RCN position on who should administer the COVID-19 vaccine and where
Most vaccines are given via primary care or through immunisation teams in community or school settings. There are differences across the UK on how these routine services are arranged. It is however inherent that all vaccinators have appropriate education and training and ongoing supervision to fulfil this role.
It is anticipated that many vaccinations for the wider flu programme and the Covid-19 programme will be offered through various delivery models to enable vaccination of large numbers of people and ensure that there is easy access all sectors in the population. The delivery models are managed through NHS hospital, primary and community care systems. The RCN are supportive of this approach to ensure all those who require vaccination can get it as soon as possible. The RCN would expect to be involved in the planning of these delivery models.
There are ongoing concerns regarding how the roll out of the programme will impact the rest of the system and the risk of disruption to other services. We would expect every effort to be made to maintain safe and effective services throughout and to see clear information and communications that support the public to access wider primary care support.
The RCN would expect that all staff, for any part of the process for large scale immunisation delivery, are sufficiently trained and to have appropriate education and training alongside a period of supervision and competency assessment. This must include the vaccination and injection process, importance of informed consent and recognition of adverse events. They should also have ongoing supervision in the workplace by experienced vaccinators.
The RCN recognise that there will be a need to support an expanded workforce for delivery of these large-scale vaccine programmes where it is anticipated that millions will need to be vaccinated, rather than rely on the existing nursing workforce. The RCN is in principle supportive of using an extended workforce, providing people are appropriately supported including having appropriate training, assessment of skills and ongoing supervision and support. The exact nature of the way vaccine delivery will work and who will fulfil different roles is different in each country.
The changes made to the Human Medicines Regulations (HMR) for Influenza and coronavirus allow for an expansion of the workforce who can administer these vaccines in an emergency situation. For the RCN the expanded workforce will potentially include; nursing associate members, applicable in England only. Alongside registered nurses, nursing support workers and potentially student nurse members across the UK. The RCN already has guidance relating to the role of Health Care Support Workers (HCSW); this is applicable in England and Wales. There is a separate document from the Scottish government and RCN guidance relating to nursing associates. The unregistered workforce is not currently supported to administer vaccines in Northern Ireland.
The legislative changes to support vaccine delivery at this time, allow for authorisation for vaccine administration under a national protocol, this will allow for different members of the workforce to deliver specific tasks and functions. Authorisation of the vaccines under a patient group direction (PGD) or written instruction (WI), for those staff who can use them, will remain as will using a prescription or patient specific direction (PSD). The legislative changes are UK wide, however, the details of the national protocol, the associated PGD and WI templates and the standard operating procedures (SOPs) will be decided at a national level. Developed with guidance from the Joint Committee for Vaccination and Immunisation (JCVI) and the Medicines and Health care Products Regulatory Agency (MHRA) who have a remit to advise all UK governments.
The RCN are working with wider stakeholders to make sure that the fundamental principles for safe delivery are in place and that there is a comprehensive education and assessment package in place to ensure safe practice, that registered and un-registered staff are always working within their competence. The education packages are being led by PHE and shared across the UK devolved administrations and Crown Dependencies for use.
In relation to student nurses; the RCN position across the UK is that If students are on placement within an area delivering COVID-19 vaccination they can support with the delivery of the vaccination providing they have the appropriate training and supervision in place and there may be valuable learning experiences available for students to be involved in such an important programme of immunisation. Students must, however, be allocated placements in accordance with the requirements of their educational programme and learning needs. Students on placement should work as part of the wider team and any activity must be relevant to their learning outcomes within the placement. They should not be used solely to deliver the COVID-19 vaccine programme. The remit for students in the delivery of the programme will be dependent on the individual country guidance and policy.
Nursing teams will be at the forefront of the vaccine delivery, this will include; leading the delivery models, training and supervising the wider workforce to support the process and administering vaccines themselves. The RCN will continue to work with stakeholders across the system. The RCN will work with employers and organisations to support promoting vaccine delivery opportunities to the membership so that experienced vaccinators can engage with services delivering the programme. It is essential that the nursing voice and contribution to the successful delivery of this programme is acknowledged.
The RCN will also make sure information and support for members is available via the RCN clinical pages.
The RCN is in discussion with the Nursing and Midwifery Council (NMC). The NMC code would support registered nurses working under a nationally agreed national protocol. The NMC have further advice and support for registrants for the vaccine programme
The RCN expect that staff would be covered by the state back indemnity schemes for any vaccines administered as part of the national influenza or COVID-19 vaccination plans.