Accountability and delegation in practice

Accountability and delegation principles apply to all members of the nursing team.

This guidance brings various RCN resources together to help support nursing staff to understand the principles of accountability and delegation particularly during this pandemic and help them feel confident in their decision making.

The resource includes case studies illustrating how the principles can be used in practice. View the case studies.

Scope of guidance

This resource includes:

• background
• accountability
• delegation
• tool to support decision making
• case studies and examples of accountability and delegation in practice
• RCN and other resources to support practice.

Background

The coronavirus pandemic has led to unprecedented demand on health and care services and has also created additional burdens on health and care staff. The healthcare workforce are vital in managing the coronavirus infection by adhering to specific infection prevention and control measures, reducing virus transmission and utilising the skill mix within new and changed teams in order to be able to deliver safe, person-centred care to those who need it. The increased need to work in different settings and with other colleagues to manage this demand has brought team working to the fore taking account of skills, knowledge and welfare of all staff to provide the best patient care possible. 

Even though working within a changing context and with different care models is seen to be a fundamental part of nursing practice, the RCN understand this can raise questions and concerns and we have produced specific redeployment guidance to support you. The Nursing and Midwifery Council (NMC), alongside other regulators, have also acknowledged that during the pandemic, health and care professionals will have concerns about decisions they may need to take in order to provide the best care in challenging circumstances. 

The principles of accountability and delegation are described. This section is designed to support all members of the nursing team on how these principles work in practice and signpost to other relevant resources and useful information.

Accountability

All health care workers are expected to perform as competently and safely as they can in these circumstances. They must also inform a more senior member of staff, such as the registered nurse assigned to care for the individual and leading the team, or the nurse in charge of the shift, when they are unable to perform competently and/or safely.

Delegation

Due to the changing context and models of care evolving as a result of the pandemic, there may be more delegation required, and it may be taking place in a busy and challenging environment. 

Registered nurses are responsible for managing the nursing care and are accountable for the appropriate delegation and supervision of care provided by others in the team. 

Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC) have a suite of resources to support delegation in practice see: Delegation. There is a delegation framework which includes a support Matrix (p.12) which may be useful for registered nurses working in a new environment, with a new team or using a new model of care.

(The NHS has unlimited indemnity cover for all its employed staff and those providing their services as locums, bank staff and other self-employed roles. Any organisation employing redeployed staff to support the coronavirus pandemic has the benefit of the NHS indemnity schemes. The Department of Health and Social Care (DHSC) has made it clear that anybody working in redeployed or backfilling roles in the coronavirus pandemic response will have indemnity cover for their work.)