NHS Nightingale: a medical student’s perspective from the front line

There were moments when I would look up at the imposing iron-arched roof through my steamed-up visor, with the beeping of monitors in the background, and feel as though I was living through a horror movie. Although this pandemic did not involve zombies, the war-like atmosphere of a field hospital proved somewhat intimidating on my first day deployed as clinical support at the NHS Nightingale North West. Just weeks beforehand, in a pre-Covid-19 world, I had been a fourth-year medical student preparing for my end-of-year OSCE examinations. I had little time to gear myself up for what was the most challenging and rewarding experience of my medical career to date.

With the NHS and the British Army working in partnership, the Nightingale Hospital North West was constructed in just 14 days to support the region's response to Covid-19. Patients who were admitted were in the recovery phase of their illness, having either been stepped down from critical care or who required general medical ward-level care. Fortunately, the 650-bed capacity of the hospital was never reached, having treated more than 100 patients in the eight week period of active operation. Now, as a fifth-year medical student, it is my first experience of being part of a diverse and highly-skilled multidisciplinary team. For many, this was also a dip into the unknown; dental nurses and care workers were deployed as fellow clinical support, while nurses from the Royal Manchester Children’s Hospital, as well as those who had been in retirement, were also drafted in. The support given to one another and from more experienced senior staff was incredible, and the quality of teamwork made the Nightingale a successful provider of patient care.

The vast majority of patients had some degree of frailty, with some having severe disability and physical and mental impairments. This generated new challenges in delivering the best quality care while operating in a former Victorian railway station. The period of operation was a process, whereby the onus was on all of us to devise new, more efficient ways of delivering care and make tasks more viable for patients as well as staff. Quick decisions had to be made by the nursing team, such as how to translate guidelines to manage a suspected outbreak of Clostridium difficile in a field hospital setting. We were able to draw on our individual knowledge and experience to aid decision-making, where each team member was valued and given the opportunity to participate in the running of the facility. Leadership was an integral factor of the clinical operation, from the CMO down to the clinical support workers delivering care on the front line, in fact during busy periods the clinical support workers took turns as ward leader. Intentional roundings and observations were reviewed frequently, making sure every patient received their fundamental care needs to the highest standard we could provide. The quality of leadership and management from all colleagues from the top down was truly inspiring, and it re-enforced in my mind why this element of clinical practice should have a greater presence in our curriculum.