COVID-19 (coronavirus) FAQs
Our frequently asked questions about COVID-19 and work
The information below has been compiled by RCN advisers in public health, infection control, and employment relations. We'll be updating it as the situation develops - so please do check back often.
We are working hard in these challenging times to keep you updated. If you can't find what you are looking for please see our Get help page or contact us and we will get back to you as soon as we can.
The HSE/HSE NI and MHRA both issue alerts and notices relating to equipment, PPE or treatment of patients.
The below list is non-exhaustive. Please speak to your employer or local procurement team about any concerns and keep up to date with any local reporting procedures and policies.
KN95 face masks
KN95 face masks must not be used as PPE for work as their effectiveness cannot be assured. Read the Health and Safety Executive’s health and safety bulletin (June 2020) for more detail.
If you are offered KN95 face masks at work as an alternative to FFP2 or 3 masks, we recommend you keep a record of this using your workplace’s incident reporting procedure (i.e. datix or equivalent). If your workplace continues to use KN95 masks despite this safety alert, please follow our PPE – are you safe? guidance. If you need further support please contact us.
Thermal cameras and temperature screening products
Please see Medicines and Healthcare products Regulatory Agency (MHRA): Don't rely on temperature screening products for detection of coronavirus (COVID-19).
Can employers re-designate bank holidays as normal working days?
The UK government has not introduced any legislation or guidance which annuls or delays bank holidays. Some NHS services, including acute hospitals and primary care, may decide to respond to the COVID-19 pandemic by deciding to run some or all services at weekday service levels during bank holidays.
In these instances, where possible, we expect organisations to approach their local staff side or trade union representatives to clarify which services this will affect and consult on communications which will go out to staff on this matter. Wherever possible, organisations should maintain staff goodwill and request volunteers rather than requiring staff to work on bank holidays.
Staff covered by NHS terms and conditions who are required to work on bank holidays, should be paid the appropriate bank holiday rate as set out in the NHS terms and conditions of service handbook. Their leave should also be credited with the public holiday so it can be taken at a later date.
If staff would normally not have worked the bank holiday (without having needed to book it off) or usually work shifts and had booked it off, the normal notice requirements for cancelling leave would apply.
If you are being asked to work bank holidays and weekends as part of a move to a full seven day service during the pandemic you will be entitled to unsocial hours payments as set out in section 2 of the NHS terms and conditions of service handbook.
For staff working in an NHS organisation, if you are being asked to cover bank holidays or weekends as overtime then section 3 of the handbook will apply.
All NHS staff are entitled to the full allocation of bank holidays, so if you are asked to work a bank holiday then you will be entitled to that day back as set out in the handbook.
For staff working in primary care (including GP practices), entitlement to pay (including enhancements) when working on public holidays will depend on your contract of employment. However, the RCN expects employers not to seek to vary contractual entitlements during the pandemic. If you have concerns regarding bank holidays you need to raise the issue with your HR Department or a more senior manager and ask the reason for this in writing. This should be done before contacting the RCN for further advice. If you have your employer’s written response but you haven’t been able to resolve the issue, you should raise your concerns with your local RCN representative directly or by contacting our advice team.
For staff working for independent employers the re-designation, or changing, of public holidays will depend on your individual contract. Staff not covered by NHS terms and conditions should check their contract of employment for their annual leave and holiday pay entitlements. If your existing contract makes provision for public/bank holidays and conditions related to those days (e.g. pay or additional leave), you are not obliged to accept a change to your existing contract. However, employers can cancel booked leave if they give the appropriate statutory notice. If you have concerns regarding bank holidays you need to raise the issue with your HR Department or a more senior manager and ask the reason for this in writing. This should be done before contacting the RCN for further advice. If you have your employer’s written response but you haven’t been able to resolve the issue, you should raise your concerns with your local RCN representative directly or by contacting our advice team.
Am I allowed to car share for work purposes, for example when visiting patients in the community?
We expect all health and social care staff to comply with the government’s stay at home guidance if they feel unwell, or meet the requirements for self-isolation. This will reduce the risk of transmission in shared vehicles.
Every employer has a legal responsibility under health and safety legislation to carry out risk assessments during this pandemic. This includes risk assessing and advising staff in relation to:
- sharing vehicles when travelling to and from work
- sharing vehicles when travelling to provide care at patients’ residences.
When preparing a risk assessment, employers should balance risks and benefits of sharing vehicles with the need to support and protect lone workers.
If you have concerns about cardiopulmonary resuscitation (CPR), please see our guidance on CPR and PPE.
To help control the spread of COVID-19, additional cleaning and disinfection will be needed. For larger spaces a number of cleaning options are available, such as fogging and the use of vapour.
It is important to note:
- A COSHH risk assessment must be undertaken and measures identified to reduce the risk of exposures must be implemented.
- Staff must be trained and competent in the use of equipment.
- Staff must be aware of Infection Prevention and Control (IPC) procedures and agreed protocols.
- Cleaning of care equipment must be as per manufacturers guidance/instructions.
- Alternative cleaning agents/disinfectant products may be used with agreement of the local IPC team or the Health Protection Team (HPT).
If you have any concerns, please see our guidance on raising concerns.
If you experience any adverse effects and need support, contact us.
For more information please see the HSE guidance on disinfecting premises during coronavirus outbreak and the UK Infection prevention and control guidance,
See our clinical guidance pages for information and advice on issues including:
- infection prevention and control
- community nursing
- critical care
- delivering services in non-clinical environments
- DNACPR and verification of death
- immunisation and large-scale vaccination delivery during COVID-19
- mental health
- occupational health: supporting industry back to work
- palliative and end of life care
- prescribing safely under COVID-19
- professional issues, including the provision of CPR and the NMC Code
- skin health
- social care and care homes
If you are working in a patient's home where family members are refusing to socially distance or ventilate the home, please see our guidance on prioritising personal safety.
If you are a student nurse, please see our COVID-19 advice for students.
The UK governments have made financial provision in the event that eligible health care workers sadly die as a result of exposure to COVID-19 at work. These are known as Coronavirus Life Assurance schemes and are detailed in rules set out by health ministers under their delegated powers.
A one-off lump sum 'coronavirus life assurance' payment of £60,000 will be payable in the event of the death of a health and social care sector worker (who worked in a publicly funded service) who dies and it is likely that they contracted COVID-19 in the course of their work. Payment is made into the estate of the deceased. This is a new benefit that will apply for the duration of the pandemic. It will be paid in addition to any other life assurance staff may have e.g. through an occupational pension scheme like the NHS Pension or Local Government Pension Scheme.
If you are a member of the NHS Pension Scheme your survivors will also receive the life assurance benefits you are entitled to under scheme rules. These are usually a lump sum plus an ongoing payment for a surviving partner and any dependent children.
The survivors of NHS staff who die as a result of COVID-19 exposure at work will receive coronavirus life assurance benefits including a lump sum of twice the workers annual salary plus an ongoing pension payment for a surviving partner and any dependent children. If the worker is in the NHS Pension scheme, their coronavirus life assurance benefit will be reduced by the amount of life assurance they receive from the NHS Pension scheme.
If a publicly funded social care worker dies without death in service cover in their contracted pension arrangements, the Scottish Government will provide a one-off payment of £60,000 to a named survivor.
Northern IrelandPlease see The Health and Social Care Coronavirus Life Assurance Scheme 2020 for further details.
WalesPlease see the NHS and Social Care Coronavirus Life Assurance Scheme 2020 (Wales) for further information.
What are the eligibility criteria?
In England, your survivors/estate will be eligible for the £60,000 payment if you:
- work in a publicly funded health role (including bank/agency staff, students on paid placement, GP Practices and returners) or
- work in a publicly funded social care role (including adult social care provided by local authorities)
- contracted COVID-19 in the course of your work, and
- worked in a workplace exposed to COVID-19 in the two weeks before you first experienced symptoms, and
- COVID-19 is deemed to be the whole of main cause of death (either on the death certificate or other formal reporting).
The payment is made at a flat rate regardless of your length of service, working hours, pension scheme membership or immigration status.
If you do not meet the all of the above criteria, your family may still be awarded a payment at the discretion of the Secretary of State / Minister for Health and Social Care - for example if you are a student on a non-paid placement or a volunteer. This may be especially relevant where COVID-19 is not listed on the death certificate but was a compounding factor.
In Scotland, your survivors will be eligible for the life assurance payments if you:
- are a permanent, fixed term, bank or locum employee of an NHS body (e.g. Health Board, Common Services Agency, Healthcare Improvement Scotland or GP practice), and
- you have worked in an environment exposed to COVID-19 and
- have COVID-19 stated as a factor on your death certificate (or where COVID-19 exposure at work is held to be partly attributable by nature of the work undertaken)
If you are an existing member of the NHS Pension scheme in Scotland you will be eligible under this scheme but your benefits will be reduced by the amount you receive from the NHS Pension scheme life assurance.
Details on the payment for social care workers have not yet been published.
How would my surviving family apply for this?
Your family should make contact with your employer who will initiate the application, discuss claim forms and any necessary documentation checks. The coronavirus life assurance schemes are being administered by the relevant NHS Pension scheme administrators.
Will this lump sum payment be taxable?
No, but it may be counted as part of your estate for inheritance tax purposes. It will also be treated as capital for means tested welfare benefit payments from the Department for Work and Pensions (DWP) (e.g. Universal Credit and tax credits).
Where can I find more information?
NHS and Social Care Coronavirus Life Assurance Scheme (England)
NHS Scotland Coronavirus Life Assurance Scheme
The Health and Social Care Coronavirus Life Assurance Scheme 2020 (Northern Ireland)
NHS and Social Care Coronavirus Life Assurance Scheme 2020 (Wales)
The RCN will provide support and assistance to the families of members who die due to COVID-19 to ensure that they receive the payments they are entitled to. Should they encounter any problems with the applications they should contact RCN Direct on 0345 722 6100.
Do I need to wear PPE to undertake verification of death?
The RCN guidance on DNACPR and verification of death includes the need to wear PPE as an element of standard infection control precautions. Find out more at COVID-19 guidance on DNACPR and verification of death.
Correct use of body bags
Nurses involved in verification of death or ‘laying out’ of patients must comply with standard infection control precautions and the appropriate use of PPE.
As the practices for caring for the deceased vary according to local, cultural and religious context, communication with key stakeholders is imperative, particularly with religious representatives and to also ensure that changes to standard practice are adhered. Transparent conversations with societal leaders led by local health and care providers is essential to maintain trust between organisations and the community.
Viewing, hygienic preparations, post-mortem and embalming are all permitted by professionals experienced in handling bodies of deceased persons, if appropriate precautions are followed, as detailed in the HSE, AAPT (Association of Anatomical Pathology Technology) and RCPath (Royal College of Pathologists) guidance.
Mourners should not take part in any rituals or practices that bring them into close contact with the body of an individual who has died from, or with symptoms of COVID-19.
Some members are reporting a shortages of body bags and are unsure how to care for deceased patients who may or have COVID-19. There is differing guidance across the 4 countries on this issue.
In Scotland, Wales and England, where the deceased was known or suspected to have been infected with COVID-19, there is no requirement for a body bag, and viewing, hygienic preparations, post-mortem and embalming are all permitted when undertaken by professionals trained in handling bodies of the deceased.
Read the full guidance
In Northern Ireland, guidance states those in direct contact with deceased bodies should use or observe the following:
a. A cloth or mask placed over the mouth of the deceased when moving them to help to prevent release of aerosols.
b. A zipped, leak-proof body bag which has had their exterior surface decontaminated using an appropriate detergent/disinfectant. The use of a body bag brings practical advantages of reducing prolonged exposure (including possible bodily fluids) from the transportation and moving of the deceased throughout their journey.
Last offices - care given after death
During the COVID-19 pandemic, care after death (last offices) including personal care, may be carried out by nursing staff who are not normally requested to complete this within their scope of practice. In some circumstances nursing staff may be redeployed into a role where this procedure is expected. Their line manager ultimately has responsibility to ensure the relevant support and competencies are in place and that staff members feel confident in carrying out last offices.
When undertaking care after death, the following considerations must be made:
- The principles of delivering dignified and compassionate care following death remain in place, including consideration of the individual’s spiritual and cultural beliefs.
- Last offices should be performed according to local policy.
- In line with UK Infection prevention and control guidance, PPE must be worn whilst performing last offices for individuals with either suspected or confirmed COVID-19
Registered Nurses who wish to undertake this extension of their role are required to understand the Special Edition of Care After Death: Registered Nurse Verification of Expected Adult Death (RNVoEAD) guidance (Hospice UK 2020) and undertake appropriate training in order to be deemed competent to verify an expected adult death. This session is designed to support this training by presenting a case study highlighting the process and responsibilities of an RN when verifying an expected adult death. The session is available via the e-lfh hub.
The Registered Nurse Verification of Expected Adult Death session will also be added to the eELCA learning path, Resources to support staff with difficult conversations and end of life care which was created to support staff during the COVID-19 pandemic and has now been accessed by more than 20 000 users. This learning is available on the e-lfh hub.
What should I expect from my employer?
Employers should ensure that all nursing staff are provided with factual information on COVID-19, the steps being taken to identify and manage suspected cases and what nursing staff can do to protect themselves, including reinforcing hand hygiene.
Please refer to your relevant national public health / NHS guidance. Information can also be found on our COVID-19 page.
Staff who may be required to deliver clinical care to affected patients should have the necessary skills and experience, and be provided with training and information on any additional infection prevention and control measures needed to work in such environments, including putting on and taking off personal protective equipment (PPE) safely. Employers should make sure staff have access to the appropriate PPE. Please see our guidance personal protective equipment (PPE) and COVID-19 for more information.
Employers are responsible for complying with all health and safety standards, contractual and statutory employment rights as well as equality rights.
How can I protect myself at work?
Your employer should be carrying out risk assessments and putting measures in place to minimise the risk of exposure by following current public health guidelines on the provision and use of PPE, as well as supplies of alcohol hand gel where appropriate. .
You should also be given information and training on the risks of exposure and how to minimise your risk. If you’re required to use PPE, you should be given training on how to properly use this.
The situation is changing daily and the number of cases in the UK is increasing rapidly. Make sure you follow workplace guidelines and safety procedures and practice good hand hygiene.
Please refer to your relevant national public health/NHS guidance and visit the UK government website for the most up-to-date guidance for health care professionals on the assessment and management of suspected UK cases.
Information can also be found on our COVID-19 page and on our COVID-19 and individual risk assessments page. If you feel your organisation is not providing the right support, see the section below on raising concerns.
What other safeguards should my employer be putting in place?
Rest breaks are very important, even more so at times like this, as fatigue can lead to mistakes and increase the risk of infection. The duty is on your employer to ensure staff can take regular breaks and monitor working hours to prevent the onset of mental and physical fatigue. Wearing protective clothing for long periods can be uncomfortable and hot so, as well as rest breaks, it is also important for staff to keep hydrated. Please see our guidance personal protective equipment (PPE) and COVID-19 for more information.
Staff employed under NHS terms and conditions can find more information on our page COVID-19 employment guidance for NHS staff.
Other RCN members, including those working in general practice, through employment agencies and in the independent sector, should check their contract of employment and local policies in the first instance, or contact their employer or local occupational health service, for information and advice.
Should Patients and visitors still wear face coverings in health and care settings?
The RCN recommend that the public patients and visitors continue to wear face coverings when entering health and care settings.
There is clear advice across the UK everyone accessing or visiting healthcare settings must continue to wear a face covering:
England: NHS England NHS Improvement: NHS Patients, staff and visitors must continue to wear face coverings in healthcare settings
Northern Ireland: Coronavirus (COVID-19): face coverings
Scotland: Coronavirus (COVID-19): face coverings guidance
Wales: Face coverings to continue to help keep Wales safe
In Northern Ireland, Scotland and Wales the requirement to wear face coverings extends to most indoor settings.
Face coverings help minimise the risk of transmission of the virus to NHS staff and other patients and should be worn wherever possible.
What do I do if patients refuse to wear a face covering?
Where patients or visitors refuse to wear masks nursing staff should liaise with their line manager in the first instance. If they feel unsafe the RCN has further guidance on refusal to treat.
If you are struggling financially as a result of COVID-19, the RCN Welfare Service has guidance on entitlements or benefits that may be available to you, advice on what to do if you're struggling with your rent, mortgage, or creditors, and how to access further support.
See COVID-19 and your finances for more details.
If you're a student, see our advice here.
The Coronavirus Job Retention Scheme is a temporary government scheme to support employers whose operations have been severely affected by coronavirus (COVID-19). This scheme has now been extended until the end of September 2021 and may be used by employees anywhere in the UK, including those who have not previously been furloughed.
The government expects that the scheme will not be used by many public sector organisations, as most should continue to provide essential public services. This means the scheme may not be relevant to members working in the NHS, but some members working for independent employers or those working via an employment agency may benefit from the scheme.
The scheme allows employers to ‘furlough’ employees (place them on a leave of absence) and then claim for 80% of the employees’ usual monthly wage costs, up to £2,500 a month. From 1 July 2021 the amount your employer can claim will be reduced.
If you are furloughed then you remain an employee and remain entitled to all your normal employment rights, for example annual leave or maternity pay.
How do I apply for the scheme?
Employees and workers do not have an automatic right to be furloughed - it remains a decision for employers and agencies to take whether to furlough staff based on the needs of their business. Employees can be furloughed more than once under the scheme, and there is no requirement to have been furloughed previously in order to make use of the scheme. Each time you are furloughed you and your employer need to agree it in writing (an email exchange may be enough to count as this written agreement). If you think you would benefit from being furloughed then in the first instance you should speak to your manager about the scheme, details of which can be found on the government website.
Does furlough apply in Wales, Scotland or Northern Ireland?
Extensions to the Coronavirus Job Retention Scheme have coincided with lockdowns in England, however the scheme applies across the whole of the UK. This means that if you live outside of England and believe that the scheme may be of benefit to you in your workplace you can still ask your employer whether they would consider furloughing you, regardless of the current level of restrictions where you live and work..
What is 'part time furlough'?
Shielding and furlough
Before reading this section, please ensure you have also read the 'Furlough: the Coronavirus Job Retention Scheme' information above.
How long would I be furloughed for?
The scheme is currently scheduled to run until the end of September 2021. There is currently no maximum or minimum time you can be furloughed within this period.
If you are currently on furlough and are concerned about being unable to return to work, for example because you do not yet have childcare available, then you should make your employer aware of these issues and discuss them with your manager in the first instance.
What will I be paid while on furlough?
If you are furloughed then your employer will only receive 80% of your normal pay from this scheme. This may be calculated based on your pay before the scheme was introduced. It will then be for your employer to decide whether to only pay you this 80% or whether to top up your pay to the full amount. The RCN encourages all employers to consider paying our members their full salary not just the 80% they receive from the government whenever they can afford to do so. If you are furloughed then you should speak to your manager about how much you are going to be paid. From July 2021 if you are still on furlough then the amount your employer receives from the government will be reduced, but your pay should stay the same.
Employees who are furloughed for part of their working time and are working their remaining hours as usual should receive full pay for the hours they work, even if they only receive 80% for the hours they are on furlough. Please note that while at work you should be paid based on your current salary, but for any hours for which you are on furlough your pay is calculated based on the average amount you were being paid before scheme was introduced, so these rates of pay may differ.
What if I don’t have a fixed salary or work through an agency or bank?
If you are an agency worker working via an umbrella company then it would be the umbrella company that would need to decide whether to furlough you and use this scheme, not your agency. If you work agency shifts but are classed as self-employed for tax purposes, then you are not eligible to be furloughed. There is separate government support for the self-employed so you may want to investigate whether you are eligible for this.
Do I still pay tax and National Insurance while I am furloughed?If your employer decides to make use of this scheme then they would pay you as normal through their payroll system, including deducting income tax, National Insurance, and where appropriate, pension contributions. It would then be your employer’s responsibility to claim this money back from the government through the scheme. From 1 November 2020 your employer can still claim for 80% of your wages but will need to pay employer National Insurance contributions and employer pension contributions, as they can no longer claim for these.
Do I accrue annual leave while I am furloughed?The guidance states that a furloughed employee continues to accrue annual leave in line with their contract. However, agency workers and those on zero hours contracts accrue holiday based on time worked. If you are furloughed by an agency, you cannot work for that agency and therefore may not be able to accrue annual leave during the furlough. The guidance to employees who have been furloughed says that you can choose to take some of your accrued annual leave while on furlough if you want to. This would mean that any furloughed worker only receiving 80% of their normal pay would have this topped up to 100% of their normal pay while they are using their annual leave.
Can I still work while I am furloughed?
If an employer or agency furloughs you then you cannot undertake any work for that organisation for the duration of the time you are furloughed. If you are on part time furlough then you should only undertake work for your employer for the hours you are expected to be at work, and not any of the hours for which you are furloughed.
If you work for more than one employer/agency then it may be possible to be furloughed by more than one organisation at the same time, since each one would only be claiming based on the amount that they usually pay you.
If you have been placed on furlough leave and want to start a new job (e.g. in the NHS, on the staff bank), you need to check this with your main employer. HMRC have confirmed that employees are permitted to work for another employer while furloughed provided their contract allows that. Therefore, please check with your main employer before agreeing to undertake additional work elsewhere.
See below for answers to your questions about self-isolating, shielding and underlying health conditions.
For more information and resources for staff with ill health or disability issues - including to speak to other members with lived experience of disability at this time - visit our Peer Support Services pages.
Employers should have policies to support employees working at home, whether permanently or because they are being asked to due to the current pandemic. These policies should cover a range of issues - from health and safety to patient confidentiality and GDPR issues. Employers should support staff to ensure compliance with these policies i.e. by providing resources for secure storage if confidential documents are being held at home.
If you are homeworking you may also want to see our information on COVID-19 and individual risk assessments.
If you are an NMC registrant, you will also need to be aware of your professional responsibilities and accountability in line with the NMC Code. You should raise any areas of concern with your employer.
See our Immigration Advice Service pages.
What incidents do I need to report?
You should follow your existing organisational policy and guidelines on reporting patient safety and clinical incidents.
The RCN is encouraging members to report incidents relating to potential breaches in health and safety requirements which have led to exposures to COVID-19. Examples include a lack of personal protective equipment (PPE), defective PPE or not being fit tested for FFP3 masks.
Where possible provide as much evidence as you can, including witnesses and where able to do so upload photographs. If this is not possible, you should keep your own records e.g. photographs.
The Health and Safety Executive (HSE) describes an incident as a:
- near miss - an event not causing harm, but has the potential to cause injury or ill health (in this guidance, the term near miss will include dangerous occurrences), or an
- undesired circumstance - a set of conditions or circumstances that have the potential to cause injury or ill health, e.g. untrained nurses handling heavy patients.
The RCN believes that lack of appropriate or sufficient PPE (including where shortages lead to re-use of PPE designated for single use) and issues around lack of training or fit testing for PPE are examples of undesired circumstances which should be reported. See our PPE guidance for more information.
Being deployed to an area and not receiving appropriate training to carry out your role safely would also justify an incident report, as it is an undesired circumstance - as would not being trained in how to don and doff PPE safely.
Reporting psychological harm
The RCN would also encourage members to report any work-related harm to their psychological health including work related stress and cases of violence, bullying and harassment or abuse.
If you don’t feel able to complete an incident form or are worried about confidentially, log your concern in writing with your occupational health provider who can support you to make your manager aware of the problem.
You should never be discouraged or victimised from completing an incident form. If you are please see our bullying and harassment guide for more information.
If you have an RCN representative in your workplace let them know about any incidents or injuries at work, so that they can follow up with your employer and offer you any necessary support, especially if you are off work as a result of an incident or injury.
An incident form also provides a useful record should you go on to develop any health conditions as a result of any workplace incidents.
Find out more in our accidents and work and personal injury guide.
What happens if something goes wrong?
You might be concerned about what protections are in place if something goes wrong in the course of your work during the COVID-19 pandemic. This is where your professional indemnity becomes relevant.
The term ‘professional indemnity’ is sometimes used to describe two different types of cover: clinical negligence cover, and representation for workplace issues.
When we talk about indemnity, we’re referring to clinical negligence cover, i.e. the cover that pays out if a patient is harmed and makes a claim for compensation against a practitioner or health care provider.
Clinical negligence cover
Representation for workplace issues
Aside from indemnity cover for clinical negligence claims, you may also be concerned about support with workplace issues such as disciplinary action, inquests or NMC referrals. Unions like the RCN provide this to their members as a benefit of membership. Some Medical Defence Organisation cover includes this service as well.
I can see clinical waste bags piling up awaiting collection - what do I do?
Waste is generated as a result of health and care practice/processes. There are clear responsibilities for both the ‘producer of the waste’ (the member) and the organisation responsible for the management of waste produced.
UK guidance, Health technical Memorandum (HTM) 07-01 is the overarching guidance for health care organisations to manage waste. This document provides a framework for best practice waste management to enable healthcare organisations/other waste producers meet their legislative requirements and minimise waste production.
The term clinical waste is commonplace in all health care environments including community settings, and is defined within the Controlled Waste (England and Wales) Regulations 2012 as waste from a health care activity that:
- contains viable micro-organisms or their toxins which are known or reliably believed to cause disease in humans or other living organisms,
- contains or is contaminated with a medicine that contains a biologically active pharmaceutical agent,
- is a sharp, or a body fluid or other biological material (including human and animal tissue) containing or contaminated with a dangerous substance (based on regulations for the classification, packaging and labelling of dangerous substances) [summarised].
Waste generated as a result of providing care to suspected or confirmed patients with COVID-19 falls into the category of clinical waste (Category B waste) as defined by the COVID-19 waste management standard operating procedure. It is the responsibility of the person generating the waste (e.g. a nurse, HCSW, midwife) to categorise the waste correctly and place it in the correct waste receptacle (bin).
Who is responsible for the management of waste, specifically safe storage?
It is the responsibility of managers to ensure that health care waste is stored securely so as to prevent the escape of waste, harm to the environment and harm to human health. Failure to do so is a breach of the statutory duty of care. This applies to storage at the point of production and bulk storage areas whilst awaiting transport for onward disposal.
Where waste accumulates and is deemed excessive members should:
- refer to their local employer’s waste policy
- report the issue to their line manager or waste manager (if present)
- complete an incident report if the issue is unresolved.
Capacity for the management of clinical waste across the health and care system is limited at times due to the amount of waste generated as a result of the pandemic. The communication/feedback of issues relating to waste management/co-ordination can be found in the NHS COVID-19 waste management standard operating procedure (England).
During these challenging times, you may be finding it difficult to maintain your mental health and wellbeing when coping with so much uncertainty and turmoil at home and at work.
For tips and resources on self care and looking after your mental health during the COVID-19 outbreak, see COVID-19 and your mental wellbeing for more details.
If you need further emotional support, you can access the RCN Counselling service, who are operating as normal to support members during this time.
You may also find these resources helpful:
Where can I find information on pregnancy and the care of pregnant women?Please see our clinical advice under Pregnancy and fertility care.
I am returning to midwifery practice but I need to refresh my skills. What support is available?
Health Education England (HEE) has developed a module specially for returning midwives.
The RCN has also created a new Return to Practice (RTP) network to support nurses working in health and social care who are returning to work during the COVID-19 pandemic. Further information is also available from the NMC on temporary registrants and returning to practice.
If you have more than one job and are being told that you cannot continue to work in all of your roles due to potential infection control risks, you need to first establish whether your employment contract or any local policy, related to second employment, allows you to hold more than one job. If you are permitted or the information is not clear, please contact us for further advice.
The process of registration and revalidation is managed by the NMC.
The NMC recognises that this is a difficult time and has put together information and advice on how they'll support you to meet the requirements.
Get in touch with the NMC directly if you have any issues or concerns.
Worried about meeting your revalidation deadline?
Read about the NMC's revalidation extensions here and talk to the NMC if you think you need one.
Concerned about meeting your Continuing Professional Development (CPD) revalidation requirement?
See our guidance on revalidation in a pandemic - meeting your CPD requirements, along with the NMC's How to revalidate during COVID-19.
The NMC has helpful guidance sheets on CPD which give examples of relevant CPD activity.
If you have been asked to witness a patient's will, please see the 'signing legal documents during the course of your employment' section of our advice for witnesses.
The RCN recognises that these are unprecedented times and nursing support workers may be required to make adjustments to their normal day to day duties.
The principles of accountability and delegation can be applied to the nursing support workforce and this includes health care assistants, assistant practitioners, trainee nursing associates and nursing apprentices.
Health service providers have a duty to ensure that they meet their legal requirements to provide a safe working environment for nursing support workers to fulfil their delegated responsibilities.
Am I still accountable if a task has been delegated to me by a registered nurse (RN)?
Yes, providing you have agreed to accept it, verbally or by deed. The RN may be in overall charge of the nursing care, however, may need to appropriately delegate to others, according to delegation frameworks/guidance in the four nations.
If you are unable to carry out the delegated task inform the RN in order to protect yourself, your patients, the organisation and even the delegator. If you are still unsure, always seek further advice or clarification. It is advised that you may want to observe a task before asking to do it under supervision, to give you the necessary skills and knowledge you need.
It is important that you have an understanding of local policies and for you to keep your skills and competencies under constant review through regular meetings, debriefing sessions with your line manager and through clinical supervision.
Further resources to support practice are available here:
NIPEC Delegation Decision Framework
You are accountable if you accept the responsibility to perform a task. As a nursing support worker you need to be sure that you have the ability to competently perform tasks allocated to you and you are working within your scope of competency, which includes your job description and terms and conditions. You must inform a senior member of staff if you are unsure.
I am more involved in end of life care during the COVID-19 pandemic. What do I need to know?
Nursing support workers in all settings must be supported - which includes relevant and adequate training, guidance and support - in order to provide the best possible end of life care. Due to COVID-19 there will be an increase in numbers of people with palliative and end of life care needs. This will include those who have also become palliative during the pandemic and those who have been impacted by changes to the health and care services. The RCN has developed palliative and end of life care information to support all of its members.
Dignity, respect and compassion must remain at the core of the delivery of end of life care. As far as reasonably possible, people’s cultural, religious and spiritual beliefs should be explored and respected. However, as the pandemic increases this may not always be possible. You must inform your team leader or line manager if you do not have the relevant skills, education, competencies and resources to support end of life care.
Further resources to support practice are available here:
What if my employer asks me to move from my normal role?
Please see our guidance on redeployment for more information.
Department of Health
I'm working extra hours outside the NHS. What are my entitlements?
Overtime and TOIL arrangements should be detailed in your contract of employment and/or employer's policy. Please check with your employer for more information about how additional working hours will be allocated, recorded and recouped.
I’m working extra hours in the NHS. What are my entitlements?
Any change to your working patterns should be agreed with you, in accordance with your employer's policies and your contract of employment.
Overtime entitlements are set out in section 3 of the NHS terms and conditions of service handbook.
Systems should also be put in place to ensure that you can take TOIL as soon as possible after you accrue it. Where TOIL cannot be taken within 3 months, managers are responsible for ensuring payments are made, as set out in section 3.5 of the NHS terms and conditions of service handbook.
Please check your employer’s policy for more information about how additional working hours will be allocated, recorded and recouped.
I am a band 8 or band 9 nurse. What are my entitlements?
It is expected that managers will need to work additional hours to support their teams respond to the pandemic.
NHS staff at bands 8 and 9 are not usually eligible for overtime when they work beyond their contracted hours. However, the RCN is calling on all UK governments to ensure that all NHS staff receive overtime payments for hours worked beyond full-time contracted hours.
The Scottish Government issued a variation order confirming that the bar on entitlement to overtime payments for staff employed on bands 8 and 9 (section 3.6 of the National Handbook) and for Executive and Senior Managers (ESMs) should be waived in Scotland for the course of the pandemic.
The Health Department for Northern Ireland has made a temporary amendment to Agenda for Change terms and conditions to allow overtime to be paid to bands 8 and above, where required for additional duties relating to COVID-19.
In England, the NHS Trade Unions and NHS Employers have issued guidance to NHS employers outlining the issues that should be included in local policies on overtime during this period – including payment for additional hours for bands 8-9.
The Welsh Government have confirmed that Welsh NHS organisations have discretion to pay overtime at time and a half to these bands where the additional activity relates specifically to the management of COVID-19.
The RCN believes that where local policies are agreed, overtime payments for band 8-9 staff should be calculated on the same basis as for staff on bands 2 to 7.
Please see our guidance on PPE.
What if I’m pregnant?
The Department for Health and Social Care in conjunction with the Health and Safety Executive (HSE), The Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM) and the Faculty of Occupational Medicine (FOM), has produced Coronavirus (COVID-19): advice for pregnant employees. This guidance is applicable in England, Scotland, Wales and Northern Ireland. It contains recommendations for those who are under 28 weeks and for those that are 28 weeks pregnant and beyond.
The RCN expects employers and occupational health departments to carry out (or review) pregnancy risk assessments for all pregnant workers. The assessment will look at your role, your work environment and the context of your health (including any underlying conditions). It must highlight any potential risks and, following the national guidance Coronavirus (COVID-19): advice for pregnant employees, take steps to remove the risk of harm to you and your unborn child. Our COVID-19 and individual risk assessments guidance includes a template letter to help you request a pregnancy risk assessment.
Where the risk can't be removed, your employer should look at suitable alternative work, including home working, the use of a single office or redeployment in line with health and safety standards.
If suitable alternative work is not available then you should be suspended on full paid leave for as long as necessary to protect your health and safety, or that of your unborn child. Employers who do not undertake risk assessments or organise suitable alternatives may be breaching the Management of Health and Safety at Work Regulations 1999 (MHSW).
If you have any concerns, discuss these with your line manager in the first instance. You may also wish to discuss the matter with your GP, midwife and Occupational Health department. It is important to contact us if you feel at risk.
If you are pregnant and want to know more about the COVID-19 vaccine, please see our section on vaccination and pregnancy below.
Can I be made to start my maternity leave early?
If you’re being asked to take early maternity leave you should inform your employer that pregnant staff cannot be required to start maternity leave early. The only requirement to start maternity leave early is if a worker has a pregnancy-related illness in the 4 weeks before their baby is due.
If, following a health and safety risk assessment, the risks cannot be removed and your employer cannot offer you suitable alternative work, including moving to a different work area or working from home, you should be medically suspended on full pay. The statutory right to medical suspension pay applies to employees across the UK who have been in their job for one month and the right lasts for 26 weeks.
If you’re being forced to take early maternity leave notwithstanding the above, you should contact us.
What if I have concerns about how coronavirus is being handled in my workplace?
Organisations should have effective procedures in place to allow nursing staff and their representatives to raise any concerns in relation to equipment, policies and processes for managing COVID-19 at the earliest opportunity.
Nursing staff should feel able to raise concerns without detriment and should receive timely feedback on their concerns. If your concerns remain unresolved, refer to our raising concerns guidance and speak to your line manager. You can also contact us for advice.
If you have concerns about staffing levels, please see our COVID-19 and staffing levels advice for more information.
What is the role of RCN safety representatives?RCN safety representatives should be kept informed of measures being taken to protect staff and there should be mechanisms in place that allow safety representatives to raise concerns with senior managers, health and safety, or infection control leads on behalf of staff.
Members who are concerned should speak to their local RCN safety representative and/or contact us.
Please see our guidance on redeployment.
Can I refuse to treat a patient with COVID-19?You should speak to your manager about your concerns in the first instance and consult our guidance around refusal to treat.
I work for a hospital bank and want to cancel my shifts. What do I do?Speak directly to the staff bank and read your bank contract to check the process you’re required to follow. Try to give the staff bank as much notice as possible to enable them to cover your shift. Make sure you keep records of who you speak to and when.
What’s the RCN’s position on retired nurses returning to work to help with the response to COVID-19?
Retired nurses are being encouraged by the UK and devolved governments to return to clinical practice to support the COVID-19 response. However, this is a matter of personal choice and they need only return to work if they choose and feel able to.
Will returning to work have an impact on my NHS Pension if I have retired?
In short – no. Following representations from the RCN, the UK government has included helpful measures in the emergency Coronavirus Bill that relate to the NHS Pension (in all UK countries). This means that the three NHS Pension schemes (England and Wales, Scotland and Northern Ireland) are amended during this period so that any restrictions on returning to work are suspended. These restrictions are usually on the number of hours worked or salary earned. The requirement for members of the 2008 and 2015 schemes to reduce their earnings in order to draw down from their pension has also been suspended.
*NB - NHS earnings and NHS pension payments will still be subject to income tax at the usual rates.
Find out more at the NHS Business Services Authority website.
Will I need to inform my NHS Pension administrator if I return to work under this initiative?
Your employer should make any necessary notifications.
All NHS Pension administrators (England & Wales, Scotland and Northern Ireland) are operating under their business continuity arrangements in order to provide a full service to scheme members and pensioners during this time. However, some non-critical processes may take more time as their workforce is reduced as staff have to work from home, are self-isolating or unwell. They are also supporting employers who may need to change some of their administrative processes due to other pressures.
What will I be paid if I return to the NHS?
If you were covered by NHS terms and conditions before retiring, you should be paid at the top of the appropriate pay band for the role you are doing, providing you previously worked in that pay band or higher.
If you return to the same pay band, you should not be paid at a pay point any lower than this.
If you choose to return to a lower pay band, you should be paid at the top of that band.
What if I want to return to a different role?
If you want to return to a more junior role than the role you retired from, you should be paid the top of the pay scale for that junior role.
What support will I have from the RCN?
Existing RCN members who are in the Retired category who join the temporary register will receive full support and representation as retired members whilst they are on the temporary register.
Any non members who are retired (and don’t have an active NMC PIN) who join as a retired member (£10 per year or 84p per month), will receive full support and representation as retired members whilst they are on the temporary register.
The RCN believes if a member of health care staff contracts COVID-19 while working in clinical practice where they have been exposed to patients with COVID-19, employers should submit a RIDDOR report in line with HSE guidance. The NHS also provides a flowchart to help identify when COVID-19 is reportable under the RIDDOR requirements.
Please see our guidance on skin health.
During the COVID-19 crisis nursing staff will turn, like everyone else, to online communication to keep in touch and to connect with their communities.
Quite rightly, there is unprecedented interest in the experiences of nursing staff on the front line of the pandemic and concern for their welfare. Importantly, nursing staff have raised issues like lack of PPE and testing that influence government policy. They must continue to speak up.
Some members have reported pressure from their employer not to mention difficulties. Whilst sympathising with the challenges faced by employers, they must continue to draw attention to their own concerns. Nursing staff are in a unique position to provide the evidence that will lead to improvement.
The purpose of this guidance is to encourage you to keep pressing for safety improvements, but to do so in ways that will not risk damage to your career. Some disputes with employers and referrals to the NMC have arisen from the use of social media during the emergency. We want to alert you to potential problems, so that they can be avoided.
Using social media safely
The NMC Code has a section specifically devoted to the use of social media, as follows:
“Use all forms of spoken, written and digital communication (including social media and networking sites) responsibly.” (The Code, paragraph 20.10)
The NMC has also produced a useful guide that sets out uses of social media that might breach sections of the Code.
Recently, the NMC has received some referrals to their Fitness to Practise Directorate involving the use of social media. These include posting misinformation about the virus, promoting sales of dubious products, inappropriate information about an employer or inappropriate comments about individuals. Hopefully, these cases will be resolved without long term difficulty, but registered nurses must remain aware that they are exposed to more scrutiny than the general public. Anything posted can end up in a public place, even if originally covered by privacy settings.
Those working in unregistered positions can be disciplined by an employer for unprofessional social media use.
How to raise concerns safely
The RCN guidance on raising concerns will lead you step by step through the process.
Social media attacks
A few members have become the victims of trolling online. If this happens to you, you can escalate the matter to your manager and your HR department may become involved. They could even involve the police. The RCN advises members to not engage with trolls and to seek RCN support.
And remember, the RCN is here to support you. We are actively challenging local and UK-wide issues on your behalf. Come to us first by speaking to your RCN advisers or your local rep. Please visit our Get help pages or contact us.
Please see our COVID-19 and staffing levels advice for more information.
Please see our position statement on staff living in care homes for more information.
Read our guidance to support you and your team as you welcome those returning to practice at this time.
Please also see our guidance COVID-19 support for nursing staff in high risk areas.
The SARS-COV-2 virus first emerged in December 2019 resulting in the COVID-19 disease pandemic. The virus has since mutated to form new variants in different locations across the world.
The COVID-19 pandemic continues to be a rapidly changing situation. The epidemiology of disease affects different countries and the health care staff in these countries at differing rates and times. This will inevitably impact on staff working in the UK who come from other countries both in relation to their wellbeing and concerns for family and friends in the affected countries, but also for some wanting to return home to visit or to support in health care delivery.
International cooperation and support is vital to address the global challenges of the pandemic. The RCN will continue to work with UK governments and representative organisations to support collaboration and to make sure aid, support, training resources, and equipment is made available.
It is essential that nurses working in the UK from affected countries are given all the support they need.
Our COVID-19 pages provide resources and information to support managing COVID-19 disease in a range of settings including critical care for inpatients and out of hospital.
The International Council of Nurses, a federation of over 130 national nurses associations, representing the more than 27 million nurses worldwide and linking to separate nursing organisations. This provides a unique nursing perspective globally to understand the effects of the pandemic on the nursing workforce at any given time.
See the links below for further information:
- International Council of Nurses COVID-19 portal.
- International Confederation of Midwives (ICM) and ICM statement on coronavirus.
- The RCN International nursing members and RCN international nurses network.
- Ministry of Health and Family Welfare, Government of India.
- Ministry of Health and Family Welfare Government of India - Algorithm for International Arrivals.
- British Indian Nurses Association (BINA)
Advice for members who need support:
- Please see our section above on Mental health and self care.
- RCN information on third party resources COVID-19 and your wellbeing.
- The Chief Nursing Officer has set aside funds to provide support for diaspora nurse organisations.
- Nurses may also be able to get support and hardship funds from the RCN foundation.
- NHS recruitment of nurses from India to the UK has been paused. Nurses need to speak with their prospective employing organisation and should be adequately reimbursed and given the opportunity to take up their posts in the UK in future, should they wish to do so.
Advice for UK nurses travelling to or from high risk areas:
- The current UK travel restrictions mean that it is not advised to travel without a specific reason as travel guidance is subject to change at short notice.
- Specific guidance is in place for those coming into the UK depending on where they are coming from.
- It is important that nurses check their employer policy and travel insurance cover is confirmed prior to leaving the UK.
- Employers may also wish to discuss specific cases with the local health protection teams.
- Anyone returning to the UK from affected areas will need to follow the current UK border control requirements.
- Government guidance on demonstrating your COVID-19 vaccination status when travelling abroad (England). Other UK countries yet to announce.
- CDC International travel guidance during COVID-19.
- RCN resources on working overseas.
- Society for Occupational Medicine (SOM) - advice for business travellers.
See also current UK travel advice:
- England: General advice for travellers and Covid-19 resources.
- Northern Ireland: Covid-19 International Travel Advice.
- Scotland: NHS Scotland - Covid-19 Health considerations for travel.
- Wales: Rules for foreign travel to and from Wales.
- UK Government guidance on travel abroad and Covid-19.
Also: RCN guidance on travel health.
The RCN supports testing of asymptomatic healthcare workers for COVID-19 where the risk assessment indicates that it is merited and proportionate.
The RCN is urging employers to ensure that testing is carried out in working hours at a convenient location and that there is no detriment suffered by its staff in the event of a positive test.
Members have queried whether they must agree to be tested and we set out below some of the issues they should consider when making a decision. Please contact us if you have concerns.
Can I refuse to be tested?
Yes. Under the common law, any person with capacity to make decisions about their own treatment can refuse medical intervention. However, this right does not prevent an employer or regulator from then taking action.
What action can my employer take if I refuse to be tested?
If your employment contract contains a clause requiring you to have testing, then refusing to comply could result in your employer taking disciplinary action against you (or even dismissing you). However, it is unlikely that many employment contracts will contain such a clause.
Even if there is no express contractual requirement to be tested, refusing the test may well amount to a breach of the implied term of mutual trust and confidence and/or a failure to comply with a reasonable management instruction. This could be deemed an act of misconduct or give rise to ‘some other substantial reason’ that may give an employer grounds to dismiss you, depending on the context in which you work and your individual circumstances. Someone who works in ITU as opposed to a non-clinical setting, for example, would be more likely to be required to take the test. Your reason for refusing would also play a part (for example, you may have a medical reason), as would the ability of your employer to deploy you safely without testing.
What should I do if my employer is asking me to be tested but I want to refuse or if I want the testing to be carried out in a different way?
If you do not want to be tested, or if you want to be tested in a different way, then you should raise your concerns with your employer. Your employer must consider the health and safety requirements of the service being provided alongside your own concerns.
The RCN advocates that testing is carried out in working hours, does not require unreasonable travel and is a proportionate response to the health and safety needs of the organisation. Testing should also be undertaken consistently.
If you are unable to resolve the issues by agreement with your employer, you should contact us for further support.
Can the NMC take action against me if I refuse to be tested?
The Code requires you to reduce, as far as possible, any potential for harm associated with your practice. This includes keeping to and promoting recommended practice relating to controlling and preventing infection. It also includes taking all reasonable precautions to avoid any potential health risks to colleagues, people receiving care and the public. If you unreasonably refuse testing and as a result there is increased risk to patients or the public, there is a chance that the NMC could commence an investigation, but it would very much depend on all the circumstances at the time.
Should staff be asked to sign a consent form for testing?
There is no need for the employer to obtain a written consent in respect of the medical procedure; provided the staff member knows what a throat-swab is and knows that the test is for COVID-19, then permitting the tester to take the swab constitutes implied consent. However, consent should also be obtained in relation to the processing of that test data.
Can my employer share my result?
Ordinarily, your employer cannot share personal data about you with anybody else without your consent. However, if you have tested positive, then those with whom you have been in contact will need to be informed in order that they can self-isolate. This should not involve naming you, but you might be identifiable from the circumstances. Otherwise, your employer can describe their testing regime to the public.
What if I have an underlying health condition and have concerns about exposure?
Government guidance lists people who may be more vulnerable to or have a higher risk of complications and higher mortality than the general population. This means that they should avoid contact with someone who is displaying symptoms of COVID-19. Also avoid non-essential use of public transport, varying your travel times to avoid rush hour, when possible and work from home where possible.
If you meet the definition of extremely clinically vulnerable as set out in government advice, and during the course of your work, you are likely to come into contact with someone who is displaying symptoms of COVID-19, you should inform your line manager immediately.
The RCN would expect employers and occupational health leads to carry out a health and safety risk assessment and put systems in place to minimise the risk of harm and allow the health care worker to work safely. The employer also has a duty to make reasonable adjustments where the staff member has identified themselves as disabled. Please also see our COVID-19 and individual risk assessments guidance.
Organisations such as Diabetes UK and Asthma UK provide additional advice on working with long term conditions.
Speaking to your employer
You should escalate your concerns to your line manager in the first instance, having checked your employer’s COVID-19 response policy. The RCN has advice on how staff can approach raising concerns should your manager be unsupportive.
Further guidance for employees and employers is also available.
Please contact us if you cannot resolve your concerns with your employer.
What if I have the vaccine?
Please see our COVID-19 and vaccination advice guide and the sections on refusal and protection from future infection.
Read our uniform and workwear guidance for more information.
Please see our COVID-19 and vaccination advice guide.
RCN members who wish to support the delivery of care and treatment to patients and the public during the pandemic can do so in a range of ways, including:
- redeploying to a different clinical setting
- returning to clinical practice
- joining the temporary NMC register, or
Our guidance on redeployment will help you if you're changing or taking on a new role.
If you are registered nurse who has left the register within the last 3 years you can apply to re-join the temporary NMC register and find more information about how to do this on the NMC website.
For nurses who are already on the NMC register wishing to return to clinical practice you will need to apply directly to any local employers who you wish to work for (see below). This is the same for those who wish to work as a nursing support worker.
Many employers are setting up fast track recruitment systems to support this. Check local websites for information. You can also join an employer’s bank or an agency to work flexibly.
Some organisations in England use NHS Professionals who have set up a rapid response process.
Most jobs within the NHS across England and Wales are advertised on NHS Jobs website.
If you're interested in volunteering (as opposed to working) to support efforts to tackle the COVID-19 pandemic, NHS Volunteer Responders is a new group that will carry out simple, non-medical tasks to support people in England who have been asked to shield themselves from coronavirus because of underlying health conditions. They will be used by healthcare professionals to make sure people who are highly vulnerable are able to stay safe and well at home.
Members in Northern Ireland who are interested in volunteering in hospitals should contact their local Health and Social Care Board for more information,
For paid work opportunities, please go to the HCSNI Jobs website for more information.
Members in Scotland who are returning to clinical practice, or are currently practicing but want to be redeployed to work for NHS Scotland can find more information on the Scottish government webpages.
Paid work opportunities can also be located through contacting agencies and through the NHS Scotland jobs site.
For members in Scotland, volunteering opportunities can be found by approaching your local NHS Board directly or through contacting Volunteer Scotland.
In addition to NHS Jobs, links to current vacancies for registered nurses and healthcare support workers can be found on each Health Board’s website:
Volunteering opportunities can be found at Volunteering Wales.
What if I have the vaccine?
Please see our COVID-19 and vaccination advice guide.
Can my employer make me opt out of the 48-hour working week?
The Working Time Regulations were adopted to ensure the health, safety and wellbeing of workers at the workplace. The 48-hour maximum working week is an average over an agreed reference period, usually 17 weeks. The reference period can be extended to up to 26 weeks without agreement or up to a maximum of 52 weeks with agreement between the employer and local trade unions.
Your employer can ask you to work more than 48 hours in any one week, without the need for an opt out - as long as they reduce your hours within the appropriate reference period, to even out your average weekly hours.
The RCN expects that during the pandemic, all employers across the UK should refrain from approaching staff to sign up to ‘individual opt-outs’ of the 48-hour average working week. According to the regulations, employees can choose to opt out of the average working week. However, the regulations make it very clear that an individual opt out is entirely voluntary.
Speak to your local RCN representative or contact us if your employer is seeking your opt-out on a continual basis or beyond the reference period that applies in your workplace.
Where staff are working long hours, employers should provide an appropriate level of supporting facilities such as rest areas, accommodation, access to food and drink, toiletries etc. as required, to enable the safe and effective provision of services during this period.
There should be no requirement for staff to sleep on site. If there are sleep facilities available for staff who wish to use them, this should be managed via existing or adapted local policies with increased infection control measures.
See the Department of Health and Social Care (England) guidance on the health, safety and well-being of staff for more information.
What if I have more than one job?
The 48-hour weekly average is the limit of what you should work, even if you have more than one job. Your employer must make sure you are not working more than an average 48 hours a week in total across both jobs. Employers must maintain accurate records and take measures to protect the health, safety and wellbeing of workers even during the pandemic - so your employer(s) can ask you about your working hours with another employer.
12 hour shifts in critical care
The risks of working 12-hour shifts in a critical care environment during the COVID-19 pandemic should not be ignored. They include:
- wearing PPE for long periods which is physically demanding, and can result in potential heat stress
- errors when donning and doffing PPE
- high levels of moving and handling activity when positioning patients
- increased time exposed to patients with infection, leading to a potentially increased viral exposure
- the potential for errors or safety lapses caused by fatigue.
There is also the significant psychological impact of caring for COVID-19 patients.
What safeguards should my employer put in place?
The Health and Safety Executive recommend the avoidance of shifts that are longer than 8 hours where the work is safety critical and physically demanding. They recommend that where 12-hour shifts are implemented there should be adequate rest breaks and that 12-hour night shifts should be limited to two or a maximum of three in a row.
The health and safety of health and care staff is of paramount importance. Where 12-hour shifts cannot be avoided, the RCN expect the following safeguards to be put in place:
- regular rest breaks
- introduction of ‘huddles’ or check-ins during the shift to check that staff have been able to take a break and arrange cover if not
- assessment of any specific needs of staff who may be going through the menopause, have long term conditions or other protected characteristics which require reasonable adjustments to be put in place
- avoid scheduling safety critical jobs (for example, drug rounds) towards the end of the shift when staff will be at risk of fatigue related errors
- provision of adequate time for safely donning and doffing PPE
- ease of access to rest facilities and quiet zones following the principles in RCN’s guidance: Rest, Rehydrate and Refuel
- ease of access to food and drink during the shift, including night shifts
- permission to have power naps during breaks
- limit to three back to back 12 hour shifts (especially night shifts). The RCN believes that 4x12 hour shifts are unsafe in these situations and could lead to a breach of the working time regulations and the employer’s duty of care.
- wellbeing check at end of the shift and check in on the safety of staff who need to drive home
- respect days off and do not call in staff to work on their scheduled days off
- compliance with the working time regulations
- where possible, offering staff flexibility and a choice of shift lengths.
If your employer isn’t following the above guidance, speak to your manger in the first instance. For further support, contact us.
- COVID-19 FAQs
- COVID-19 and vaccination FAQs
- COVID-19 and staffing levels
- COVID-19 and time off
- Employment guidance for NHS staff
- Individual risk assessments
- Nursing students & trainee nursing associates advice
- Personal protective equipment (PPE) advice
- Redeployment guidance
- Managing COVID-19
- COVID-19 vaccination
- Immunisation & large-scale vaccination delivery during COVID-19
- Prescribing safely under COVID-19
- DNACPR & verification of death
- Mental health care delivery
Page last updated - 22/07/2021