One day, you too will need a nurse

I remember the first time I was bleeped in the middle of the night to assess a “sudden shortness of breath” on the ward. It was my first ever night on call and I was lying in my on-call room bed, wide awake and staring at the ceiling – waiting for something to go wrong. I leapt up, already fully clothed, and sprinted to the ward, adrenaline coursing through my veins as I rehearsed the common causes of shortness of breath in my mind – “infection, heart failure, blood clot, asthma attack, panic attack…” Three flights of stairs later, I pushed open the door to the medical ward and made my way past the hushed, gloomy bedspaces. My internal monologue shifted to “Please don’t die. Not tonight. Please don’t die.”

“Are you OK?” A staff nurse, who was looking up at me from behind the nurses’ station, asked through a yawn.

“Hi, yeah, Mrs Greenstreet? Short of breath. I’m the medical house officer on call. Jim… Down. I was bleeped about a Mrs Greenstreet, this is Mercury ward isn’t it? Shit I’ve forgotten my stethoscope.”

“She’s fine,” the nurse replied, “really, it’s fine. She looks better than you.”

“Ha!”

“I’m not joking. Now breathe. I’m Karen by the way, nurse in charge tonight.”

“Karen, great. Hi, I’m Jim.”

Twenty minutes later, after I had examined Mrs Greenstreet and ordered almost every test I could think of (blood tests, a chest X-ray, an ECG and a peak-flow measurement) Karen persuaded me that Mrs Greenstreet was almost certainly suffering from an asthma attack. She then reminded me of the dose of nebuliser and steroid to prescribe and reassured me that a CT scan was not required, right now, at 3am. She would keep an eye on Mrs Greenstreet, she promised, and call me back should things not improve. Despite my flapping, she also managed to reassure Mrs Greenstreet, and avoid leaving me feeling undermined. It was impressive, but all in a day’s work for Karen. She had seen brand new doctors arrive on her ward every six months for the last 10 years. Training them up was just another part of her job.

An hour later I’d looked at the blood tests, chest X-ray and ECG, and at Mrs Greenstreet herself multiple times. Even I had to admit she was looking much better, so I stole one last Quality Street from the tin and turned to leave the ward. Three steps down the ward however, I lost my nerve and turned back to Karen.

“Are you sure there’s nothing else I should do?”

“Go to bed! Don’t worry, I’ll call you.”

Over the subsequent 25 years nurses have got me out of scrapes countless times. It’s not always been with such grace and generosity, but regularly they’ve spotted things I’ve missed, talked down angry patients, questioned erroneous prescriptions and gently nudged me towards the correct course of action. I’ve disagreed with them, been frustrated by them and seen them make mistakes, but those occasions are dwarfed by the number of times I’ve been blown away by their dedication, skill, knowledge and wisdom. And alongside that they spend the whole of their working lives caring for people, when those people need it most – with seemingly endless compassion, day and night, seven days a week.

That, in my opinion, is what makes nurses worthy of special praise and admiration. Their ability to combine being highly skilled professionals, who deliver complex and often dangerous treatments, with looking after people. They don’t just manage the physiology, as doctors sometimes do – they care for the whole person.

I work in intensive care with a plethora of devoted, highly skilled staff. The physiotherapists are vital, particularly for the longer-term patients who are trying to regain their physical and mental strength, the pharmacists give invaluable advice about complex combinations of drugs, the dieticians keep the patients fed and the doctors are of course marvellous, but the nurses are the heart of the unit. They often spend their whole 12-and-a-half hour shift (bar one hour of unpaid meal break) with one patient who is clinging to life.

They wash that patient, turn them, brush their teeth, shave them, wash their hair, lubricate their eyes, suction secretions from their lungs, deliver the infusions of sedation, pain relief and blood-pressure support, apply dressings, manage the dialysis machine and ventilator, annotate and react to changes in the vital signs, deliver nasogastric feed and medications, clean up faeces, calm them when they are confused or half awake, and comfort their desperate relatives. One mistake, a disconnected tube or a drug error can be fatal, and one misjudged conversation devastating.

During the pandemic many senior doctors in other specialities volunteered to work as nursing assistants on the ICU. Their day jobs had been put on hold and they desperately wanted to help, so in they came. It was humbling to see consultant eye surgeons in their 60s emptying catheter bags on night shifts, but it was a consultant gynaecologist/ICU nursing assistant who really encapsulated the truth of it.

“I cannot believe the sheer volume of care the nurses deliver to these patients in a single shift,” he admitted to me through his PPE. “It’s staggering.”

I did six hours as a nursing assistant during the pandemic. I started by covering someone’s lunch break, but having completely messed up their observation charts, I was soon moved on to help the qualified nurses with their turning round. Three of us repositioned and cleaned 18 unconscious, ventilated Covid patients, the majority of whom weighed well over 100kg and had countless tubes and lines that needed to be meticulously managed as we pulled and pushed them around their bed. When I finally doffed my PPE I was exhausted, both physically and mentally, but the nurses weren’t stopping. They still had drugs to check and more breaks to cover.

The quality of nursing makes a difference, not just to the experience of the patients, but to their outcome. During the years I have worked in intensive care there have been countless exciting clinical trials of new medical interventions and drugs, but I would struggle to think of more than five that have changed my practice (and one of those got disproved by a subsequent trial). Twelve years ago, however, our new ICU matron made it her mission to eliminate pressure sores – and she’s done it. Before then one in seven patients developed skin breakdown during their ICU stay, leading to weeks of misery and further complications, but now, due to a massive nursing effort, it is unheard of. They have had a similar effect on cross-infections and patient falls.

So I will do whatever I can to support our nurses who wish to strike. As you may have spotted, I don’t have the skills to stand in for them and I know that few from ICU will be able to down tools due to the emergency nature of the work, but I stand beside those who want to and can. I understand the counter-arguments about spiralling wages and inflation, and I am not sure whether a 19% pay rise is realistic, but nurses have suffered a real-terms pay cut of 8% over the last 10 years and with the cost-of-living crisis, many can no longer afford to heat their homes and feed their families, particularly in expensive areas such as London.

The UK is desperately short of nurses, in part due to the devastating effects of Brexit – another day – so it is vital that we encourage young people into the profession and then keep them there. To do that we need to listen to them, pay them properly and value them for the highly skilled professional graduates they are. At some point most of us, whether we like it or not, will put our lives in their hands.

I spent one night as a patient on my own intensive care unit. I was suffering with abdominal pain caused largely by hypochondria, but for some reason my heart rate had dropped to an alarming 30 beats per minute. The medical opinions varied dramatically (the surgical registrar believed that I was the fittest man he’d ever met and should compete in the Tour de France, while his medical counterpart was convinced that I needed a pacemaker), but eventually we compromised on a night being monitored on our ICU. It was unnerving, but it afforded me the opportunity to see the unit from a completely different, much more vulnerable perspective. I’ll never forget the understated compassion of my nurse, Stephen. I still don’t know which doctor was right (my heart rate magically improved in the morning), but Stephen was brilliant.

The strikes will not put patients at risk, but they will cause inconvenience to many and I support the nurses in doing that. They are exceptional and we should recognise that.

Dr Jim Down is an intensive care consultant in London. He is the author of Life in the Balance: A Doctor’s Stories of Intensive Care and Life Support: Diary of an ICU Doctor on the Frontline of the Covid Crisis