Redeployment is our term for when the specialist nurse post is asked to take on additional clinical duties which detract from their specialist nurse role. The commonest example is being asked to work on the wards.
You may receive some notice of this change. Use this time to get prepared, and start planning as soon as you receive notice of the process.
- identify what the key deadlines are
- contact your union eg RCN, UNISON to alert them to the change in service
- contact your supporting organisation/charity eg MS Trust, Parkinson's UK, Epilepsy Action , Epilepsy Society etc. Check whether they are aware of the situation and talk through what support you want now and what you might want in the future.
- start gathering evidence to support your case
- make your case following steps A, B, C and D below, remembering these rules first:
Rules for making your case
- prepare brief factual evidence that supports your case including your case load, key responsibilities etc.
- avoid personal terms such as I, we, me, us or our and steer clear of emotional statements or responses. Always refer to 'the service'
- paint a realistic picture of the new service. With redeployment, it's likely that the specialist nursing service for your condition will be reduced; ensure patients and service users are aware of the potential for a reduced service in future, not that you can continue to provide everything as you do now. Ensure management is aware that you may be deskilled for working on the ward and require training.
- remember the 'bigger picture' and the risks for your employer, because it will help shape your response appropriately. Consider national and local guidance, eg NICE Guidance, NHS Outcomes Framework, Healthcare Improvement Scotland neurological standards etc.
- talk to your national patient organisation at all stages of the process
- listen to advice and support
Analysing the threat: materials to support your response
This step is all about getting the evidence together. How you use them to make your case is covered in step B. Remember to keep all the elements concise.
1. Describe the threat and its drivers
Assess where the information you've received about this threat originates? Is it a reliable and credible source? If you are unsure ask your manager.
Identify the causes of the threat, if it is genuine, eg financial pressures, recruitment difficulties etc
Click the link for a generic description which you can amend to fit your particular specialist nursing service
Click the link for a sample risk assessment which you can amend to fit your particular circumstances
Looking at the service description and risk assessment, write down the consequences of having less hours in the condition-specific service. For example:
- reduced number of clinics
- reduced telephone support
- reduced time available for mentoring, clinical supervision, education and training of generalists
- deskilled for working on wards
Explain the likely results of a reduction in service in terms of what it might mean for patients – what will happen to them and where will they go if your current service is unavailable? Eg
- Does this put pressure on other neurology services?
- Are they more likely to:
- Contract UTIs
- Fail to comply with medication
- be at higher risk of serious adverse incidents eg SUDEP (sudden unexplained death in epilepsy) etc?
Describe what this will mean for your employer eg
- pressure on waiting times for neurology outpatients
- higher risk of emergency admissions/readmissions within 30 days
- increased length of stay etc
The risk assessment completed at step 3 should help you here.
If you are unsure of what to do at this stage, contact your supporting patient organisation. We can look at the evidence you have and help pull the words together to describe what happens if your service is reduced.
5. Summarise the arguments
List what you have found in point 4 in up to 10 key bullet points eg
- reduction in staff = reduction in specialisation
- greater pressure on neurology registrars and consultant neurologists
- potentially greater waiting times for patients, risk of breaching 18 week referral to treatment targets
- potential for more emergency admissions and readmissions
- unmanageable specialist nurse caseload
Include any direct financial consequences you know will result, eg increase in emergency admissions/readmissions, loss of income from nurse-led clinics etc
6. Craft an executive summary
In 200 words or less, create an upfront statement about the likely effect on your service of the bullet points found in point 5. For example:
We recommend retaining the role of MS specialist nurse in its current form.
Redeploying the MS specialist nurse so that 0.2 FTE of time is spent managing the neurological ward will have an adverse impact on safe, high quality patient care, both for inpatients and outpatients, will create longer waiting lists for neurologists and for out patient appointments, risking breaches of the 18 week referral to treatment target. It will increase the risk of emergency admissions by 20% and raise the risk of emergency readmissions within 28 days by 50%. The specialist nurse's caseload will not change, but fewer clinical hours will lead to a reduction in service, so the majority will not be offered annual reviews including symptom management and medication reviews: this will lead to increased pharmacy costs, and avoidable admissions for patients poorly managed in primary care. The specialist nurse will be able to offer much less support to inpatients, risking increased readmissions within 28 days and significantly delayed discharges, as well as poorer medication adherence. It is likely that the specialist nurse will no longer be able to offer as much clinical supervision, education and training to non-specialists. Additionally, the education requirements of the post-holder will rise in order to ensure safe practice whilst working on the wards, particularly in relation to medicines management, manual handling, and staff management. This has implications for study leave time and costs.
Creating your response, using materials from analysing the threat
Cut and paste all the answers from section A into a coherent document. Check whether your management requires a particular format for the document, in which case you will have to follow that.
In all other cases, write a business case as follows:
- Executive summary – cut and paste from section 6 above
- Describe the situation – cut and paste from section 1 above. Exclude drivers if these are known but unhelpful, eg a personality conflict with management
- List your key arguments in bullet points – cut and paste from section 5 above
- Describe your service– cut and paste section 2 above
- Describe the risks – cut and paste section 3 above
- Describe the consequences– cut and paste section 4 above
Ask an external party to read it
Ask your supporting charity to read the final document. Sometimes a fresh pair of eyes can spot things you've missed that can help support your case.
Submit your document
Ensure you know who should receive this, eg local management, senior management, commissioners etc. Discuss with your national patient organisation if you are unsure.