With chronic PPE shortages, healthcare professionals are faced with incredibly hard choices including their own safety. How does fitness to practise fit with refusing treatment? 

This is the issue responded to by the Royal College of Nursing (RCN) and the Nursing & Midwifery Council (NMC). 

Whilst the context of this article is specifically relevant to nursing, the regulatory and legal principles could be applied to other healthcare regulators because context is absolutely key in fitness to practise issues arising from the current coronavirus (Covid-19) pandemic. 

The Royal College of Nursing told nurses and midwives that nurses can refuse to treat patients if their safety is compromised.  The RCN’s “Guidance for members: Refusal to treat due to lack of adequate PPE during the pandemic” states:

“Ultimately, if you have exhausted all other measures to reduce the risk and you have notbeen given appropriate PPE in line with the UK Infection Prevention and Control guidance, you are entitled to refuse to work. This will be a last resort and the RCN recognises what a difficult step this would be for nursing staff.”

Fitness to Practise implications?

The NMC, like all other healthcare regulators, have made it clear there is an appreciation that the present circumstances are unprecedented and that ‘context’ will be a key consideration in decision making.

That approach is not different in circumstances where a nurse or midwife chose to refuse treatment if their own safety and protection would be compromised.  NMC chief executive Andrea Sutcliffe has been reported to have said:

“We know the consistent and timely availability of appropriate PPE continues to be a significant challenge in health and social care across the UK.

 

“Understandably PPE [as an issue] is being raised with us by our registrants and their employers and is the focus of intense activity at a national level.”

Practical steps to protect yourself

Record keeping

What will be absolutely key in any subsequent fitness to practise investigation will be clear justification of issues and decisions.  The NMC stated in their official statement on the issue of PPE that it is important for nurses to record any decisions taken in relation to PPE and safety concerns.

These notes are key for contextual understanding of clinical decisions and whether these decisions were justifiable under the circumstances.

Employer responsibility

Nurses and midwives must remember it is their employer who 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.

Coming back to the issue or recording keeping, make sure you have a record of any communication with your employer specifically on the issue of PPE, the implications of this and any support you are requesting.

Follow local and/or national clinical guidance, advice and protocols

The NMC advised that 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.