feel as a Northern Nightingale, I have a deepened sense of belonging with my peers in this group. In sharing our experiences in the limited, remote times we have experienced since, makes that time precious. In a virtual Schwartz round in August, three extremely brave Nightingales shared their experience. Schwartz Rounds are group reflective practice forums giving staff from all disciplines an opportunity to reflect on the emotional and social aspects of working in healthcare. It was touching, emotional and shed new light on how diverse our leadership experiences have been throughout this pandemic.

The COVID-19 pandemic has brought to the fore the values that I hold dear and would wish to demonstrate on a personal level in my work. The leadership that I witnessed amongst my leaders and peers alike conveyed steadfastness, support, knowledge that was up to date in real time and the feeling of approachability. Managers led by example in their expertise being shared with care homes where they provided hands on care. There was real compassion shown when I struggled to meet childcare needs. Yes, there were the professional demands of work but like many, many others, I have two young children at home who needed their mum too. It was during the ‘lockdown’ period that I discovered that we were expecting child number three. This altered my role to provide leadership and support from the peripheral rather than the front – something that I struggled with.

‘Faced with adversity…’

Faced with adversity, my team demonstrated utmost professionalism. Relationships with one another were further strengthened at a time when they could have been challenged. The dying patient still had their hand held, the frail and elderly continued to enjoy the social aspect of our visits, albeit behind the now normal Personal Protective Equipment (PPE), and we maintained the usual business of supporting our caseload and the additional new referrals we received during this period. My focus was to build upon this, knowing that these attributes would assist us to get through it together. However, the standards that innately existed within my team members really shone through and exemplified respect, candour, excellence and working well together resiliently and with real care and camaraderie with one another. The team were my eyes and ears of the caseload and I feel very blessed to work with them because of their abilities in applying collective leadership.

Our first encounter with a patient diagnosed with COVID-19 set the bar for future encounters. The advanced communication skills of the District Nurse were tested to the limits. A clear aim within the team from the outset of this crisis was that no patient in the community or their family should feel marginalised. As nurses, we are well versed in caring for patients with various infections and this would be no different. All steps were taken to communicate effectively with them and telephone contact took place prior to the visit. In the telephone exchange, a description of what PPE would be worn on the visit was discussed. We discussed issues like waste disposal as well as our role as a District Nursing Team. Collaborative care planning was set out to empower the patient, and a rapport was developed rapidly which was informative, allaying fears and anxieties whilst protecting their person centred needs, and instilling trust and confidence. I later received heart-warming feedback from one particular patient who conveyed that they automatically relaxed when contacted, that the initial fear they experienced at potentially transmitting this illness to staff entering the house was alleviated, and that despite relying on the District Nursing Team, the feeling of independence that this person wished for was facilitated by the Team.

A Northern Trust Festival of Appreciation was held online in August and I had the privilege of participating in the event ‘Leading through extraordinary times’. During this session we were acquainted with James Kerr. As the wife of a former rugby player, this immediately piqued my interest in knowing that this gentleman had spent time with and written a book about the leadership within the New Zealand All Blacks – I was a little star-struck! In his seminar, James Kerr highlighted the need for humility, compassion and respect to allow flourishing within a team. With a backdrop of an impending second wave approaching, there was an air of anticipation but with more knowledge than the first and experience under our belts, James reassured us that we are more than capable of facing the challenges ahead.

I feel that I only skim the surface in reflecting on how I have developed my own coping strategies and resilience during this time. Prior to the lockdown period, if someone asked how I was, I was likely to respond “busy”. Whilst that is still very much the case, I have personally learned that my time does not need to be filled like it used to be. I have learned that the enjoyment of a walk in the great outdoors, greater reliance on my faith, spending much appreciated time with my loved ones and enjoying the beauty that our own country has to offer, have been invaluable in unwinding from the demands of work and establishing the work life balance.

Winter pressures have certainly arrived prematurely in 2020 and are presently in full swing against the positive backdrop of an incoming vaccine programme. It is my hope that we may begin to experience the important elements of what was normal to us in the past. I feel that with the hope that comes with 2021, as nurses and midwives, our professionalism will be truly recognised, even celebrated in the long term and not just for a designated period; that we will face the future as empowered individuals and most importantly that we nurture ourselves with the same kindness as we provide to others in our care.

Ruth McDowell, District Nursing Sister, Magherafelt District Nursing Team

Ruth is one of the 27 Northern Trust nurses and midwives taking part in the Nightingale Challenge, launched by Nursing Now which is a programme of the Burdett Trust for Nursing, to improve health globally in collaboration with the International Council of Nursing and the World Health Organisation. The Nightingale Challenge asks for every large healthcare employer to provide leadership and development training for a group of young nurses and midwives during 2020, the International Year of the Nurse and the Midwife.

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