Nurses and midwives have been required to expand their roles and/or undertake roles outside of their usual work to support patients and their health services throughout Australia’s response to COVID-19.  Read about the experiences of several of our colleagues involved in COVID-19 testing, contact tracing and vaccination rollout. 
 

Outreach COVID-19 testing programs 

Liz Crock - HPP Nurse Practitioner, Bolton Clarke



In Melbourne, we had the opportunity to participate in COVID-19 testing.  HIV team members at Bolton Clarke (RDNS) were keen to take part.  On our first day, we met in a suburban town hall to be briefed with dozens of others. An emergency nurse coordinated allocations, we paired up with another nurse who knew the ropes, and set off for a local park.  When we arrived, nothing was set up and people were already queuing.  Two ambulance officers joined us, and we organised a system as best we could.  The State Emergency Service set up a tent for shelter.

The public patiently waited. Having never done the testing procedure, I started with the laborious documentation - handwritten and in duplicate.  Families came, of all nationalities.  As the queue increased to encircle the park, we called in reinforcements. Two nurses from Adelaide arrived:  they had been testing full-time for months, declaring they each did 250 per day.  The ambos described them as ‘cowboys’ as they sped through our backlog.  So, with the ‘Adelaide cowboys’ as our teachers, we got up a slick and safe routine.  On my first day, I did 25 tests on young and old, overwhelmingly appreciative despite long waits in the cold.  We kept a list of people’s relatives who were unable to leave home; they would be followed up by the ‘Call to Test’ Program.

In the ‘Call to Test’ Program, we were given a list of people across Melbourne.  We drove about 300 kms, in two cars, one undertaking testing and the other, assisting with PPE and documentation.  We tested the elderly and frail, people with dementia, people in disability accommodation and people with symptoms who were unable to get to a testing centre.  One man who simply could not tolerate the nasal swab when he attended a testing centre had been reported to the health department, despite having gone for testing voluntarily; we coaxed him to do his own nasal swab.  At the end of the day, we checked in with the others in the day’s team, and we delivered our boot-load of swabs to a lab in Heidelberg.


Working in the NSW Health COVID-19 Response  

Timmy Lockwood - Clinical Nurse Consultant, NSW Health Centre for Population Health, STI Programs Unit

 

On Tuesday the 10th of March at 9:30pm I received an SMS message from my executive director Carolyn Murray that there was going to be NSW Health COVID contact tracing team (CTT), so could I come over to St Leonards to lend a hand? Four of us came together the next day but in the following months the team would grow to approximately 300 staff. To begin with had no idea the huge impact COVID would have on the world and that skills from a decade in sexual health work would be so very useful in building an effective contact tracing team and systems.

The CCT was initially built from employees whose usual work had stopped due to COVID. People came from all parts of the public sector such as Health, Education, Film, Department of Primary Industries and the Australian Defence Force. While everyone was very enthusiastic to make calls most staff hadn’t worked in this capacity before so we rapidly developed a training video with the HETI education team. New recruits could use this to quickly get up to speed and better understand the complexities of contact tracing including confidentiality, empathy, empowerment, active listening and problem solving.

My knowledge and soft skills from sexual health were very transferable and made a good role model for less experienced staff to follow. The know-how I had from regularly dealing with the pressure of late clinic walk-in clients or providing HIV diagnosis helped me project a sense of clam to the team when thing got very hectic.

Distributing, tracking and reporting the work was the next challenge to overcome, with similarities to the requirements in sexual health clinics but in a much more fluid environment. As there was no custom software just sitting, ready for a pandemic of this size, we needed to find an alternative solution. Fortunately, MS Team had just been purchased by NSW Health and this was the perfect tool to allow collaboration between Local Health Districts, NSW Ministry of Health and other off site agency’s to work together in calling 10,000s of contacts. Things weren’t perfect right away but with continual quality improvement and lots of late nights we had a well-functioning system to distribute and report back on calls and outcomes.

While team leading contact tracing I was exposed to a lot about communications, education and public perceptions regarding COVID which were vital to an effective response. On reflection I can see that while our sectors targeted work in the HIV / BBV / STI is very effective, it’s also important to take the rest of the general public along the same journey. I think this particularly importing to combat the stigma and discrimination we face and that hinders us from all our programs having a greater impact. I plan to focus a lot my time and effort advocating for effective action in this area in line with the new NSW HIV STRATEGY 2021–2025.

I feel very lucky to have made a small contribution to the success of the NSW COVID response and want to thank all the incredible staff and the general public for their efforts in helping NSW stay safe from COVID-19.


Challenges of COVID-19 vaccination rollout

Marrianne Black - Management and Treatment Coordinator Hepatitis, HIV/AIDS and Sexual Health Program, Ethnic Communities Council of Queensland


 

The rollout of the COVID vaccine in GP Practices has been well accepted but challenging at the same time. Not all GP practices are geared up to be able to initiate the vaccines, whether that relates to availability of staff, capacity, space and willingness to take on the additional burden to already busy practices. Practice Nurses are taking on additional responsibilities to coordinate vaccination clinics and support the vaccine rollout in their practices.

The following themes have been identified from some GP practices I approached to understand their thoughts on the rollout. 

Work required to respond to interest about the vaccines:

  • Initially a large volume of calls were received to access the vaccine, this has substantially decreased following the concerns around the Astra Zeneca vaccine.
  • The establishment and management of waiting lists, including managing  additional calls from patients to be removed from the waiting lists.
  • Administrative time with additional appointment bookings for doctor review prior to vaccine to ensure patient meets criteria.
  • Scheduling of appropriate patients to attend the ‘COVID Vaccination clinic’, including the need to ensure adequate and appropriate space, time, staff and number of patients to ensure once the cold chain is broken that the all the vaccine in the vial is distributed.

 

Additional Nursing staff responsibilities:

  • Additional time required to set up clinics (for some Practices outside of normal hours) and be available to assist the GP.
  • Ensuring 10 people available to receive the vaccine once the cold chain is broken. If a patient cancels or reschedules, a new patient needs to be contacted and available to attend the clinic (this is often a nursing responsibility).
  • Obtaining informed consent, including arranging interpreters and coordinating clinics to optimise their time.
  • Patient education to reduce concerns regarding the vaccine, whilst some nurses have advised that the older population are less concerned (mostly related to knowing the increased risk of COVID) some who are eligible are concerned about possible reactions.
  • Creating a patient profile for patients referred from (non-vaccinating practices)
  • The time required to record patient details to the AIR post vaccination.

 

Some additional concerns included:

  • Changes to eligibility has caused concern and has been identified as reducing trust within the community.
  • Many people who are eligible are opting to wait.
  • Concerns raised for those under 50 who had received the first dose before the changes, one doctor stating some patients feel ‘robbed’.
  • The need to use staff as interpreters at times.
  • Adequate remuneration for the amount of work and staff involved for each patient.
  • People are obtaining information from many sources and many myths and misconceptions need to be addressed. This includes social media, and ethnic media (people accessing information in their first language from their country of origin that may be having a vastly different experience than here in Australia).
  • Patients who are seen at non-vaccinating clinics following receipt of a health summary, are directed to register on-line or find clinics with vaccine available.
  • Some communities are more conservative and opting to wait.