Regulation of nursing associates by the Nursing and Midwifery Council will provide “a bit more comfort” to nurses when they delegate tasks, but the level to which they are professionally accountable will not change, a lawyer who specialises in fitness to practise cases has said.
In an interview with Nursing Times, Penny Maudsley – a former nurse and midwife who is now a barrister at Alexander Chambers in London – said she partly agreed with claims by the head of the NMC that nurses would benefit from associates being trained to standards set by the regulator.
“The registered nurse could be accountable for inappropriate delegation”
She said this was because regulation meant nursing associates would be responsible for ensuring they are competent to accept a delegated task – which unregulated healthcare assistants are not required to do.
However, nurses will still be responsible for ensuring nursing associates are trained to carry out the delegated task – as they are with HCAs, she said. If something goes wrong, both the nurse and associate could be held accountable, but in different ways, said Ms Maudsley. “The registered nurse could be accountable for inappropriate delegation,” she said.
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“They have to be absolutely certain the nursing associate is competent in that she knows she is following any policy or protocol, she knows she is properly trained and has seen any training records to ensure the associate has been signed off,” she said.
”Also the nurse must ensure that it’s in the patient’s best interest for the task to be delegated, that everyone knows it is being delegated to the associate, and that the associate is supervised,” she said.
“The nursing associate will have to make sure she is happy to have the task delegated to her”
Ms Maudsley suggested nurses should, as a precaution, check for specific training records instead of assuming that because associates had qualified they were competent – especially since it was expected that they would be giving medications and carrying out drug calculations.
“Meanwhile, the nursing associate will have to make sure she is happy to have the task delegated to her. If she is not competent or doesn’t feel confident, she needs to say because she could be responsible for her own acts or omissions if she has taken on a task she is not really competent to do,” added Ms Maudsley.
Ms Maudsley noted that for HCAs considering becoming associates, they would need to understand the additional responsibility that will be attached to this new role.
“Their personal risk will be increased because they will have to take on personal accountability that they haven’t had as an unregulated worker when they can leave all the responsibility to the nurse,” she said.
Case Study: Incorrect nurse delegation – an ongoing internal investigation at a trust
The legal view: nurse delegation of tasks to the new nursing associate role
A doctor prescribed an incorrect medication to take home for a patient. It was sent to the pharmacist who didn’t identify the incorrect prescription from the doctor.
The medicine was then transferred back to the ward and handed over to the registered nurse. The nurse failed to note it was incorrect and then handed it over to the healthcare assistant, who then gave it to the patient.
Penny Maudsley: “In my view, there is a responsibility on the doctor, pharmacist, and registered nurse.”
“The registered nurse failed to recognise the wrong medication but she also incorrectly delegated it to the HCA and she shouldn’t have done. The nurse is responsible for her own acts and omissions – as well as for delegating it to someone who was not competent - and the patient could have come to some harm.”
“The HCA is not regulated so there is no responsibility or accountability for them. Whereas now with regulated nursing associates, they should be questioning that when they are handed something like that, that they are competent to carry out the task.”