Expert advice

COVID-19: why nurses should only work within the limits of their competence

Use your judgement when working in challenging, unfamiliar environments during the pandemic

Picture: iStockphoto

The COVID-19 pandemic is subjecting many healthcare workers to unprecedented situations. These include final-year nursing students temporarily registered to work in clinical practice, retired healthcare workers returning to work, and newly qualified nurses deployed in unfamiliar areas.

Healthcare staff are also being asked to work in ways they have not done before, including critical care nurses who have to care for more patients than usual. Under new staffing guidance from NHS England, the staffing ratio during the coronavirus pandemic is one critical care nurse to every six patients – with support from less experienced staff – as opposed to the usual one nurse per patient.

It is vital that healthcare workers are protected physically during the coronavirus pandemic, but professional protection also needs to be considered.

Any regulatory investigation will take work context into account 

In early March, the chief executives of the statutory regulators of health and social care professionals – including the Nursing and Midwifery Council and the General Medical Council – issued a joint statement outlining how they will support health and social care workers during the coronavirus pandemic.

The statement says that ‘where a concern is raised about a registered professional, it will always be considered on the specific facts of the case, taking into account the factors relevant to the environment in which the professional is working. We would also take account of any relevant information about resources, guidelines or protocols in place at the time’.

Context will be vital in any disciplinary or regulatory investigation that occurs as a result of actions carried out during the coronavirus pandemic. It is hoped that common sense will also come into play.

Meeting the required standard expected of nurses

If a healthcare worker – whether permanently or temporarily registered – faces disciplinary action from their regulator due to work carried out during the COVID-19 pandemic, the additional pressures and constraints on their practice during this time should be mitigating factors in the individual’s defence.

A major aspect of any investigation would be whether the health worker met the required standard expected of them. As there are many types of healthcare staff, who work in different areas with different aspects to their roles, it is impossible to have standards for each and every occasion.

However, there are legal principles that can be applied to see if a specific healthcare worker has met the standard for a specific action undertaken at a specific time.

The legal principles arise from two cases:

  • Bolam v Friern Hospital Management Committee [1957]. This put forward what has become known as the ‘Bolam test’, which asks what others would have done in the same circumstances. If your actions are the same as those that would have been carried out by others, you have met the required standard.
  • Bolitho v City & Hackney Health Authority [1997]. This case modified the Bolam test by requiring some logical and rational support for your actions, as well as what your peers say they would have done. This is where the context you are working in comes into play; given the limitations and constraints of your working environment, what was reasonable and logical for you to do? What was reasonable and logical for your colleague to have done, and are they the same? If so, you have most likely met the legal principle and therefore the required standard. 

Whatever you do, document it. Justifying your actions is vital, so write it all down and explain what you did and why you did it.

Competence and using your judgement

The best way to avoid facing disciplinary action is to only work within your sphere of competence and to never perform a task you are not competent to carry out.

Competence is related to judgement – you know if you have the necessary knowledge, skills and abilities to undertake a specific act or role, and you must use your own judgement to determine this.

How can you ensure you meet the required legal principles while working in the NHS during the COVID-19 pandemic? These tips will help:

  • If you do not feel competent to undertake a task or role, do not do it. You can ask to be supervised for the duration of the task but if this support is not available, do not undertake the task alone.
  • Request training or guidance on how to undertake tasks you are unfamiliar with.
  • If you know you are going be redeployed to an area you are unfamiliar with, ask for an induction before the redeployment starts and seek guidance and advice from those who normally work in this area
  • Seek advice from those more senior to you and/or a practice supervisor, and ensure you work alongside others so you can increase your confidence and competence.
  • Even if you cannot perform at the same level as those who normally work in an area, you can help ease the pressure on regular staff members by asking what you can do to help. Just because certain tasks are outside your level of competence, that does not mean that everything is.

View our COVID-19 resource centre

To all of the healthcare workers protecting us all at this difficult time, thank you.

Marc Cornock is a qualified nurse, academic lawyer and senior lecturer at the Open University. He gives his views in a personal capacity only and they do not necessarily reflect those of the RCN or RCNi