COVID-19 and vaccination employment guidance

The following is a brief summary of the COVID-19 pandemic, vaccination and our involvement:

• March 2020. The COVID-19 pandemic was declared in the UK. 
• December 2020. The vaccine roll out commenced across the UK.
• June 2021. The government required all registered persons of all Care Quality Commission (CQC) registered care homes to be vaccinated. These regulations came into force on 11 November 2021. Read more here on GOV.UK.
• June 2021.The RCN responded See our consultation response here.
• September 2021. The government sought to widen these regulations and in Sept 2021 the RCN released our position statement on mandating the vaccination for health and social care staff and in November 2021, we published our consultation response.
• November 2021. The UK Government extended the regulations to other health and wider social care settings (including NHS workers).
• December 2021. The RCN called on the Health Secretary to delay the implementation. 
• January 2022. The Secretary of State for Health and Social Care announced that it was no longer proportionate to require vaccination as a condition of deployment. Read our response here.
• March 2022. Following a public consultation, legislation that revoked vaccination as a condition of deployment (VCOD) policy came into force.

The RCN strongly recommends all RCN members are vaccinated as soon as they can be. It is considered best practice to protect you, your patients and clients, as well as friends and family, and is evidenced in the COVID-19 vaccine surveillance reports.

The RCN consider that vaccination is a key pillar in infection control and disease prevention in health care settings and:

• vaccination is the right thing to do as part of the health care workers duty of care and that where vaccines are recommended these should be taken up
• we would want staff to have easy access to these as part of occupational health or other provision
• pre employment assessment and offer of vaccination is recommended and should be encouraged by organisations as per the Control of Substances Hazardous to Health (COSHH) regulations
• specific vaccination requirements need should be based be identified from on the risk assessment in the particular workplace and the role staff are undertaking.

The RCN recognise that the best way to achieve high uptake is for vaccines to be easily accessible to staff during the working day and where staff have anxieties or concerns about vaccines, they are given relevant  information to help accept vaccination in a supportive and non-punitive environment.

The RCN do not agree that vaccination should be compulsory or mandated as this will not help achieve high uptake or support staff who have questions to accept vaccination.

As detailed above in the background section within this guide, from March 2022 people working or volunteering in care homes are no longer legally required to have  a COVID-19 vaccine. It is also not a legal requirement for people to have received a COVID-19 vaccine in order to be deployed in NHS settings, or to deliver face to face CQC-regulated activities in wider social care settings. 

Though the legislation has been revoked, there is a  professional duty for staff to be vaccinated as recommended see NMC statement to be vaccinated against COVID-19. As well as for health and safety requirements in the workplace, See Chapter 12 of the ‘Green Book’: immunisation of health care and laboratory staff. 

This may be a requirement as part of an occupational health assessment. It should not be asked by line managers. 

Vaccination information is classed as 'special category data' under data protection legislation - all employers must therefore comply with this. More guidance on this is available from the Information Commissioners Office (ICO).

If you have any concerns about how your data is being gathered or used, contact us for support.

Under regulation 7 of the Control of Substances Hazardous to Health Regulations (COSHH) 2002, employers are required to assess the risk to staff of occupational exposure to hazardous substances (including biological agents and pathogens) and take measures to control and reduce the risk of exposure.

Under regulation 3 of the COSHH Regulations employers have a duty to risk assess and put in place control measures to extend to those who may be affected by the work carried out by the employer. This includes taking all reasonable steps to ensure agency and bank staff are protected, vaccinated and provided with PPE.

The HSE advise that employees may not wish to take up the offer of immunisation, or they may not respond to a vaccine and will, therefore, not be immune. If so, employers should consider the effectiveness of the other controls and consider whether any additional controls should be implemented to allow them to work safely. In practice this will mean the continued provision of respiratory and other protective equipment, effective ventilation and where the risk of harm remains high, or potentially redeployment. 

RCN support

The RCN recommends taking up vaccination as best practice. Staff need to be able to make this decision in a supportive environment with the right information, encouragement and clear explanation of the benefit and value of the vaccine.  

If you are facing formal action because of refusing the COVID-19 vaccination, see our section on ‘do I need to be vaccinated’ and contact us if you need support.

Further information

Our risk assessment toolkit which supports RCN members and wider health care professionals manage risks in the workplace.

NHS England/NHS Improvement have produced some resources to support employers and organisations with vaccine update.

NHS staff or those employed outside the NHS who have not been offered the vaccine, should contact their employer. 

Agency workers should speak to their agency.

Student nurses should contact their placement coordinator and/or university. Please also see our student advice guide.

Please see COVID-19 and indemnity: what you need to know.

Guidance from the RCOG on COVID-19 vaccines, pregnancy and breastfeeding and Coronavirus infection and pregnancy.

Conception and fertility

There is absolutely no evidence, and no theoretical reason, that any of the vaccines can affect the fertility of women or men. Everyone is advised to have the vaccine as soon as they are eligible. Those who are trying to become pregnant do not need to avoid pregnancy after vaccination.

The British Fertility Society COVID-19 vaccines and fertility FAQs.

Pregnancy

Pregnant women are advised to be vaccinated. MBRACCE UK, UKOSS and BPSU have produced an infographic summarising the latest data showing the worsening outcomes from COVID-19 among pregnant women and their babies.

The advice, in the Green Book, chapter 14a on COVID-19  is that pregnant women should be vaccinated and if necessary, discuss the risks and benefits of vaccination with their midwife or clinician. The Department of Health and Social Care has produced a new short film encouraging pregnant women to come forward for vaccination.

Breastfeeding

There is no known risk associated with giving non-live vaccines whilst breastfeeding. JCVI advises that breastfeeding women may be offered any suitable COVID-19 vaccine.

Further information

Guidance from the RCOG on COVID-19 vaccines, pregnancy and breastfeeding and Coronavirus infection and pregnancy. 

The RCM has also produced information on COVID-19 vaccines. Merged information sheet and decision aid tool (RCOG, RCM, MacDonald obstetric medicine society and UK teratology information service.

The British Society for Immunology video COVID-19 vaccine Q&A: fertility, pregnancy and breastfeeding

Short webinar Pregnancy and fertility Q&A

An individual employer may mandate that vaccination is a requirement for its workers and this may be included in contracts of employment for new starters working in some roles and sectors.

For NHS staff, guidance suggests that employers will continue to include the requirement for vaccination in job adverts for in scope roles.

Having prolonged COVID-19 symptoms is not a contraindication to receiving the COVID-19 vaccine. If people are seriously debilitated, still under active investigation, or have evidence of recent deterioration, deferral of vaccination may be considered to avoid incorrect attribution of any change in the person’s underlying condition to the vaccine. 

See COVID-19 vaccination: information for healthcare practitioners and the ‘Green Book’ chapter COVID-19: the green book, chapter 14a.

If you are experiencing difficulties at work as a result of time off due to COVID-19 please see our Long COVID advice guide.

If you are subject to formal absence management, speak to your RCN steward for support or contact us. 

Immunisers are advised on the infection prevention and control precautions and appropriate PPE for immunisation within the UK infection prevention and control guidance document (see page 17) i.e. wear an FRSM mask on a sessional basis, and risk assess the need for eye protection.

Gloves and aprons are not routinely required unless there is an additional risk of exposure to blood or body fluid contamination/broken skin. This risk is generally very low. If gloves and aprons are worn they are single use and must be removed and changed in between each patient. Hand hygiene must be rigorously applied between each vaccination episode and patient/person contact. You can see the RCN's poster ‘Why you don’t always need to wear gloves when giving vaccines’.

The WHO Framework for decision-making: implementation of mass vaccination campaigns in the context of COVID-19: interim guidance, 22 May 2020 has similar guidance.

I have had the vaccine. Do I still need to wear PPE at work?

All vaccinated staff should still follow current COVID-19 guidelines on PPE and social distancing where appropriate.

Please also see our sections on returning to work, protection from future infection along with our PPE guide.

As with any medicine, the COVID-19 vaccines can cause side effects. These are mostly mild and short lived paracetamol or Non Steroidal Anti-inflammatoy (NSAI) such as Ibuprofen can help alleviate symptoms. Anyone who becomes very unwell should call 111 or their GP.

Please see 'What to expect after your COVID-19 vaccination' for more detailed information and printable leaflets in a range of languages. Contact us if your employer is taking any formal action against you due to sickness absence in relation to the vaccine. You can also see our COVID-19 and time off guidance.

It is really important that people return for the second dose of vaccine

Reporting and monitoring of adverse events after vaccination

All medicines adverse events are monitored by the Medicines and Health Care Products Regulatory Agency (MHRA) and there is a dedicated Coronavirus Yellow Card reporting site.

Any member of the public or health professional can submit suspected side effects through the Yellow Card scheme. The MHRA also publish a Coronavirus COVID-19 vaccine adverse reactions report detailing the adverse events to date reported from the vaccine programme roll out.

Allergies

As with any vaccine there is a small risk of serious allergy and anaphylaxis but this is very rare, please see Contraindications and special considerations: the Green Book, chapter 6.

The Nursing and Midwifery Council (NMC) strongly encourage anyone eligible to be fully vaccinated as quickly as possible. The NMC adds that “our Code and our standards have always made clear that professionals have a responsibility to maintain their own level of health, taking all reasonable personal precautions to avoid potential health risks to colleagues and people receiving care.”

Refusal

However, the NMC has stated that they “do not consider that solely turning down COVID-19 vaccinations is a basis for a Fitness to Practise referral”. See the NMC’s full position statement here. if you are considering refusing, please also see our section ‘Do I need to be vaccinated’ within this guide and Chapter 12 of the ‘Green Book’: immunisation of health care and laboratory staff.

Find resources and guidance around COVID-19 vaccination delivery on our public health pages. See also:

• WHO Vaccines Explained 
• UK COVID-19 vaccines delivery plan

Regulation

• MHRA guidance on coronavirus (COVID-19)

Country specific guidance

England

• Public Health England COVID-19 vaccination hub
• NHS England COVID-19 vaccination programme
• Public Health England COVID-19 vaccination: information for healthcare practitioners
• NHS England resources and guidance on legal mechanisms to support vaccine delivery - including the national protocol and Patient Group Direction template

Wales

• COVID-19 vaccination information - Public Health Wales
• COVID-19 vaccination strategy
• Public Health Wales resources for health and social care professionals
• Public Health Wales patient information

Scotland

• Public Health Scotland resources
• Scottish government guidance 
• NHS Inform vaccination information and resources

Northern Ireland

• HSC Public Health Agency have a range of resources in various languages and easy to read formats
• HSC Public Health Agency COVID-19 vaccination programme
• NI Direct COVID-19 vaccination programme