Not all can cope with stress of working with Covid-19 patients in ICU, say S'pore nurses

Senior staff nurse Queennie Lee (left) was deployed to ICU from a general ward.
Senior staff nurse Queennie Lee (left) was deployed to ICU from a general ward.PHOTO: NHG

SINGAPORE - "Papa, wake up. Papa, it's me, please wake up."

These are some heart-wrenching moments nurses caring for intensive care unit (ICU) patients have to deal with, aside from the normal stress of their job.

Doctors and nurses working in the ICU take care of the sickest patients, who might require continuous care throughout their shift.

In the Covid-19 ICU, there is the added burden of infection control, where they have to don personal protective equipment (PPE).

Dr Hoi Shu Yin, Tan Tock Seng Hospital's (TTSH) chief nurse who also oversees nurses at the National Centre for Infectious Diseases (NCID) next door, said a nurse may spend the entire shift in PPE in the patient's room, with only short intermittent breaks.

If the patient is more stable, they may need to go in once every hour or two, to turn the patient, give medicine or insulin, and hook him on to a dialysis machine if his kidneys are failing.

Senior staff nurse Queennie Lee, who was deployed to the ICU from a general ward, said not all nurses can cope. "It can be very scary," she said.

In a general ward, nurses can talk to patients, who usually can also eat on their own. In the ICU, the patient might have five tubes inserted to provide oxygen, food and medication as well as being hooked up to monitoring devices.

So they worry: "What if I accidentally do something wrong?"

As Covid-19 patients are not allowed visitors, the nurses may help facilitate video calls with their families. "It's tough, seeing loved ones crying over the phone," said Ms Laura Ho, deputy director of nursing at TTSH.

Ms Geeta Pattath Raghavan, assistant director of nursing at TTSH who has worked in intensive care for 25 years, said it is painful to see a patient die, and sometimes they may see deaths often and nurses are affected.

This is when compassion fatigue may set in. Dr Hoi said the management looks out for this and will give the nurse a day off and psychiatric counselling if needed.

Compassion fatigue is different from burnout, which is more work-related, she said. That happens when nurses "no longer find meaning in what they are doing, and are just going through the motions of nursing".

Added Ms Ho: "We always need to know that we are nursing a patient who is somebody's father or sister."


(From left) Tan Tock Seng Hospital deputy director of nursing Laura Ho, assistant director of nursing Geeta Pattath Raghavan and chief nurse Hoi Shu Yin having a discussion. PHOTO: NATIONAL HEALTHCARE GROUP

Dr Hoi said it can be more difficult for foreign nurses away from their families. For them, their colleagues in the ward are their second families, but when they are posted to the ICU, they work with people they do not know under very stressful conditions.

The hospital provides engagement sessions for new ICU nurses and they have "buddies" to help them cope. But sometimes, after three to six months, a nurse might ask to be transferred out.

Then there are nurses like Ms Geeta, who said: "I want to be only in ICU, where I see very sick patients become all right and go back. It's very satisfying to see them transfer to a general ward."