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COVID clinic, screening and vaccinations
Regional Victoria

My nursing career commenced in 1997. After completing a graduate nursing year at a large regional hospital, I settled into twenty-two years of orthopaedic and short-stay surgical nursing. During that time, I had various roles including clinical nurse specialist and associate nurse unit manager but I always held a strong interest in infection control.

In 2018, I completed a twenty-four-week course in infection prevention and control with a view to transferring to that area when shift work became unsustainable. Little did I know that that opportunity would arise at the start of 2020.

Returning from holidays at the end of January 2020 with my wife and two teenage children was a little surreal. We had heard little about COVID-19 while away, so I was not expecting to be asked to participate in a secondment to infection control. Nor did I anticipate the impact this move would have on my career, my family and those around me. Prior experience of the SARS and MERS coronavirus outbreaks had built a false expectation that COVID would not greatly affect us. I could not have been more wrong!

At the start of 2020, our organisation envisaged the need for a COVID screening clinic and our emergency department was tasked with creating this fledgling service. My role quickly evolved into managing the return of COVID results to those who were screened.

At this point in time, our pathology service was not returning results directly to clients on our behalf, so our systems were largely manual. Initially, we called through every result. As volumes increased, we resorted to texts, and then to mass messaging just to keep up.

As demand increased, we also had to build confidence within our hospital in the use and availability of PPE, and the likelihood that COVID- positive patients would present to our service. The initial inadequate supply of N95 face masks and disposable gowns meant staff had to use surgical masks and re-processable cloth gowns. With scenes on our TVs from overseas of people in full hazmat suits, this created a lot of anxiety which had to be overcome. Adherence to good processes and the appropriate use of the PPE we had available kept us safe. During this period, I also squeezed in a nurse immuniser qualification.

In July 2020, with anticipated increased demand on our emergency department, the control of our COVID screening clinic transferred to our infection control unit and I was asked to manage it. My previous experience as an associate nurse unit manager gave me some capacity for the role, but it still held challenges that nothing could have prepared me for.

Shortly after taking on the role, we had our first large outbreak of COVID-19 in the region and had to expand our screening capacity rapidly. While a capable colleague established rapid-response testing capabilities and proved their effectiveness at the local meat works, my focus was increasing the capacity of walk-in screening and establishing our first drive-through screening clinic. I had magnificent support to do so from our supply and buildings and infrastructure departments, but increasing clinical capacity was always going to be challenging given the many competing priorities of our health service and the difficulty recruiting staff—an issue shared by many regional health services. Over the ensuing months, time and again, we set up testing locations right across the region, in response to outbreaks and increasing testing demands.

As 2020 progressed and the likelihood of COVID vaccinations became more real, it was obvious that our workforce would be tasked with the delivery. We were successful in securing funding to train additional nurse immunisers and we worked tirelessly with our recruitment team to build a suitable workforce to undertake this mammoth task.

As 2021 commenced, I left screening in the capable hands of another colleague and shifted my focus entirely to vaccination. The vaccination program was labile to say the least: fluctuations in vaccine availability, changes to eligible cohorts, shifting government directions, new information and concern over side-effects meant we needed to train—and then retrain—a largely novice and novel workforce.

Even that workforce was changeable. With surges in COVID cases and a downturn in elective surgery, we requisitioned staff from other areas. This helped to ease the pressure on our workforce for brief periods of time, but when business as usual resumed, our vaccination workforce was again whittled away.

The COVID response by our health services was highly scrutinised, adapted, modified and sometimes criticised. I firmly believe we did the best we could with the resources we had, but it was heartbreaking to see huge lines waiting to be screened or vaccinated, knowing we were doing everything we could to maximise flow and could do no more. We took the punches on the chin and just kept going because there was no other option.

My experience was the absolute opposite of those living in our major cities who spent so much time in lockdown and isolation. I was rarely home, and when I was, my mind was elsewhere.

It would be a full two years of screening and vaccinating before I could take a breath and look back and realise that our kids had gotten two years older and that I had not really been present for my family that entire time. It was not just the time spent constantly adapting and expanding our service, but the time at home, engrossed in thought, responding to the team and worrying about the next day’s challenges.

I am proud of what we achieved in caring for our community and trying to keep them safe. I hope my family can forgive my absence in that time.