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NMC code change mooted to clarify delegation to nursing associates


The Nursing and Midwifery Council has been told by parts of the profession that a change to the code may be required to ensure nurses are clear about delegation to nursing associates.

The NMC’s director of education, Geraldine Walters, has said that, as part of its work in preparation for regulating nursing associates, the body had started by looking at how far the NMC’s code for nurses and midwives could be applied to the new role.

“We need to understand whether it’s the registrant we are holding to account for the delegation of tasks or the nursing associate”

Ruth Walker

“So, will it be the same code as for nurses and midwives, will it be completely different, or is it similar but perhaps with some amendments?” she told the NMC’s latest council meeting last week, noting that a final decision would only be made after a public consultation.

Discussions so far with the pilot sites testing out trainee associates had led to suggestions by some that “a lot of the code is relevant – but it may need some amendments”, she said.

NMC council member Ruth Walker later suggested that an important part of the NMC’s work would be to clarify what level of responsibility, authority and accountability associates had – rather than just stating the tasks they should be able to complete.

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Geraldine Walters

“That’s particularly relevant in the context of delegation,” said Ms Walker, who is executive nurse director at Cardiff and Vale University Health Board.

“We need to understand whether it’s the registrant we are holding to account for the delegation of tasks or the nursing associate in their own right,” she said.

In response, Ms Walters noted that the issue of delegation – and a potential change to the nurse’s code – had been put forward during early discussions with pilot sites.

“When we are looking at the code…. [and] a few comments have been made about should there be an amendment to the code – the amendments are more in the sphere of delegation for the registered nurse, rather than changing the code for the nursing associate,” she said.

In an interview with Nursing Times following the meeting, NMC chief executive and registrar Jackie Smith stressed it would be down to the regulator’s council to decide whether there should be separate codes for nurses and associates, and if there should be any amendment to the existing one for registrants.

She said a potential change to the current code in response to concerns about delegation would be “up for discussion”.

“We wouldn’t say here is the solution. We would look at pros and cons – [and then the decision] is entirely up to the council,” she said.

The NMC will begin drawing up professional standards for the new nursing associate role this summer, with a formal consultation on the standards and code planned for the spring.

Around 2,000 associates began training at pilot organisations in England at the start of this year, with the first cohort due to complete programmes in January 2019.



Readers' comments (10)

  • What?

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  • Ah - being responsible for the delegation of a group of co-workers with a poorly defined job role. Thanks NMC - you've excelled yourself once again and I for one can't wait for my fees to be increased again next year.

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  • Our registration fee at work.

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  • NMC do you have anyone working at NMC that knows what nurses & midwives do?
    Such as Nurses & Midwives?

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  • So let's simplify the waffle. If I delegate a task that the associate has been signed off as competant and the associate makes a mistake that harms the patient, who would be held the account?

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  • 55HCA

    I work as a Senior HCA- and all HCA's are responsible under civil law for their actions at work ( and would be held responsible in a court of law). As such they should feel they can refuse to undertake tasks, which they have not received training in, or they feel they are not competent enough to undertake.
    I assume the Associates role would be similar from a legal stand point. Though I think this new role should be registered with the NMC as the old SEN role was.

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  • karen Webb

    Why is everything road tested in acute hospitals??? Who are these associate nurses? I work in a care home, where I feel my nursing role being placed under increasing threat because there aren't enough of us so they'll probably make district nurses responsible for care in them soon!
    This is ALL about money! There were too many of us and we have cost "too much" Nurses are resented in the system by managers (in the same way as people resent paying the woman who cleans their house for them).
    Just train nurses the way we used to. It worked. Once they qualify, then help them to top up knowledge to degree level. Locally.

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  • Of course HCA's are responsible and under civil law anyone could be, it's civil law after all, of a person has been wronged they can take that person to court.

    However the point is that a nurse may appropriately delegate to a HCA with is trained, competent, and willing to accept the responsibility, but if the HCA is negligent, the nurse is ultimately accountable. This is undisputed.

    Is this fair? Is this right?

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  • JMHCA - you are correct in your assertion that HCA's are responsible for their actions under law. The difference here is that, so is the Registered nurse and it is the nurse who will be before the NMC, not you. If a nurse can be sanctioned for not attempting resuscitation on a dead person, god knows what they will do to us when someone to whom we have allocated a task, who is trained to undertake that task and who has been signed of as competent, makes a serious error. It is our job on the line too. Unfairly so.

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  • have worked as a hca within the NHS for the past twenty years, a band 3 for the last twelve. I have been given a fantastic opportunity by my trust to train as a nuse associate as have so many others.
    We are a workforce of health care support staff who have gained great knowledge and skills whilst delivering patient centered care. Enabling qualified members of staff to undertake their role, a difficult one under such pressures.
    I for one was unable to undertake my nurse training for reasons out of my control and had reached a plateau within my role as a hca, unable to further develop.
    Is it not patient care we should be thinking about and how a nurse associate can assist a registered nurse deliver high quality care. I have to attend university just like a student nurse, I have to undertake OSCE's just like a student nurse. I have assignments to write, and a maths exam also just like a student nurse. Whilst having to work full time and undertaking additional study set out by my trust.
    We study for two years missing a third. I'm sure my TNA colleagues feel the same. We are not cheap nurses, we don't want to take your jobs we want to add to the nursing profession and support registered nurses. We will be regulated by the NMC and have a code of conduct and pay to have my name placed on a register, so you alone won't be responsible for any care I deliver.
    I hope the nursing profession warms to this new role, you have a skilled workforce already behind you in your hca staff. Surely giving this workforce an opportunity to develop and assist in an already stretched workforce is the way forward in bridging the gap.

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