Nurse Delegation Information for Caregivers

Are you a nursing assistant or home care aide interested in receiving nurse delegation? Understanding the delegation process helps you provide better care for the patients and residents you serve. This page explains what nurse delegation is, how it works, and what you need to know to receive delegation in Washington State.

What is Nurse Delegation?

Nurse delegation is a legal process in Washington State where a registered nurse (RN) authorizes qualified caregivers to perform certain nursing tasks. Under WAC 246-840, RNs can delegate tasks like medication administration to nursing assistants and home care aides who have completed proper training.

Without delegation, only licensed nurses can administer medications or perform clinical tasks. Delegation enables you to legally help patients with these needs while the RN maintains oversight and responsibility for the care.

Who Can Receive Delegation?

In Washington State, the following caregivers can receive nurse delegation:

• Nursing Assistant - Registered (NA-R): Entry-level nursing assistant credential
• Nursing Assistant - Certified (NA-C): Certified nursing assistant who has passed the state exam
• Home Care Aide (HCA): Caregivers certified to provide in-home care services

You must have an active, unrestricted credential with the Washington State Department of Health to receive delegation.

Training Requirements

Before you can receive nurse delegation, you must complete specific training:

1. Core Delegation Training (Required)

All caregivers must complete Core Delegation Training through a DSHS-approved training provider. This training covers:

• The legal framework for nurse delegation in Washington
• Your role and responsibilities as a delegatee
• When and how to communicate with the delegating RN
• Documentation requirements
• What to do if something goes wrong

Core delegation training is typically 7 hours and available both online and in-person.

2. Special Focus on Diabetes (For Insulin Delegation)

If you'll be administering insulin, you need additional diabetes-focused training that covers:

• Understanding diabetes and blood glucose
• Types of insulin and how they work
• Proper injection technique
• Blood glucose monitoring
• Recognizing and responding to hypoglycemia and hyperglycemia

3. Task-Specific Training (Provided by the RN)

For each patient and task, the delegating RN provides specific training on:

• The patient's specific medications and administration schedule
• Proper technique for each delegated task
• Signs and symptoms to watch for and report
• Documentation requirements
• When to contact the RN or emergency services

What Tasks Can Be Delegated to You?

Depending on your training and the patient's needs, you may receive delegation for:

• Medication Administration: Oral medications (pills, liquids), topical medications (creams, patches), eye drops, ear drops, nasal sprays, inhalers, suppositories
• Insulin Injections: With proper diabetes training
• G-tube Feedings: Tube feeding administration and basic tube care
• Wound Care: Simple dressing changes and skin care
• Catheter Care: Routine catheter care and hygiene
• Bowel Programs: Digital stimulation and scheduled bowel care
• Respiratory Care: Suctioning and cough-assist devices

Your Responsibilities as a Delegatee

When you accept delegation, you're taking on important responsibilities:

• Follow the Delegation: Only perform tasks exactly as delegated—no more, no less
• Document Accurately: Record every medication administration or task as instructed
• Report Problems: Contact the RN if you observe changes or have concerns
• Know Your Limits: Never perform tasks you haven't been trained and delegated to do
• Ask Questions: If you're unsure about anything, ask the RN before proceeding
• Maintain Competency: Keep your skills current and participate in reassessments

What to Expect During Delegation

When you receive delegation from Seattle Nurse Delegation, here's what happens:

1. Credential Verification: The RN confirms your NA or HCA credential is active and unrestricted
2. Training Verification: The RN confirms you've completed core delegation training
3. Patient-Specific Training: The RN teaches you about the specific patient's needs and medications
4. Demonstration: The RN demonstrates each task you'll be performing
5. Return Demonstration: You demonstrate the tasks back to the RN
6. Competency Verification: The RN verifies you can perform tasks safely and correctly
7. Documentation: Both you and the RN sign delegation documents
8. Ongoing Support: The RN remains available for questions and conducts regular reassessments