This article was first published on 8 May 2020 in issue 4/2020 of Nurse, the professional magazine of the Finnish Nurses Association.
Following the article, there is a fact box about the dairists, plus numbered photo captions.
Nine nurses working at Helsinki University Hospital kept a diary for a week in March and April 2020.
BY KATRI SIMOLA, PHOTOS BY LEENA KOSKELA AND DIARISTS, ENGLISH TRANSLATION BY MARK WALLER
There are 1,313 laboratory-confirmed coronavirus infections in Finland, of which 143 are receiving hospital care, 49 are in intensive care, and 13 have died. Thirty-seven new infections have been diagnosed in the area covered by the HUS Helsinki University Hospital. There are more than 740,000 infections worldwide.
The Finnish government will continue with restrictive measures, such as internal border controls, controls on assembly and distance learning for schools, until 13 May. The corona virus has spread to all provinces in Finland. Uusimaa province has been in lockdown since Saturday.
Saila: I’m on emergency duty at Meilahti’s drive-through testing site. I’m joined by two new employees. I’m the coordinating nurse because I have the most experience. I get to know the clean side and the dirty side, and am getting more personal protective equipment. There’s only a handful of patients.
Jaana: I transferred from consultant work to the frontline at Meilahti’s drive-through testing site. Working feels safe. Personal protective equipment is available, and the instructions for dressing and undressing are always clearly visible. There’s palpable professional respect and cooperation between the different units
Eliisa: Monday mornings are busy. The situations and patients that have come over the weekend need to be discussed. The atmosphere is collegial. We are prepared and are making further plans. I’ve got to focus on supervisory work and the reorganisation of department’s operations.
Kaisa: Yesterday evening I was on shortfall shift so I wasn’t at my freshest in this morning. The ward has only 11 patients: four have tested positive for corona, the rest are suspected corona cases. Two of the staff have become ill. I’ve told them to call occupational healthcare. Getting insufficient staff and PPEs.
Emmi: Last week has heavy and I slept all weekend. As the Covid-19 situation progresses, there’ll be an increasing number of training requests by ICUs. The atmosphere is good. After one day, I look at the feedback from the training and realise that I’m in the right place right now.
Anni: Weekend leave, Friday Master’s graduation, feeling of change and new job started over a month ago motivate early rising. A new colleague, work with patients, constant corona communications work, counting equipment, medical exam supervision, and a “when can you go to ICU?” call gave a lot of stimulation to the day.
Anne: I’ve overtime from last week, so I would have been able to have a day off. But I anyway came in this morning to make up for the lack of staff. Some relief among other things by transferring non-urgent treatments and converting visits to remote visits. Help with medication received from the pharmacy.
Anna: I plan, arrange and conduct training of nurses for ICU. There’d be more trainees than we can take. My partner’s first corona test sample came up negative, so the kids went back to kindergarten and school. Working nursing sector, neither parent has the opportunity to work remotely.
Linnea: A 13-hour day. There were fewer train carriages on the way to work and we were packed like sardines. There was a calm feeling at work. Today the induction started of nurses from the wards, who are coming to help us if we are needed elsewhere as ICU specialists or if several of us get sick or exposed. Great collective sense of survival!
There are 1 384 laboratory-confirmed coronavirus infections in Finland, of which 137 are receiving hospital care, 56 are in intensive care, and 17 have died. Thirty-six new infections have been diagnosed in the area covered by the Helsinki University Hospital. There are more than 800,000 infections worldwide.
ICU capacity has increased in recent weeks from 300 to 500 beds. Helsinki University Hospital is providing fast-track training for up to 500 ICU nurses a week. Research shows that restrictions on outdoor movement and other activities have saved tens of thousands of lives in Europe.
Saila: One staff member had to be transferred from the morning shift to another unit, so there was just three of us. Today I know both my colleagues. There’s an availability problem with nasopharyngeal test kits but there are still sufficient tonight. From tomorrow, we will move on to throat swabs, as planned.
Jaana: The changes made to instructions have been reported by the media. I understand that the situation may be distressing, but the point was to make up to date info readily available. We get updated info via Teams on taking test samples. I’ve downloaded Teams on my cell phone.
Anni: What are we supposed to think of all this? A special concern is the non-invasive ventilation of Covid patients, causing aerosols. Does the equipment really work? There’s plenty of encouraging talk but in the isolation rooms, nurses have lonely moments with seriously ill patients.
Kaisa: Arranging shifts, recruiting new staff members, Skype and Teams meetings. Corona, in its severe form, has proven to be a really severe disease. Patients drift into intensive care, even to death. There is a sense of inadequacy, anxiety, and fear in the air. Fortunately, today is the first defusing meeting. We can unload our feelings.
Anne: Staff flexibility and stretching has been important. In recent weeks the work has been from morning to night. A lot of work still lies ahead. It’s been wonderful to see a colleague able to express thanks, help out, advise and give support amidst all the rush.
There are 1,446 laboratory-confirmed coronavirus infections in Finland, of which 159 are receiving hospital care, 62 are in intensive care, and 17 have died. Twenty-eight new infections have been diagnosed in the area covered by the HUS Helsinki University Hospital. There are more than 883,000 infections worldwide.
Finland’s testing capacity will be doubled or tripled in the coming period. Now, about 2 500 samples are being tested per day. HUS says that it has received obsolete respiratory protective equipment from emergency stocks. According to the Ministry of Social Affairs and Health, most respirator protective equipment distributed to hospitals are in good condition.
Eliisa: The cheery morning changed when I was told to transfer ten nurses to another hospital starting tomorrow. Conversations with nurses demonstrate their flexibility and collegiality. There were also tears. We pledged to look after each other.
Jaana: My new assignment is to start coordinating HUS’s ICU resourcing. Have to consider the placement of the people, interview experts, and think about the situation as a whole in close cooperation with management. The workday will go on till after six as all the time there’s more phone and email traffic.
Anna: An intensive care unit will be opened in the Surgical Hospital, where 25 nurses from my own unit will go. For the first time, there were concerns about staff numbers among trainers.
Kaisa: A ‘million’ things to take care of. A long to-do list. I am happy about my wonderful, skilled and smart colleagues. A multi-professional team works and just seems to become welded more closely together.
Anne: The only day off this week. I slept late and had several cups of coffee. I read my work emails because there’s not enough time to do so at work. There are new instructions on protective equipment and other things.
Anni: A day of many encounters and good cooperation – everyone focused on fighting the disease! We got another transfer respirator from Meilahti and a new colleague was added to the already great list of names. I feel that the year of learning is just beginning. In addition to the workday communications and equipment count: now there should be enough counted equipment to last the weekend. Maybe.
Linnea: Day off. Arrangement for a date with a friend and colleague was changed to a phone call. Uppermost, the idea that we are in this situation together and together we will survive too! Grateful to be allowed to have the rest of the week off with no calls to come to work!
Emmi: It was a good day. I made a copy of our proning technique. By the end of next week I’ll be able to do it in my sleep. I routinely check the Covid-19 news. I see the numbers but can’t react to them. It would be easier to cope with this mission if we knew the cut-off date.
Saila: I heard that tomorrow I’ll be transferred to Meilahti ICU. I’ve been expecting this because of my eight years experience of critical care nursing. The evening shift’s test sampling was busy. I found out in the evening that I was to go on the morning shift. On the way home, I cycled via Töölö hospital to fetch my work shoes.
There are 1,518 laboratory-confirmed coronavirus infections in Finland, of which 160 are receiving hospital care, 65 are in intensive care, and 19 have died. Sixty-four new infections have been diagnosed in the area covered by the HUS Helsinki University Hospital. There are more than a million infections worldwide.
Parliament approves the closing of restaurants and bars, and the extension of lockdown restrictions. The Technical Research Centre of Finland, HUS, and the University of Helsinki are developing a rapid test. Over a million Finns are in high risk groups of severe illness from Covid-19.
Eliisa: Yesterday’s decision was tough and made it hard to sleep. A walk in the forest with my child calmed my mind, and felt more serene at work on Thursday. A colleague’s fighting spirit and experience of previous crises sensitised many of us. Thanks everyone.
Saila: Morning shift in ICU. Ten nurses are being moved from ‘my ICU’ to emergency duties at Meilahti. Will have to find out how long the orientation lasts, and I don’t know what my shifts are after the next five days. We familiarise ourselves with the ward and check out the locations of the equipment. Good atmosphere in the ward.
Anni: A clear day’s work! MET [Medical Emergency Team] procedures aimed for corona patients have been started together with the outpatients clinic. The overall goal of treating patients in the best possible way feels good – it’s probably a universal feeling among nurses.
Emmi: Yesterday on the way home, I dropped a note in at the hamburger bar. Today we got food and so much praise that I burst into tears. I have decided not to follow social media. I’m not worried by Covid-19 news but about all the epidemiologists and the negativity of my own life.
Anna: Training hundreds of people requires planning. Adherence to safety distances, keeping the group size small and instructing acquaintances to work in protective equipment bring their own challenges. We have admired the attitude of the trainees. Hopefully, at some point, this flexibility will be rewarded quite concretely.
Kaisa: Constantly updating instructions is kind of frustrating. I remind myself and others that there’s a reason: Covid-19 is still a big unknown and we are learning more all the time, and so even instructions are clarified along the way. So, updating them is a good thing! There’s a steady stream of new patients.
Anne: On the evening shift. The quarantined nurses have returned to work. One parent has asked whether her child will receive care or whether treatment will have to be canceled if there are not enough nurses. Reassured the parent and said that all children would get the care they needed.
There are 1,615 laboratory-confirmed coronavirus infections in Finland, of which 180 are receiving hospital care, 72 are in intensive care, and 20 have died. Sixty-five new infections have been diagnosed in the area covered by the HUS Helsinki University Hospital. There are more than 1,1-million infections worldwide.
Three residents in a care home in Yläsavola have died of the coronavirus. HUS ICUs are beginning to study the treatment of Covid-19 using two drugs. In Helsinki, containers have been brought to the yard of Laakso Hospital to store corpses if there are more dead bodies than usual.
Anni: We live in the most crucial days concerning every nurse’s aptitude and adaptation to the new. There’s a lot compressed into one’s own sense of capability, because there exists no ideal situation for this is at all. From the windows a magnificent northern spring light accentuates colours throughout the day.
Anna: Second training week done and dusted. Nearly 300 people have been trained. The training has also been followed by other hospitals, and instructions distributed widely among different departments. Worn out by the weekend. It feels as if under the title of ‘nurse’ I’m a training planner, trainer and do logistical work.
Jaana: Thursday and Friday proceeded with the same tasks I started on Wednesday. The goal is to increase intensive care capacity next week, and for that more staff will be needed all the time. I find my job very important and I try to work well with the supervisors and management.
Saila: I have a day off. I go for a 10 kilometre run, move the furniture around, and install lights on the ceiling. The sun is shining and I’m feeling good. I read the latest corona news in the newspaper every day. I do my own obligatory work as the coordinator of the Brain Hub.
Kaisa: The good news at the end of the week: none of our employees have contracted the corona virus. We have also already been able to discharge many corona patients. Someone wonderful has given us a bag of treats. The show of gratitude is heart warming.
There are 1,882 laboratory-confirmed coronavirus infections in Finland, of which 187 are receiving hospital care, 73 are in intensive care, and 25 have died. Sixty-five new infections have been diagnosed in the area covered by the HUS Helsinki University Hospital. Over 60 000 people have died worldwide.
The numbers of tests carried out have doubled since the start of the week. Restaurants, cafes and bars will be closed until the end of May. At night, Finlandia Hall is bathed in blue light in honour of nursing staff and others working in critical sectors.
Anni: After a good night’s sleep, a feeling of relief at work as the equipment ordered the other day has arrived. Chocolate delivered to the ward! Businesses remembered! The distinction and challenge of the profession are now closely intertwined.
Kaisa: A day off! We moved back home after being evacuated due to re-plumbing. The small but efficient moving gang – a dream team: my own boys plus aspirant daughters-in-law. Tired but happy.
Anna: First free day of the week. I go out but it’s hard not to keep scheduling and just be. Our household includes, apart from my own family of four, another family of three. The concern about bringing the disease home involves seven people.
Emmi: Foggy day. I slept for 17 hours. Every now and then my partner would wake me to see if I was hungry.
Anne: Night shift. The child patients are used to nurses using surgical masks all the time. It’s harder for the little babies because they can’t see the nurses’ expressions.
There are 1,927 laboratory-confirmed coronavirus infections in Finland, of which 209 are receiving hospital care, 76 are in intensive care, and 27 have died. Seventy-three new infections have been diagnosed in the area covered by the HUS Helsinki University Hospital. There are more than 1,2-million infections worldwide.
Three residents of a care home in Espoo have died of Covid-19. Queen Elizabeth of the United Kingdom has thanked healthcare workers in a television address to the nation, and Prime Minister Boris Johnson has been hospitalised.
Saila: During morning shift in ICU I received instructions on using respirators and the shift schedule for the next two weeks. Though the situation in Finland and the rest of the world is hard, I’m excited to learn new things and feel that we are all acting together in the face of this.
Jaana: Taking test samples during the morning shift. We repeat the instructions and make sure there is sufficient equipment and protection equipment. The four-person team has a nursing background, being, in addition to myself, a finance manager, a community nurse and a laboratory nurse. It is a pleasure to meet new and old colleagues.
Emmi: I watch the sun from the living-room windows. Feel like going out. We go for a quick jog until I feel anxious about the numbers of people out and about and return home. When this training rumpus started, I promised myself I wouldn’t check the email at home. I relent. My ICU supervisor asks when I’ll be back in harness. In a week, I promise.
Kaisa: At the stables riding first thing in the morning, wonderful air off-road. Day off always crowned by a good nap – check! Jogging in the evening in the woods with the dog. Mind rested and body refreshed.
Anna: Tomorrow the bustle of the next week starts. We know it’ll be at least as busy as previous weeks. The work is typified by being constantly one step behind. Trainees come at short notice and we don’t always know where they’re located. On the other hand, routines are starting to take shape. Weighed down by tiredness even after two days off.
Anni: The working week finished with a day off. But throughout the day your thoughts wander into corona issues and the days ahead. What’s in store next week?
There are 3 868 laboratory-confirmed coronavirus infections in Finland, of which 209 are receiving hospital care, 67 are in intensive care, and 98 have died. Forty-eight new infections have been diagnosed in the area covered by the HUS Helsinki University Hospital. There are more than 2,4-million infections worldwide and 166 000 deaths.
The government is discussing the continuation of restrictions. Uusimaa province is no longer under lockdown. The review of the procurement of PPE by the National Emergency Supply Agency continues.
Jaana: The new week started with the coordination of intensive care. Fortunately, the situation is calm and there are enough vacancies and staff. Nature is waking up to springtime. In healthcare, different scenarios and plans are being reviewed all the time. I am glad that I got to be in good health!
Eliisa: Neurosurgical patients need intensive care too during corona. Our department is filled with our own patients, and today I got permission to make a request to have four of my nurses back. The organisation of activities and the work of supervisors are now at the centre of everything so that everyone will receive top quality intensive care.
Emmi: Trainings are over for my part and I’ve returned to clinical practice. A great relief, as awesome as training is. It was wonderful to return to the best work community in the world as if I’d never been away! Today’s mood: 5/5.
Anne: I’ve remained healthy. In the ward, the situation is calm among patients and staff. Some parents have expressed fears for the health of their children. The issue has been discussed with the parents and they have been given support and reassurance.
Anni: Everyday corona life is the new normal. There’s no end in sight, though we haven’t yet been totally overwhelmed. It is difficult in ‘civilian’ life to break away from corona when the whole of society revolves around it. Sleep is the best relaxation. Colleagues help you go forward.
Kaisa: Today didn’t go so well for me. Knocked down with flu at the weekend, and I immediately went to get tested. The result came back in a day and I tested positive, so I have corona. I’m astonished because I have followed all the precautions and avoided contact. My condition is still good and I must hope that I just have the mild form of the disease.
Saila: At the hospital the situation is still under control and the atmosphere is one of anticipation. It would make it easier to know whether there’ll be a summer holiday and how long the situation will last. Of course no one can answer this. Let’s take it one day at a time and hope for the best.
Anna: The mood has remained good despite all the hustle and bustle. The job of those working in this field is to take good care of the patient, whether or not it’s an emergency. There is still time to learn and train. Thoughts dwell on how the family is coping and childcare arrangements.
Linnea: It’s still quiet at work, but preparations continue. We are ready if the situation worsens. It’s a little worrying that people are moving around more and seem to be less earnest about the restrictions. However, birdsong and the sun already turn your mind towards thoughts of summer!
Finnish Broadcasting Company (Yle), Finnish News Agency, Helsingin Sanomat. Covid-19 statistics from the Finnish Institute for Health and Welfare, HUS Helsinki University Hospital, Johns Hopkins University.
Assistant Ward Nurse, Malmi Hospital, Department of Internal Medicine 5
Nurse, Teaching Nurse, Meilahti Hospital, intensive care unit M1
Teaching Nurse, Assistant Ward Nurse, Malmi Hospital, Emergency and Supervision Department
Clinical Nurse Specialist, acting Development Manager, HUS Helsinki University Hospital
Nurse, New Children’s Hospital, Paediatric ICU, Laakso
Nurse, New Children’s Hospital, Taika Ward
Nurse, HUS Helsinki University Hospital Resuscitation Coordinator, HUS Töölö ICU and Academic Simulation Centre
Nurse, Brain Hub coordinator, on sabbatical from the Neurosurgery Intensive Care Department
Ward Nurse, Department of Neurosurgery Intensive Care and Observation Ward, Töölö Hospital
1. Preparing for battle. Assistant ward nurse Kaisa Haverinen puts on the requisite personal protective equipment at Malmi Hospital.
2. Community spirit. Nurse Linnea Mäkipää celebrates the spirit of survival.
3. Morning shift. Nurse Anni Kanto cycles from Leppävaara in Espoo to Malmi Hospital.
4. New organisation. At Töölö Hospital, ward nurse Eliisa Valovirta-Hästö had to transfer her own nurses to another hospital.
5. Taking test samples. Nurse Jaana Kotila on emergency duty at drive-through testing.