RCN guidance on redeployment - COVID-19

This guide provides information for all RCN members, across the health and social care workforce, including students, on what to do if you are asked to move from your normal working environment. 

It also provides advice for students (please see student redeployment) specialist nurses who are asked to work on a ward. In addition to this, it also provides advice for pregnant women and those in risk groups (please see what are the occupational health / health and safety considerations?).

See also: the RCN COVID-19 resource and the clinical guidance section includes links to national guidance and health protection advice across the UK.

Context of need for redeployment due to infection outbreak/pandemic:

As a pandemic, COVID-19 will require health and social care professionals to be flexible in what they do. It may entail working in unfamiliar circumstances or surroundings or working in clinical areas outside of their usual practice for the benefit of patients, individuals and the population as a whole. Any redeployment must be done within the basic principles of best practice and with a rational, pragmatic approach to varying practice to cover this emergency.

The temporary movement of staff is a necessary part of business continuity for all health care areas, which enables the delivery of core essential services required by an increasing number of patients and/or to cover for expected/unexpected staff absence.

The planning and preparation for a pandemic situation has focused primarily on influenza infection but the principles within these plans apply to COVID-19.

There is a general expectation within the NMC Code that nursing staff support in emergency situations within the bounds of their individual competence and providing the appropriate safeguards, including relevant personal protective equipment (PPE), are in place. See also the HSE  guidance.

The NMC and other health care regulators have recognised that this is an extraordinary situation and will present challenging issues. They have published a joint statement on how they will regulate and take the current situation into context.

The temporary movement of staff in this context is specifically for the purposes of support as the organisation manages high demand and increases in patient volumes and care needs due to COVID-19.

The next section provides detail alongside key questions members and employers need to consider based on the national guidance:

virus

COVID-19: what you need to know

Find out how to protect yourself, what you should expect from your employer and what to do if you have concerns.

COVID-19 briefing for health and social care workforce

Guidance on the NMC COVID-19 temporary register.

Questions and answers

  • Your employer can usually request that you work somewhere other than your normal environment as a temporary measure, but they must be sure about your competence level.

     

  • If you are asked to move, you should consider the following:
    • Your environment - Do you know where to find important equipment, the location of fire exits and emergency equipment, etc.? If moving to another organisation, check the appropriate indemnity arrangements are in place.
    • Your patients - What level of care will you be expected to give? Do you have any experience with this type of patient? If not, you should only be required to deliver the fundamentals of care.
    • Work – What will you be doing? Who will be your point of contact for any queries? Who else will you be working with?
  • If you do not feel competent to work in this area you should speak to your manager. If this does not resolve the situation, please document your concerns and contact RCN Direct: Tel; 0345 772 6100, 8.30am to 8.30pm seven days a week, 365 days a year.
  • If you are a registered nurse you must ensure you follow the Nursing and Midwifery Council (NMC) Code at all times, which states that you must recognise and work within the limits of your competence. You must speak out if the move may undermine your ability to follow the NMC Code.
  • You are within your rights to refuse to do something if you are not competent to do so,but you cannot refuse to learn how to do something if it is a requirement for patient care or safety, see the RCN advice on refusal to treat. Also see the advice on the NMC web site.

  • During the surge of COVID-19 patients there will be a requirement to change from the traditional methods of nurse staffing due to staff absence and the need to increase bed capacity.
  • Staff may be required to cover other areas of the organisation due to increase demand in particular areas or to cover potential sickness absence from other staff.
  • This may mean covering wards or clinics or support in other areas, for example general practice nurses required to work in different practice settings.
  • It may require staff to support in different areas, such as supporting on call desks to manage increase volume of calls for COVID-19 advice, providing they receive the correct training.

As the coronavirus pandemic escalates, very high numbers of patients will be critically unwell – far more than the current critical care capacity in hospitals. Surge (additional) critical care capacity will be created in other locations to manage these critically unwell patients. 

There are not enough critical care nurses to care for these patients and as such nurse to patient ratios will be much higher than usual.To save life, colleagues from other specialties will need to assist, this will includes colleagues who have previously worked in critical care but also those who have not. We understand that this will be daunting for registered nurses, Health Care Assistants and multi-professional support staff who are redeployed to established or newly formed critical care units. Critical care nurses will need to be supported to manage increased numbers of critically ill patients whilst supervising and delegating to non critical care colleagues. This is an unprecedented situation and it is essential that a team working approach rather than a patient ratio approach needs to be adopted, taking account of skills, knowledge and welfare of all staff to provide the best patient care possible.

The key is that you are all supporting a process of patient care, as part of a team, still bringing your individual skill set into that team. This means you will be working to provide nursing care as you do in your usual environment, within the limits of your competence. The difference will be that the patients will be critically ill and high numbers will be ventilated. A critical care trained nurse will be responsible for the technical aspects unique to the intensive care environment such as ventilator and dialysis machines. Non critical care staff will receive training, induction and orientation to critical care specific to the role you will perform to lessen anxiety, understand the care needed and meet this unique challenge to work cooperatively with colleagues to care for people.

The process overall will help to ensure that as many patients as possible are treated and all of your skills and knowledge are vital in their care. Further information specific to redeployment to critical care is available here and general redeployment guidance can be found here

Please see:

  • Your employer is responsible for ensuring staff have the necessary skills and knowledge to take on work. This is relevant for all members; across the health and social care workforce, including students (see: student redeployment).
  • The employer is also accountable for the work of their staff and need to take staff limitations into consideration when delegation or temporarily moving staff. The employer needs to make sure individual staff have the appropriate skills and knowledge.

  • Staff need to have a health and safety induction and be made aware of safety procedures within the new environment.
  • Staff need to have access to all policies, procedures and guidelines relevant to the patient population must be readily and easily available as must information on who to seek guidance from.
  • Staff need to have induction into the clinical area and the equipment.
  • Staff need an induction on the IT systems, incident reporting and record keeping as well as other support telephone systems and alarms.
  • Staff need to consider their own competence to meet patient needs these will include for example; IV drugs, respiratory care, drug administration, use of different equipment, such as resus equipment.
  • Staff to check they are covered to work under the host organisation’s indemnity.
  • Staff need to raise their concerns on being moved with their immediate line manager.
  • Staff need to follow the process for escalating issues whilst in the new role, if they have any issues/concerns or other needs:
    • staff will need contact details for the senior nurse in charge and or out of hours manager
    • see under ‘who is responsible’. Staff need to consider their own accountability and competence and have information on how to raise concerns when delegated care is not appropriate for their level of competence. See the RCN guidance on raising concerns.

  • The RCN would expect employers to undertake a risk assessment based on the individuals experience and skills before considering areas to redeploy staff.
  • The RCN would expect employers to provide the health and safety induction and initial support as outlined in the section on ‘what staff need to consider’.
  • The RCN would expect staff to be given the appropriate personal protective equipment (PPE) and appropriate training to ensure they are able to use it correctly, including safe donning and doffing.
  • The RCN would expect manager’s confirmation that staff will not experience any detriment in relation to pay, and terms and conditions of employment if they are asked to move to a new work area or are temporarily moved to work for a different employer.
  • The RCN would expect employers to comply with the requirements of the Working Time Regulations. Organisations must also ensure arrangements for recording and accruing overtime and TOIL are in place and related payments are made. See the RCN advice on COVID-19 What you need to know.
  • The RCN would expect employers to make sure the appropriate indemnity insurance is in place for all staff who are required to move to a new work area.

  • If individuals have a disability or an underlying medical condition, for example immunodeficiency, which means they may face a risk to their health or wellbeing if they move to an unfamiliar or new working environment, they should inform their line manager or an appropriate line manager and/or seek advice from their local occupational health service before agreeing to move.
  • If individuals are already employed in a particular area/service as part of medical redeployment and are now expected to go to somewhere that is not suitable for them, they should inform their line manager, or an appropriate line manager, and/or seek advice from their local occupational health service before agreeing to move.
  • You should consult with your manager and make your concerns known verbally or in writing as soon as possible.

  • Reporting health needs/risks: where staff have particular health needs, they should be offered risk assessments and measures should be put in place to minimise the risk of exposure by following current public health guidelines on the provision and use of PPE.
  • Use of PPE - FIT testing: Staff should be provided with the necessary PPE relevant to the area they are being asked to work in and in line with the current public health guidelines.They should be given the appropriate training in using and discarding this (known as donning and doffing).
  • Pregnant women: The current government advice is that pregnant women should practice social distancing and avoid contact with someone who is displaying symptoms of coronavirus (COVID-19), avoid non-essential use of public transport, vary their times to avoid rush hour, when possible and work from home where possible. The RCN would expect employers and occupational health to carry out or review a pregnancy risk assessment and put systems in place to protect the health care working including home working. The RCOG has updated information on the advice for healthcare workers who are pregnant here (see Question 7). Also see the Health Safety Executive (HSE) guidance for expectant mothers.

    Information from the Royal College of Midwives can be found here and here.
    • Lone workers: consideration needs to be given if staff are asked to work on their own and how they will advise their line manager and the organisation of where they are. How they will access support and be issued with mobile phones or lone worker alarms where appropriate also needs consideration.
    • Staff with underlying health needs: The government guidance lists people who may be more vulnerable to or have a higher risk of complications and higher mortality than the general population.The current government advice is that these individuals should practice social distancing and avoid contact with someone who is displaying symptoms of coronavirus (COVID-19), avoid non-essential use of public transport, vary their travel times to avoid rush hour, when possible and work from home where possible. The RCN would expect employers and occupational health leads to carry out a risk assessment and put systems in place to allow the health care worker to practice social distancing including home working.

    • All concerns should be reported to the individual line manager in the first instance.
    • Staff also need to know who else to report issues and concerns to where immediate response is necessary.

    • Staff being temporarily moved to another area need to be advised who their immediate line manager will be during the redeployment and be introduced to the wider team.
    • Ideally their substantive line manager needs to be part of this discussion.
    • Where there are concerns staff being temporarily moved to another area need to raise these with their immediate line manager and be able to escalate these to their substantive line manager.

    Student redeployment

    • Emergency education standards have been introduced by the NMC for those joining the register in their last 6 months of final year of an undergraduate pre-registration degree. 
    • This is a voluntary registration onto the emergency register.
    • The NMC have announced that they will take into account the emergency conditions for students and nurses are operating in the coming months, and we expect clear guidance to be provided to employers in support of this.

    Responsibilities

    The following table provides an overview and summary of the responsibilities for the employer/organisation, individual ward clinic or unit and the individual.

    Organisational responsibilities

    A full risk assessment of the completed considering:

    • staff competence and skill
    • health and safety assessments of the area the member of staff is being moved from and to
    • staff health and safety (see section on occupational health)
    • primary movement of bank/agency staff if competent and skilled.

     

    Ward/unit responsibilities

    Completion of a Health and Safety check:

    • orientation to the ward area and with health and safety equipment ad procedure.

     

    Individual staff responsibilities

    • Highlight skills and competence to senior staff.
    • Complete health and safety orientations.
    • Highlight areas of concern.
    • Escalate areas of concern to senior managers and the RCN as required.