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

Yes. Vermont lets RNs and LPNs delegate nursing tasks to qualified unlicensed staff using the national five rights of delegation, and its Board recognizes delegation in settings like group homes where nurses are not on site. The rules do not say whether home care aides can be delegated medication administration or insulin. Vermont's medication nursing assistants work under on-site supervision in facilities and cannot give insulin. Attendants in attendant care programs are exempt from the nursing law.

What conditions apply?

• RNs and LPNs may delegate nursing interventions; a licensee must not delegate to someone not qualified by training, experience, education or credentials
• Nurses must apply the NCSBN/ANA five rights of delegation: right task, circumstance (stable patient), person, direction and communication, and supervision and evaluation
• Assessment, care planning and evaluation of care cannot be delegated to unlicensed staff
• The Board's position statement recognizes delegation in settings where nurses cannot supervise on site; there the nurse may limit their role to teaching the task and validating competence, and should communicate that limit to others involved
• Medication nursing assistants (MNAs) are supervised on site on the unit and give oral, inhaled, topical, drop and suppository medications to residents; they may not give injections, insulin or tube feedings

Is there an exception for self-directed care?

The Nurse Practice Act does not prohibit the work and duties of attendants in attendant care services programs, or care of the sick by domestic help employed primarily in a domestic capacity.

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?

Confirm with the Vermont Board of Nursing before delegating medication tasks to home care aides.