Caregiver Clinical Tasks Allowed Under WA Nurse Delegation

One of the most common questions we hear from AFH operators and caregivers is simple: what clinical tasks am I actually allowed to do?

The answer depends on Washington's nurse delegation law. In Washington, unlicensed caregivers can perform certain nursing tasks — but only when a registered nurse has delegated them for a specific patient, and only after the caregiver has been trained and shown competency.

Tasks that can be delegated

Under Washington's delegation framework, the following tasks are commonly delegated to caregivers in adult family homes and in-home care:

• Medication administration — oral, topical, eye/ear drops, and inhaled medications, including counting and charting them on the medication administration record (MAR)
• Blood glucose checks — monitoring and recording glucose levels
• Insulin administration — requires extra "Special Focus on Diabetes" training and a specific delegation
• G-tube feedings — tube feeding, flushing, and site care
• Wound care — routine dressing changes for wounds that have been assessed as stable
• Catheter care — emptying, cleaning, and routine care of urinary catheters
• Ostomy care — cleaning and changing ostomy appliances
• Respiratory support — tasks such as oxygen administration and nebulizer treatments, where appropriate

Each of these is delegated on a patient-by-patient basis. Delegation isn't a blanket license to perform a task for everyone — it's authorization for a specific caregiver to perform a specific task for a specific resident.

Tasks that cannot be delegated

There are important limits. Washington law generally prohibits delegation of:

• Injectable medications other than insulin
• IV medications and IV therapy
• Central line care
• Tasks that require nursing judgment about dosing or whether to give a medication at all
• Tube feedings into a newly placed tube or other tasks during an unstable period

When in doubt, the RN assessor makes the call. That assessment is exactly what happens during an adult family home assessment before a new resident moves in.

What must happen before a caregiver performs any delegated task

Delegation in Washington follows a strict sequence:

1. RN assessment of the patient — a registered nurse evaluates the resident's condition and care needs
2. Credential verification — the caregiver must hold an active Nursing Assistant Registered, Nursing Assistant Certified, or Home Care Aide credential, plus completed core delegation training
3. Task-specific training — the RN trains the caregiver on the exact task and patient
4. Return demonstration — the caregiver shows they can perform the task correctly
5. Written delegation — both parties sign the delegation documentation

Skipping any of these steps means the task isn't legally delegated — and a facility can be cited for it during a survey.

What this means for your facility

If you're an AFH owner, the practical takeaway is: your caregivers can do a lot, but nothing happens without an RN. That's where Seattle Nurse Delegation comes in. We verify credentials, train caregivers, complete the delegation documentation, and provide ongoing supervisory visits so you stay compliant.

If you need a caregiver trained and authorized for new tasks, learn more about new caregiver delegation. Want to understand the bigger picture? Start with RN Delegation Explained.