Standard 1: Understand your role

Amara Nadia, I want to start with something that sounds obvious. What is my role? Because when I asked three care workers that this week, all three of them gave me a list of tasks.

Nadia And that is exactly the problem. Washing, dressing, meals, medication prompts. All true, and all beside the point. A role in care is not a list of tasks. It is a boundary.

Amara Go on.

Nadia Inside that boundary you are trained, supported, insured and accountable. Four things. Step outside it and you lose all four at once. And here is the part people forget: so does the person you are caring for. Your protection and theirs are the same protection.

Amara So where is the boundary written down? Because nobody hands you a map on day one.

Nadia Three documents, and they are not the same thing, which is where the confusion starts. Your contract of employment is the legal relationship between you and your employer. Your job description is what you were hired to do. And your agreed ways of working, which is your service's phrase for policies and procedures, tells you how.

Amara Which one do people actually breach?

Nadia The third one, nine times out of ten. When an inspector says a worker went beyond their role, they very rarely mean somebody did surgery in the lounge. They mean somebody did a task the right way for a different service, or the way they were taught in a different country, and not the way this service has agreed and written down.

Amara And above all of that, presumably, sits the law.

Nadia It does. The Care Quality Commission registers and inspects services in England against fundamental standards written into the Health and Social Care Act 2008 Regulated Activities Regulations 2014. I want you to hear the word floor there. Those standards are a floor, not a target. The Care Act 2014 gives local authorities their duties around wellbeing and safeguarding. And Skills for Care sets the workforce standards, including this Care Certificate.

Amara Now can I ask you about the bit I think is genuinely hard? Everybody says keep professional boundaries. But you are in somebody's home, you know their grandchildren's names, you have seen them cry. It does not feel like a transaction.

Nadia No, and it should not. Good care is warm. That is precisely why this line gets crossed by kind people with entirely good intentions, rather than by bad ones.

Amara So how do I know when I have crossed it? In the moment, on a shift, not in a classroom.

Nadia Use a two part test. Would you write it in the record? And would you be relaxed if your manager read it back to you? Accepting a cup of tea passes. Accepting a hundred pounds does not. A lift in your own car that is not in the care plan does not. A friend request does not.

Amara That is a useful test. Is there a pattern in where it goes wrong?

Nadia Five things, and it is nearly always one of them. Gifts. Money. Keys. Lifts. Social media. Add lending or borrowing and you have the complete set. Every one of those has a policy in your service, and I would find yours this week rather than the week you need it.

Amara Right. Last thing, and this is the one I would panic about. Somebody asks me to do something that is not my job. A dressing, say. What do I actually say?

Nadia Not that is not my job. That is a terrible answer, because the person still has a sore leg after you have said it.

Amara So what instead?

Nadia Three moves. Acknowledge the need. State the limit in one plain sentence, no jargon. Then commit to a specific next action with a time attached. Like this. I can see that is sore. Dressings are the district nurse's job rather than mine, so I am going to ring them now, and I will tell you what they say before I leave.

Amara That is not a refusal at all, is it.

Nadia It is a referral. And it is probably the most professional thing you will do this week. New workers come to harm far more often by agreeing to something they should have declined than by declining something they should have done.

Amara One more. What if a colleague tells me it is fine, they do it all the time?

Nadia Then it is still not delegated. A clinical task is only delegated when the registered professional accountable for it has delegated it to you personally, you have been trained and assessed on that specific task, and it is recorded in the care plan. Reassurance from a colleague in a corridor is not delegation. It is just a colleague in a corridor.