The Ward Round: Staffing The Nightingale

All eyes are on London’s temporary hospital at the Excel centre, which is due to officially open on Friday. Other field hospitals are springing up around the country, but the NHS Nightingale will be by far the largest, with its recruitment target understood to be around 16,000 staff.

The hospital was initially described by senior figures familiar with its care model, which is being refined on a regular basis, crudely as a “critical care barn”. But plans outlining the clinical model for the hospital — details of which were exclusively revealed by HSJ today — say the site will not take the most complex and unstable patients.

It will, however, focus on a cohort of patients who have confirmed covid-19 related respiratory failure, some of whom will be seriously ill, with the plan suggesting between 16 and 20 per cent of patients who arrive at the facility “might” die.

The hospital will not have anywhere near 16,000 staff when it opens tomorrow. And fundamental questions surround where this huge number of staff will come from and if local trusts can spare them.

The internal proposals seen by HSJ say the Nightingale’s clinical model allows it to “safely change the ratio of our most valuable resource — critical care trained nurses and intensive care doctors and anaesthetists”.

HSJ has previously reported on plans to dilute staff-patient ratios, which would see one specialist nurse for every six patients, supported by two non-specialist nurses and two healthcare assistants.

The plans for the Nightingale are clear the “experience levels of nursing staff at the hospital will vary” and adds some nurses will be asked to perform ICU tasks they are unfamiliar with, for which “quick reference guides” will be provided.

Nicki Credland, chair of the British Association of Critical Care Nurses, has consistently warned of massive concern around the ability of critical care nurses to simultaneously care for patients and provide guidance for less specialist staff.

And while it seems inevitable asking non-specialist nurses to perform tasks they are unfamiliar with will put pressure on their specialist colleagues, the workforce is left with no other option.

A ‘tap on the shoulder’

The Nightingale has been described as an “outpost” of Barts Health and some staff at the trust have already been told they are to be redeployed from their normal place of work to the Excel. This, of course, goes far beyond doctors and nurses and encompasses health care assistants, physios, porters, occupational health and non-clinical volunteers.

The recruitment process has been described by some as a “tap on the shoulder”, and when speaking to staff at Barts Health, many have no idea how redeployment is being organised, leading to anxiety and confusion.

Concerns have also — fairly — been raised about the implications of staff being moved from already stretched hospital departments and into the Nightingale. However, the capital is arguably in a better position than other parts of the country for numbers of medical staffing. The impact on hospitals in other parts of the country, such as East of England, will surely be more severe when they are asked to supply their local field hospital.

Signing up the ‘bedside buddies’

The hospital, according to NHS Professionals and the NHS Volunteers websites, is enthusiastically recruiting non-clinical volunteers — some paid and some not — who are asked on application if they are happy to relocate to a hotel in the Excel. It is now understood this is not mandatory, but the application form is clear they have to self-isolate for 14 days before returning home.

The role of volunteers and “bedside buddies” is a response to the diluted nursing-patient ratios. It has been acknowledged by some this will result, in some cases, in suboptimal care. But then again, perhaps diluting care is the only option in this unprecedented situation.

Staff wellbeing

Although the staff wellbeing chapter of the Nightingale’s clinical model is, as it stands, currently empty, this is a significant consideration for the temporary hospital. Staff will be working in an unfamiliar, pressurised environment, some dealing with situations and tasks they have never encountered before.

HSJ is continuously being made aware of staff wellbeing concerns, whether it’s staff being told not to work at home or being asked to come into work despite concerns about unwell family members.

Multiple reports have come in of staff refusing to work — and completely understandably so — without proper personal protective equipment.

Chief executives I’ve spoken to have talked about the guilt some staff feel when colleagues are working at the coalface and they’re at home. Many also observe that the crisis is forcing the NHS to adapt in all sorts of remarkable ways, and that it could lead to some benefits in the longer term.

This is certainly true. But, for now, the NHS must retain a laser-sharp focus on doing everything it can, not just for the wellbeing of its patients, but also of its key asset: its staff.