ABOUT NURSE DELEGATION

Nurse delegation is required when a patient needs a licensed caregiver to put medication in or on the patient’s body.  It is also required when a patient can put the medication in or on their own body, but they do not understand they are taking medication.  This is known as the Washington State rule (WAC 246-840-910 to 920).  This includes both over the counter and prescription medications.  

In instances where a medical professional deems that a person is suffering from cognitive impairment or is frail such that medication administration must occur, medications must be under nurse delegation. Washington law is written to protect older adults who may not have the mental capacity or physical functionality to know what medications they are taking or may not be able to consume the medication without assistance. This requires specific written orders from the primary care provider.  

Nurse Delegation enables an individual who requires nursing care to remain living in an AFH, ALF, or at home instead of being placed in a nursing home.  For example, an individual requires medical care from a registered nurse (RN) daily, such as assistance with medications and medication management, wound care, tube feedings or insulin injections. Previously, patients had the choice of moving into a nursing home or paying privately for daily visits from a registered nurse. Under the Nurse Delegation Program, a registered nurse teaches the appointed non-medically trained caregiver in the proper technique(s) for managing the patient.  

The caregiver must be licensed with the state as a nursing assistant.  Once competent at handling nurse delegated tasks, daily visits from a nurse or extended stays at a nursing home are no longer required, thereby 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.  They must have taken the 9-hour nurse delegation class and have a certificate.  If the client needs insulin, then the caregiver has to have an additional 3-hour certificate for diabetes training.  They must also have 40 hrs. completed of the 75 hr. basic training or be exempt from having this with proof.    

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 

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:

1.  Injections other than insulin

2.  Sterile procedures

3.  Maintenance of central lines

4.  Anything that requires nursing judgement/Assessment 

The State of Washington requires that a patient is “stable and predictable” prior to receiving nurse delegation services.  When an I Care 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, then they will need to have a new nursing assessment done prior to delegation.  You will need to have signed physician orders for the medications and tasks you would like to be delegated.   

An I Care nurse will perform an initial comprehensive visit.  If a client is getting caregivers delegated for insulin the visits will be a minimum of weekly for the first 4 weeks.  For other tasks the visits will be a minimum of the initial visit and every 90 days or sooner.  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.

Currently the only programs that pay for Nurse Delegation is Medicaid, Labor and Industries and The Veterans Association in special circumstances.  If the patient is not part of any of these programs then the service is a private pay service.