Can a nurse delegate tasks to home care caregivers in Montana?

Yes. Montana lets licensed nurses delegate low-risk, predictable nursing tasks to trained assistive personnel after personally assessing the patient, under the Board's delegation rules. The Board's old rule listing which medication tasks could be delegated has been repealed, so current rules do not say whether medication administration or insulin can be delegated. Separately, a person with a disability can direct a personal assistant to give medications and do other health maintenance tasks at home without nurse delegation.

What conditions apply?

• Delegation must be based on the patient's own nurse personally assessing the patient
• The assistive person must have the education and demonstrated competency for the task, and the task must fit their job description
• Results must be reasonably predictable, the task must pose minimal risk and follow clear, exact directions, and it cannot require clinical reasoning or nursing judgment
• The nurse supervises, evaluates, follows up on problems and documents; assessment, nursing diagnosis, care planning, evaluation, taking verbal orders and patient teaching cannot be delegated
• The Board's former rule listing medication tasks that may be delegated (ARM 24.159.1616) has been repealed

Is there an exception for self-directed care?

The Nurse Practice Act does not apply to a personal assistant performing health maintenance activities (including administration of medications, bowel and urinary care, and wound care) at the direction of a person with a disability, when a health care professional believes the person could do them if physically able and they can be done safely at home. It also exempts gratuitous family care and trained individuals giving nutrition and prescribed medications through a G- or J-tube outside skilled facilities.

What is the difference between medication reminders and administration?

Reminding a client to take their medicine, or handing them a container they open themselves, is usually treated as assistance. Giving the medicine, such as placing pills in the mouth, giving an injection or crushing tablets, is administration and generally needs a license or nurse delegation. Check your state's rule and the client's care plan.

What should you confirm with the state?

Montana's current delegation rules do not address medications directly; confirm with the Montana Board of Nursing.