OH during COVID-19

Pandemic Story

Elizabeth Murdoch, Lead Occupational Health (OH) Nurse, Occupational Health Service, FVRH

I have been nursing since 1987, qualifying as RGN in 1992 then specialising in Occupational Health with SCPHN qualification in 1998. I am passionate about the NHS and decided to stay in the NHS, working in NHS OH Departments in Glasgow and in NHS Forth Valley since 2004.

OH is a highly specialised area of Specialist Community Public Health Nursing, our roles are often misunderstood given that OH is not in the curriculum of pre registration nurse training this is understandable. Employees who have been fit, well and not faced any workplace issues impacting on their health will have had minimal contact with the service.

The role of the OH nurse has evolved greatly in my career. There is a national shortage of OH nurses and the courses to qualify are two years of structured training. It takes years of experience to be a confident practitioner. As a practice teacher it involves two years to support an OH nurse through training and achieving all the competencies of SCPHN. I have completed this process with several OH students and supported a practice teacher in training so it’s a slow process bring new practitioners to the profession.

OH is a small multi disciplinary Team in a large organisation providing services to NHS Forth Valley’s workforce such as pre employment health screening, case management for sickness absence, case conferences, health promotion, assessing fitness to work, providing OH advice, health surveillance, administering vaccines and venepuncture to test immunity and infectivity of diseases. The OH nurses work autonomously using clinical and analytical skills to undertake their roles and make decisions. The OH consultant works closely with the team providing expert opinion in more complex cases. We also have a counsellor and Psychologist in the team providing services to for staff with mental health problems. OH practitioners use a bio psychosocial model of care and the department is a confidential space for employees to talk openly about symptoms, feelings and problems with life.

The admin team are the hub where all enquiries come in to the department and they support the OH team with receptionist duties, secretarial duties, data management, reports and IT skills.

Last year my line manager retired and I was successful in becoming Lead Occupational Health Adviser, which was a once in a life time opportunity. Little did I know the biggest challenge of our life time was going to happen and I would be leading the OH Team along with the very experienced Service Manager in delivering OH services to NHS Forth Valley’s workforce during a pandemic.

Although we have always spoken about a pandemic and being prepared, it has been a completely new experience and the greatest challenge of our careers. In normal times the OH department is always busy with waves of increased activity when we provide additional services such as Flu immunisation programme. The pandemic was like a Tsunami and I want to describe the challenges the OH Team have come through to now.

Phone calls:

In the beginning there was ever increasing telephone calls from managers and the workforce with COVID -19 enquiries, it was overwhelming. We put systems in place to manage and log calls. In order to respond, we had to cease usual daily work and this was difficult for the team to stop what we had always done and we felt like we were letting down our clients.

COVID -19 Risk Assessments:

The volume of enquiries were the same but started to change. Another more complex wave of calls started to come in. Increasing evidence and media coverage was coming from other countries, individuals with underlying health conditions were at risk of death. Managers along with OH practitioners were to carry out Risk Assessments and decide who was to shield and work from home if possible. I remember everyone with their heads in their hands, expecting we would be experiencing loss of life among health care workers. The risk assessments from Scottish Government were slow to come through, this frustrated us and we were ‘holding’ these enquiries until we had the guidance. The team worked through many Risk assessments and this was new complex work. I had to look at the skill mix and delegate these to the trained OH nurses and consultant.

Testing:

OH worked collaboratively with ICT, Public Health, medical records, newly developed testing centres, laboratories and information management to organise a testing service for symptomatic staff. This then expanded to testing asymptomatic health care workers in contact with high risk patients routinely and we assisted services in taking this forward by developing forms for referral and instructions on using ordercomms and labels.

Mask and PPE:

Shortages of masks, gloves and alcohol gel became apparent. The ICT led on face fit training for FFP3 masks. We began to experience referrals for staff with allergies and irritation to masks. Skin on faces and hands of health care workers broke down due to PPE use. Referrals with skin issues reached a peak and alternative products, other work and products to relieve symptoms had to be identified to keep those individuals affected safe at work.

Weekends:

Normal hours were not possible and the team worked weekends to arrange testing and continue with some normal services.

Near Me/Telephone consultations:

Face to face consultations had to cease to reduce footfall and the overall risk of COVID, all consultations changed to being over the telephone or by video call on near me. Clients who were lonely and isolated struggled with this. We worked collaboratively with our partners such as staff physiotherapy who stepped in to draw up return to work plans to assist smooth returns to work. The OH team contacted their clients to support them whilst doing all the other new activities.

Mental Health:

Throughout the pandemic the OH team have supported staff with anxiety and stress. COVID has brought challenging times for all and staff contact OH for support to discuss coping strategies. Staff support and well being has been well structured and many additional services are available and more accessible than OH services. Staff tend to come to OH in these difficult times and have not been fully aware these services exist. The OH team have had to adapt and we cannot deliver the support we have in the past, we have sign posted staff to these services and there is good feedback from those who utilised these services.

New team members & Help from other services:

New team members came to join the OH team during COVID and we have celebrated them joining us.

Help from other services:

Emma from health promotion came to help, on loan from her own department and she has continued to support the team by working on reception every Monday and Tuesday.

Medical Records have been wonderful and worked closely with OH, appointing all our Flu appointments this year, reducing the work load of the admin team.

Retired nurses continue to come in and contribute to the workload, revisiting old skills and bringing their expertise back to the fore.

New Doctors August 2020:

We recruited new Doctors in August, which is normal but we managed to achieve this along with the COVID work continuing.

Recruitment:

There will be a surge in recruitment for winter and we will need to balance this with the flu clinics to ensure the workforce is prepared for the winter months.

Reflection and Appreciation:

In July we organised these sessions with Organisational Development to reflect on our experience and take space to talk over what it has been like to work through the pandemic. I think this was important to stop and listen to each other and look at what we have achieved. We have recognised we need to also care for ourselves and each other, looking at self care and being kind.

Flu Immunisation

The OH Team, delivered Peer Flu immunisation training to Peer Immunisers who will assist in vaccinating staff against Flu. A fully comprehensive training package was developed and will be moved on to Learnpro for next year. Along with pharmacy and resuscitation, the training package was presented to 130 peer immunisers. This is already proving to be very successful.

This year flu programme needs to be delivered differently and OH will operate with booked appointments. The admin team are now able to use trakcare and again, medical records have helped OH achieve this.

Looking back it needs to be noted, the Team have been subject to difficult conversations and decisions in the pandemic. It can be very challenging when people don’t understand and are angry. The OH team have been resilient and worked together to overcome the emotional challenges of our work that result from the difficult conversations. We often feel forgotten and invisible as we saw other services being thanked by the community with gifts. It was a special moment to go outside to the sunshine and see the Spitfire fly over and be thanked in such a special way.

The OH team work behind the scenes, caring for the health and wellbeing of the work force. The team work very hard and have been inspirational, adapting to all the changes and challenges. The OH team received positive feedback and praise from many services users and this was shared and celebrated.

Looking to the future we now have 4 members of the team trained as wellness coaches which will be beneficial to our clients once time permits to start using these new found skills.

I cannot thank all of them enough and can’t do what I do without them.