Accountability and delegation
Health care teams include a range of registered professionals, health care assistants (HCAs), assistant practitioners (APs) and students. It is vital that each member of the team is clear about their level of accountability and that the registered staff are confident when delegating tasks to their colleagues.
This film shows HCAs at work discussing issues around these important subjects, with comments from experts from the RCN explaining the principles that can be transferred into many situations, wherever you work. The scenarios are as relevant to nurses and HCAs as they are to students and APs.
The RCN is aware that support workers have a huge range of titles, and therefore in the film and leaflets the term ‘health care assistant’ is used generally to encompass all titles.
The film is accompanied by the resources listed below. Please share them with your colleagues.
Accountability and delegation: what you need to know (PDF 478KB). Whether you are a nurse, student, health care assistant (HCA) or assistant practitioner (AP), the principles of both delegation and accountability will be important to you and your patients. This booklet outlines the key issues so that you have a clear understanding of accountability in practice, wherever you work.
Accountability and delegation checklist (PDF 342kB)
Delegation must take into account the context of every situation rather than focusing on tasks alone. This checklist is for both nurses who delegate and HCAs accepting delegation.
Please also see advice from the NMC on delegation.
The RCN has also produced a delegation information sheet (PDF 207KB).
Accountability, responsibility and team work
Health professionals – like nurses, doctors, dentists, pharmacists, midwives and allied health professionals all have professional accountability and responsibility. They are accountable for the assessment, planning and evaluation of standards of care, and for delegating work to support staff like HCAs and APs.
Legal accountability relates to the obligation of citizens to obey the laws of the country and to be able to defend their actions through the court if required to do so. Legal responsibility encompasses civil law (e.g. the duty of care), criminal law (duty towards the public) and employment law (duty towards the employer).
Professional accountability relates to the additional obligation of the professions not to abuse trust and to be able to justify their professional actions. Nurses and midwives are professionally accountable to the Nursing and Midwifery Council (NMC).
As an HCA or AP, like other team members, you are accountable for your actions. You have social, ethical, legal and contractual accountabilities and are responsible for the tasks that you undertake. You must not work beyond your level of competence.
Accountability for team working includes a commitment that team members make to themselves and their team members to demonstrate the attitudes, behaviours and actions that promote team effectiveness and therefore high standards of care. The part that registered nurses play in the act of delegation is a critical one and an essential factor in enabling the HCA or AP to become a fully integrated member of the team.
Principles of delegation
The primary motivation for delegation is to serve the interests of the patient and public.
When delegating the registered nurse must ensure that:
- the needs of patients are always assessed: their personal needs should define who within the team carries out particular activities
- the level of experience, competence and role of the person to whom the task is delegated is appropriate
- appropriate assessment, planning, implementation and evaluation of the delegated activity is undertaken
- the level of supervision and feedback is appropriate to the task delegated
- rigorous protocols clearly define the HCA/AP’s role within a clinical activity
- protocols should be regularly reviewed
- the competences of the HCA/AP to deliver specific delegated clinical activities must be assessed prior to delegation and reviewed at regular intervals.
The distinction between the roles and responsibilities of professionally trained nurses, HCAs and APs is often not clear to others, as boundaries between different health disciplines are becoming increasingly blurred. Team members, patients and the public frequently misunderstand the difference between the registered nurse and the support worker role. In order to maximise safety and quality of care, HCAs and APs must only be asked to perform tasks that fall within their assessed competence.