Where high levels of service demand are coupled with an influx of temporary staff members, the delegation of nursing and midwifery tasks becomes an important factor in the organisation of care along with the process of handover.
The Deciding to Delegate Decision Support Framework is designed to assist nurses and midwives to make decisions around delegating appropriate tasks and duties and is relevant to all areas where registrants work. Section 11 of the NMC Code states clearly that nurses and midwives are accountable for decisions to delegate tasks and duties to other people. That includes the responsibility to confirm that the outcome of any task delegated meets the required standard for the task.
On many occasions the decision to delegate will be a straightforward one, with clarity on each element of the framework providing an obvious choice to delegate. On other occasions, the decision to delegate will require a number of arrangements to be in place, including described mechanisms to provide evidence to the delegator that the identified outcomes of the delegated task have been achieved.
A shortened version of Deciding to Delegate can be accessed here.
Click the headings below for further information:
For additional information specific to particular care settings e.g. Private Nursing Homes, please see below.
The purpose of delegation is to ensure the most appropriate use of skills within a health and social care team to achieve person-centred outcomes. In a clinical context and during COVID-19, delegation of nursing and midwifery tasks and duties should, where possible, continue to be focussed on the needs and wishes of the person receiving care or services.
In the Deciding to Delegate Framework, delegation is defined as the process by which a nurse or midwife (delegator) allocates clinical or non-clinical tasks and duties to a competent person (delegatee).
The delegator remains accountable for:
- the overall management of practice, for example, in a clinical context: the plan of care for a service user
- the decision to delegate.
The delegator will not be accountable for the decisions and actions of the delegatee.
DELEGATION TO OTHER NURSES AND MIDWIVES
The NMC has established that on occasion nurses and midwives may delegate tasks or duties to other registered nurses or midwives. In these cases, there may be particular circumstances where accountability for each element of practice is clearly defined and agreed. This does not reflect the usual practice environment, however, where each registered nurse or midwife acts autonomously.
During periods of surge demand, this may happen more frequently as there may be a number of temporary registered staff in clinical settings. In such cases the usual principles for delegation apply.
TASKS AND DUTIES
There are many tasks and duties that nurses and midwives undertake in their daily workload that may or may not be linked to a prescribed person-centred plan of nursing or midwifery care.
Some of these organisational activities that are not distinct to the role of a nurse or midwife may be easily allocated to others to undertake as part of the multidisciplinary approach and deployment of temporary team members during COVID-19.
Other tasks and duties may be linked to a person-centred nursing or midwifery plan of care and therefore a process of delegation by the registered nurse or midwife occurs to another person for example to an AHP, pharmacist, student of nursing or midwifery etc. with the appropriate skills. Examples of these activities include:
Organisational Activity Professional Activity (linked to a plan of care) Organisation of virtual visits for patients Assistance with the fundamentals of care such as: Feeding, washing, dressing, mouth care, skin care and toileting Family liaison calls Presence with patients at end of life Stocking and ordering of stores and provisions Preparation of and administration of Nasogastric (NG) feeds/Percutaneous Endoscopic Gastrostomy (PEG) feeds Equipment decontamination and audit. Presence with patients with delirium who are at risk of harm
Administration of bolus doses of medication.
The delegation resources referred to in this section are applicable in Private Nursing Home settings. There are other resources, such as: the Handover Prompt Sheet, which have been altered to reflect the Nursing Home environment.