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.”