The Strike Diaries: a week in the life of an NHS nurse
“I can't keep the tears in”
As the UK’s public service industries continue their industrial action for better pay and working conditions, THE FACE asked young people in each sector to keep accounts of their typical working weeks. These are the realities behind their picket-line demands.
Molly is a 25-year-old nurse, who started her training in 2018 and became qualified in 2021. She currently works on an inpatient oncology ward in London and took part in strikes with the Royal College of Nursing in December, January, February and May.
This week, Molly worked three night shifts and one day shift, totalling 50.5 hours, including 4.5 hours overtime.
Thursday night shift
I got the Tube into work for 7:45pm, changed into my uniform and put my “lunch” in the staff room. It’s always hard to eat properly in between shifts, especially on nights, so before I went to work I made a big pot of pasta to last me the next few days.
Tonight I have five patients, which is good for a night shift. My ward has high acuity [meaning patients require more care], so we should be one nurse to four to five patients. But this tends to be rare – we usually have six or seven. Last year, our ward was fully staffed on 20 days out of 365.
I introduce myself to my patients, gauge their general baseline and ask how their symptoms are at present – things like pain, nausea and vomiting. I then start my medication round. Many patients will be on long-acting pain relief that is administered every 12 hours, so we do these first. These are controlled drugs (CDs), so they’re locked up and it takes two nurses to sign them out and do the safety checks. By 9ish, all the long-acting CDs are dispensed, and I finish off administering the other medications before focusing on the IVs.
At around 10pm, I start assisting any patients with personal care, for example, if they need help going to the loo or repositioning so they’re comfortable. Their observations (blood pressure, respiratory rate, heart rate, temperature and oxygen levels) are taken every four hours, more frequently if there’s a concern. We’re supposed to have nursing assistants that do this, but if we don’t have the staffing, then we do it.
One half of the ward is currently closed off as there’s been a Covid-19 outbreak. Visiting is restricted, which is always hard for the patients, but it has other challenges logistically for staff, like having to wear FFP3 masks on both sides of the ward. The [emergency] crash bell alarms on the Covid side of the ward. As it’s an emergency, I put on PPE as quickly as I can and run to support the south staff. I assist until I’m no longer needed. Unfortunately, the patient died.
It’s around midnight and I have a 20 min tea break. I then make a start on my notes for each patient and update flowsheets. One of the patients spikes in temperature, so I inform the doctor on call. We need to do a septic screen, which is a variety of tests and cultures we send from blood, urine and sputum if they cough up fluid. Luckily a colleague is free to help me, as trying to get the vein and keep the needle in place whilst filling the different vials with one hand can be a challenge. I’m still quite new to venipuncture, but thankfully was able to get the bloods on the first attempt.
My patient is exhausted, in pain and hasn’t been able to sleep much. I give pain relief and help her settle and get comfortable. I try to reassure her, as she was quite recently diagnosed with a poor prognosis. We speak for a while about her family and she tells me about her daughters – they are a close unit. This helps distract her and she manages to get some sleep.
It’s nearly 5am and I haven’t taken a proper break as I got too busy. I’ll be starting morning medication rounds soon, so I eat a bit, then finish my documentation and help any patients who call or need pain relief. I hand over to the day team and leave around 8:40am. I get home, have a shower and try to get to sleep. I fall asleep about midday and wake up at around 4pm. Not ideal.
Friday night shift
I ran to work as I’m trying to get my training in and the sun’s out. I had a shower in the changing room and put my uniform on.
Handover again. I have six patients today, but they’re mostly the same as yesterday’s. I’m also the nurse in charge today, so there’s other jobs I need to do and I carry the ward phone. I do my usual routine and then start to focus on nurse-in-charge jobs. This includes things like checking the crash trolleys, the fridges and counting the controlled drugs – a CD check is done once a shift to make sure everything is accounted for and see what medications need ordering. I also need to check staffing and update the handover sheets for the morning patients.
At 2am I get a new admission into one of my beds. This a patient who’s been in before, so say we say our hellos. She’s admitted with electrolyte imbalance, so needs IV fluids to help correct this and rehydrate her. Unfortunately, her cannula has tissued, which means a new one needs to be inserted. My colleague, who’s coordinating the ward and is more senior, offers to try as this patient has very difficult veins. She manages to get one in and my patient is able to rest.
I write notes, document flow sheets and cover my colleagues’ breaks. I often don’t take a full hour break or, if I do, I use it to write my notes to avoid leaving late. But today is going well, so I can have a proper break. The staff room and areas with a sofa or chairs are already taken by other staff, so I go to the main reception and have a dose under one of the desks for 40 minutes.
At 5am, I come back and start prepping trays for medications and check that my colleagues are OK. It gets busy towards the end of shift as a patient becomes unwell and medications get delayed. I finish later because of the last minute rush. It’s rare that I leave on time. Most days I leave 30 minutes or so late, but sometimes it can be two hours.
I left the hospital at 09:30am. I was going to run home, but I felt too tired so got the Tube instead. Once home, I make some toast and go to sleep.
Saturday night shift
I get into work and do the usual handover and medications. One of my patients is on chemo that’s been infusing for a couple days. This needs flushing and to be taken down. I’m not chemo trained yet but plan to start the process soon, so a more senior nurse takes it down.
One of my patients needs end-of-life care. He’s 20 and it’s likely he will die in the next few days or weeks. There’s a lot of young people on the ward at the moment. Sarcoma is a rare type of cancer, but it can be aggressive and often is in young people. At around 5:30am, I went in to give him some pain relief as he was becoming less lucid. He asked me where we were going next, so I provided reassurance, held his arm for a bit and told him he didn’t need to go anywhere. He then went to sleep and, as I left the room, I squeezed his mum’s hand. Her face stays with me. I leave the room promptly as I can’t keep the tears in.
I carry on with the rest of the shift. I finished on time today.
I finished nights on Sunday morning and had Monday off to switch back into day mode. When I arrive into work at 7:45am, I take a handover and start morning medication rounds. The south side is open again after the Covid outbreak, so we’re split across the whole ward. We’re not staffed well and I don’t have a nursing assistant, so I’m grateful to have a student nurse who can assist, as a lot of my patients are bed bound with complex needs that require two people to deal with.
I check all the bedside equipment and introduce myself to the patients, assisting with changing beds and washing or changing pads. I then check observations and the blood glucose of patients who are diabetic or on steroids. One of my patients is very unwell and needs closer monitoring. We are waiting to transfer him to ITU, so I help him get washed and changed before he goes.
Medication takes a while as we are one nurse down and lots of the medications that need to be given require two people. There is then an IT issue and most of the WOWs (workstations on wheels) are down. They stay down for four hours, so lunchtime medications take a lot longer. I also have a patient who needs a blood transfusion, but luckily the one working WOW has a working scanner, so my colleague and I are able to complete the transfusion and carry out all the safety checks.
I take my lunch break late and go through some feedback with the student, as I know there won’t be time later and I don’t want either of us to finish late. Then I finish off documenting and trying to catch up after the IT issues, before doing evening medication rounds and giving a handover to the night staff. I’m not able to finish all my documentation on time, so stay to finish off. I leave 45 minutes late at 9pm.
Why I’m striking
I wanted to become a nurse as working with people gives me a sense of purpose, being able to make a difference and help patients at what often is a very difficult time in their lives. We are in a privileged position as healthcare professionals. You see the best and worst in people when they’re most vulnerable.
What is difficult now is the feeling you can’t help more, due to the ongoing pressures the NHS is facing. A lot of nurses are leaving the profession. They’re burnt out and the pandemic was relentless. We’re now trying to catch up and, with the financial worries, the distress isn’t worth it.
I started my training in 2018 with the new system, where we get a degree but have to pay the fees. During my three years training, I had to do the academic side, plus 2300 hours in clinical settings, which was exhausting. But this isn’t reflected in my pay now.
Even before the pandemic, years of cuts and austerity were causing issues. A lot more of the NHS has been privatized than people think – it’s been done stealthily. The strikes are for fair pay; we haven’t had a pay rise in years and, if we have, it’s been a piddly 1 per cent which is nowhere near inflation. Despite what the media says, for safety, strike days are often better staffed than some normal shifts.