For a registered nurse, "delegation" isn't a single act — it's a discipline. In Washington's adult family home setting, the RN who oversees a facility is constantly deciding what to delegate, to whom, and how much oversight each task needs.
Three words capture that discipline: delegation, prioritization, and assignment.
Delegation: transferring a task, not the accountability
Delegation means an RN authorizes a caregiver to perform a specific nursing task for a specific patient. Critically, the RN remains accountable for the outcome even though the caregiver performs the task. That's why Washington law (WAC 246-840-910) doesn't let delegation happen casually.
Every delegation should pass the five rights:
- Right task — the task is appropriate to delegate for this patient
- Right circumstance — the patient is stable and the setting supports it
- Right person — the caregiver holds the proper credential and training
- Right direction and communication — clear instructions and documentation
- Right supervision — the RN monitors the caregiver, at minimum every 90 days
Prioritization: deciding what matters most
An RN walks into a facility with six residents and a dozen potential tasks. Prioritization is how they decide the order of what gets delegated and supervised:
- High-risk tasks first — insulin, medications with narrow margins, anything affecting airway or airway-adjacent care
- New or changed tasks — a medication that was just prescribed or adjusted
- Unstable patients — residents with recent changes in condition get more of the RN's direct attention
- Compliance deadlines — tasks tied to move-in or survey timelines
The pre-placement assessment is itself an act of prioritization: before a resident ever moves in, the RN determines which of their care needs are serious enough to require delegation.
Assignment: matching the task to the right caregiver
Assignment is where delegation becomes concrete. The RN assigns each delegated task to a specific caregiver — and the assignment should match the caregiver's credential, training, and demonstrated competency.
Not every caregiver gets every task. A caregiver certified for basic medication administration may not yet be delegated insulin. Someone new to the facility may carry a lighter assignment until they've demonstrated competency under supervision.
This individual, documented assignment is what makes delegation defensible. It's also why the paperwork matters: every delegation should be able to answer who is doing what, for which resident, since when, and under whose supervision.
What this looks like in practice
In a well-run adult family home, the RN delegator's work looks like:
- Initial setup — assess new residents and delegate the tasks their care requires
- Caregiver training — new caregiver delegation for staff as they're hired
- Medication changes — new medication delegation every time a prescription changes
- Quarterly oversight — 90-day supervisory visits to confirm everything is still safe and appropriate
- Annual review — a full assessment renewal to update the plan
When the RN, the caregivers, and the documentation all line up, delegation runs quietly in the background and residents get safe, consistent care. When it doesn't line up, that's when surveys find deficiencies.
At Seattle Nurse Delegation, we run this entire workflow for facilities across Washington. If you'd like to understand the foundation first, read RN Delegation Explained, or get in touch to set up delegation at your facility.