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Stop redeploying nurses outside their specialist areas


Demanding that a nurse makes a permanent move from their chosen field to plug staffing gaps compromises professional practice and patient safety, says Tina Donnelly

It infuriates me when I hear people saying that nurses can work anywhere once they have qualified.

Redeployment policies in the NHS mean that nurses are moved from pillar to post. I wonder what would happen if we were to apply this to other professional groups, such as accountants. I do not know of any accountant who would say that once qualified they can work anywhere. Like nurses, they have discrete areas of practice that share a common foundation and have specialisms.

But all of us in the nursing family, regardless of our area of clinical practice, share the common bond of caring. We became nurses because we wanted to care and help people and make a difference. Some of us have always known that we wanted to become nurses while others have come to nursing much later in life.

Caring is at the heart of nursing and everything we do. No matter how sophisticated the equipment or treatment, or how technically proficient or intellectually challenging the practice – without caring, nursing fails to deliver excellence in patient care.

“We all have reasons why we became nurses and why we chose our fields of practice”

Our professional competence and caring should not be compromised because some people believe that anyone can provide basic nursing care. I don’t understand that term. There is nothing basic about assessing vulnerable patients and planning their care to ensure the correct treatment then evaluating their progress.

The delivery of high-quality patient care depends on the skills and experience of nurses, but there are simply not enough skilled nurses in the workforce. We should not enable the powerful individuals who make decisions to redeploy nurses to use our profession to compromise patient safety and our professional practice because they do not have sufficient staff.

I agree that a nurse can choose to work in many different specialities within the community or in hospitals or clinics. A nurse’s initial training provides for transferable nursing skills, such as communication, respect and dignity in care, nutrition and hydration and compassion. These are essential in preparing a newly registered nurse for care delivery, no matter which area of nursing the nurse chooses to practice.

To put it simply, the Royal College of Nursing’s Principles of Nursing Practice describe what everyone can expect from nursing. Moreover, the principles tell us what patients, colleagues, families and carers can expect.

The RCN is closely monitoring the effects of measures being taken across the health service to help make the efficiency savings required in the economic situation we face. Identifying trends that directly affect the quality of care being delivered is important to nurses at every level. The long-term improvement and stability of the NHS across the UK should not be sacrificed in the drive to secure short-term delivery efficiency savings.

Local health boards and NHS trusts have taken to redeploying nurses to balance shortages within clinical specialties that are finding recruitment a problem.

Redeploying nurses outside their clinical fields of practice is not a quick fix to this problem of understaffing. Nurses are anxious when they are redeployed to a new clinical area to plug gaps. They worry about their competency in an unfamiliar area of practice. This leaves nurses feeling devalued.

Yet they are often placed in the position of having to move at short notice “just to help out”.

Nursing care often reaches beyond fundamental care. For example, many nurses undertake specialist study at higher education. Specialist nurses work in a defined area of practice – they may work at advanced levels in a specialist role for example, be nurse prescribers or simply focus their practice in one area, becoming experienced in that field. When these nurses are redeployed to areas outside their specialty, their efforts can be counterproductive, which may prove detrimental to patient care and to themselves.

Without orientation and training in a new area, an experienced nurse may feel inept. This may lead to feeling a lack of worth and satisfaction with the role. There is an increase in the workload of permanent staff, who have to answer questions and act as buddies for nurses new to the area. This relationship may be difficult if the incoming nurse has different ways of working.

Furthermore, selecting a field of practice is a very personal issue for a nurse. We all have reasons why we became nurses and why we chose our fields of practice.

Nurses have often chosen a specific area of practice because they feel a passion for those groups of people. Caring for children or people who are mentally ill, disabled, critically ill, older or at the end of life are all unique areas of practice.

Requesting and even in some cases demanding that a nurse makes a permanent move from her or his chosen field is unfair and can be difficult for the nurse to see that this is for the benefit for the organisation.

Tina Donnelly is director of the Royal College of Nursing in Wales


Readers' comments (22)

  • Good article. The first people to be redeployed should be the "managers" who are responsible for creating organisational chaos.

    My qualifications and experience in a specialist and high tech environment would enable me to secure a senior clinical position in most places either in the UK or abroad.

    If some idiot "manager" attempted to mess with my deployment they would very rapidly receive my resignation which would detail the precise reasons for my leaving. I would copy my resignation to the local press, MP and as many ex patients/relatives that I could find an address for.

    To put it in crude terms I would make sure that the sh*t really did hit the fan!

    I am aware that my social circumstance, education and experience enable me to be more assertive toward the clowns who believe they are "managing" the service but their failures are not my responsibly nor yours.

    Mangers, who attempt to run a service with minimum staffing, such that if one staff member failing to undertake shift (for what ever reason), results in a crisis are not fit to practise and should be struck from the NMC's register.

    Refuse to play their game !

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  • It is pretty clearly wasteful of skills, to employ specialists as generalists: unless there simply is no role, for the specialist.

    And if someone only wants to be involved in children's nursing, they might indeed walk away if you force them to move into something else.


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  • I completely agree with Jenny and Anon above. Yes, all nurses have completed basic training but we all have our area of interest. Nurses should be allowed to work in their area of preference so we can give our best to patient care.

    I am a gastro nurse, with a surgical background. I was completely lost and felt like a newly qualified nurse when i had to cover a shift on an orthopaedic ward. Imagine! Yes, i did my best but i felt it was not good enough. There are special ways of turning these patients and i had no clue!

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  • I couldn't agree more - these days there isn't an area of practice which doesn't require specialist education and experience and to devalue and waste this is not cost-effective or sensible, quite apart from being a poor way to treat staff.

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  • I have only ever worked on a rehab unit, I may have to be redeployed. The offers are ITU CCU and MAU. How stupid is that

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  • Not only is this a patient safety issue it is also one of quality and economics. With so many services dependent on specialist nurses, it makes no economic sense to then utilse them in such an unproductive way. There is no such thing as a "generalist" nurse. Healthcare is now so complex everyone is a specialist. There is simply a difference between the fundemantal skills and the complex ones.

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  • Anonymous | 14-Aug-2012 10:46 pm

    don't pin your hopes too high. a friend from general medical nursing went and did the year's course in ICU and on her final oral exam was told she was not suitable material and had to leave. she was gutted and left the hospital and got a job she hated in a care home.

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  • Just to remind you. The people responsible for these hair brained schemes call themselves Nurses. If they are Nurses they can be redeployed! As I stated in my first post they should be the first to be redeployed and lead by example ! (I am laughing as I write this !)

    I would happily "stand in" for these so called "managers"

    How could I possibly make a bigger dogs dinner than them ?

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  • As specialist nurses we frequently receive emails asking us to cover ward shifts. My reply is always: "So who is going to cover my work and make complex prescribing decisions for neurology patients, see them in A&E and MAU, diagnose them correctly and speak to the 10 or so GP's who phone daily needing advice on management." If they can cover my shift with an equally experienced professional, meeting all these needs, then I will work on a ward with the caveat that it is not my speciality, and there will be many tasks I won't be updated enough to carry out. If they can't replace me with someone of equal skills, then I will need 7.5 hours overtime, at the weekend, to cover the work I would have done during my ward shift.

    I've just had an idea - wouldn't it be so much better to hire a bank or agency staff nurse to cover the ward shift? Being a staff nurse is a speciality in itself, we should stop distinguishing between different bands when we use the term specialist because every job is special. We should value patients enough to provide them with enough nurses of the right kind, who know what they are doing.

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  • Anonymous | 17-Aug-2012 8:21 am

    just looks as though in the future patients will no longer get the benefits of these specialist skills and the quality of care and treatment outcomes will deteriorate further before anything is done about it.

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