How the Nightingale Challenge Northern Ireland Global Leadership Development Programme helped build my skills, resilience and confidence through the COVID-19 pandemic
Jeffrey Carrasco, Staff Nurse, Cardiac Theatres, Belfast Health and Social Care Trust
My name is Jeff. I’m a 29 year old international staff nurse working in Cardiac Theatres in Belfast. In late 2019, I was nominated to join a cohort of 30 young leaders from across Northern Ireland to participate in the Nightingale Challenge Northern Ireland Global Leadership Development Programme (NCNI GLDP) – commissioned by the Department of Health and launched in January 2020 (alongside the 2020 International Year of the Nurse and the Midwife).
In this blog, I will share my journey over the past year through the time of the global COVID-19 pandemic – the challenges I’ve faced as I stepped up as a young nurse leader as well as the support I have received throughout this turbulent time.
I qualified in the Philippines as a registered nurse in 2012. After working for two years on medical and surgical wards and two years in operating theatres in the Philippines, I was recruited in 2018 as part of an international recruitment initiative to the Belfast Health and Social Care Trust.
I was initially deployed to an elderly care ward and although it wasn’t my nursing background, I found that the team was brilliant and the experience I gained throughout was very useful. From the start of my professional nursing journey, I knew that my real passion was for working in surgery, so when an opportunity arose to join the cardiac operating theatre team in 2019, I grabbed it.
In January 2020, the World Health Organisation (WHO) expressed deep concerns about the emerging COVID-19 virus. By mid-March 2020, a global pandemic was declared. During all of this, in January 2020, we had commenced the NCNI GLDP, aimed in particular at:
- improving leadership skills
- policy-making
- advocacy
- developing young nursing and midwifery leaders’ understanding of global health issues
Looking back, we were really fortunate to have two face-to-face workshops (in January and March 2020) before we were forced to link virtually via technology – using emails, WhatsApp, Facebook Groups and Zoom. After the workshops, I found that I was always so energised and motivated, and I was determined to capitalise on this excellent leadership opportunity.
Much of our theoretical learning was via e-learning modules and I managed to complete four of the Institute of Healthcare Improvements (IHI) quality improvement modules and the United Nations ‘Primer on the Sustainable Development Goals’. I also undertook some personal development exercises, including the NHS Leadership self-assessment, Belbin Team Roles Assessment and Honey and Mumford Learning Styles – all have been very useful learning for me.
By early March 2020, COVID-19 cases had risen. However, I decided to continue with my long-booked plans of going home to the Philippines on holiday (I hadn’t been home in over two years). As I arrived in the Philippines, I immediately found myself forced to self-isolate for the first two weeks, then ultimately having to extend my stay for a total of two months because all flights back to the UK were cancelled.
In retrospect, I would not have made the trip home because my colleagues working in Cardiac Theatres were left to deal with the crisis, while I was stuck, but in the company of my family. After several calls to various airlines, I was able to travel back to Belfast in May 2020, only to find similar lockdown restrictions in place.
The first wave of COVID-19 cases admitted to hospital had by then peaked (and had now begun steadily declining) and discussions were underway as to how routine operations and services could be restored. During the time I was away, cardiac operations were transferred from their designated operating theatre to a shared arrangement with general surgery, including hepatobiliary and upper gastrointestinal.
Personal Protective Equipment (PPE) had become a standard uniform requirement, not least in Cardiac Surgery due to the higher risk of aerosol spread due to the lungs being exposed as part of open heart surgery. Working in the operating theatres during COVID-19 meant staff wore PPE for up to six hours. Enough staff were deployed so that the ‘scrubbing role’ could be split to enable staff to have a much needed and welcome break from wearing PPE after three to four hours.
All of these were COVID-19 response practices that I managed to adapt to in a short period of time. The surgeons were amazing in their support of the team and team colleagues from BHSCT were fantastic everywhere I went.
By summer, there was a significant dip in COVID-19 cases and I was able to enjoy my days off with the warmer weather. However, the respite from COVID-19 admissions to hospital was inevitably short lived. The virus continued to spread and routine operations were again cancelled. The decision was made to cut down on elective cardiac surgery cases and redeploy staff to the Northern Ireland Nightingale Hospital – a new bespoke intensive care facility specifically intended for COVID-19 patients.
I received training as part of the ‘second wave’ COVID-19 response to further upskill me in order to meet the challenges of working in intensive care. This was particularly helpful to me as I had missed much of the training during the initial onset of the pandemic, having been in the Philippines. In ICU, I was often paired with a more experienced senior nurse caring for up to four patients in a designated bay area. On one of my work placements in ICU, I met one of the NCNI GLDP participants and was very pleased to see a familiar face – she was very helpful and supportive.
The NCNI GLDP programme continued online with workshops and personal support. We began to network with other young nurses and midwives from across the globe (known as our Global Associates) and had the opportunity to hear from and discuss issues with very senior leaders from Northern Ireland (which was an amazing opportunity), in particular Professor Charlotte McArdle, Chief Nursing Officer NI, Mary Frances McManus and the team from the Department of Health, and Dr Catherine Hannaway, Global Health Consultant, as well as global leaders such as Elizabeth Iro (Chief Nursing Officer, WHO), Howard Catton (CEO, ICN), Lord Nigel Crisp (Co-Chair, Nursing Now) and many others.
At a local and personal level, this gave me the confidence to network with the new wider team that I was now in, as there were many team members who I had never worked with before. I needed to be flexible and quickly adapt in the way I worked, and the NCNI GLDP gave me the confidence and competence to do this effectively.
The NCNI GLDP also helped me build my resilience and agility to cover a wider range of duties and shift patterns to meet the demands of the ICU. I conscientiously interacted closely with the patients, developing a habit and manner (style) of asking them if I could undertake a task or intervention, even though they were sedated and unable to respond. I felt it was the right thing to do in the circumstances.
During winter 2020, efforts were made again to restore routine surgery. I was redeployed for two weeks – this time to the BHSCT Regional Intensive Care Unit (RICU) for non-COVID-19 cases. The unit was newly opened and consisted of two levels, enough to accommodate 32 patients in state-of-the-art rooms. I was then redeployed a final time to the Cardiac Surgical ICU. Fortunately, it was just next door to my own home unit.
At this time, cardiac surgery cases had gradually ramped up and support was needed to cover staffing levels as many of their staff were still redeployed to the Nightingale Hospital. This was a welcome placement as it enabled me to observe the whole journey of cardiac patients rather than just the actual surgical procedure in the operating theatre. It provided me with great insights and learning.
On a personal level, my family were very supportive and I also benefited from the resources made available by the Belfast Health and Social Care Trust to promote the health and wellbeing of staff. I was also finally able to recover and re-energise when I took some annual leave during the third wave of COVID-19, after having worked several five-day work weeks along with occasional on-call shifts.
I am very proud of myself for having coped with stepping up to the challenge of three redeployments over the course of five months as part of the BHSCT COVID-19 response. Looking back, I am very lucky that all the places I was redeployed to were very accommodating, inclusive and supportive, and that I really felt I was a valued member of the team (even for that short time).
The experiences I have gained, along with the support and the learning from the NCNI GLDP, were far reaching and definitely helped me make a real difference to the lives of our patients and to the efforts globally to fight the pandemic.