Back to the future: From fever nursing to COVID-19

Professor Dame Anne Marie Rafferty CBE 28 May 2020 RCN President Prof Anne Marie Rafferty

Anne Marie Rafferty reflects on what we can learn from our past to build a better future for nursing.

My mother trained in ‘fevers’, as a fever nurse in late 1930s Glasgow. It must have been quite a daunting prospect going from a small mining village in Fife to such a large city.   

In looking at photographs of the time, the physical as well as emotional austerity was striking. But it was where she learned to nurse patients suffering from all manner of infectious diseases and her stories made it clear that patients survived or died on the strength of the nursing care they received. 

Pride of place within her skillset was that she knew how to make patients comfortable. As someone who recently contracted COVID-19, I found myself reaching out to the comfort measures my mother used to nurse me in the past to help me through my fevered state.  

When my mum started nursing this was, of course, the era before antibiotics, and there was very little else in the therapeutic armoury to help them. When the miracle drug, penicillin, became available in the 1940s, it was in such short supply that it had to be extracted from the urine of treated patients and recycled for therapeutic purposes. Britain did not have the capacity to produce penicillin at scale and was reliant on the US for sending batches of the new wonder drug.  

Now the race for a vaccine for COVID-19 is underway, but until one is developed, we have to fall back on test, track and treat regimes. As in the pre-antibiotic era we have to use the technologies we have to hand - mechanical ventilation, oxygen and those fundamental caregiving skills to humanise sometimes alienating environments. 

This time there is the added angst of having high-tech without high-touch care to comfort patients and their families at their hour of need. This is agonising for both staff and patients’ families, and a source of moral distress for nurses. Added to the burden are the daily struggles of accessing personal protective equipment for infection prevention and control, with particular pinch-points in care home and community settings. 

There are some significant parallels to be drawn between the Second World War and the COVID-19-crisis.  We faced a massive shortage of nurses then too, which meant a surge in recruitment of 30,000-70,000 extra nurses to deal with the estimated air raid casualties of 1-3 million.  Before the current pandemic, the UK was already short of at least 50,000 nurses – though that was simply the number of existing vacant posts, rather than any calculation of the number of nurses the population actually needs.

Wars and pandemics reveal the fault-lines in our society, and the demands made on citizens prompt consideration of the kind of society which should be constructed afterwards. Many of the emergency arrangements became permanent fixtures in the post-war welfare state. If there is any parallel, we need to plan what the next steps in nursing policy might be; to build on the best of what the pandemic has brought in its wake

It is worth considering how to incentivise those who have stepped up to offer their services to continue after the pandemic to fill the gaps in workforce provision. 

Relying on appeals to patriotism this time will not wash. The Prime Minister’s own recent experience of nursing care provoked his heartfelt gratitude to the two nurses overseeing his care. The key will be to ensure that such strong praise and appreciation of nurses’ skills translates into a well-structured and remunerated pay system, with a career progression that enables us to build resilience and strength of leadership to support nurses to stay the course. 

This is where the greatest gain and return in investment can be made. As the World Health Organisation called for in their ground-breaking State of the World’s Nursing Report - 2020 last month, we need a massive investment in nurse education, including continuing education for qualified nurses, decent jobs and leadership at all levels.

The tsunami of problems coming our way after the outbreak ends will create a long tail, and we need to invest in building support of many different kinds on a scale previously unimaginable. This is our moment; we need to halt history and use the heightened value of nursing to secure positive policy outcomes and an investment plan designed to secure the frontline for the future.  

Professor Anne Marie Rafferty

Professor Dame Anne Marie Rafferty CBE

RCN President


Anne Marie is Professor of Nursing Policy at the Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care at King’s College London. 
Professor Rafferty has been involved in the RCN since she was a student in 1977. She has previously acted as an RCN representative on the Health Quality Improvement Partnership and currently acts as a member of the Safe Staffing Expert Reference Group. She was named one of the 70 most influential nurses in 70 years of the NHS.

Page last updated - 31/10/2020