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Clinical Updates

Paid-for travel vaccinations now covered by the RCN indemnity scheme

The state-backed indemnity scheme does not provide cover when vaccines are paid for by the patient.



Travel Vaccination

Indemnity cover will be provided for NHS staff providing paid-for vaccinations.

The Royal College of Nursing (RCN) has announced that staff providing paid-for travel vaccinations in England and Wales will now be protected by the RCN indemnity scheme.

A State-backed indemnity scheme for general practice (GP) staff was introduced by the NHS in England and Wales earlier this year. It is provided by NHS Resolution and offers automatic cover to all staff working in NHS GP services.


While the idemnity schemes included travel vaccinations given in GP surgeries, it excluded circumstances where vaccinations are paid for by the patient.

The RCN has now extended its indemnity scheme to cover this gap.

The change means both employed and self-employed RCN members providing paid-for travel vaccinations from GP practices not included in CNSGP in England and GMPI in Wales will be covered by the RCN indemnity scheme.

Peace of mind.

Roz Hooper, RCN Head of Legal Services (Regulatory), said: “For the most part, these new state-backed schemes in England and Wales give our members working in GP services peace of mind about their indemnity cover as they’re automatically included.

“However, members providing important paid-for travel vaccinations have now been told that this service will not be included in the scheme. We know this must be worrying to members and we want to support them so they don’t have to face the decision of either no longer providing the service or purchasing expensive insurance just for this.

“We think that the provision of travel vaccinations in GP practices is an important public health benefit in local communities, because expert advice can be given at reasonable cost.

“We have decided to extend our RCN indemnity scheme to cover both employed and self-employed members in England and Wales who provide travel vaccinations from GP services. This is so they can be fully confident that between the state-backed schemes and the RCN, they are covered for all their clinical practice.

“Importantly, for the same subscription, our members also have access to all the RCN’s other professional legal workplace services, including employment advice and support for NMC referrals, criminal investigations, inquests and employment tribunals.”

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.



Nurse with patient in bed

Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.


Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 




A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.


Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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