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Members Update: 12th April 2020
Redeployment, PPE, Childcare, Pronouncement of death

Dear Member,

We met directly with the Minister for Health on Wednesday to raise a number of urgent issues. This note is to update you on five of those: redeployment, PPE, childcare, death pronouncement and accommodation.

As ever, all the latest updates are at the INMO’s dedicated COVID-19 page: https://www.inmo.ie/Covid19

1. Redeployment

The HSE are aiming to provide at least very basic care in services which are understaffed and overwhelmed – as we have seen in parts of the private nursing sector. This would involve some redeployment of staff.

The INMO, along with other unions in the health sector, have been negotiating with the HSE to agree a redeployment policy (which you can read here).

The INMO Executive Council have analysed the policy and their view is that it provides strong protection for members, as it guarantees that (a) redeployment is a voluntary process and (b) that certain supports must be in place before any redeployment.

This policy applies to confirmed outbreaks (three or more positive cases) of COVID-19 within a facility. It requires the HSE COVID-19 response team to assess the situation and determine the level of intervention required.

In this context, some staff in the public sector may be requested to redeploy from public services to private nursing homes. It is very important to note the following:

  • Redeployment is a voluntary process, which must take account of your scope of practice.
  • Deploying public sector staff to private nursing homes is an absolute last resort having exhausted all other options.
  • Your manager must be satisfied this redeployment does not create unacceptable risk or service impairment in the service.
  • Appropriate personal protective equipment must be guaranteed and available in advance of any redeployment.
  • Redeployed staff continue to report to their existing HSE line manager, and strong lines of communication and support must exist.
  • HSE staff should be deployed in at least pairs on any shift. 

We have insisted that this policy is kept under constant review.

2. Personal Protective Equipment (PPE)

PPE has consistently been the INMO’s top priority. Our position is that members - no matter where they work - must be protected.

Thanks to your reports via our PPE hotline INMO’s PPE freephone hotline (8:30am - 8pm, 7 days a week) on 1800 320 087, or text 087 719 7188​, we have intervened in many workplaces where there are shortages or problems, securing corrections to mistaken guidance and proper supplies of appropriate equipment.

Many reports to our help line were circumstances that should not have developed, such as artificial restrictions on PPE or managers refusing to allow staff wear masks. The INMO does not tolerate such measures and have successfully intervened to stop them where they have arisen. If you are facing similar issues, please get in touch .

The HSE guidelines on PPE are an important standard, but they do not substitute for your professional, clinical judgment and assessment as a nurse or midwife. Should any INMO member face difficulties in this area, we will continue to represent you and argue the case with your employer.

The INMO has called for a policy of facemasks (at minimum) for all healthcare workers in all settings. The HSE has not yet issued guidance agreeing to this. The HSE advise that next Tuesday the 14th the issues we have raised are to be considered by the National Public Health Emergency Team.

In the meantime, our advice to members stands. If you are facing difficulty in your own workplace on this issue, please contact the INMO via your workplace rep or through the PPE helpline. We have been making three key points to employers who refuse to accept requests by nurses and midwives to wear facemasks. They may be helpful to you at work and are set out below:

A: Professional judgement:

It is unacceptable to interfere with the judgement of a registered nurse or midwife on the necessity for PPE use, as they have specific duties as registered professionals.

The NMBI’s Code of Professional Conduct and Ethics states that nurses and midwives must make sure that the healthcare environment is safe for themselves, their patients, and their colleagues. (Principle 3, Value 2)

B: Risk to patients and health system:

The majority of healthcare professionals in Ireland infected with COVID-19 have been infected via community transmission. Pre-symptomatic transmission does occur, with an average incubation period of 5-6 days, up to a maximum of 14 days.

In those circumstances, the clinical judgement of a nurse or midwife that they may well pose a transmission risk to vulnerable service users/residents and to colleagues is rational and evidence based. Therefore, a member’s decision to wear a surgical mask is entirely justified.

C: Equality of treatment across services

Some acute services have taken decisions to require all staff wear surgical masks as infection control measures. Interfering with the clinical judgement of our members that this measure is necessary in other settings would, in effect, be a decision to ration/restrict PPE in those locations.

Such rationing without a clear basis – in care of the elderly services, for example – would increase risk in those services and would not be supported by the government’s ethical framework for decision making in a pandemic.

3. Childcare

We have been consistently calling for practical childcare provision for nurses and midwives. Our view is that, in light of school closures, our members need extra support in order to attend work. What we have sought includes:

  • a database of vetted, volunteer childcare workers by region who are willing and available to provide these services in the home of nurses and midwives.
  • where nurses or midwives source childcare themselves and incur a cost, the HSE and Dept of Health must reimburse the cost – please keep a record/receipt of any costs to date.
  • where nurses or midwives cannot attend work due to childcare not being available then the HSE and Dept must confirm that they continue to receive salary and that this is not classified as annual leave.

We have made this case in the media, to the HSE, and directly in meetings with the Minister for Health. The government appear to have some form of scheme prepared, but say they are awaiting approval from public health experts.

The delay has been unacceptable, and we will pursue this matter vigorously until we have an outcome which is acceptable to our members.

4. Pronouncement of death

We expect that the National Policy for Pronouncement of Expected Death by Registered Nurses (2017) will be brought to some members’ attention. It is important to note that this is the only policy which allows for nursing pronouncement of death.

Prior to implementing this policy all registered nurses must have undertaken the relevant training, have participated in a competence assessment, and there must be GP involvement in the process a per the policy.

We expect that an amended process may be developed in the context of the current circumstances, and we are consulting with the HSE on this. However, prior to any new guidance issuing the 2017 Policy is the only one applicable to the health services.

5. Accommodation

Several members – particularly those in shared accommodation – have been seeking temporary alternative accommodation during the pandemic. The government have set up a scheme to provide for this. Details on how it works and who is eligible are here.

Finally, I wanted to thank you for your professionalism and dedication over recent weeks. Your actions are rightly a source of pride for our professions – both in Ireland and around the world. Our skills, training and commitment have never been as needed as they are now. Not for the first time, nurses and midwives are stepping up and facing the challenge with bravery, dignity and compassion.

Yours sincerely,

Phil Ní Sheaghdha                                        
General Secretary

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Irish Nurses & Midwives Organisation (Cumann Altrai agus Ban Cabhrach na hEireann). The Whitworth Building, North Brunswick Street, Dublin 7. T:+353 1 664 0600 E:inmo@inmo.ie