Intended for healthcare professionals


Is it my moral duty to cover shifts in the absence of staff?

BMJ 2021; 375 doi: (Published 11 October 2021) Cite this as: BMJ 2021;375:n2443
  1. Abi Rimmer
  1. The BMJ

It can be difficult to turn down requests to cover rota gaps. However, you must balance your own needs against those of the service, Abi Rimmer hears

It’s our moral duty to get enough rest

Emmeline Lagunes-Cordoba, psychiatrist, psychotherapist, and crisis team specialty doctor, says, “The short answer is no. The long answer is still no—but here’s the argument.

“In its Good Medical Practice guidance1 the General Medical Council describes professional values and behaviours that we must adhere to in order to maintain our licence to practise.

“Regarding shift cover, the guidance states that patient safety may be affected if there is not enough medical cover. So, you must take up any post you have formally accepted and work your contractual notice period before leaving a job.

“It is our responsibility, then, to take a post or shift that we have formally accepted. However, to work extra hours to cover shifts we are not contracted to do can create conflicts with other obligations we have outside our working life.

“I would also argue that it is our moral and legal duty to make sure we have enough rest to avoid a negative impact on our judgement and performance, it is our moral and legal duty to take care of those who depend on us, and it is our moral duty to stick to commitments we agreed with family and friends.

“Finally, it is our moral duty to take care of our wellbeing and mental health. Not doing so can be detrimental for us and for those we are aiming to help.

“So, next time you’re questioned regarding your moral duty to cover shifts, you need to remember that you are the most important person in your life, so it’s your moral duty to take care of yourself and those you love.”

A moral argument is open to abuse

Partha Kar, consultant in diabetes and endocrinology, says, “The answer—at least from my point of view—is a firm ‘no.’ There are always exceptional circumstances where colleagues help each other out, but to couch that in terms of moral obligation is a slippery slope.

“The moral argument harks back to the perennial debate about whether medicine is a vocation or a job—with both camps perhaps missing the fact that these things don’t need to be mutually exclusive.

“A moral argument gives licence to those who would like to abuse a trainee’s good will or guilt trip a colleague into covering a shift, even when the long term damage done to the individual—not to mention the overall system—outweighs the short term need.

“We in the NHS need to be crystal clear about one basic concept—when burnout happens, there is no one, bar your own friends and family, to look after you.

“A systemic problem with staffing should not translate into staff believing that it’s their moral duty to cover unfilled shifts. That would leave them open to abuse and is something that senior colleagues need to bear in mind when implying that trainees won’t stay in their ‘good books’ if they refuse to provide cover.

“The reality is that, in most cases, cover is most likely to be found by polite requests, asking for help, or, frankly, being more flexible about locum rates. An argument of a moral duty is the thin end of the wedge and that same argument could apply to seniors when it comes to waiting lists or reviewing patients on the wards when emergency departments are full.

“Better to be careful what you wish for.”

Consider the personal cost of covering the shift

Tharusha Gunawardena, cardiology interventional specialist register, says, “Locum shifts are a good way of supplementing income yet it’s important to understand and establish what your boundaries are. There are a lot of rota gaps—and therefore a demand for locums—and some people will look to take advantage of your willingness to cover shifts.

“We are all aware of the shortfalls in staff numbers, however the responsibility for this is collective and not reliant on one person.

“While covering the odd extra shift might be financially beneficial, the payoff may mean less time with loved ones or simply less time relaxing. Taking on too many extra shifts risks burnout, both physically and mentally.

“Make sure your indemnity covers the extra work you do, particularly if it’s in a different setting to your usual work. Remember that if an incident occurs during a locum shift, your reason for taking the shift could be framed differently—doing the shift for extra money rather than covering a gap.

“Covering a rota gap is something that is best facilitated by kind and considerate rota coordination, hospital management, and senior cover, to ensure it’s done in a safe and empowering way.”


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