With complaints against nurses increasing, clinical risk manager Kate Taylor shares tips on how to decrease risks associated with delegation
Within a climate of stretched resources and increasing demands on general practice, practice nursing roles are taking on more patient care that traditionally would have been managed by GPs.
However, complaints against nurses are on the rise with the number of referrals to the Nursing and Midwifery Council (NMC) rising by 36% from 2009/10 to 2013/14. In this increasingly challenging environment it is important to be aware of the risk management issues relating to delegation, nursing responsibilities and accountability.
The Royal College of Nursing and General Medical Council (GMC) are clear in their respective guidance for nurses and doctors that practitioners have a duty of care and a legal liability with regard to patients. According to the GMC’s Good Medical Practice: “When you do not provide your patients’ care yourself, for example when you are off duty, or you delegate the care of a patient to a colleague, you must be satisfied that the person providing care has the appropriate qualifications, skills and experience to provide safe care for the patient.”
If a GP or a registered nurse delegates a task they must ensure that the task has been appropriately delegated, meaning:
the task is necessary and delegation is in the patient’s best interest
the nurse or support worker delegated the task understands the task and how it is to be performed
the nurse or support worker has the skills and abilities to perform the task competently
the nurse or support worker accepts the responsibility to perform the task competently.
"Each individual nurse will adopt his/her own safeguarding processes prior to delegation"
The NMC Code of Conduct summarises the accountability of a nurse delegating a task:
“If the nurse or midwife is delegating care to another professional, health care support staff, carer or relative, they must delegate effectively and are accountable for the appropriateness of the delegation.”
Translating this to general practice means ensuring practice teams have appropriate systems and processes in place to safeguard the delegation of any nursing activities.
Each individual nurse will adopt his/ her own safeguarding processes prior to delegation; however it is useful to consider a structured approach. The RCN sets out clear guidance on key questions to consider when delegating to another member of the team:
Is the delegation in the best interest of the patient?
Is the person you are delegating to suitably trained and have they been assessed as competent, preferably with written evidence of the assessment?
Are there clear and robust protocols and guidelines in place?
Does the task form part of the member of staff’s job description?
Do the members of the team know this task has been delegated?
Is there sufficient supervision and support available?
Is ongoing training and development available to ensure the member of staff remains competent?
Has a risk assessment been undertaken?
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