Our Code and Standards support nurses, midwives and nursing associates in these difficult situations by setting out the key principles to follow to keep themselves, those they lead or manage and those they care for safe.
To support our registrants further we set out below some key points to help them as they put the Code into practice and exercise their professional judgment during this unprecedented pandemic situation.
How national guidance and the Code supports you as a nurse, midwife or nursing associate dealing with challenging PPE issues
National guidance on the use of PPE has been issued to support you during this time. Whether you are a nurses, midwife, nursing associate or a student on clinical placement you should follow this guidance, which covers a range of infection control measures, including hand hygiene and respiratory and cough hygiene, as well as advice on appropriate PPE and best practice.
Your employer is responsible for ensuring that you and any staff you lead or manage have all the necessary protective equipment – including protective clothing – and that you have access to current guidance on how and when to use it correctly to minimise the risk of transmission of Covid-19. Your employer is there to help you and your colleagues by managing resources effectively and dealing with risk, so that that the safety and quality of care or service you provide for people can be maintained.
As set out in the Code, if you have any concerns about the availability or use of PPE you must raise these with your manager as soon as possible, to make sure that they are aware of the issue and can take action to support you. You can also refer to our raising concerns guidance or seek advice from your representative body or trade union.
If situations arise where suitable equipment is not available difficult decisions may need to be made quickly about the safest and best course of action. The Code states that to preserve safety you must take account of your own personal safety, the safety of others and the availability of other options for care. So you shouldn’t feel that when making decisions, you have to place yourself or others at risk, or that you need to make these decisions on your own.
Where possible you should work with colleagues to find the best way forward in these circumstances. It is important to take into consideration the balance of risks in relation to those people who are dependent on care services, as well as the requirement to protect yourself and other staff so that they are able to provide ongoing care.
Any decisions you make should take account of local and/or national clinical guidance, advice and protocols.
Factors to consider include:
- whether treatment can be delayed or provided differently (for example, remotely)
- the availability of different levels of PPE that may offer sufficient protection to you and others in particular care activities
- whether some members of the wider team are at a higher risk of infection than others
- whether different care and treatment decisions might be appropriate to minimise the risk of transmission in accordance with local and national advice
- Taking account of all the options available, what course of action is likely to result in the least harm in the circumstances, taking into account your own safety, the safety of others and the people in your care.
You should make a record of your decisions regarding how you handle any safety concerns. You should describe how you used your own professional judgment, the role of other members of the team in decision making, and the outcome.
We acknowledge that in exercising your professional judgment in line with the Code you may decide that you need to refuse to provide care or treatment to an individual because it is not safe for you to do so.
If a concern is raised with us about any registrant refusing to treat a patient because of their concerns about inadequate PPE or being responsible for service delivery in the absence of adequate PPE, we would follow the approach that we have set out in our joint regulatory statement. As part of this approach we would consider the context of the current pandemic, including the risks that the individual registrant was exposed to and how they exercised and recorded their professional judgment in line with the Code.