One of the many worries about a swine flu pandemic is the effect it would have on the case mix inside hospitals. If we were overrun with seriously ill children then traditional paediatric ITU services could be swamped. There has been plenty of warning over this, plenty of constructive thought and a good deal of local planning.
The net result will involve a major rearrangement of how health care staff are deployed if the worst-case scenarios come true - hospitals might consider cancelling non-urgent surgery and moving staff around in order to cope with the changing patterns of disease. Even staff not directly affected by swine flu may be affected by repercussions of this. The exact way that this will pan out in practice is not yet known.
Earlier in the year the GMC issued some fairly sensible advice on this. It states that doctors may be asked to work outside their normal scope of practice, and some doctors who have retired, or who are not working in the profession, may be asked to return to work. They strongly encourage doctors to respond positively to such requests.
“Doctors need to feel confident that they are working within agreed standards and principles of practice, and will not be subject to criticism because of the difficult decisions they are forced to make, or the standards of care provided during a pandemic,” it says.
The GMC guidance goes on to explicitly state that: “In an emergency, wherever it arises, you must offer assistance, taking account of your own safety, your competence, and the availability of other options for care. In a pandemic, this means that you may work outside your normal field of practice, either in providing care to patients with influenza, or patients with other conditions.”
However the Nursing and Midwifery Council have taken a contrary view, which is encapsulated in the cliched phrase: “We’re not happy”. In their website guidance on swine flu, modified earlier this month, they write that: “All nurses and midwives are expected to practise within their competency level…If faced with any aspect of practice that is either outside their area of registration or beyond their competency level, they must seek supervision or advice from a competent practitioner…Nurses and midwives are able to extend their scope of practice, within the healthcare legal framework, but must ensure that they have the knowledge and skills to do so in a competent manner. If competency levels are not adequate, support and supervision must be sought from a competent practitioner.”
This guidance makes it clear that nurses who are forced by circumstances to work outside their comfort zone cannot expect any support from their regulators if they get into trouble. In the meantime they have written to 90,000 nurses who are out of practice, asking them if they would like to return to work to “address any potential staffing shortages which may occur in the event of a surge in the swine flu pandemic.”
The mixed messages that this is sending out are confusing.
Most nurses I talk to are very aware of the possible clinical problems. If the brown stuff started to hit the fan then they would do what seemed most appropriate at the time. As individuals they would want to do their level best and do what needed to be done. The disconnection between the nurses on the ground and their regulators needs to be explained.
To me this issue highlights a major cultural difference between doctors and nurses and their attitude to risk and diversity.
Read MPS advice on swine flu practice.
Tags: Swine Flu
