Deciding to Delegate: A Decision Support Framework for Nursing and Midwifery

All nurses/midwives must refer to Deciding to Delegate: A Decision Support Framework for Nursing and Midwifery when making decisions to delegate care.

Nurses and midwives may ask other members of the health and social care team to take responsibility for providing aspects of care or treatment on their behalf. Accountability is shared between the nurse/midwife who delegates and the person who accepts the delegated task. Delegation must always be based on an individual assessment of the person’s health needs and must be in their best interest, operating within organisational governance, line management structures and clear lines of accountability. Delegation of healthcare interventions/tasks must also consider the person’s preferences and risk enablement to promote the choice and control of the person receiving the care.

Regulated nurses/midwives cannot delegate the nursing/midwifery assessment and risk assessment of the individual’s healthcare needs which will determine the healthcare interventions that may be required. Following assessment, they may then delegate the provision of aspects of healthcare to another practitioner who is competent to carry out the care.

The delegatee must judge whether the healthcare intervention is appropriate to delegate based on the individual situation and the following actions:

• Risk Assessment: Evaluating the complexity of the healthcare intervention and the potential risk involved and the predictability of the outcome for both the person receiving the care and the person who the intervention is delegated to;
• Ensuring Competence: assess level of competence, providing training as needed and confirming both the understanding and confidence of the delegatee to perform the intervention to the required standard;
• Supervision, monitoring and Review: the nurse/midwife should stipulate the supervision required for the intervention, (direct or indirect) regularly checking the performance of the intervention and the outcome, updating competency assessment and training as needed;
• Maintaining Communication with the user of the service and the delegatee: being available to address any questions, concerns and/or unexpected developments, ensuring a clear pathway is agreed for escalation.

When should Delegation not happen?

There are a limited number of interventions that should not be delegated by the nurse/midwife or restricted by law, outlined below (this list is not exhaustive and decisions should always be based on professional judgement and guided by regional and organisational policy):

• Nursing/Midwifery assessment, risk assessment, care planning and evaluation of outcomes. These functions require professional nursing judgement
• Involves high risk procedures or requires professional judgment such as diagnosing or prescribing
• Falls outside the delegatee’s scope of practice or legal authority
• Cannot be safely overseen or monitored
• Midwifery – delivering a baby
• Prescribing medicines
• Certification of death
• Administration of medications by injection (by intramuscular, intradermal, subcutaneous, intraosseous, intravenous, or otherwise) with the exception of insulin injections in some parts of the UK.
• Sterile procedures.
• Central line maintenance.
• Acts that require nursing/midwifery professional judgement

In deciding to delegate the nurse/midwife should be guided by the NIPEC Decision to Delegate Framework (including a decision-making matrix) to ensure the safety and effectiveness of any decision to delegate taken by the nurse/midwife. – link to that page

When nurses/midwives are delegating healthcare interventions/ tasks to social care practitioners they can refer to the  Circular-OSS-02-2018.pdf. This provides a framework to social care workers, social workers and their managers on what is required of them when undertaking a delegated interventions/tasks.

View the practical checklist for the Nurse/Midwife for delegated health care interventions/tasks.