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

Yes. Texas lets an RN delegate many nursing tasks to unlicensed caregivers in a client's home when the client's condition is stable and predictable. Delegable tasks include oral and tube-fed medications, wound care, catheter care and insulin injections. Insulin has extra rules: written client acknowledgment, caregiver teaching and at least three RN supervisory visits in the first 60 days. Some tasks can be treated as health maintenance activities that need no delegation at all.

What conditions apply?

• Applies to clients with stable and predictable conditions in independent living environments such as the client's home
• RN assesses the client first and decides whether the task is an ADL or health maintenance activity (no delegation needed), can be delegated, or must be done by a nurse
• Delegable medication routes include oral, via permanent feeding tube, topical, eye/ear/nose drops, suppositories, inhaled unit doses and oxygen
• Insulin and other diabetes injectables may be delegated: the client or responsible adult must acknowledge in writing, the RN teaches the caregiver (including checking blood sugar before each dose) and leaves written instructions
• For insulin, the RN makes at least three supervisory visits in the first 60 days for each caregiver and must be on call 24 hours a day
• Delegation is specific to one client and cannot be transferred to other clients

Is there an exception for self-directed care?

Under 22 TAC 225.6, the RN may decide a task is an activity of daily living or a health maintenance activity that needs no delegation, weighing whether the client or a responsible adult can direct the unlicensed person.

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.