Unpicking the terminology

‘Flexible working’ is the broad term used for a range of elements that can be adapted to better meet the needs of employees and employers, such as how many hours an individual works, when they work and where they work.

The latter includes ‘home working’ or ‘remote working’ – where an individual works entirely from home or another location than an on-site workplace – and ‘hybrid working’ or ‘agile working’ is where an individual works both on-site and from home.

Is it the right fit for you and your employer?

Anyone directly employed by the NHS can now ask to work flexibly from their first day in a job, and at any time thereafter, with no limit on the number of requests allowed, says the NHS Staff Council. Applying simply involves speaking to your line manager.

However, the NHS Staff Council advises staff to work through the document Flexible Working in the NHS: A Toolkit for Individuals to help map out how flexibility can support them and the organisation before making a request.

Managers should respond positively and in a sympathetic way to all requests, especially given ‘overwork and burnout are so commonplace with the staffing crisis’, explains Unison deputy head of health Helga Pile.

But flexible working must be beneficial for both the organisation and the employee, so not all requests will be agreed in the way an individual might hope, she says. ‘Anyone whose job is patient-facing and based in a hospital may find it hard to make a case for working from home without affecting already hard-pressed colleagues.’

Flexibility does not always mean working from home

If home working is out of the question, Ms Pile says, managers must try to find an alternative mutually acceptable outcome. This could include working outside standard shift hours, compressed working (where someone does more hours over a shorter number of days), only working during term time, doing staggered or annualised hours, job sharing, or self rostering.

If a solution cannot be found, the next stage is for managers to seek help and advice. This might include looking at other vacancies in the organisation that might be suitable for the person, says Ms Pile.

‘This stage is there to ensure line managers don’t just say “no” because they can’t see a solution within their own team.’

Ms Pile urges managers to ensure that any move to a more flexible working arrangement comes with clear roles and expectations, constant feedback and regular reviews.

Advice for staff with disabilities

NHS employees with disabilities can also request home and hybrid working as part of wider considerations to reduce workplace barriers, states the NHS Staff Council.

Picture credit: iStock

In such cases Ms Pile advises individuals to make it clear they are applying for flexible working as a ‘reasonable adjustment’ because it is an additional statutory right on top on their contractual right as an NHS employee with a disability.

Many nurses who work at home have telephone-based roles. These span triage, primary, community, mental health and palliative care. The RCN says there are a number of nursing roles that lend themselves to home working, including in nurse education, training and research, and health informatics, recruitment, case management and occupational health (see box, page 11).

Best of both worlds: telephone triage

Clinical nurse specialist Anne Porritt works exclusively from home in a part-time role with the single point of contact team at St Christopher’s Hospice, which covers five London boroughs. She works three days a week and her job includes triaging palliative care referrals from hospitals, emergency services, GPs, patients and their families.

She does a first telephone assessment to prioritise urgency and then hands over to the St Christopher’s specialist community nursing team. She can also make urgent referrals to acute care, district nursing, social services and continuing healthcare funding and can prescribe remotely if a patient needs medications.

Ms Porritt, who has worked for St Christopher’s for more than 30 years, was offered the opportunity to work from home when she decided to move out of London ahead of retirement.

‘It gives me the best of both worlds,’ she says. ‘I get to live where I want and work for an organisation I want to be part of. I have fewer distractions at home and without distractions it is much easier to be focused and disciplined.’

Flexibility helps beat burnout

Nurse and community midwife Debbie James left her role due to burnout and instead took up a full-time clinical advisor position with NHS 111 at the Welsh Ambulance Services NHS Trust.

She initially worked at the organisation’s call centre providing urgent care triage, but once she was confident and her call times and outcomes were good her manager offered her the chance to work remotely in a hybrid arrangement.

‘There is a home working policy,’ Ms James says. ‘What they’re looking for from the clinician is that you’re quite confident with your decision-making because obviously you will be working alone when you are at home. I was there about eight months before I began working remotely – I didn’t rush into it.’

Flexible working can help to recalibrate your work-life balance

Picture credit: iStock

Ms James loves the flexibility hybrid working offers. She does one or two shifts a week in the Swansea call centre and works from home the rest of the time – often at weekends, as it is less noisy, and this gives her time in the week to do her master’s course.

‘I do it because I Iike it; it is more flexible for my needs,’ she says. ‘I’m doing my advanced clinical practitioner course, so it works around my placement hours and uni. It takes a bit of the stress off, not having to get up and go into work every day. I did not have that flexibility as a community midwife. I was never off duty. And you can only be like that for so long. After 24 years, I just got burnt out.’

A healthy workplace at home

Working at home with computer equipment can lead to musculoskeletal discomfort or pain, headaches and eye strain if your work station is not set up appropriately. Furthermore, isolation, poor home facilities and having to move equipment to and from the workplace can present health and safety issues.

Employers should have clear procedures for home workers to report problems, states NHS guidance, and employees must follow their employer’s instructions and report any health and safety concerns or incidents.

The guidance is intended to ensure jobs can be carried out as well at home as they can be in an office or on a ward, Ms Pile says.

With her shift to hybrid working, Ms James was issued with a laptop, keyboard and two big screens so she could work as if she is in a call centre. She says being confident from an IT perspective is important when it comes to home working.

Ms James has a specific room she works from, which she refers to as her ‘safe space’, where she cannot be overheard while on calls, to ensure patient confidentiality is maintained.

Types of home working roles in nursing

Remote working or home working have become more common since the pandemic, says the RCN. Some roles involve working from home most of the time, or part of the time, it says. Examples include:

• » Telephone triage nurse (for GPs or services such as NHS 111)

• » Nurse adviser (telephone based)

• » Practice nurse (telephone based)

• » Occupational health nurse

• » Nursing roles in health insurance/health surveillance/health screening

• » Trainer roles

• » Nursing journalists/editors

• » Nurse expert witness

• » Recruitment

• » Nurse interviewer (interviewing nurses for jobs or agency roles)

• » Health informatics, eHealth or digital roles

• » Counsellor (telephone based)

• » Wellness advisor (telephone based)

• » Life coach (telephone based)

• » Case management – personal independence payment assessment, nurse disability and continuing health assessment

• » Office roles

Source: RCN: tinyurl.com/RCN-work-life-balance

Picture credit: Jim Varney

Not for every role – or everyone

Home working will not be an option for all. Clinical nurse specialist Ms Porritt says that exclusively working from home was only available to her because of her experience – and she does not believe the role would suit a more junior nurse.

‘I’ve worked at St Christopher’s since 1987, so I feel very comfortable and confident with what I do,’ she says. ‘But it’s not a remote working job. I do not think it is a job for an inexperienced nurse. It is not a way to learn palliative care.’

Ms Porritt also worries that not being in the office limits her ability to teach junior colleagues, which has been an important part of her role.

‘I was going up to the office once a week, but I don’t do that anymore,’ she says. ‘So, I can’t share or observe others. I can’t support others so easily in the way you can in an office. You can learn a lot by just listening to people. Communication is crucial in palliative care and if you’re listening to some experienced clinicians, it stays with you.

Home working can also be isolating, agrees Ms James. ‘It can be lonely working from home because you’re in, headset on and down to work. I try and do one or two shifts in the call centre each week because it’s nice to have contact with people.

For Ms Porritt, the move to home working was a way for St Christopher’s Hospice to retain her as she neared the end of her career. However, Ms James was looking for a ‘change’. And hybrid working at NHS 111 has come with new opportunities.

‘I’ve done the remote clinical decision-making course and now I’m on the advanced practitioner course and I’ve been here just two years,’ she says. ‘It’s all funded and I get the time to do it.

‘I feel lucky that I’ve got this opportunity, as someone who’s been in the profession a long time.’

See careers, page 23

Find out more

NHS Staff Council: Guidance to support regularising ad hoc home and agile/hybrid working arrangements

NHS Employers Handbook amendments (section 33)

Flexible working in the NHS: A toolkit for individuals

Remote nursing consultations: how to get them right rcni.com/video-consults