If you run an adult family home, assisted living facility, or in-home care agency in Washington State, the term "nurse delegation" comes up constantly — during licensing, during state surveys, and every time a caregiver needs to give a resident a medication. But what does it actually mean?
In short, nurse delegation is the legal process by which a registered nurse (RN) authorizes an unlicensed caregiver to perform specific nursing tasks for a specific patient. In Washington, that process is governed by WAC 246-840-910 and the state's delegation laws.
Why Washington State requires delegation
Washington is one of the few states where certain clinical tasks — including medication administration — can be performed by unlicensed caregivers. But the state only allows it under strict conditions: a licensed RN must first assess the patient, determine that delegation is safe, train the caregiver, and then provide ongoing supervision.
The requirement exists to protect residents. A caregiver may be excellent at daily support, but safely giving insulin or managing a feeding tube requires clinical judgment. Delegation puts a registered nurse in charge of that judgment while letting caregivers do the day-to-day work.
What delegation actually involves
Every delegation in Washington follows the same basic structure:
- Patient assessment — Before any task is delegated, the RN evaluates the resident's health status, medication regimen, and care needs. This is exactly what our adult family home assessment covers for new residents.
- Task selection — The RN determines which specific tasks are appropriate to delegate to a caregiver for that particular patient.
- Training — The caregiver receives task-specific training and must demonstrate competency through a return demonstration.
- Delegation authorization — Both the RN and the caregiver sign the delegation documentation.
- Ongoing supervision — The RN provides regular supervisory visits, at minimum every 90 days, to monitor safety.
What can be delegated?
Common delegated tasks in adult family homes and in-home care include:
- Medication administration (oral, topical, inhaled)
- Blood glucose monitoring and insulin administration
- G-tube feedings
- Wound care
- Catheter care
- Ostomy care
Not everything can be delegated. Injections other than insulin, IV medications, and tasks requiring ongoing nursing judgment generally cannot be delegated to unlicensed caregivers. We cover the full list in Caregiver Clinical Tasks Allowed Under WA Nurse Delegation.
The RN's ongoing role
Delegation isn't a one-time event. Once tasks are delegated, the RN is legally responsible for supervising how they're performed. That means:
- 90-day supervisory visits to observe caregivers, review documentation, and reassess patient stability
- Care plan review to make sure delegated tasks still match the resident's needs
- Reassessment when a patient's condition changes
- Annual assessment renewal to evaluate overall health status
This ongoing oversight is what separates professional delegation from simply "teaching someone to give pills." It's why facilities that work with a dedicated RN delegator rarely run into survey deficiencies related to delegation.
Who benefits from working with an RN delegator
- AFH operators get compliant delegation documentation without hiring a full-time nurse
- Caregivers get clear, task-specific training and legal authorization to do their jobs
- Families get the peace of mind that a registered nurse is overseeing their loved one's care
At Seattle Nurse Delegation, we handle the entire workflow — from the pre-placement assessment through caregiver training, medication delegation, and quarterly oversight. If you're ready to get set up, learn more about new caregiver delegation or give us a call.