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RCN steward Phil Noyes shares his advice on how to make sure members experiencing work-related stress are supported by their employers and get the sick pay they're entitled to

As nursing staff, we don’t want to let patients down. That’s our central motivation to keep going even when we’re under pressure. 

When teams are struggling on without the resources they need, inevitably people sometimes need to take sick leave because of the stress they’re under.

If someone does have to take sick leave due to work-related stress, it’s really important that they’re supported properly by their employer and the cause of the stress is recognised with measures put in place to alleviate the pressure.

Work-related stress is a health and safety issue and employers have a legal duty to ensure people’s health and safety at work, including their mental wellbeing. As an RCN steward, I find examples of work-related stress in many of my cases.

Work-related stress is a health and safety issue and employers have a legal duty to ensure people’s health and safety at work

If someone has a lot of time off work due to ill health, it may trigger disciplinary processes linked to sickness absence policies. In order to ensure members experiencing work-related stress are exempt from this, we need to establish that the stress, and therefore the resulting sickness absence, is “wholly” or “mainly” due to work. 

Members with long-term sickness absence may also be eligible for NHS injury allowance (NHSIA) which protects their pay from falling below 85% of their normal pay if the stress is “wholly” or “mainly” due to work. This can be challenging to establish.

I often have to rely on the early steps taken by the member. If the discussions with their manager are undocumented then it makes the job harder. 

I recently supported a member who followed all the right steps and although we didn’t secure immediate agreement from the employer, the groundwork the member had put in was so effective that senior managers did eventually agree that NHSIA was applicable.

I’m sharing this advice in the hope that it may help others who are experiencing work-related stress and the reps who are supporting them.

Speak out early and confirm your concerns in writing

Nursing staff should tell their line manager about their specific concerns as early as possible and confirm this in writing. If no action is taken to address the concerns, the emails can be used as evidence at a later stage.

In this case, the member spoke to her manager very early on and backed it up with an email citing previous instances of overwork and predicting further issues. 

The member worked in the community and had a large caseload spread over a broad, geographical area. She had some support on a temporary basis but it was ending soon. 

She flagged this to her manager and explained that she was concerned about how big the workload would be when she was working alone. Previously, when she had no support, she had been under a lot of pressure and it had been quite stressful.  

Get RCN support from an early stage

The sooner a member seeks RCN support, the better. Members should contact their local workplace RCN rep or RCN office as soon as possible. They can also call RCN Direct on 0345 772 6100. 

My member didn’t call for help until quite late on but fortunately she did everything I would have advised her to do and kept records.

For reps, it’s really important to establish what expectations are being placed on the member in question and how these compare to the job description. 

Escalate your concerns if necessary

Members should continue to highlight the risks and their concerns, and if they don’t receive an adequate response, escalate these to a senior manager. The RCN can support members with this process if needed. 

We should remind members that their health is really important so they need to be persistent. If there are particular stressors, they should make sure these are flagged up to managers so they have a chance to do something to alleviate them. 

My member escalated her concerns to her senior manager without success.

Engage with any helpful measure

Occupational health, peer support and clinical supervision all have much to offer but it’s important to maintain a focus on how the workplace is having an impact on the individual. If a member needs this sort of support, they should ask for it and follow up the request in writing.

Ask for a stress risk assessment

As with any other risk, managers have a duty to assess stress under the Management of Health and Safety at Work Regulations 1999, and local policies should feature this. 

If this doesn’t happen (as is too often the case), members can ask for a stress risk assessment to be carried out. If nothing happens, they can carry out their own and send a draft of this to their manager. This is what my member did.

Seek advice from your GP

If a member is unable to remain at work, they should seek advice from their GP. Members need to be very clear with their GP about the source of the stress. It’s important to reassure members that their GP should be sympathetic. 

Sick notes will reflect the causes, while fit notes will add to the argument that steps need to be taken to alleviate stress at work.

Five months after first raising concerns with her manager, everything my member had feared would happen, did happen. She was extremely overworked and stressed and had to visit her GP and take sick leave. 

There were no other pressures in her life – only work. People who work under pressure tend to keep up a façade and it’s only when they can no longer do this, that the real toll begins to show. 

Make sure measures are in place when returning to work

If organisations fail to put measures in place to mitigate stress, they can face significant costs from personal injury claims. A good process will feature a discussion ahead of the members’ return to work in which the member and their manager can agree how the situations that led to stress could either be avoided or managed. 

In the end, at my urging, this did happen for my member and the measures proved very effective. In my view these measures could, and should, have been put in place earlier to avoid the situation arising in the first place, but in this case it’s better late than never.

Review the measures put in place

Of course, things can develop and change once people are back at work, and it is really important to pick up emerging issues quickly as people who are returning to work after a period of absence may feel very vulnerable at this stage. 

I was pleased to see that due to restructuring there was a new direct manager for my member, and we found them very supportive and understanding.

How I supported the member

Having been told that she did not meet the criteria for NHS Injury Allowance, I advised my member to challenge this decision through the appeal process, and when this was unsuccessful, by bringing a stage 3 grievance on the grounds of the appeal decision failing to recognise the well evidenced link. This was also on the grounds of the employer presenting scant evidence to counter our case.

At the final hearing, my member’s professional approach and attention to detail was recognised by senior managers and HR colleagues, who decided that her grievance was well founded and they upheld it. 

It was obvious to all that it would have been far better for her if immediate managers had acted appropriately when she gave them the opportunity, as prevention is best. She has now been successful in getting a secondment to a new role and is demonstrating her skills in that role.

I believe our role as reps is to support members to tell their story so managers have to address it properly and give them support

This case illustrates how important it is to follow the right steps from an early stage. 

Because we were able to supply emails and a clear timeline of events, the employer recognised that the member had taken every reasonable step to raise concerns at an early stage and accepted her sickness absence was a workplace injury. 

I believe our role as reps is to support members to tell their story about how their job is impacting them in a clear and targeted way so managers have to address it properly and give them the support they need to provide the best care.

RCN steward Phil NoyesPhil Noyes

More information

You can find more advice and information about work-related stress, including examples of stress risk assessments, on the Health and Safety Executive (HSE) website. Visit the HSE website.

For advice on how to reduce stress, read the RCN's booklet Stress and You: A Guide for Nursing Staff.

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