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Delegation in Nursing and Midwifery

Dr Carole McKenna, Senior Professional Officer

Following discussion at the regional Central Nursing and Midwifery Advisory Committee (CNMAC) meeting in June 2014, it was agreed that the practice of delegating aspects of nursing tasks and duties in Northern Ireland required further exploration.

A range of activities taken forward by the Health and Social Care (HSC) Clinical Education Centre (CEC), and NIPEC under the commission of the CNO, identified a number of priorities that were subsequently presented to CNMAC in December 2015, to determine immediate and future action, ensuring that the process of delegation of nursing and midwifery care at a local and regional level would meet the requirements of the Nursing and Midwifery Council (NMC) Code and support the highest possible level of patient/client safety.

Kathy Fodey, Director of Regulation and Nursing, Regulation and Quality Improvement Authority (RQIA) and Colum Conway, Chief Executive, Northern Ireland Social Care Council (NISCC) were asked by the CNO in 2016 to jointly chair a Task and Finish Group to develop an approach to delegation of nursing and midwifery tasks and duties. The final product was reported to CNO via CNMAC in March 2018. CNMAC then took some time to consider the process of implementation prior to launch.

The development work included:

  • A workshop in October 2016, informed by the considerable work which has taken place by other countries to date and attended by representation across statutory, non-statutory, education, policy and staff-side organisations to bring together a range of nursing and midwifery colleagues from across sectors to discuss their understanding of delegation in nursing and midwifery, ideas to support effective delegation and then test an outline framework which was based on best evidence in this area. With a view to the intersection of nursing and midwifery care and services with social care, a number of social work colleagues attended the event to listen and contribute to the discussion, to enable future thinking for social care settings and inter-professional teams.
  • Three meetings of a Sub Group to refine the framework based on the feedback obtained through the October 2016 workshop.
  • Two rounds of small scale testing of the draft decision support framework in a range of nursing and midwifery practice settings to enable final refinement and feedback.
  • Presentation to the Chief Nursing Officer’s Business Team meeting and Central Nursing and Midwifery Advisory Committee (CNMAC).
  • Agreement for publication and use in Northern Ireland in November 2018 at the CNO Business Team meeting and the CNMAC Sub Group for Workforce and Education (SWE).

View the final publication Deciding to Delegate: A Decision Support Framework for Nurses and Midwives

As part of this phase of the project a number of challenges were identified relating to working within integrated teams and delegation of nursing and midwifery tasks and duties.

A round table summit between Executive Directors of Nursing, Executive Directors of Social Work and Directors of Adult Care was held in September 2018 to discuss a way forward.

Informing that discussion was a literature review carried out by Dr George Wilson, commissioned by NIPEC and NISCC.

View the literature review

This group is now taking forward an exciting collaborative project to determine governance arrangements for multi-professional delegation. The project is being support jointly by NIPEC and the Northern Ireland Social Care Council.

View the Project documents

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