At hospitals around the UK nurses continue to pull on fresh scrubs and prepare for another day caring for patients. But many have been “rocked to the core” by the Lucy Letby case and some fear the foundation of public trust has been shaken. That was the message from senior nurses on Tuesday as the horror of the child killer’s sentencing sank in and the profession braced for a long task to reassure families and patients that Letby’s crimes, and the institutional failings that appeared to have allowed them to continue, were truly an anomaly. The focus is sharpest on neonatal nurses, charged with caring and often saving the lives of the smallest and most vulnerable people – newborn babies. The Neonatal Nurses Association is encouraging its members to seek help and said there would be an impact on them all. “Your work, day in, day out, is essential, valued and is making a positive difference to babies and families,” it told them in a Facebook message. “We urge you to seek support as needed and recognise as individuals how challenged this verdict may make you feel.” There has been a sense of shock, anger and, at the Countess of Chester hospital where Letby worked, guilt that her crimes were not prevented. “You can see everyone questioning what has gone wrong, how could this have happened,” said Dr Amanda Lee, a neonatal nurse for more than two decades and now a senior lecturer in nursing at Manchester Metropolitan University. “As happened with the Beverley Allitt case, you start questioning everything that you do.” Allitt, a nurse on a children’s ward in Lincolnshire, killed four infants in 1991. Letby’s crimes – killing seven babies and attempting to murder six more – have struck to the heart of nurses’ responsibility to “do no harm”, Lee said. What has happened feels “almost like a professional slight”, she said. “People keep referring to Letby as ‘the nurse’ but she isn’t a nurse now,” said Lee. “That is really grating on me as a professional nurse. My professional status means that I have to uphold trust with the public; that I do no harm.” There is some limited solace in the fact that Letby was “an outlier but it has happened on people’s watch”, she said. “Everyone around her will be questioning, could I, should I have done anything different.” Ann Lloyd Keen, the chair of the Patients Association, a campaigning charity, said nurses had a privileged position of trust in society but “if we can’t look after the newborn babies, what are we about?” As well as advocating for patients, Keen is a registered nurse who used to work in neonatal care, and was a health minister under Gordon Brown. She said nurses were “horrified that it was not spotted” and considered that the fact that Letby was “white, blonde, very middle class” probably affected the failure to stop her as she “didn’t look like a murderer”, adding: “The sad reality is that if you were black, brown, Asian, you probably would have been investigated a lot quicker. “I am angry with how this was managed,” Keen said. “The guilt that will be around the clinicians that were involved in that case will be tremendous.” Dr Ravi Jayaram, a consultant paediatrician at the Countess of Chester hospital, has said he repeatedly raised concerns about Letby months before police were alerted. Keen said: “Safety isn’t a priority of the NHS at the moment. I hear nurses saying quite regularly to me that they know they’re not caring at the standard that they want to. How can you be safety-aware when you’re nursing in corridors?” Dr Jayne Chidgey-Clark, who leads an NHS-funded network of Freedom to Speak Up guardians, which gives staff a place to express concerns, said the Letby case “shocked me to the core … [and] I am sure nurses across the country are feeling as I do right now”. She said nurses “absolutely can – and must – speak up if something doesn’t feel right”, adding: “The judge called Letby’s actions ‘malevolence bordering on sadism’. “The terrible actions of such criminals in healthcare is extremely rare. I hope the actions of this one individual do not erode that trust. We saw during the pandemic how the overwhelming majority of nurses come to work, sometimes putting their own health at risk, because they care deeply for the people in their care and their families.”