Accountability and delegation

The principles of accountability and delegation are relevant to all members of the nursing team. Whether you're a nurse, health care assistant (HCA), assistant practitioner (AP), nursing associate (NA) or student, this page tells you what you need to know.

Accountability

Health service providers are accountable to the criminal and civil courts to make sure their activities meet legal requirements. In addition, employees are accountable to their employer to follow their contract of duty. Registered practitioners are also accountable to regulatory bodies in terms of standards of practice and patient care. Registered nurses, midwives and registered nursing associates are professionally accountable to the Nursing and Midwifery Council (NMC).

The law imposes a duty of care on practitioners, whether they are HCAs, APs, nursing associates, students, registered nurses, doctors or others. The duty of care applies whether they are performing straightforward activities such as bathing patients or undertaking complex surgery.

All practitioners must ensure that they perform competently and that they don't work beyond their level of competence. They must inform a senior member of staff when they are unable to perform competently.

To be accountable, practitioners must:

• have the ability to perform the activity or intervention
• accept responsibility for doing the activity
• have the authority to perform the activity, through delegation and the policies and protocols of the organisation.

Delegation

Registered nurses have a duty of care and a legal liability to their patients. When delegating an activity, for example to an HCA or AP, they must ensure that it has been appropriately delegated.

The NMC code says registrants must be accountable for their decisions to delegate tasks and duties to other people.

It says they must:

• only delegate tasks and duties that are within the other person's competence
• make sure that everyone they delegate tasks to is adequately supervised and supported 
• confirm that the outcome of any task they have delegated to someone else meets the required standard.

Employers have responsibilities too. They must ensure their staff are trained and supervised properly until they are competent.

Employers accept vicarious liability for their employees. This means that if their employees are working within their sphere of competence and in connection with their employment, the employer is also accountable for their actions.

Principles of delegation

• delegation must always be in the best interest of the patient and not performed simply to save time or money
• the support worker must have been suitably trained to perform the intervention
• full records of training given, including dates, should be kept
• evidence that support workers' competence has been assessed should be recorded, preferably against recognised standards such as National Occupational Standards
• there should be clear guidelines and protocols in place so that the support worker is not required to make a standalone clinical judgement
• the role should be within the support worker’s job description
• the team and any support staff need to be informed that the activity has been delegated
• the person who delegates the activity must ensure that an appropriate level of supervision is available and that the support worker has the opportunity for mentorship. The level of supervision and feedback needed depends on the recorded knowledge and competence of the support worker, the needs of the patient/client, the service setting and the activities assigned
• support workers must have ongoing development to make sure their competency is maintained
• the whole process must be assessed to identify any risks.