Background: Changing models of healthcare have resulted in the need for registered nurses to be competent in delegating and supervising the unregistered health care assistant. However research evidence suggests nurse education does not prepare students for the practicalities of this role.Objectives: This paper reports on undergraduate student nurses' level of preparation when working with health care assistants (HCA). It is part of a large scale project, undertaken between 2005 and 2011, which explored pre-registration student nurses' perceptions of the role of the HCA and how this affects their clinical learning.Design: A sequential transformative mixed method research design was adopted.Setting: One higher educational institution in the United Kingdom.Participants: Forty-five pre-registration nursing students took part in phase one and 662 participated in phase two.Methods: Phase one used focus groups (n=32) and interviews (n=13) and phase two used a semi-structured questionnaire.Results:Whilst most students reported that they were familiar with the role of the health care assistant, findings showed that nurse training did not initially prepare students for the realities of clinical practice, however as students progressed they became more aware of such issues. For some such skills were learnt on the job and they identified a number of barriers they faced when delegating tasks such as fear of causing conflict. Overall the lack of initial preparation was perceived by participants to be a hindrance to meeting the goals of clinical learning and to understanding the dynamics within the nursing hierarchy.Conclusions: Students in this study highlighted gaps in their educational programme and clinical experiences regarding their preparation for a delegatory and/or supervisory role. Given the importance of such skills, it is imperative that universities provide pre-registration student nurses with the education necessary to develop delegation strategies and to adapt to their evolving professional role.