Teams and Staffing
Redeployment of the workforce will require a different way of working. Under these conditions, nursing and midwifery staff need to consider how any ‘new’ team is managed. Whilst continuing to deliver person-centred care, a more task based model may be necessary, based on professional judgement, to maximise the contribution of team members’ knowledge and skills. It should be recognised however, that whilst there may be an element of task orientated care required during this time of pandemic arrangements for COVID-19 surge in service demand, it is important that each individual being cared for has a regular holistic review by the registered nurse or midwife delegating the tasks or duties.
In relation to redeployment of nurses and midwives, each employing organisation has local policies outlining processes and other support for staff e.g. health and well being resources. Please refer to the Trust intranet, or contact the organisational HR Department for further information.
This includes the delegation and supervision of tasks and duties to others in the team using the Deciding to Delegate Framework NIPEC (2019).
Over any period of surge demand it is recognised that ensuring optimum staffing levels and skill mix as outlined in the Delivering Care Policy Framework (2014) will be difficult to sustain. Staffing levels in line with the normative policy ranges should be adhered to as far and as long as is possible, however, including the supervisory status of the Ward Sister/ Charge Nurse/ Team Leader, in line with local organisational arrangements.
To do that, nursing and midwifery teams may need enhanced with additional registrants employed through return to practice and return to register schemes supported by the Nursing and Midwifery Council (NMC) and the COVID-19 emergency legislation.
As Northern Ireland starts to reach surge demand levels coupled with predicted increased staff absences, it is anticipated that the normative ranges will be difficult to maintain. At this point escalation to the Chief Nursing Officer (CNO) through the Executive Directors of Nursing should be activated. The CNO may then seek to suspend Delivering Care for a period of time and require Trusts to employ professional judgement in determining safe staffing requirements using a blended multi-disciplinary team approach to providing nursing and midwifery care, and considering delegation of nursing and midwifery tasks and duties.
A set of principles outlining how the workforce could be determined has been co-produced by nursing and midwifery workforce leads in the Health and Social Care Trusts and is available to support this approach, along with local guidance on raising and escalating concerns appropriately.
During December 2020, NIPEC worked with the Public Health Agency and HSC Trusts to further develop this guidance for the third surge. A copy of the agreed principles is available here
Further advice is also available on this microsite in the following sections:
For additional information specific to particular care settings e.g. Private Nursing Homes, please see below.
Similarly to HSC Trusts, the independent sector is anticipated to encounter a surge in service demand during periods of outbreak of COVID-19.
The extant staffing levels guidance provided by RQIA can be found at https://www.rqia.org.uk/guidance/guidance-for-service-providers/frequently-asked-questions-for-service-providers/ where it is outlined that the responsibility for the management and operation of a registered nursing home lies with the registered persons (registered provider and registered manager) who are required to “carry on and manage the nursing home (as the case may be) with sufficient care, competence and skill”.
Regulation 20 (1) (a) of the Nursing Homes Regulations (Northern Ireland) 2005 states that the registered person shall, having regard to the size of the nursing home, the statement of purpose and the number and needs of patients ensure that at all times suitably qualified, competent and experienced persons are working at the nursing home in such numbers as are appropriate for the health and welfare of patients.
In the Departmental guidance, recognising that the needs of clients may escalate considerably during periods of surge demand, requires providers and Trusts to plan in partnership, making the best use of all available assets, to ensure the availability and adequate training of staff.
Where a registered home manager has concerns about staffing levels to provide safe, effective, person-centred care, he or she should escalate this matter to the RQIA as soon as possible.