Imagine having to watch a patient suffocate because they're not eligible for ventilation. Now imagine you're their only comfort as they take their last breath. It's a gut-wrenching reality for nurses treating COVID-19 patients due to visitation restrictions on hospital wards. It's a lonely reality that Sydney ICU nurse Janet Wilks is all too familiar.

A nurse with Healthcare Australia, Ms Wilks has witnessed the devasting impact of the pandemic in Sydney's ICUs, the Hotel Quarantine Project and nursing homes.

The most confronting experience, she says, came after being assigned a COVID-19-suspected patient on shift, which resulted in her greatest fear being realised - the worst possible outcome.

"She was an elderly, kind woman. I assisted her with her daily cares, and I helped her back to bed. Then later in the shift, I came back to assess her and give some medication.

"Her oxygen had decreased, and she was having trouble swallowing and had developed a cough very quickly."

A CT scan confirmed that the patient was COVID-19 positive and that her lungs were quickly becoming overwhelmed.

"She was not eligible for ventilation, but we gave her oxygen and made her comfortable.

The task of delivering this tragic news to the patient's family was difficult, explains Ms Wilks, but denying them personal contact with their loved one was worse.

"They were not allowed to visit her in her last hours. That was the worst part. The only person who could be with her was me.

"I Skyped the family so they could say goodbye to their Grandma, Mum and Sister. She deteriorated within hours and passed away while I was at her bedside.

"This was my worst day since the pandemic started. She died without her family at her side, without a friendly face either, as we wear so much protective equipment. She couldn't even see us!"

Critical care nurses have had to face many challenges during this pandemic, but staying abreast of the ever-changing policies, protocols and research is the most frustrating, says Ms Wilks.

"It has been confusing, confronting and constantly changing.

"Every day, you come to work, to find things have changed again.

"A co-worker tells us one thing, and then we find another standard by the CEC, the Ministry of Health, WHO or CDC.

"An email with restrictions for personal protective equipment use or new regulations for airway management.

"We are protecting our personal protective equipment like gold and for a good reason!"

Another surprising challenge for critical care nurses is job-loss due to the many cancelled elective surgeries.

"We prepped for this, as we knew the global pandemic would be on our doorstep soon, and then many of the critical care nurses were stood down for months as there were COVID-19 patients, but not many, as many elective services were stopped."

As well as the challenges, there are constant fears that make nursing during a pandemic stressful, explains Ms Wilks, including catching the disease, passing it to loved ones and the possibility of having to be part of unconscionable decisions over life and death.

"We fear that we will care for COVID-19 patients, and our PPE will fail.

"Some of our older nurses feared coming to work, as we didn't know who was COVID-19 or not, and the older nurses feared for their lives.

"I fear, every day, that I will come down with a sniffle, cough, sore throat or another symptom and develop COVID-19 and be ventilated.

"Many ICU nurses have taken care of ventilated patients, but to be one of them would be devastating.

"We fear that this disease will spread, and our ICUs will be overwhelmed.

"We fear having to turn patients away when we are overwhelmed and having to make decisions based on how many ventilators we have.

"We fear having to watch people suffocate because their body will no longer work properly because COVID-19 has overwhelmed their body.

"We fear having to call families to tell them their loved ones are gone."

As well as being challenging and stressful, it's also an honour to be part of a profession that's making a difference, reflects Ms Wilks.

"The hotel quarantine is a huge achievement and an excellent project to protect this community against incoming international COVID-19 cases in Sydney.

"We have been able to assist passengers with mental health issues, prevent other medical problems from occurring during quarantine and keep quarantined passengers safe in as many ways as possible.

"It feels great to be able to provide such a service to our city."

Ms Wilks will travel to Melbourne to assist in the efforts with infection control as part of the Hotel Quarantine Project and various nursing homes.

"Since we've have had so much success in Sydney, my experience will be beneficial.

"Guidance and education with infection control can only help make the situation better, and we hope to get COVID-19 under control, so Melbourne is no longer considered a hotspot and can thrive again as a city.

"Many of our nursing team have already tested positive in Melbourne, and the situation could become dire very quickly.

"It is scary to be heading into a hot zone, but we know that they need nurses desperately."