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

Yes. Washington has one of the broadest nurse delegation programs. An RN can delegate medication administration, including insulin injections, and other nursing tasks to certified home care aides and nursing assistants in a client's home. The aide needs core delegation training, the client must consent, and the RN must supervise at least every 90 days.

What conditions apply?

• Only in community-based or in-home care settings, for a client whose condition is stable and predictable
• Caregiver must be a registered or certified nursing assistant or a certified home care aide
• Caregiver must complete basic caregiver training and core nurse delegation training before any delegated task; insulin also requires the diabetes special focus training
• Written client consent at the first use of delegation (verbal consent allowed if written follows within 30 days)
• RN gives written, client-specific instructions and verifies competence
• RN supervises and reevaluates at least every 90 days; for insulin, at least every two weeks for the first four weeks
• No injections other than insulin, no sterile procedures, no central line maintenance

Is there an exception for self-directed care?

Under RCW 74.39.050, an adult with a functional disability living at home may direct a paid personal aide to perform health care tasks without nurse delegation, after telling the ordering provider they will self-direct.

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.