Career advice

COVID-19: working within the limits of your competence

The coronavirus pandemic means nurses are working in exceptional circumstances – but always ensure you practise at the right level for your skills and experience

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Picture: iStock

These are unprecedented times for us as a country, as the COVID-19 pandemic continues to spread.

Never before in peacetime has the UK population faced such drastic changes to the way we lead our lives.

Business is anything but usual and nurses will have to call on all their emotional and physical reserves as they navigate these testing times.

Nursing and midwifery staff working in ‘unfamiliar circumstances’

Earlier this month, the chief nursing officers of the four UK countries issued a joint letter to nursing and midwifery staff across the UK.

The letter – which was also signed by the chief executives of the RCN, Royal College of Midwives and the Nursing and Midwifery Council, as well as the chair of the Council of Deans of Health – thanked staff for all their hard work during the coronavirus outbreak.

It said that health and care professional will need to be flexible, which ‘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’.

‘It is important to remember that you cannot make rational decisions if you are not looking after your own needs, so it is imperative that you keep your blood sugar levels up, stay hydrated and get some rest’

The letter acknowledged that this could be stressful for staff, who may have concerns about the professional practicalities and implications of working in such circumstances.

So how can you protect yourself professionally in the weeks and months ahead?

Professional judgement plays a part when varying your practice

Regardless of the situation, registered nurses must practice according to the NMC code, section 13 of which states you must ‘recognise and work within the limits of your competence’.

While this still applies during the current pandemic, the joint letter from nurse leaders recognises that this is an ‘abnormal emergency situation’ and asks nursing and midwifery staff to use their ‘professional judgement to assess risk and to make sure people receive safe care’.

It adds that adopting a rational approach to varying practice in an emergency is part of that professional response.

Working within the limits of your competence is an important aspect of maintaining patient safety. Although you want to help as much as you can, this is not the time to put yourself or your patients at risk. 

‘Saying no is never easy, especially when you and your colleagues are under so much pressure, but apologising for a mistake is even harder’

You will need to be able to assess, most likely quickly, whether you are competent and qualified to take on additional tasks or work in a different clinical area.

    Despite the gravity of the situation, do not be afraid to ask for help if requested to carry out any action or procedure that is beyond the limits of your competence. Not only is this vital for patient safety, it is your professional duty under the Code.

    Practising within your competence: a checklist for nurses

    When asked to take on a task or work in a clinical area outside of your usual practice, the following checklist may help you decide how to proceed.

    • Situation: Do you understand what is being asked of you and why? Nursing is no longer a task-orientated profession and to practise safely you must be able to explain the rationale behind your actions, omissions and delegations
    • Environment: Do you know where to find everything you need, such as equipment and paperwork? Do you know which team you are working with and who the nurse in charge is?
    • Level of care: What level of care will you be expected to provide? Do you have any experience caring for patients with these types of conditions?
    • Knowledge and experience: Have you been adequately trained and assessed as competent to carry out the tasks you are being asked to perform, or to work in a particular area of practice? You may have witnessed colleagues undertaking elements of advanced practice, for example, but you are not competent to do so unless you have passed competency-based training programmes in these areas

    Don’t neglect health and safety – your patients’ and your own

    It is important to remember that you cannot make rational decisions if you are not looking after your own needs, so it is imperative that you keep your blood sugar levels up, stay hydrated and get some rest.

    Your employer also has a legal responsibility regarding your health and safety, so make sure that you document and report any concerns. Saying no is never easy, especially when you and your colleagues are under so much pressure, but apologising for a mistake is even harder.

    During these testing times, it's important to try to keep as calm as possible and avoid getting defensive or apologising excessively.

    Tensions will be running high as staff try to cope with COVID-19, but the pandemic is not your fault and you cannot fix things single-handedly. What you can do is continue to care for your patients as safely and effectively as possible, while not neglecting your own health and well-being.

    Stay safe everyone.

    View our COVID-19 resources


    Mandy Day-Calder is a life/health coach with a nursing background. She runs a healthcare training company

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