Working time directive tsar says the 48-hour week is good for nursing

Nurses should welcome the implementation of the maximum 48-hour working week, according to Wendy Reid, the Department of Health’s national clinical lead for the European working time directive.

‘Tired doctors are dangerous,’ said Ms Reid, who is a practising consultant in obstetrics and gynaecology at the Royal Free Hampstead NHS Trust and was previously national clinical lead for the Hospital at Night programme.

Compliance with the maximum 48-hour working week would offer the protection doctors needed, she said, especially at the most junior level, to have ‘a reasonable pattern of work so they can learn and perform well for patients’.

‘I’ve never heard a nurse not support that,’ she told Nursing Times.

Ms Reid is confident that the changes in staff skill-mix and reduction in barriers between roles caused by the EWTD would not only mean better working conditions for doctors but also provide greater autonomy for nurses and, most importantly, she said, improve care for patients.

‘We are missing a huge opportunity if we talk about the EWTD in terms of just changing rotas so that doctors work 48 hours a week,’ she said.

‘I think there is much more of an opportunity to look at how we deliver the service – it’s really about patient-centred care.

‘The organisations that are 48-hour compliant now have not done this just by looking at the junior doctors. They’ve done it by looking at the service – asking what do our patients need, who delivers that service to that patient at whatever time.’

She added: ‘That may well be a senior nurse, a nursing team, a team led by nurses – a lot of the critical care outreach teams are nurse led.’

For example, Ms Reid highlighted the Hospital at Night model, which uses multidisciplinary teams to provide out-of-hours clinical cover, that has been successfully implemented by many NHS organisations.  

She said that the schemes provided ‘enormous clinical leadership opportunities for nurses’. ‘Some of the most effective night teams are nurse led,’ she said.

However, Ms Reid rejected any suggestion that greater use of multidisciplinary teams or other health professionals in place of doctors would mean patients that would not receive the same level of care as previously.

Instead, she said, it was all part of restructuring the NHS so that services were provided by the most appropriate health professional – not necessarily a doctor.

‘Patients no longer care what your badge says’

Wendy Reid

‘It isn’t a matter of nurses doing the tasks that doctors don’t want to do – which is the question I’m always asked in public meetings – it’s a matter of the people who are trained to do the task at that level doing it,’ she said.

‘That could be HCAs for certain things. Physicians’ assistants are increasing – not huge numbers as yet in the UK but I know there are some very good neonatal physicians assistants around, for example. It could be operating department assistants, it could be the nurse, it could be very senior clinical nurses running a coronary care unit,’ she said.

‘It is quite clear to me that [patients] no longer care what your badge says – it’s whether you’ve got the skills able to deliver the care.’

She said that this was the feedback that she had received from talking to patients treated by Hospital at Night teams.

‘If you ask some of the Hospital at Night patients, they don’t know who’s treated them. They don’t know whether it’s been a nurse or a doctor – and how fantastic is that? Because you know what? They’ve had excellent treatment at the bedside,’ she said.    

As well as being positive about the overall effect of the EWTD, Ms Reid is also confident that the majority of the NHS will have complied with the directive by the 1 August deadline.

Latest information from strategic health authorities, which show compliance levels reached by March, suggested around one-third of hospital rotas were not yet compliant with the directive.

‘We’re getting there,’ said Ms Reid. ‘At the moment, two-thirds of junior doctors are compliant and we have expectations that we will reach way up into the top percentages,’ she said. ‘If the direction of travel continues as it. is we should be over 90%, perhaps 95% compliant.’

She added: ‘Inevitably, in life there is always that last-minute thing. I fully understand that [earlier] procrastination. It’s the focus of detailed activity now, as it should be – it’s time has come.’

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