NMC - Nursing Midwifery Council Professional Accountability and Delegation Questions and Answers 1 — Questions and Answers
Question 1: Which of the following statements most accurately describes the principle of professional accountability as defined by the NMC Code?
- Accountability can be delegated to a more senior colleague if a nurse feels a task is beyond their personal scope.
- Accountability rests solely with the employer, who is responsible for any errors made by nursing staff.
- A nurse is answerable for their own actions and omissions, and cannot blame others for their professional judgements. (Correct answer)
- Accountability primarily means completing incident forms correctly after an adverse event has occurred.
Correct answer: A nurse is answerable for their own actions and omissions, and cannot blame others for their professional judgements.
The NMC Code explicitly states that registered professionals are accountable for their own actions and omissions. This means they are answerable for their decisions and cannot defer this responsibility to others, regardless of advice or direction. Accountability is a personal, professional responsibility that cannot be delegated. While employers have responsibilities, the individual practitioner remains accountable for their practice.
Question 2: A registered nurse on a busy surgical ward needs to delegate a task to a competent and experienced Healthcare Assistant (HCA). Which of the following tasks is most appropriate to delegate?
- Administering a patient's prescribed intravenous antibiotics.
- Assisting a stable, post-operative patient with their personal hygiene. (Correct answer)
- Developing the initial plan of care for a newly admitted patient.
- Evaluating the effectiveness of a patient's prescribed pain relief.
Correct answer: Assisting a stable, post-operative patient with their personal hygiene.
Assisting a stable patient with personal hygiene falls within the typical scope of practice for a competent HCA. The other tasks require the clinical judgement, specific registration, and assessment skills of a registered nurse. Initial assessment, care planning, medication administration (especially IV), and evaluation are not delegable to HCAs.
Question 3: A newly qualified nurse administers a medication and later realises they gave the wrong dose. The patient is stable and shows no adverse effects. According to the principle of professional accountability and the duty of candour, what is the nurse's immediate priority?
- Waiting to see if the patient develops any symptoms before reporting the error.
- Documenting the correct dose in the patient's notes to avoid raising an alarm.
- Asking a senior colleague to take over the patient's care immediately.
- Immediately reporting the error to the nurse in charge and completing an incident form. (Correct answer)
Correct answer: Immediately reporting the error to the nurse in charge and completing an incident form.
The professional duty of candour requires nurses to be open and honest with patients and their organisation when things go wrong. The nurse's first priority is to ensure patient safety and then report the incident transparently to the nurse in charge and document it via an incident form. This upholds accountability and allows for organisational learning. Waiting, falsifying records, or simply handing over care without reporting are all breaches of professional accountability.
Question 4: A registered nurse (RN) is delegating the task of measuring and recording a patient's fluid balance to a Nursing Associate (NA). Which statement best describes the RN's accountability in this situation?
- The RN must directly observe the NA performing the entire task to ensure accuracy.
- Once delegated, the NA assumes full accountability for the task, absolving the RN of all responsibility.
- The RN remains accountable for the decision to delegate and for the overall management and evaluation of the patient's care. (Correct answer)
- The RN is only accountable if the NA makes an error in recording the measurements.
Correct answer: The RN remains accountable for the decision to delegate and for the overall management and evaluation of the patient's care.
While the NA is accountable for their own actions in performing the task safely, the RN who delegates retains accountability for the decision to delegate in the first place. The RN must be satisfied that the NA is competent and, most importantly, the RN remains accountable for the overall plan of care, which includes evaluating the outcomes of the delegated task. Supervision should be appropriate to the situation, not necessarily direct observation every time.
Question 5: A healthcare assistant (HCA) is asked by a registered nurse to change a complex surgical dressing, a task for which they have not been trained. The HCA feels it is outside their level of competence. What is the HCA's most accountable action?
- Politely decline the task and clearly explain that they are not trained or competent to perform it. (Correct answer)
- Attempt the dressing change carefully using the patient's notes as a guide to be helpful.
- Ask another, more experienced HCA to perform the task instead.
- Perform the task but immediately report the nurse for inappropriate delegation afterwards.
Correct answer: Politely decline the task and clearly explain that they are not trained or competent to perform it.
Every healthcare professional, including HCAs, is accountable for working within their own level of competence. The most accountable and safest action is to refuse the task and clearly state the reason. This protects the patient from harm and upholds the HCA's own professional responsibility. Attempting a task beyond one's competence is unsafe.
Question 6: When a registered nurse delegates a task, they must ensure 'right direction and communication'. Which of the following best exemplifies this principle?
- Telling the healthcare assistant to 'sort out' the patient in bed 3.
- Assuming the student nurse has read the patient's care plan and knows what to do.
- Providing clear, concise instructions, including the specific task, expected outcome, and when to report back. (Correct answer)
- Writing a brief note in the handover sheet for the next shift to follow up on the task.
Correct answer: Providing clear, concise instructions, including the specific task, expected outcome, and when to report back.
Right direction and communication involves providing clear, concise, correct, and complete instructions. This includes specifying the task, the patient, any limitations, the expected outcome, and the lines of communication for reporting back or seeking help. The other options are vague, rely on assumptions, or do not provide direct communication to the person being delegated to, which can lead to errors and compromise patient safety.
NMC - Nursing Midwifery Council Professional Accountability and Delegation Questions and Answers 1
Which of the following statements most accurately describes the principle of professional accountability as defined by the NMC Code?