Our workplace is an ex-supermarket. Rather than selling bread and detergent, we are offering free vaccines.
The building has been converted from a large, cavernous space once filled with aisles and checkouts to a clinic comprising pods and desks and workstations. Our thirty-six pods are minimalist, made from prefabricated materials coated with a smooth whiteboard-type finish and each day we personalise them and decorate them with our names. It’s a noisy, busy and bustling community of healthcare and support workers typing at workstations, marshalling clients, administering vaccines and watching over those who have been vaccinated before they head for home.
It’s August 2021 and I am exactly where I want to be. In April the previous year, I made the decision to be a part of the COVID-19 solution. Back then I was working from home, teaching nursing over Zoom. One Wednesday evening, I took part in a regular online nursing seminar. The topic was COVID and the mood was a feeling of helplessness as we shared stories of the anxiety, frustration and fear of dealing with COVID. I could see the day when a vaccine would become available and everyone would need it in order to get back to normal freedoms, so I enrolled in an immunisation course to become a nurse immuniser in my regional community.
Now I am in this former supermarket with a COVID-19 vaccine syringe with needle in my hand.
We open our doors from 8:30am six days a week and we finish at 5pm on weekdays and 4:30pm on Saturdays. When more vaccine supplies become available, we finish later on Fridays, staying open until 8pm. This also helps clients who work nine to five.
The team is led by a nurse unit manager with associate nurse unit managers acting as team leaders and overseeing the day-to-day activities. Our immunisers are registered nurses, enrolled nurses and registered nurse immunisers, supported by assistants in nursing and administrative staff. We have a resident medical officer onsite, a security team present at all times, and a team of concierges managing crowd control. The heart of the unit is the pharmacy where a fulltime pharmacist manages our vaccine supply and the cold chain system which stores the vaccines at the right temperatures for preservation and use.
Communication is a challenge. Almost all our staff are part-time or casual, with very few fulltime staff, so it’s critical to catch up with the developments on our days off. We have daily team huddles to share updates and our whiteboard walls carry the latest information. Communication is critical so we can respond to the regular and frequent changes to work practices, client eligibility for vaccinations, and information about emerging vaccination side-effects. Without good communication we can’t properly screen our clients and make sure we are giving the correct vaccine to the correct cohort according to the current government guidelines.
Wearing P2 masks and visors can make communication difficult. In addition to the physical discomfort we feel, when we are communicating with clients—assessing the myriad health screening questions and explaining side-effects and risks—we have to speak louder and enunciate more clearly and slowly. For those clients who rely on lip reading to supplement their hearing, it is even harder. But we do have the capacity to manage people with disabilities and their carers, as well as those from culturally and linguistically diverse communities. We regularly access the official interpreter service when we need to gain informed consent from clients whose first language is not English.
There are also cross-border stresses. We are located on the New South Wales-Victoria border. Staff have to get permits to travel to work. Often this leads to delays. And there are different rules in New South Wales to those in Victoria. On our side, Victoria, there are tougher restrictions on wearing masks. The vaccine management system we use is state-based and does not always contain information relevant to clients from outside Victoria.
Our clients can also be challenging at times. Anxiety and needle phobia are very common, and there is always the risk of anaphylaxis (a severe allergic reaction), although our screening methods aim to pre-identify high-risk patients. Some clients become argumentative and demanding when they don’t fit the eligibility criteria for vaccines. The public’s level of health literacy and knowledge about vaccines and the virus varies greatly. Taking time to clearly explain the possible side-effects of thrombosis with thrombocytopenia syndrome (TTS), a very rare blood-clotting syndrome relating to AstraZeneca, and pericarditis and myocarditis, inflammation of the membrane around the heart or the heart muscle associated with Pfizer, helps reassure clients and calm anxieties caused by misinformation.
Perhaps the hardest thing is the change in how we are feeling. When we started out vaccinating, we were very positive about what we were doing. The first people who came in were extremely grateful for what we were doing. But when COVID went on for longer and vaccinations were mandated, a lot of our clients became passive aggressive. For some, we went from being people who were helping the public to people who were harming them.
Despite all of these challenges, our team pulls together. We look after each other and ourselves. Our wellness team regularly brings ‘treats’ to thank us for our work, mostly on days when we break our vaccination record for the highest numbers per day. It is also critical to practise self-care and take the time to have proper breaks and stay hydrated, because wearing the P2 mask and visor for long periods is uncomfortable and tough.
We share the common goal of vaccinating our way to a safe and normal life again sometime in the future. We innovate and roll out a mobile bus service to vulnerable people who can’t make it into the clinic, and we feel genuine satisfaction when the program is successful. It’s also rewarding when we are able to educate the public so they understand that vaccination is critical to protecting themselves, their loved ones and their communities.
But hearing of COVID outbreaks getting closer to our COVID-free regional community is very stressful. We know how evil this virus is and how it seeks out the vulnerable and ill-informed. Like all nurses and healthcare professionals, we are at risk of burnout or carer stress, the spectre of COVID entering our clinic and then our homes ever present. This virus is deadly and debilitating.
That is why we do what we do, and that is why I am where I want—and need—to be.