A joint letter from the CNOs and NMC to directors of nursing across the UK

There’s no doubt that 2021 was one of the most difficult years that the nursing and midwifery professions have faced in modern times. And it’s clear the Omicron variant will pose yet more challenges over the coming weeks and months into 2022.

Thank you for all you have done through the busy festive period and continue to do for patients, the public, and those receiving care.

As we all know, there are already sustained additional pressures on the NHS and across all sectors and settings of health and care provision. Staffing shortages due to sickness, Covid-related absences or caring responsibilities are adding to the pressures and despite actions to date to address this, the impact on staff both personally and professionally will be profound and potentially prolonged throughout the coming months.

We recognise how difficult the situation is, and that you’re likely to have concerns about both the professional practicalities and implications of working in such circumstances. We are committed to doing what we can to ensure you feel supported, as you support those in your teams to deliver the best possible care through this challenging time.

Helping to strengthen the workforce capacity

The NMC’s Covid-19 temporary register remains open and we encourage employers to make use of the professionals who volunteered to join it. It’s made up of professionals who had recently left the NMC’s register and professionals from overseas awaiting their final assessment in the UK. As well as using those already registered, you can:

• Encourage anyone who recently lapsed from the register to join the temporary register. The temporary register is open to anyone who lapsed after 1 March 2015.
• Seek temporary registration for nurses from overseas who you’re supporting through the test of competence.
• Continue to support overseas-trained professionals to join the permanent register.

The NMC Code 

As registered professionals we know you and your teams are practising in line with the NMC Code and use your professional judgement, taking account of the realities of the high pressured situations you are working within. The NMC Code is here to support you and, even in the most difficult of circumstances, is a valuable tool to help guide practice.

We know from what you tell us that in some situations clinicians may need to depart from established procedures to care for people in these highly challenging but time-bound circumstances. This does not necessarily mean that clinicians are breaching the Code, but it does imply a higher level of risk for professionals who are having to rely more on their own independent professional judgement to make difficult decisions.

We recognise that your professional focus is the safety of the people you are caring for and your teams, and we know you will continue to work with your colleagues and employer to raise issues and suggest improvements using your professional judgement to continually assess and reassess risks.

We understand why you may feel anxious about how the consequences of difficult decisions made in challenging circumstances may affect you and your staff, particularly if ultimately, there is a poor outcome. We know that you are feeling vulnerable, and a common concern that people raise with us, is the fear of being referred to the NMC. We want to reassure you that although referrals are still relatively rare, should this happen the NMC considers context in all of its fitness to practise decision making. In doing this, it considers the specific facts of each individual case, as provided by the professional as well as the referrer, including policies in place at the time.

Supporting the nurses and midwives of the future

Nursing and midwifery students are placed in clinical areas to achieve learning outcomes. However, they can also make a valuable contribution to care, while being supervised in practice. The NMC’s latest education standards are more flexible and allow a range of models of supervision and support. As part of the standards, we encourage supervisors to allow students to practice the skills in which they have been deemed competent with more independence in order to build their confidence.

The NMC has also contacted universities to encourage them to register their final year students at the earliest possible opportunity, once they have completed their practice hours and achieved their learning outcomes. Your local university should be able to confirm if this is something they’re planning to do, which may help with workforce planning from summer 2022.

As the pandemic moves into its third year, the impact on students and newly qualified nurses and midwives is becoming clearer. Recent graduates have all had significant disruption to their education and practice placements, and are now facing practice as newly qualified professionals in the toughest times our professions have ever encountered.

Effective preceptorship is therefore even more important, and will improve recruitment and retention rates. Many organisations will already have established preceptorship programmes. The NMC’s principles of preceptorship have been developed to support organisations to review their programmes and give new recruits some guidance about what to expect from a preceptorship programme.

Support for professionals’ health and wellbeing

You’ve already gone above and beyond in this pandemic and we cannot emphasise enough how grateful we are for the hard work you have put into caring for your community. We know it isn’t always easy to find the time to take care of yourself, but this sustained effort can have a real impact on your health and wellbeing. We ask that you seek support from your organisations if you need it. We also ask that we support each other, ensuring that as part of a team, we recognise the impact, providing support and advice as it’s needed.

There’s a range of supporting resources available and we have included details at the end of this letter to help you.

Finally, we would like to sincerely thank all the nurses, midwives, nursing associates and those around them who continue to work in these extraordinary circumstances. Despite the challenges, we know you’re making an incredible difference to people’s lives.

Ruth May, Chief Nursing Officer, England
Alex McMahon, Chief Nursing Officer, Scotland
Linda Kelly, Chief Nursing Officer, Northern Ireland
Sue Tranka, Chief Nursing Officer, Wales
Andrea Sutcliffe CBE, Chief Executive and Registrar, NMC

Download the signed joint letter. 

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