Nurses are the backbone of healthcare, whose indispensable work is being highlighted during the current COVID-19 crisis.

With everyday roles spanning diagnosis, treatment and coordinating with specialists, to implementing diverse and multi-faceted public health plans, they are the key to the health of a country during times of both calm and crisis.

Year of the Nurse

Fittingly coinciding with the worst healthcare crisis in generations, 2020 is the World Health Organization (WHO) designated International Year of the Nurse and the Midwife, as well as the 200th anniversary of the birth of 19th century nurse, statistician, and social reformer Florence Nightingale.

The year-long WHO celebration of the work of nurses and midwives aims to highlight the challenging conditions they often face and advocates for increased investments in their line
of work.

Local nursing

Within the nursing profession is a myriad of categories: registered nurses, registered practical nurses, nursing assistants, midwives, and a seemingly endless list of specialities from paediatrics to oncology, public health to dialysis, and prison health to home care.

Doctors Hospital has 25 nurses on staff in all subsections. Health City Cayman Islands has 100, with a further 15 to 25 nurses due to be taken on this year to strengthen their team.

The Health Services Authority (HSA) has 208 registered nurses, while private clinics and care providers have their own nurses on staff.

Their frontline work during the COVID-19 crisis has proved their perseverance, team spirit and ability to apply their skills to any departments in need.

“No nurse is unaffected by the pandemic,” said Dr. Hazel Brown, chief nursing officer at the HSA, and this is evident across all of the islands’ hospitals and clinics. “All nurses have been involved in the provision of care throughout the COVID-19 crisis.”

Health City Cayman Islands nurses pre-COVID-19.

Teamwork

“Everyone has really pulled together. We have a dynamic team with outstanding teamwork,” said Jennifer Williams, chief nurse at Doctors Hospital. “For example, our operating room team has been integral in working with our screening team, and those working in our out-patient department have assisted in our medical surgical department etc.”

Health City’s nurses are also continuing to work together for the betterment of their patients.

“From screening every patient to attending to the medical and emotional needs of COVID-19-positive patients, our nurses, alongside our clinicians, are doing their best,” said Nilam Singh, head of nursing at Health City. “Nurses are a bridge between the patient and their loved ones, often counselling both the patient and their family members and giving them the emotional support and care they need during this crisis.”

Changes

The pandemic has brought with it changes to the way nurses work.

As the location of the only COVID-19 death in Cayman, and the subsequent infection of four nurses in direct contact with the patient, Health City responded with changes to their care to reduce and stop potential spread.

“At present, the hospital is divided into two wings – one for suspected and positive COVID-19 patients, and the other for non-COVID-19 patients,” explained Singh, who said that nurses have been divided into two cohorts, one for each wing. “These nurses are being kept completely separated in order to stop potential spread.”

At HSA, some services have been scaled back, but the work of nurses has been expanded. “We have added responsibilities and protocols that require more nursing hours, extended knowledge and up-skilling across our facilities,” said Dr. Brown.

“Inpatient nurses continue to provide care to COVID-19 and to acutely ill, non-COVID-19 patients under the weight of personal protective equipment (PPE). Outpatient nurses have been re-deployed to support the inpatient units and to enhance the public health programmes that are expanded to respond to the crisis.

Shift changes have been implemented not only to redistribute nurses to busier areas, but also to support nurses wearing personal protective equipment (PPE) for the duration of their shift, explained Dr. Brown.

“Nurses typically work 12-hour shifts but that is no longer sustainable due to the physical toll that comes with wearing PPE all day,” she said. “Nurses who are wearing full PPE are now working eight-hour shifts to help reduce physical and emotional stress.”

Noble profession

The work of nurses is indispensable, whether in a global pandemic or not, but COVID-19 makes this even more undeniable.

“It’s in times like these that you see the nobility of the profession, the commitment to the patient and nurses going above and beyond to provide patient care under trying circumstances,” said Dr. Brown.

“It has been amazing to watch our nurses work together. In many ways, this is what the nursing profession has been training for, the skillsets to deal with such a pandemic.”

The drive to face COVID-19 head-on is felt by nurses island-wide, with Health City nurses motivated by their colleagues’ experiences with the virus.

“A few of them fougçht against COVID-19 and emerged victorious,” said Singh. “Their victory has motivated each one of us and has made us stronger than ever before. Now, we stand together united to fight this pandemic.”

And fight they do, in each aspect of their varied job.

“From the most trivial of tasks to the most significant, our nurses care for patients in a way that no one else can,” said Dr. Williams. “They are the heroes at the front lines of care, providing tireless service that plays an incredible role in the outcomes and experiences of every patient.”

Mum Sandy Mighty with baby Noa.

New life during crisis

UNICEF estimates 116 million babies will be born “under the shadow” of the pandemic, and within these numbers Cayman continues to welcome new life in maternity wards.

“There has been an average of five babies born each week throughout the month of April at Doctors Hospital,” said Dr. Williams. “All of our patients who come into the hospital are following the same screening process. We are allowing for one support person to accompany them during their stay with us.”

The HSA, which saw 25 babies born between mid-March and early May, also adheres to maternity visitor restrictions and the one support person rule.

“All patients and their support person must wear a face mask for their length of stay and full PPE is worn by midwives during each delivery to ensure extra measure of protection,” said Dr. Brown.

“Our midwives have also needed to adjust communication efforts to patients during labour due to the restrictions of PPE as well as extra emotional support and reassurance to expectant mothers during the crisis.”

Baby Noa was one of the babies welcomed last month, entering a very disrupted world at 8.41p.m. on 28 April, weighing 9 lbs. Mother Sandy Mighty praised the HSA for their work to make her experience as calm as possible.

“In the run up to my due date I was a bit anxious with everything that has been going on, but the staff at HSA put my mind at ease and took very special care of both me and baby Noa,” said Mighty. “There were restrictions in place at the hospital for our safety with only my partner able to come with me for the birth. Both of us were given face masks to wear and he was also given a protective gown.”

Following Noa’s birth, with no visitors allowed, Mighty enjoyed the quiet time to bond with her new baby, all the while looking forward to returning home to her family and introducing Noa to her siblings.

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