Nurses have always responded in times of crisis, striving to ensure the best possible care for their patients and clients, often in extremely challenging contexts. The speed of contagion and pervasive effects of the Covid-19 pandemic have resulted in a paralysis of the social world we knew, as governments combat the spread of this potentially deadly virus.
Working with core group of colleagues from Dublin City University, Dr Liam Mac Gabhann, Dr Donal O’Gorman and Dr Siobhan Rothwell in Dublin City University, we established and ran a call centre with 50 workstations to provide an effective COVID-19 contact tracing service.
Initially, our efforts were focussed on providing a safe working environment, with appropriate distance between staff and the provision of hand sanitisation equipment, ensuring there was appropriate hardware and software for computing and telephony. We also had to manage the ongoing information, educational and support needs of approximately 120 staff.
In accordance with the World Health Organisation and national guidance, the process of contact tracing involved three phases, which meant each case required at least three telephone calls. Phase one was about identifying and informing the person about their COVID-19 diagnosis. Phase two involved obtaining details of all the contacts that person had made with other individuals during the infectious period. Phase three was the process of contacting all the people considered to have contact with the infected person.
Each phase was associated with a different type of call and required a varying level of skill from the call handler. Nurses were involved in all phases of the contact tracing process, initially directly liaising with infected persons in phase one calls, but subsequently they were used as a resource for other call centre staff.
A number of skills were used in each call, including the provision of information and advice, public health and clinical assessment of infected persons, and as data entry in real time. Initial problems with data collection system were identified, reported and fixed.
As the COVID-19 pandemic evolved, continuous communication with a representative from the Health Service Executive (HSE) in Ireland resulted in changes in the criteria for testing and contact tracing, which affected the level of work and required sudden alterations to services.
Every day brought changes to our work: in the first three weeks there was 15 revisions to the call scripts. This meant that all staff required multiple communications to ensure they were updated and familiar with each change and any consequent amendments to working practices. Support for the multiple technological issues was consistently provided by Dr O’Gorman, who emerged as an invaluable system ‘super user’ and a conduit for information updates between the HSE technology team and the call centre’s staff.
The nursing work undertaken in these calls mirrored the ICN definition of nursing, insofar as nurses were interacting with individuals of all ages, in varying states of health and in all settings. Staff contacted individuals in their homes, in hospitals and in nursing homes. This wide contextual variation resulted in many clinical, ethical and public health dilemmas.
As a co-ordinator, I witnessed my colleagues deliver health promotion information, advice on managing COVID-19 symptoms and advice on occupational health in an extremely professional manner, and it was an honour to witness their commitment to the care of the people they called.
At times we also had to handle calls from upset relatives who told us that the person we were trying to contact had sadly died from COVID-19. Given the (understandably) relatively minimal training our call handlers had received, the competence of our staff and the quality of the service they delivered was remarkable.
The four of us worked as front-line staff delivering the call centre service to the public in our free time and carried on our existing university teaching work online throughout the semester.
To add to the challenge, two weeks into the call centre’s operations I fell ill with (thankfully mild) symptoms of COVID-19. Clearly, I had to adhere to the social isolation precautions and remain at home, but I wished to continue working and initiated a team to set up a remote call centre service to compliment the in house service that my colleagues continued to run in my absence. Running a remote call centre (from home) was challenging initially, but eventually settled into a routine where those who were socially isolated or unable to travel could deliver a service to clients from their homes.
As I write this, I note that all of this has happened in less than five weeks. Thousands of individuals have received COVID-19 diagnoses and thousands of calls have been made. Hundreds of hours of voluntary time have been given by the core team and the staff they were charged with managing.
While sadly hundreds have died in our country so far, and we acknowledge the many thousands who lost their lives worldwide), the sharp predicted ‘curve’ of potential admissions to hospital in Ireland was flattened, at least in some part due to the service we have been providing.
We may never know the number of lives we have saved, but we are consoled by knowing that each call potentially made a difference. Colleagues I did not know before have become firm friends and I am grateful to them all for their contributions.
Most importantly, perhaps, my pride in being a nurse and working among fellow nurse colleagues has been rejuvenated and my faith in the future of nursing has been rekindled, and my hope for humanity remains as the kindness and commitment of all I have encountered in the face of a pandemic has been profound. We will never forget 2020 – the Year of the Nurse.
Contributor: Melissa Corbally