The capacity of a health system to respond to a crisis, particularly an emerging infectious disease, is dependent on multiple factors. Having an adequate number of appropriately skilled doctors, nurses and other clinicians, along with suitable acute and primary care facilities and equipment to care for those infected or most at risk, is essential to save lives and reduce the transmission of and impact from the disease.
Nurses account for almost 40% of the health workforce in Scotland, comprising the largest group of professionals delivering front-line services in hospitals and the community. Before the coronavirus pandemic, the numbers of nurses being trained was increasing slowly to replace those retiring and care for increasing numbers of older adults with complex health and social care needs. Despite this, the rapid spread of Covid-19 has meant some areas, particularly critical care and community nursing, have experienced shortages of staff, complicating testing, diagnosis and treatment. Nurses working in care homes run by private or third sector organisations or local councils have also faced similar challenges. Other countries such as Germany have more nurses and critical care beds and reported lower numbers of deaths per head of population than Scotland. Hence, investing in the nursing workforce could reduce the risk of future outbreaks of infectious disease escalating to pandemic levels.
The stress that comes from caring for those critically ill and dying, along with supporting families and relatives who cannot visit their loved ones due to strict infection control procedures around Covid-19, has put additional strain on nurses working in intensive care and in care homes. As professionals, they also have to grapple with the risk of contracting the disease and worry about spreading it among colleagues and their own families and children. A district nurse, Janice Graham, died at Inverclyde Royal Hospital in April 2020 after contracting Covid-19; the first NHS worker in Scotland to die from the virus. Nurses, many of whom are women, have also been subject to verbal and physical abuse working in communities who do not recognise their value and see them as a threat to spreading the infection.
While some are able to work remotely and monitor people’s health at home through telehealth technologies, or triage those experiencing symptoms over the telephone, poor digital infrastructure in some parts of Scotland and restrictions on mobile technology in the NHS limit the reach and impact nurses can have. What remains to be seen is whether nursing continues to be viewed as an attractive career in the future and whether the public see it as a more precarious occupation or recognise it as a skilled profession that is invaluable to the health of a nation.