Nursing Delegation
What Is Nursing Delegation?
Nurse delegation is a Washington State-approved program that allows a Registered Nurse (RN) to assign specific nursing tasks to a qualified caregiver. This means a caregiver, such as a certified nursing assistant (CNA), home care aide (HCA), or nursing assistant-registered (NAR), may be trained and authorized by a licensed RN to perform tasks that would normally require a nurse’s license. This system helps clients remain in Adult Family Homes (AFHs), Assisted Living Facilities (ALFs), or private homes, rather than moving into more expensive nursing homes, while still receiving essential nursing care.
When Is Delegation Required?
Delegation is required when:
- A caregiver is responsible for administering medications, either over-the-counter or prescription, by mouth, injection, through the skin, or other routes.
- A caregiver must perform a medical procedure, such as insulin injection, wound care, or tube feeding.
- A client is able to physically take medication themselves but lacks the cognitive ability to understand what they are taking.
- A licensed professional determines the client is medically frail or cognitively impaired, and medication administration must be closely supervised. Washington State WAC 246-840-910 through 920 outlines these rules to protect individuals who may not fully understand their medications or require help to take them safely.
Delegation cannot be provided unless there is a signed physician’s order for each task or medication.
Provided by Erika Stardig, RN • Oregon RN License #201905520RN ·
Washington RN License #RN.RN.61199822.MSL · NPI #1073202396
Nurse delegation occurs in a community setting.
Community settings include;
- Certified community residential programs for the developmentally disabled,
- Licensed Adult Family Homes, licensed boarding homes, Licensed Assisted Living Facilities or In the client’s home period
Family members are not required to have nursing delegation. Many family members choose to have medication education; however, this is not called delegation. It is a great way to learn about your loved one’s care and keep them safe, however again not a state rule.
There are 4 tasks that CANNOT be delegated at this current time:
- Injections other than insulin
- Sterile procedures
- Maintenance of central lines
- Anything that requires nursing judgement/Assessment
In order to provide delegation in the State of Washington, a patient must be “stable and predictable” prior to receiving nurse delegation services. When a nurse arrives to perform delegation, they will do a brief head to toe assessment of the client. If the client has had any significant changes from their last full comprehensive nursing assessment on file, they will require a new nursing assessment prior to delegation. You will need to have signed physician orders for the medications and tasks you would like to be delegated.
Who Can Be Delegated?
Not every caregiver qualifies to receive delegation.
Caregivers must:
- Be actively certified as an HCA, CNA, HCA-C, or NAR.
- Have a current and unrestricted license.
- Complete the 9-hour Nurse Delegation Course and have the certificate on file. If delegated to give insulin, complete an additional 3-hour Diabetes Delegation Course.
- Complete at least 40 hours of the required training for NAR and 75 hours training for HCA, unless they are legally exempt with proof.
Only a Registered Nurse (RN) who is officially trained and approved as a delegating nurse may provide delegation. LPNs (Licensed Practical Nurses) and non-delegating RNs cannot authorize these tasks.
Contact Us: www.stardignursingservices.com
503-680-7709 • Info@stardignursingservices.com
What Tasks Can Be Delegated?
Tasks that CAN be delegated include:
- Giving medications (oral, topical, eye drops, inhalers, nasal spray, suppositories)
- Blood sugar monitoring and insulin administration
- Wound dressing and simple skin treatments
- Tube feeding (G-tube or J-tube)
- Hospice comfort kit administration
- Straight catheterization (with training)
- Established Ostomy
Tasks that CANNOT be delegated include:
- Injections (except for insulin)
- Sterile procedures
- Central line care
- Any task that requires ongoing nursing judgment, interpretation, or decision-making
The client must also be considered “stable and predictable” in their condition to qualify for delegation. Please ask your delegating nurse if you are unsure if something can/cannot be delegated.
How Often Are Nurse Visits Required?
We will see most clients every 30-90 days. Each client’s visit frequency is based on how complex their care is, how many caregivers are involved, and nursing judgement, and compliance of afh/agency. There could be a time where daily or weekly visits may be needed, however this is rare and not for extended periods.
Additional visits are required if any of the following occur:
- There is a new medication added.
- A new task needs to be delegated.
- A new caregiver begins working with the client.
- There is a change in the client’s condition, including hospitalization, hospice enrollment, or return from rehab.
- A caregiver is struggling to perform the task correctly or requests further training.
- The delegating RN identifies a safety concern or needs to reassess the client.
- Patient goes to hospital (same day notice required).
- In some cases, more frequent visits may be required based on clinical judgment, for example, newly delegated insulin or G-tube care.
Contact Us: www.stardignursingservices.com
503-680-7709 • Info@stardignursingservices.com
What Is the Nurse’s Role?
The delegating nurse’s job is to:
- Assess the client to determine if they are stable and delegation is appropriate.
- Train the caregiver on the specific task(s).
- Monitor and supervise the caregiver’s performance regularly. Reassess delegation anytime there is a change in client status or task.
Only the delegating RN may delegate and oversee these tasks. Other healthcare professionals (home health, hospice, or visiting nurses) may be involved in care, but they cannot override or replace the delegating nurse’s responsibility”
What is medication delegation?
Nurse Delegation helps to ensure patients who require nursing care to remain living in an AFH, ALF, or at home instead of being placed in a nursing home. Upon hospital discharge a patient without Nurse delegation and in need of care from a registered nurse (RN) daily, such as assistance with medications and/or medication management, wound care, tube feedings or insulin injections would need placement in a nursing home. By obtaining Nurse Delegation via a Registered Nurse delegator, the required tasks are to be able to be taught to caregivers in an AFH, ALF or families who take care of the patient. This enables increased patient independence and livability in the AFH or home setting. Currently Stardig Nursing Services, PLLC accepts patients on Medicaid for nurse delegation. If the patient is not part of any of these programs, then the service is a private pay service.
Why obtain Nursing delegation :
Nurse delegation is required when a patient needs a licensed caregiver to put medication in or on the patient’s body. In accordance with Washington State rule (WAC 246-840-910 to 920) delegation is required when a patient can put the medication in or on their own body, but they do not understand they are taking medication, including both over the counter and prescription medications. Additional circumstances where nurse delegation is needed includes when a person is suffering from cognitive impairment or is frail such that medication administration must occur. Washington law aims to protect older adults who may not have the mental awareness or functionality to know what medications they are taking. Written orders from the primary care provider for medication administration.
Delegation alleviates the need for extended stays in nursing homes or hospitals and can significantly reduce ones care costs
Delegation Requirements:
In order to provide nursing delegation, the caregiver must be licensed with the state as a nursing assistant or home health aides certified under chapter 18.88B RCW. Once teaching and delegation have been competently understood and return demonstrated to the nurse delegator the caregiver can then provide the necessary care for the delegated patient. This then alleviates the need for extended stays at a nursing home and can significantly reducing one’s care costs. It is important to note that not all nursing skills can be delegated.
Only a Registered Nurse can delegate a qualified caregiver. Furthermore, the nurse must be a delegating nurse and assume formal delegation responsibility for the client. For instance, a home health nurse who is an RN cannot delegate a caregiver if not the RN delegator. An LPN CANNOT delegate. Nursing delegation means an RN transfers the performance of a specific task for an individual client to a qualified Nursing Assistant working in a community setting.
Registered nurses delegating tasks are accountable to the Washington State Nursing Care Quality Assurance Commission. The registered nurse delegator and nursing assistant are accountable for their own individual actions in the delegation process. No person may coerce a registered nurse into compromising patient safety by requiring the registered nurse to delegate. Not all licensed caregivers qualify to be delegated to assist with these tasks. A caregiver must be a CNA, HCA, HCA-C, or NAR and have a current unrestricted license.
Diabetic Delegation:
Diabetic delegation will require a nurse to perform an initial comprehensive visit. If a client is getting caregivers delegated for insulin the visits will be a minimum of 4 supervised weekly visits for the first 4 weeks. Non diabetic delegation will require an initial visit and every 90 days reassessment or sooner as needed for change in status. If there are any changes in medications or client condition, then a visit will be made. If a new caregiver begins to work with the patient a visit will be made.