COVID-19: a guide to the big issues for nurses
Frequently asked questions on coronavirus-related issues, including self-isolation, sick pay, redeployment and staff well-being
- What support can nurses expect if they need to self-isolate, and what moves are there to increase testing for front-line NHS staff?
- NHS organisations have been asked to make adjustments so staff members at increased risk of coronavirus can stay well and at work
- Regulators have written to more than 65,000 nursing and medical staff asking if they will return to the NHS
If someone in my household develops symptoms can I continue to work or must I self-isolate?
NHS England chief executive Sir Simon Stevens has told trusts they should offer staff who become subject to Public Health England’s 14-day household isolation policy the option of staying in hotel accommodation, paid for by the NHS, while they continue to work.
If that option is not available or is impractical for the individual, they remain subject to the 14-day isolation guidance.
Nursing staff who live alone and who develop COVID-19 symptoms must stay home for seven days from when their symptoms begin.
Will I be paid if I have to self-isolate?
The RCN says it expects all employers to ensure nursing staff suffer no financial penalty if they are following national public health guidance to self-isolate.
The NHS is following that principle in all four UK countries.
NHS Scotland, for example, is clear that if employees have self-isolated in line with medical or public health guidance, they will be paid ‘as if at work’, and self-isolation will not be a trigger for sickness absence reviews.
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Health and Social Care in Northern Ireland says nursing staff who are required to self-isolate ‘as per occupational health’ will receive special paid leave.
NHS bank staff who have to self-isolate can expect to be paid for any booked shifts.
If you are off sick from an NHS post because you have COVID-19, normal arrangements for sick pay apply. See section 14 of the NHS Terms and Conditions of Service Handbook (different sections for each UK country) for more information.
If you work outside the NHS, the RCN advises you to check local policies on sick pay and speak to your manager.
Will I be tested for the virus?
Healthcare staff have been calling for increased testing so they know whether there is a risk of them passing on COVID-19 to patients and to avoid unnecessary self-isolation.
A junior doctor’s online petition calling for priority testing for front-line NHS staff attracted more than 1.2 million signatures, while the RCN has called on the UK and devolved governments to prioritise testing of all health and care staff as a matter of urgency.
On March 27 the Department for Health and Social Care said NHS staff will be first in line for a new COVID-19 testing programme.
The NHS is aiming to get to 25,000 of these tests per day, with the ultimate aim being several hundred thousand, but health officials say this target will not be met until the end of April.
But cabinet minister Michael Gove said at a Downing Street press conference on March 31 that the UK must go 'further, faster' to ramp up testing capacity.
Health and social care secretary Matt Hancock also issued an order that all spare coronavirus tests are used for NHS staff.
Therefore, if you develop symptoms and have not been tested you should follow self-isolation guidance.
What if I am pregnant?
NHS organisations have been asked to make adjustments so staff members at increased risk of coronavirus, including pregnant women, can stay well and at work ‘wherever possible’.
The Royal College of Obstetricians and Gynaecologists has issued guidance on pregnancy and COVID-19. The advice is different depending on the stage of your pregnancy. For example, women in their third trimester (over 28 weeks' pregnant) should be particularly attentive to social distancing measures and minimise their contact with others.
Remote working or moving to a lower risk area are among the adjustments suggested by NHS leaders.
The RCN stresses that under health and safety law, employers should undertake a risk assessment of expectant mothers in the workplace and ensure measures are in place to reduce the risk of harm to the woman and her unborn child.
I have an underlying health issue. Can I work from home?
The government is advising people who are at increased risk of severe illness from COVID-19 to be particularly stringent in following social distancing measures.
Staff who are healthy but who may be at greater risk of severe illness because of COVID-19 should be considered for home-based roles, says NHS England.
These could include telephone or video/digital-based outpatient consultations or supporting NHS 111.
Some nurses with underlying health issues may not be able to work from home, for example because of a lack of space.
In those cases, the NHS says it expects staff and employers to reach a ‘sensible compromise and come to a solution that best meets both parties’ needs’.
I have been asked to redeploy to a different working environment. How should I respond?
COVID-19 is a pandemic that poses unique challenges for healthcare systems. As such, it requires staff to be flexible so that the best possible care can still be offered to patients. Temporary redeployment may be necessary to ensure the continued delivery of core services.
- RELATED: Letter to NHS England staff states COVID-19 epidemic would require changes in nursing practice
That said, the RCN stresses that basic principles of best practice should be applied if nurses are asked to move to different clinical areas. Your employer must be certain of your competence to work in the new area.
If you are asked to redeploy, the RCN advises you to consider:
- Your environment and safety procedures: Whether, for example, you know where emergency equipment is stored and the location of fire exits.
- The patients you will be caring for: Whether you have experience in the sort of care they require.
- The work you will be doing: Its nature, who you will be working with and who to ask if you have questions.
You should also expect a thorough induction that covers the clinical area, as well as topics such as IT and telephone systems, policies and procedures, and record-keeping.
The Nursing and Midwifery Council (NMC) says that in the current challenging circumstances registrants ‘may need to depart from established procedures in order to care for patients’ but the Code continues to apply.
The regulator adds: ‘In line with the Code, use your professional judgement, working with other colleagues across all disciplines, to assess risk [and] find the best way to care for people while recognising and working within the limits of your competence.’
If you have concerns about being moved, you should raise them with your line manager or, if your concerns relate to a disability or underlying health condition, with your occupational health service.
Registered nurses and midwives working in non-patient-facing roles will be asked to support direct clinical practice, following local induction and with appropriate support. Bank and part-time staff may be asked to work additional hours.
I recently retired from nursing but would like to return – where do I stand?
The UK government’s new Coronavirus Act allows regulators to establish temporary ‘emergency registration’ for healthcare professionals, including those who retired within the past three years and students in the final six months of their training.
In a move backed by health unions, regulators have written to more than 65,000 nursing and medical staff asking if they would be willing to return to the NHS to help tackle the crisis. Thousands have already responded.
Health secretary Matt Hancock told the BBC: ‘This really is the moment when the NHS needs you.’
Unite said: ‘Unprecedented events demand flexible and rapid responses.’
Nurses who choose to return to work will be able to do so without negative repercussions for their pensions.
The NMC stresses that applying to join the temporary register is completely optional.
The emergency legislation is time-limited – for two years – and allows the four UK governments to switch on the staffing measures when they are needed and off when no longer required.
What about personal protective equipment – is there enough?
Not according to some sources. The RCN wrote to prime minister Boris Johnson in March to express serious concerns around a lack of personal protective equipment (PPE) and COVID-19 testing for staff, while front-line nurses have told Nursing Standard of concerns around supply and quality of PPE.
The RCN has said it will not accept anything less than aprons, gloves and masks for all staff, in all settings, but say this a minimum – and even that level of protection has yet to be provided.
‘Every minute we wait is a minute too long,’ said RCN general secretary Dame Donna Kinnair. ‘All nursing staff, no matter where they work, must feel safe. We need action, we need equipment, we need it now.’
Following a letter in the Sunday Times from almost 4,000 NHS workers around PPE concerns, the army was drafted in to deliver supplies.
Questioned by the Commons health and social care committee in mid-March, NHS England chief executive Sir Simon Stevens admitted production of protective equipment would need to increase but said there were sufficient supplies for the coming weeks.
The NHS has more than 28 million of the ‘most intense’ type of face mask, he told the committee. But domestic production of gowns, in particular, and other types of face mask will need to ‘ramp up’, Sir Simon said.
On April 1, the RCN wrote the Health and Safety Executive demanding an intervention of the lack of PPE, a situation she described as 'inconscionable'.
Trade union safety representatives can raise concerns about PPE with managers and infection control leads.
The government has produced guidance on putting on and removing PPE during the coronavirus pandemic.
I am a nursing student. How will COVID-19 affect my training?
There are now a range of options for nursing students, depending on which year of the programme, they are on.
The regulator has produced a set of emergency education standards that allows for greater flexibility for all students and will enable some to contribute their skills and knowledge to fighting the pandemic.
Final-year nursing students in their final six months now have the option to finish their courses on a paid, extended, clinical placement for six months. Some of these students will have the option – through nomination by their university -to join the new COVID-19 emergency register, which will offer them temporary registration and a rate of pay determined by their country’s government. This would be optional.
Alternatively, these students can choose to step off programmes until the crisis is over or step off and take up employment as healthcare assistants. If university resources are there, students can also continue their programmes on the same basis as prior to the pandemic,
First-year students may pause placements and spend 100% of their first-year programmes in theory or academic learning. In addition, second- and third-year students, final-year students in their first six months of study, and first-year postgraduate students can now spend up to 80% of their hours in clinical placements and 20% in theoretical learning.
Chair of the Council of Deans of Health Brian Webster-Henderson says: ‘We know this is a very difficult period for students and universities and that everyone is dealing with great uncertainty. We are proud and confident of the contribution that our members and students will make over the coming months.’
Are there sources of psychological support for nurses during the pandemic?
As well as being at risk of infection with COVID-19, nursing staff may become vulnerable to mental health issues as services struggle to cope with the current crisis. NHS bosses have asked employers to ensure ‘enhanced health and well-being support’ is available during what they acknowledge is a ‘difficult time’.
The WHO says stress and feeling under pressure are normal responses to what are exceptional circumstances. Such reactions are ‘by no means a reflection that you cannot do your job or that you are weak’.
Strategies that have previously helped you to combat stress will probably continue to help now.
The WHO also highlights the value of breaks while at work and sufficient rest between shifts, as well as the importance of healthy eating.
It recommends staying in contact with friends and family where possible and engaging in healthy activity. Plenty of home workout and meditation or mindfulness resources are available online.
Alcohol and drugs are not helpful and in the long run may worsen your mental health.
There is a risk that some health workers may experience avoidance by their family or community for fear of contagion, the WHO warns. It says staying connected digitally is an option if this happens to you. And turn to your colleagues for social support – they may be having similar experiences.
RELATED: COVID-19 staff well-being
The RCN counselling service offers free, confidential support to members.
Daniel Allen is a health journalist