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NMC under fire for lack of support on swine flu surge

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Senior nurse leaders fear staff will refuse to work outside their normal area of practice during a swine flu surge because of the “extremely unhelpful” approach of the Nursing and Midwifery Council.

If, as predicted, there is a significant outbreak in the winter, nurses are likely to be asked to cover sickness in other specialities or help in expanded intensive care units.

So far nurses with any queries about how to respond have simply been directed by the NMC to its existing code. This says nurses are “accountable for their actions or omissions” if asked to work outside their normal practice.

Nursing directors believe clearer guidance is needed to reassure staff who fear they could be struck off if moved. One told Nursing Times: “Not to be providing that for nurses who are looking to their regulator for individual guidance is extremely unhelpful.”

Nursing directors have called for the NMC to follow the approach of doctors’ regulator the General Medical Council.

In March the GMC published guidance which said some its normal requirements of doctors would be lifted during a pandemic. The guidance said it had added qualifying clauses to the guidance, “recognising that contraints on time and other resources may limit doctors’ ability to provide detailed information or help for patients”.

Janice Sigsworth, nursing director at Imperial College Healthcare Trust - England’s largest trust - and former deputy chief nursing officer, told Nuring Times: “The NMC should offer leadership around this issue and supportive guidance both to organisations and registrants.

“It should be providing leadership to its registrants at this very difficult time to ensure they work within the code of practice, and not to scare them so they think they will be struck off if they have to undertake an activity that they ordinarily do not.”

She said: “We are telling our nurses if they are faced with any area outside their competency they have got to seek supervision and advice.”

University College Hospitals London Foundation Trust nursing director Louise Boden said all nurses were able to “look after the physical needs of a patient in a bed”, whether the patient also needed care from a different specialist or not. The trust expected them to do that wherever they were asked to, she said.

Ms Boden said: “That is something all trained nurses can do no matter where it is.” She added: “We all look to the NMC for help and assistance in troubled times.”

Another nursing director told Nursing Times there was strong concern about being able to move nurses if there is a swine flu surge in the winter, particularly under plans to double trusts’ intensive care capacity where necessary.

However, Guy’s and St Thomas’ Foundation Trust chief nurse Eileen Sills said she did not have a problem with the NMC guidance. The trust is currently auditing staffs’ skills, so they can potentially be moved to other areas where they are competent.

She said: “We should work within the scope of our professional practice and never put ourselves in a position whereby we are operating outside of our skill set.”

Royal College of Nursing director of legal services Chris Cox said the NMC guidance was right to state that nurses can be held legally and professionally responsible, and they normally should not work outside their competency.

He said courts and the regulator accepted that lower standards might be provided in an “unplanned, unforeseen emergency situation”, where a nurse is called upon. However, this is unlikely to apply to swine flu-hit hospitals because of the time they have had to plan ahead.

Mr Cox said: “An unplanned emergency could influence the standard that could be expected. What the NMC won’t accept is if you know the situation is coming up and don’t make plans for ensuring you have relief. That would be unacceptable.

“What I don’t think it would be right to say is, ‘A different situation has arisen, we will now deliver lower standards of care.’”

Mr Cox said setting aside parts of the code because of swine flu could set a precedent for other situations.

The NMC said it would not issue new guidance, but its director of standards Roger Thompson said in a statement: “We are in a very fast moving situation so we are keeping our guidelines under constant review to take account of the changing circumstances.

“We will continue to work closely with the UK health departments and other stakeholders as the situation develops.”

A Department of Health spokesman said: “Several directors of nursing have raised this issue with us and we have passed their concerns on to the Nursing and Midwifery Council.”

  • 4 Comments

Readers' comments (4)

  • i agree with the above post. as a learning disability nurse i have a wide knowledge and skill base in being able to support individuals in increasing independence and enabling self advocacy; managing exceptionally challenging behaviour and facilitating all aspects of health promotion with people with complex communication issues. my skill base is not caring for sick people - yes i can recognise the symptoms of infection and respond appropriately. however, I haven't administered medication for a long time and then it was from blister packs, the last time i gave an injection i was a student at around the same time i recorded BP,temp and respirations. i have never been trained to insert venous canulae or set up a drip.
    over the last months, i have worked a large number of shifts on the Anti viral Dispensing Clinics (following a half day training session) and enjoyed the experience as it is so different from my usual role. but to be competent in an acute medical setting i too would need some refresher training (and indeed some first time training) in the clinical skills required.

    Since the end of project 2000 training there will be a high number of nurses (namely any branch not adult/child trained) who have never set foot in a hospital based placement and need full support in learning how inpatient medical services function. So no not every nurse can do it!

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  • I must say I agree...I am a specialist oncology nurse, I am confident administering complex chemotherapy, I would not be happy being moved to an Intensive Care unit for example and looking after a patient on a ventilator-of which I have never had any experience or training! Surely Nurse leaders must realise this or do they think we are 'Jacks of all trades'? This is a typical outdated old fashoned view on what nurses do and shows no consideration for the fact that we are practitioners in our chosen field of speciality and have developed competence in that area-we cannot be expected to provide competent care in all areas at the whim of nurse managers and I would have serious concerns were this to happen.

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  • Ronald Luton-Brown

    What about care homes?
    I work in the so called Private sector as a RMN (Part 3) working with a range of clients from mental health to Learning Disabilities and ages 18 to 98! I have experience of General Nursing through out my career so feel able to deal with Physical care But what about others whom i have worked with who have had problems dealing with someone with a bad cold let alone Flu!? OK People need supervision and should ork within their limits any idiot knows that! What the NMC needs to show it will offer a miniscul mount of support to someone who may get into difficulties IF they stray a little. BUT Then the NMC is not their for Registered Nurses is it? Its to Protect the General Public from us wild Registered Nurses! Time for Change i say Give the RCN more clout and chuck out the Quango!

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  • All regulators seem to be litigation averse. I asked the Scottish Commission for the Regulation of Care if they would relax their enforcement if staffing levels and skill mix did not comply with the staffing schedule in registered servces. They procrastinated and did not give me an answer.
    Looks like the sharp end staff are on their own again

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