Table 6.
Thematic analysis of free-text responses
| Category | Sub-themes | Quote |
|---|---|---|
| Support received | Management support | ‘Our trust management have left us to it. Within the renal team, the support we have given and received from each other has been incredible, but the trust has supported the staff who have been burdened with dealing with Covid extremely badly.’ (Female, 35–44 years) |
| ‘Professionally we (our department) had to be more proactive in sourcing PPE and developing isolation and protocols—we good not rely on the machinery of the Trust which moved more slowly. However, the Trust were fantastic in ensuring that our vulnerable patients were vaccinated promptly.’ (Male, 55–64 years) | ||
| Training | ‘Training severely disrupted and little communication initially regarding going forward. This is a function of degree of knowledge about the disease and the impact of COVID on the population.’ (Male, 35–44 years) | |
| ‘Charities have had a reduction in funding available to support clinical academic career pathways which has altered the ability to apply and gain access to training programmes. Alongside this the nature of work during COVID has meant there has been less time to focus on your own personal and professional development.’ (Female, 25–34 years) | ||
| Expectations from managers | ‘Barely any emotional support from seniors. Unreal expectations of performance in extremely stressful circumstances. GMC as per usual absolutely useless—a dire institution.’ (Male, 25–34 y) | |
| ‘Overall yes—although during times when my child's nursery was shut I was expected to look after him and work from home. This was an extremely difficult and stressful time as I felt like I was unable to perform either task adequately.’ (Female, 35–44 years) | ||
| Working relationships with colleagues | Teamwork | ‘Strong feeling of camaraderie in 1st wave replaced by exhaustion as the pandemic continued with having to cover for sick or shielding staff and extra clinical duties.’ (Male, 55–64 years) |
| ‘More remote working makes the team more distant, and communication can suffer. Also, close teams provide support and good moral, this has been more difficult. Covering people who have to isolate can be tiring and stressful.’ (Female, 45–54 years) | ||
| Feeling of ‘tiredness’ | ‘We are all tired and need a break but we keep going!’ (Female, 45–54 years) | |
| ‘Not so much during the first wave but I think definitely by the later waves people were beginning to get tired and becoming shorter with each other—especially without the ability to unwind in our usual ways when on annual leave or away from work.’ (Female, 25–34 years) | ||
| ‘Tiredness, some staff refusing to care for suspected or confirmed infected patients.’ (Male, 45–54 years) | ||
| Workload and ability to deliver timely and effective care to patients | Staff shortage | ‘1st wave—I was redeployed to the acute dialysis team. With 2 staff also not present due to non-covid sickness and 1 shielding, the team was severely short-handed. Quality of care suffered. This did not occur in following waves as there was no redeployed staff or shielding.’ (Male, 35–44 years) |
| ‘We have not been able to order our usual cleaning products for the unit. We have struggled with staffing levels due to colleagues shielding, plus increased workload with additional testing of patients and COVID restrictions. We have relied a lot on bank staff, however, have been running some shifts with less staff than usual.’ (Female, 35–44 years) | ||
| ‘Not enough staff or time to cover all covid policies throughout the pandemic, especially when we have had our own staff off sick covid related.’ (Female, 45–54 years) | ||
| Lack of face-to-face outpatient activity | ‘Difficult to get face to face appointments. Specialist nurses unable to see patients and reduced in numbers leading to poor patient preparation for dialysis.’ (Female, 35–44 years) | |
| ‘Less patients in clinic due to social distancing means longer waits for clinic appointments’ (Male, 44–54 years) | ||
| ‘In some gen neph clinics especially difficult to have appropriate discussions on the phone and assess complications appropriately.’ (Female, 25–34 years) | ||
| Working patterns and conditions | Flexibility/remote working | ‘Some working from home is good as there are (generally!) less interruptions and the lack of commute makes it less tiring. However, working from home has an impact on the team atmosphere in the workplace which is detrimental. I think it is only because we were such a strong team before the pandemic that this hasn't destroyed us!’ (Female, 35–44 years) |
| ‘Huge numbers of MS teams meetings which can be easily set up (as you don't need a room)—these impact massively on availability of non-structured time’ (Female, 45–54 years) | ||
| ‘There is some merit to virtual working—not every patient needs to attend clinics and if the infrastructure is in place to get tests, blood organised in advance its more efficient. Less hassle for patients than attending in person and greener nephrology! Zoom access to meetings/didactic teaching/conferences is also very efficient and easier to access.’ (Male, 55–64 years) | ||
| ‘Clinicians working from home—doctoring cannot be done remotely unfortunately. Now only consultants are allowed to work from home. This means more responsibilities are shifted towards more junior grade doctors. 2. Low threshold for absence from home…’ (Male, 35–44 years) | ||
| Face masks and personal protective equipment | ‘Wearing masks, some patients are unable to hear and lip read. Unable to give patients a reassuring smile.’ (Female, 25–34 years) | |
| ‘Wearing masks and visors—frightening and impersonal for patients, restricts communication, uncomfortable…’ (Female, 35–44 years) | ||
| ‘Mask wearing. It is a barrier to communication, even more so in the hard of hearing.’ (Male, 55–64 years) |