The focus of this Decision to Delegate Framework is centred on the person being cared for and the need for safe and effective delegation that supports services to enable and promote health, independence and wellbeing in the place of the person’s choice, as far as is possible.’ The Framework for nursing and midwifery practice in Northern Ireland was developed to ensure that the process of delegation at a local and regional level will meet the requirements of the Nursing and Midwifery Council (NMC) Code and support the highest possible level of patient/client safety.
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.
Guidance for Nurses/Midwives on Healthcare Delegation
Nurses and midwives may delegate aspects of care to competent members of the health and social care workforce. Delegation must be based on an assessment of the person’s needs, be in their best interests, and operate within clear governance and accountability arrangements. The preferences, choice and control of the person receiving care should always be considered.
Nurses and midwives remain accountable for the decision to delegate. They cannot delegate assessment, risk assessment, care planning or evaluation of outcomes, as these require professional judgement.
Before delegating, nurses and midwives should:
- assess the risks and complexity of the intervention;
- confirm the individual’s competence to undertake the task/intervention;
- provide appropriate supervision and review; and
- ensure clear communication and escalation arrangements are in place.
When Delegation Is Not Appropriate
Delegation should not occur where:
- professional nursing or midwifery judgement is required;
- the task/intervention is high risk or restricted by law;
- the individual lacks the necessary competence or authority; or
- safe supervision and monitoring cannot be provided.
Examples include prescribing, certification of death, delivering a baby, and other activities requiring professional judgement or legal authority.
When nurses/midwives are delegating healthcare interventions/ tasks to social care practitioners they can refer to the Circular-OSS-02-2018. 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.
Recording Tool for Nurses and Midwives
Key message: Safe delegation requires an individual assessment, competent staff, appropriate oversight, and clear accountability.