Nurses sound alarm over healthcare tasks being delegated to school teachers

A general practice nurse (GPN) is among those who have raised concerns around healthcare tasks being inappropriately delegated to school staff and non-health professionals.

East Lancashire GPN Temitope Babajide warned a room of nurses at this year’s Royal College of Nursing (RCN) Congress that any delegation must be done with ‘confidence’ and not because of ‘convenience’.

She was speaking during a matter for discussion which was focused on the delegation of healthcare tasks to school staff and non-healthcare professionals when she questioned: ‘Are we delegating competence or delegating risk?’

Ms Babajide, a former school nurse, said: ‘[Delegation] should never be a way of filling gaps created because of workplace shortages, and it should never be putting school staff at risk.

‘In the school, you see teachers dealing with issues, you see classroom assistants supporting children with the use of inhalers – this is a difficult position to put school staff that are not trained in.

Related Article: Report highlights impact of nature-based projects led by community nurses

‘They are not clinically competent to be able to monitor… to be able to support. If anything goes wrong, when delegation goes wrong, everybody asks who is responsible.

‘This discussion is not really about tasks, it’s about trust, it’s about ethical behaviour, it’s about accountability, and ultimately, it’s about protecting both the person receiving care, who could be a child, a teenager, and the person being asked to provide it.

‘Let’s make sure we are delegating with confidence, not convenience.’

Other members of congress also highlighted concerns around professional risk, workload, and liability.

They emphasised the need for proper training, competency assessments, and supervision.

RCN Diabetes Forum member Nicky Dawson raised issues with inappropriate delegation in diabetes care, stating it has become increasingly common within education and community settings.

She said: ‘School staff are now expected to support highly complex clinical care, including insulin administration, carbohydrate counting, interpreting glucose monitors and data, and managing hybrid closed loop settings.

‘These are not simple tasks, these are medical interventions that require careful judgement and quick decision making, and if mistakes are made, the consequences can be serious and potentially life-threatening.’

Related Article: MenB jab uptake in babies increases but ‘significant’ variation for MMRV, early data shows

RCN student committee vice chair Ben White and Cardiff and Vale branch nurse Malcolm Chalk discussed the ‘exploitation’ of unregistered staff.

Mr White said: ‘I remember one of my people in my cohort being given a caseload of 12 patients on her first day of being a first-year nurse on her first placement.

‘I remember also people being asked to do skills that they’re not insured to do or trained to do, obviously risking patient lives.

‘Inappropriate delegation can also be that we’re not giving students learning opportunities to be able to develop.’

Mr Chalk added: ‘Many areas within healthcare are being exploited by health boards and trusts by undermining registered nurses by using unregistered staff to carry out nursing tasks.

Related Article: Hundreds of new nurses and midwives not offered NHS roles due to lack of vacancies

‘A small and unusual example of many inappropriate delegations within healthcare settings is within the immunisation service, where the legacy of the emergency Covid pandemic lingers on, and the use of unregistered staff are still being used to draw up and vaccinate service users.’

The consensus was that delegation should enhance, not replace nursing care, and that proper guidelines are essential to protect both professionals and patients.

This was one of several debates which took place in Liverpool this week, with nurses voting for RCN council to act upon attempts to ‘undermine’ advanced nursing practice, to tackle misinformation, protect nursing education, and create a programme to help build the confidence of nursing staff in addressing racism.