Risk Alert - nurses and delegation
With complaints against nurses increasing,
clinical risk manager Kate Taylor shares
tips on how to decrease risks associated
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
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
- 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
- Is ongoing training and development
available to ensure the member of staff
- Has a risk assessment been undertaken?