While scrolling through social media recently, I noticed a recurring theme among nursing professionals: the fear of saying no. It’s a quiet but powerful issue, especially in general practice where the role of nursing staff has expanded rapidly over the past decade.

The expanding role of general practice nurses

Today’s general practice nurses are expected to take on more responsibilities than ever before. However, this expansion often comes without:

• adequate training or protected time to learn
• capability assessments or supervision
• clear boundaries between registered and unregistered staff roles
• fair remuneration.

The result? A growing number of unregistered staff are performing tasks traditionally reserved for registered nurses, raising concerns about safety, accountability, and professional integrity.

Development should be structured, not rushed

I fully support professional development and the opportunity for nurses to grow their skills and careers. But this must happen in a safe, structured, and supported way. The old model of “watch one, do one, teach one” is no longer acceptable and rightly so.

Why saying no feels so hard

In general practice, saying no can feel almost impossible. Many nurses work for independent employers, often without a dedicated HR department. When the person asking you to perform a task is also your boss, it’s natural to worry:

• Will I be seen as difficult?
• Will I be labelled as not a team player?
• Could I face disciplinary action?

These fears are real, and they can lead nurses to take on tasks they’re not trained or confident to perform.

Empowerment through professionalism

We must remember nurses are highly skilled professionals. We are trained in reflection, critical thinking, and ethical decision-making. Our duty is to provide safe, high-quality care and that means recognising when we’re not equipped to perform a task.

The Nursing and Midwifery Council Code is clear: we must not put ourselves in compromising positions that could endanger patients or ourselves.

How to say no - professionally and proactively

Saying no doesn’t mean shutting down the conversation. It means being honest, transparent, and proactive. Here’s how:

• Check the training requirements for the task.
• Be honest and say “I haven’t had the training to do this,” or “I don’t feel confident performing this task.”
• Offer a solution: “I’d like to learn this skill can we explore training options and create a development plan together?”

This approach protects patients, supports your professional growth, and fosters a culture of safety and respect.

Final thoughts

The fear of saying no is real, but it shouldn’t be a barrier to safe practice. By speaking up, seeking support, and advocating for structured development, we can ensure that general practice nursing continues to evolve in a way that benefits both patients and professionals.

Remember, the Royal College of Nursing (RCN) is here to support you. Whether you need advice, guidance, or advocacy, the RCN offers a wealth of resources to help you navigate professional challenges.

For more information, visit: Get help and advice from the RCN