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Blog: My reflections through the Covid-19 Pandemic, Dani McAllister, Critical Care Staff Nurse

25th August 2021

Nightingale Challenge Northern Ireland Global Leadership Development Programme – my reflections through the Covid-19 Pandemic

Dani McAllister, Critical Care Staff Nurse, Regional Intensive Care Unit RVH Belfast.

My name is Dani McAllister and apart from wanting to own a sweet shop (I was very young), I have always wanted to be a nurse. From a young age I was a frequent visitor at hospitals, due to my sister often being ill. Having experienced being ‘on the
other side of the bed’ I decided that I wanted to be a nurse who would really make a
difference for patients and their families.

In 2016 I graduated from Ulster University with a degree in adult nursing. My plan was to eventually move to the USA to work, so I thought that experience in an emergency department or intensive care unit would help my career develop overseas at a future date.

My first post as a newly qualified registered nurse was in the Regional Intensive Care Unit (ICU) in the Royal Victoria Hospital, Belfast. Reflecting on day 1 in my new role, I was terrified. I had never even had a placement in ICU as a student and remember feeling quite out of my depth and wondered what on earth I had done! However, I was always made to feel so welcome, supported and valued as part of the team. I quickly settled and started building my knowledge and skills with thanks to my extremely patient colleagues and mentors. Relatively quickly, realised that I loved the job of caring for critically ill patients and their families. I really enjoyed being part of such a supportive team and decided there was no way I was leaving to go to America.
Following further study at Queens University, Belfast and completing a specialist nursing course in Critical Care, it was fast approaching 2020 which had been designated by the World Health Organisation as the ‘International Year of the Nurse and Midwife’ in honour of the 200th anniversary of Florence Nightingale’s birth. As part of the Nursing Now global campaign, the Nightingale Challenge Northern Ireland Global Leadership Development Programme (NCNI GLDP) was established, an opportunity for young nurses and midwives to further develop their skills in leadership, policymaking, advocacy, and global health to enable us to lead from the front and continue to drive nursing and midwifery forward.

I was delighted to be nominated for a place on the programme as one of 30 young nurses and midwives from across Northern Ireland. When I began my NCNI GLDP journey, my aim was to develop my personal leadership skills, to learn from top leaders in nursing and midwifery and bring that passion and inspiration back into my everyday working. It was fantastic to be able to engage with nurse leaders such as Professor Charlotte McArdle, CNO for Northern Ireland and the senior team from the Department of Health, as well as nurse leaders from the World Health organisation, the International Council of Nurses, and many others. Since starting the NCNI GLDP I have completed a series of Institute for Healthcare Improvement (IHI, USA) modules on quality Improvement and the United Nations Sustainable Development Goals Primer Certificate. I have undertaken personal development tools, such as Belbin Team Roles and have had the opportunity to engage with some of the most successful leaders within the nursing and midwifery professions, and policymakers such as Lord Nigel Crisp and Minister Robin Swann. This networking has been valuable and provided rich learning. I have also had the opportunity to connect with other young nurses and midwives from around the world (our Global Associates), which has been a unique opportunity for me to better understand some of the differences in practice as well as the things that are common to us all, regardless of where you live. Connecting with nurses and midwives from around the world makes you feel you really can take on anything together and really make a difference.

When the NCNI GLDP began in January 2020 we did not anticipate that we would be completing this programme during a global pandemic. As Covid-19 swept its way across the world our programme was turned on its head. We had expected to be attending workshops and travelling overseas on a learning visit, however, Programme Director, Dr Catherine Hannaway had to work very quickly to change the way the programme would be provided to us using technology solutions like Zoom and Facebook. We set up a WhatsApp group, and many registered with other social media like Twitter.

Before the pandemic, when people asked me where I worked it was usually followed up with “and what is ICU, what exactly happens there?” Now people seem to have a much greater understanding of the challenges faced by those of us who work there. As Covid-19 became a real concern, we quickly began to prepare for what was predicted may be to come. An enormous amount of work, unseen hours and planning was undertaken to ensure we were prepared for all possibilities, whilst attempting to care for the critically ill patients we already had and the patients we were anticipating who would need us and our services once Covid-19 took hold in Northern Ireland. Critical care clinical leads came together with what evidence was available to adapt clinical processes and practice to manage the situation as best we could, as well as protecting our staff.

Elective surgery was postponed, and plans were in place for staff re-deployment from other areas to support Critical Care and ICU Arrangements were made for additional training and support to facilitate those re-deployed, alongside sourcing additional critical care beds and resources across Northern Ireland. While we were putting plans and actions into motion we were preparing to manage and overcome something we had yet to encounter. It was a media frenzy, Covid-19 was everywhere, and we knew it would be on its way to Northern Ireland.

Then came the stark reality that healthcare workers were falling ill with the virus, nurses and doctors and other care workers were becoming patients in intensive care. It was a very real possibility we may be required to care for our close colleagues. This realisation sparked conversations that I will never forget. We hit the ground running, wearing layers of Personal Protective Equipment (PPE). But for all our preparations, we never could have imagined what we were facing head on. It became clear that the existing Intensive Care Units were not enough, arrangements were made, and the Belfast City Hospital became a Nightingale Hospital to provide critical care to those who required it with Covid-19. It was a really challenging time for everyone, but I was in awe of those who had no experience in critical care, yet they volunteered to work alongside and support us. I reflected on how terrified I had been when I first began working in critical care – and that was without a pandemic.

With the help of a few years of experience working in critical care, I can be flexible and adapt well to rapidly changing situations. However, I could not have managed to navigate through the pandemic without the strength and the collective effort of the critical care team, both professionally and personally. Given our teams’ ability to pull through for our patients and

Learning together about the SDGs Working with our Global Associates

each other helped me keep things in perspective, that we would get through these challenging times. We had regular debriefs after a shift, sometimes simply walking out to the car together, discussing and off-loading to each other things our families could not understand, either because they were confidential or simply what we could not burden our loved ones with. Equally, the NCNI GLDP zoom workshops and on-line modules gave me a valuable platform where I could still learn and connect outside of my team and enabling me to develop a different viewpoint.

Unfortunately, yet again there is increasing pressure in healthcare due to Covid-19 and even more upsetting is that people are requiring Intensive Care and invasive mechanical ventilation due to the virus. This means more families unable to visit their loved ones who are critically ill, and the only contact may be a phone call with a staff member. The Covid-19 vaccination programme has done an incredible job to date, but it remains our individual responsibility to get the vaccine to protect ourselves and our communities so we can work towards some normality again.

My reflections on the NCNI GLDP are that it has demonstrated to me that nurses have an important role in shaping the future of healthcare. Not least because of this learning experience and the support of the Intensive Care team I have been able to role model the positive leadership behaviours including making a valuable contribution as part of a team in the interests of the patient’s we care for and the colleagues we value. The past 18 months have been really challenging, but the support from my colleagues and the NCNI GLDP has got me through it. The BHSCT has many resources (and very quickly developed new ones) to support staff through the pandemic, with signposting to some great mobile phone Apps and other activities. I have also been able to utilise resources via NCNI GLDP and my own Intensive Care colleagues. I continue to love my nursing role and am determined to use all the learning and skills that I have as I progress through my career, to continue to make a real difference as part of the team.