What it's been like to work in Queensland hospitals and health services during COVID-19
Wednesday 30 September 2020
This article was written during the Queensland response to the COVID-19 pandemic and reflects the information available at the date of publication. Please check the Queensland Government COVID-19 webpage for updated information and current health advice regarding COVID-19 in Queensland. All information was correct as per the experience of the interviewee at the time of their interview.
For many staff working in Queensland hospitals and health services, the COVID-19 pandemic has changed the way they do their jobs. Some staff have been asked to take on new roles, while others have had to set up entirely new clinics or wards to deal with testing and treatment of COVID-19 cases. All have had to deal with the threat of an unknown virus and a rapidly changing situation, while continuing to deliver outstanding patient care.
We spoke with Queensland Health staff from across the state about how COVID-19 has impacted their work this year.
Keeping informed when information changes daily
Kelly is normally the Nurse Unit Manager (NUM) of the Logan Outpatients Department, but when the pandemic hit, she became the NUM of the hospital’s fever clinic, where staff work to test people who might have COVID-19. In her role, Kelly is not just responsible for patient care, but for looking after the nurses in her team.
“It’s not just the patients and what they need, but my nurses, and what they need to provide that care,” she says.
Kelly’s team required information and processes to help them do their jobs effectively and safely, in a time when information was rapidly changing. For Kelly, the challenge was making sure her staff felt confident that they had the right knowledge at the right time.
“The biggest thing I did for my staff was to say, ‘No information comes to the team except through me,’ and that gave them a sense of consistency,” explains Kelly. “I wanted to make sure my staff felt that I knew what was going on. Every morning, I had the printed public health guideline in my hand and an adjusted flowchart, so my staff knew I had the most up-to-date information.”
For Peter, an Advanced Medicine Trainee at Gold Coast University Hospital, watching the speed at which information about the virus became known and was able to be implemented in medical practice was thrilling.
“The speed at which information was spread through the medical community, and the speed at which things like typing the virus were achieved, has been really eye-opening,” he says. “It was amazing how quickly we had a specific test for the virus, that really was incredibly. It’s been interesting to see the dynamics of how it’s worked not only in the medical world, but in the broader community as well, playing out through the media and public spheres.”
Managing anxiety when working with an unknown virus
Right across Queensland and the world, frontline healthcare staff have fronted up to work on tackling COVID-19 each day, even though doing so could put them at higher risk of catching the virus.
For NUM Kelly, the risk involved in working with COVID-19 patients wasn’t a new part of the job.
“We’ve always been at risk,” she says. “We’ve always been able to catch things from our patients and so we take proper precautions to try and stop that from happening. This is a lot more virulent and lot more unknown, so it’s scarier, but this is what we signed up for. The public can sometimes forget that this is what we do every day.”
Many staff weren’t as concerned for their own health as they were for the people at home who they would return to at the end of the day. Some made the decision to change their routines outside of work as an extra precaution.
“I think what is really scary for a lot of nurses was that we don’t want to take it home to our families as well,” says Megan, an ICU nurse at the Princess Alexandra Hospital, who is directly involved in the care of very unwell COVID-19 patients. “You know, I’m young, but my parents aren’t that young. I didn’t want to go and visit and give it to them and or to my grandma.”
Advanced Medical Trainee Andrew says that an unforeseen aspect of his role became reassuring other staff members, so that everyone could keep doing their job to the highest standard.
“Even in medical professionals who would normally be quite calm and relaxed, you could feel a bit of anxiety and panic,” he says. “So, there’s that non-medical aspect of keeping people reassured as much as possible, and that our priority was still just to look after people, that the patient still comes first.”
What it’s like to work with COVID-19 patients
When the pandemic was declared, staff in specialist areas including hospital Intensive Care Units and newly developed COVID-19 wards and fever clinics were quickly mobilised to care for confirmed cases.
COVID-19 in the ICU
Princess Alexandra Hospital nurse Megan explains what it’s like to care for very unwell COVID-19 patients in the ICU.
“The Intensive Care Unit is where the sickest people end up,” she says. “We have one nurse to one patient, which means we’re able to give constant care, and we’re responsible for looking after that sole patient for our shift.”
So far, Megan’s team have been responsible for looking after a handful of extremely unwell COVID-19 patients. She says that while all ICU patients are very sick, COVID-19 patients present unique challenges.
“One big difference is that with anyone who has COVID – they can’t have visitors. You’re not allowed to visit them in hospital,” she says. “That means that I’m almost the only person who is going to be in the room with that person for that 12 hours. It’s me and the patient.”
A big part of nursing is also caring for the loved ones of patients, but instead of being able to talk directly with her COVID-19 patients’ families, Megan has to rely on the unit’s social workers and doctors to communicate about the patients’ wellbeing.
“When you’re in that room and you’re wearing all the protective equipment, you can’t even hold a phone up to your face to talk to the family,” she explains. “It’s very isolating for the patient and for their family.”
Megan’s patients are often sedated and on a ventilator, which means they aren’t always aware of exactly what is happening to them. She says COVID-19 protocols can make waking up in the ICU an even more distressing experience than it would normally be.
“Starting to wake up and not knowing where you are and having someone coming at you wearing a face mask, a face shield and big blue gown, trying to tell you it’s okay – I can only imagine it would be terrifying,” she says.
On the COVID-19 wards
Registered nurse Erin works at the Gold Coast University Hospital, as part of the team who looked after Queensland’s first COVID-19 patients.
“We received the three families who had travelled from Wuhan. They were our first positive patients, and they were with us for three weeks.”
Erin and her team faced the challenge of working with these patients while they were also being constantly updated with information from the outside world. Changing information and language barriers made communication key to keeping these patients calm.
“They were scared, they were watching everything on social media, too,” she says. “The pandemic was really taking hold, and so they were reading and learning about it as well. The language barrier meant we needed to find new and novel ways to communicate with them, and we always had an interpreter with us.”
Erin also found the PPE requirements made her job more challenging, especially when trying to reassure these patients during a very stressful time.
“The care for them was the same high level of care we offer everybody, but the PPE made it a different job,” she says. “Every time we went into a room – they could only see our eyes, they couldn’t see our smiles, they couldn’t see how our facial expressions. You can imagine being scared and being locked in a room in a foreign country, and then having someone come in with gown, gloves, booties, hats, masks. It was scary for them and it was a challenge for us, but in the end, they all recovered and that was a great feeling.”
Advanced Medical Trainee Peter has chosen to specialise in infectious disease, but even so, he didn’t expect to ever be part of a pandemic response.
“I never thought I’d actually be part of a pandemic,” he says. “It’s a once-in-a-career occurrence.”
He says that dealing with all the unknowns of COVID-19 made working with the first patients extra complex.
“Initially you are quite anxious,” he says, “because you don’t know what to expect for the patient and their care. You’re wondering what their pathway will be through their illness.”
But as he and his team became more familiar with how COVID-19 could affect people, they began to feel more confident in assessing patients and predicting the care they would need.
“The first step is figuring out how far along in the illness are you,” he says. “When people do deteriorate, that’s often in the second week of illness, from that inflammatory response of the immune system. So, we need to gauge where in illness they are. Then, I look at how the patient is presenting. Are they comfortable, are they able to sit up and are they speaking in full sentences? Or, are they short of breath, are they fatigued and drowsy in bed?”
Peter says that as a doctor, assessing a patient’s condition comes down to far more than a symptoms checklist.
“I’m more reassured if someone looks reasonably well but has symptoms, versus someone who isn’t responding well or is drowsy and lethargic,” he says. “That delineates where that patient is going and what care they’ll need. If they are well, even with symptoms, and young enough, we can look after them at home through phone calls and monitoring their symptoms. But if they’re not looking well, they’re not able to have a conversation, they seem confused or drowsy, then we know quickly that they are pretty sick and we might need to think about rapidly escalating their care.”
Cleaning during COVID-19 – more important than ever
24 hours a day, seven days a week, cleaning teams are tasked with making our hospitals and health services a safe place for healthcare delivery.
“It’s about safety for patients, but also safety for everyone who works here,” says Loretta Goleby, from the Princess Alexandra Hospital Isolation cleaning crew.
This year, the team’s crew has doubled, with staff working hard to make sure that the risk of COVID-19 transmission in the hospital is as low as possible.
“We are organised into shifts covering 24 hours a day and our main responsibility is about making sure patients are presented with a clinical space that keeps them safe, from COVID-19 or any other germs,” says Loretta. “The ISO team is responsible for cleaning after patients are discharged, isolation areas, mop-up of spills, COVID cleaning in wards, ED and the screening clinic.”
“Our cleaners are amazing, and they don’t often get recognised,” says Gold Coast University Hospital nurse, Erin. “It’s often about the doctors and the nurses, but these are the people that need to be highlighted. Without the cleaners, it wouldn’t be a safe place to work or to be treated.”
Nurse Unit Manager at Logan Hospital, Kelly, agrees. “The COVID-19 response has been a whole service response, and we shouldn’t forget that this has taken cooperation and work from every single team. The cleaning teams keep us safe. Without support from everyone including cleaning teams through to the executive teams, we wouldn’t have been able to achieve these results.”
Keeping Queenslanders safe through education and enforcement
Adam, Senior Environmental Health Officer at the Metro North Public Health Service, leads a team which this year, has worked to assist and monitor businesses in implementing safe operating practices during the pandemic.
The Public Health Unit is responsible for monitoring business compliance, health screening at the airport, hotel quarantine and contact tracing confirmed cases. The Public Health Unit team has coordinated the different organisations who ensure that businesses understand how to implement COVID-19 restrictions and monitoring their compliance.
“We liaise with local government and other agencies, we share an approach to monitoring compliance of businesses in the area,” he says. “This can include everything from restaurants, to nail salons, and places that hold large-scale events.”
Adam was involved in Queensland’s response to swine flu in 2009, but says that the required response to COVID-19 has been much larger in scale than anything he has seen before.
“The size of the response has surprised me,” he says. “We were fortunate with swine flu, this is obviously more serious and has required and will required a large-scale, sustained response for a long time.”