An impending vacancy arises when a specialist nurse is choosing to move on, and there appears to be no plan to fill the role. This can have significant knock on effects, such as:
- internal move – specialist nurse is given no end date for the current role, and little information about planned developments, leaving post holder and patients abandoned
- external move or retirement – specialist nurse moves on, leaving the team with a gap in service or no service for an extended period of time
Occasionally an impending vacancy is known about in advance, for example for a planned retirement. To anticipate these occasions, preparing a succession plan is useful. Succession plan is a separate document which is not yet available
Depending on the situation, it may not be appropriate to complete a full case to make to management about why the specialist nurse role should be retained. For example, for a lone practitioner it may be more appropriate simply to leverage support to clarify the situation.
If the vacancy occurs in a condition-specific or a mixed neurological specialist nursing team where the loss of one specialist nurse will lead to other nurses picking up the extra workload, you may need to make a full case.
identify what outcomes you want from this, for example
as a service leader you may want
- commitment from management to continue service/role
- commitment from management about when they will advertise
- commitment from management about type of role eg banding, previous experience
as an individual nurse moving on, you may want
- guaranteed end date
- some idea of future plans, so you can keep patients informed
- an ongoing care plan for existing patients eg point of access to services
These outcomes will define your approach.
Actions for lone practitioners
- identify any key deadlines
- contact your supporting organisation/charity, for example MS Trust, Parkinson's UK, Epilepsy Action , Epilepsy Society. Ensure they are aware of the current situation. Consider providing your supporting organisation with any basic data that would support continuation of the service, eg size of caseload, numbers of clinics offered etc.
- check with management to ensure you have some idea of future plans
- talk through what support you want now and what you might want in the future in order to leave but help to ensure the service continues in the future
Actions for specialist nursing service managers/team leaders
- identify any key deadlines
- contact your supporting organisation/charity, for example MS Trust, Parkinson's UK, Epilepsy Action , Epilepsy Society. 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 – use your succession plan, if any
- think about your best outcome. Do you want to replace the individual who is leaving with the same again, or is this an opportunity to think through a potential service redesign or extension? Be pragmatic about what you think your employer might be willing to accommodate, and also consider whether you have any likely candidates who will step into the role. What you know about these options will help you define your case. For example, if you have an existing Band 6 who is suitable to move up to a Band 7 role, but wants to work part-time and your vacancy is for a full-time role, can it be tweaked? Or does your employer currently have a policy of employing full-time roles only?
- contact HR for a job description and person specification for the person who is leaving the role if you do not hold these: you will need these to make your case for the new role.
- 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 despecialisation, 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.
- remember the 'bigger picture' and the risks for your employer, because it will help shape your response appropriately.
- 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
1. Describe the threat and its drivers
Ensure you have all the facts about the planned vacancy: ensure you are aware of an actual end date and of likely lead times for advertising and interviewing a possible replacement. This is particularly true of issues around leaving dates, replacement recruitment, contingency planning for complete gaps in service provision 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 being a staff member down in the specialist nursing service. There may be specific tasks that that nurse used to undertake which will now have to be covered by the rest of the team,eg self-management courses. What will this mean in consequence, for example
- reduced or no telephone support
- reduced time or no provision of mentoring, clinical supervision, education and training of generalists
- reduced time available for clinical updating, leading to risks of unsafe care
Spell out 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? for example
- 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
Spell out what this will mean for your employer, for example
- pressure on waiting times for neurology outpatients
- higher risk of emergency admissions/readmissions within 28 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 national 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 or disappears.
5. Summarise the arguments
List what you have found in point 4 in up to 10 key bullet points, for example
- 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
- greater demand by patients for GP and other primary care, without specialist input, leading to more pressure on other services
Include any direct financial consequences you know will result, for example 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 replacing the specialist nurse as soon as possible. We recommend advertising for a full-time Band 7 specialist nurse role.
Leaving the current specialist nurse role vacant will have an adverse impact on safe, high quality patient care, both for inpatients and outpatients. It risks creating longer waiting lists for neurologists and for out patient appointments, potentially breaching the 18 week referral to treatment target. It will increase the risk of emergency admissions and raise the risk of emergency readmissions within 28 days. Without specialist nursing input to the wards, and to aid with discharge, increased length of stay for admitted patients seems likely. The specialist nurse will not be offering regular symptom management, via telephone and nurse-led clinic, nor will annual reviews be available: this will lead to increased pharmacy costs, and avoidable admissions for patients poorly managed in primary care. Without a specialist nurse in post, clinical supervision will need to be rearranged for her supervisees, and the current education programmes of patient self-management and a basic grounding in the condition for GPs and community nurses and therapists will no longer be available."
Creating your response, using materials from analysing the threat
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
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