Frequently Asked Questions

What is nurse delegation?

Nurse delegation is the process by which a registered nurse (RN) authorizes a nursing assistant or home care aide to perform specific nursing tasks that would normally require a nursing license. Under Washington State law (WAC 246-840), this allows qualified caregivers to provide medication administration and other care tasks under RN oversight in community-based and in-home settings.

The purpose of nurse delegation is to enable patients to live more independently in community settings—such as adult family homes, assisted living facilities, or their own residences—rather than requiring placement in skilled nursing facilities. When properly implemented, delegation extends the reach of nursing care while maintaining patient safety through ongoing RN oversight.

The National Council of State Boards of Nursing (NCSBN) provides national guidance on delegation principles that inform Washington State's regulatory framework.

Who can delegate nursing tasks in Washington State?

Only registered nurses (RNs) licensed in Washington State can delegate nursing tasks. Key requirements for the delegating RN include:

• Active, unrestricted Washington State RN license
• Knowledge and experience in the specific tasks being delegated
• Understanding of WAC 246-840 requirements
• Willingness to maintain ongoing oversight and accountability

Important: Licensed practical nurses (LPNs) cannot delegate nursing tasks under Washington State law. Only RNs have the authority to delegate. You can verify any nurse's license through the Washington State Department of Health Provider Credential Search.

Who can receive nurse delegation?

Nursing assistants (NA-R or NA-C) and home care aides (HCA) who have completed core delegation training through a DSHS-approved provider can receive delegation. Requirements include:

• Current registration or certification in Washington State without restriction
• Completion of core delegation training (through DSHS-approved provider)
• For insulin delegation: Special Focus on Diabetes training
• Demonstrated competency in specific tasks being delegated

The delegating RN must verify caregiver credentials and training before delegation. Caregivers must also demonstrate competency in each specific task through return demonstration as part of the delegation process.

What tasks can be delegated to caregivers?

Common delegated tasks in Washington State include:

Medication Administration

• Oral medications (tablets, capsules, liquids)
• Topical medications (creams, ointments, patches)
• Eye drops and ointments (ophthalmic)
• Ear drops (otic)
• Nasal sprays and drops
• Inhalers and nebulizers
• Rectal and vaginal suppositories
• Insulin injections (with Special Focus on Diabetes training)

Clinical Tasks

• G-tube feedings and basic tube care
• Simple wound care and dressing changes
• Ostomy care
• Urinary catheter care
• Bowel programs and digital stimulation
• Oral and tracheal suctioning
• Cough-assist machine operation

The delegating RN determines which specific tasks can be safely delegated for each patient based on their assessment.

What nursing tasks cannot be delegated?

Per WAC 246-840-910, the following cannot be delegated:

• Injections other than insulin (IM, subcutaneous, IV)
• Sterile procedures
• Central line maintenance and care
• Any task requiring nursing judgment
• Nursing assessment and care planning
• Evaluation of patient outcomes
• Tasks for patients who are not stable and predictable

If a patient requires tasks that cannot be delegated, alternative care arrangements—such as home health nursing or skilled nursing facility placement—may be needed.

What training is required before receiving delegation?

Before receiving delegation, caregivers must complete several training requirements:

Basic Caregiver Training

• Home Care Aides: 75 hours of basic training
• Nursing Assistants: NA-R or NA-C training and certification

Core Delegation Training

All caregivers must complete core delegation training through a DSHS-approved provider. This training covers the legal framework for delegation, scope and limitations, communication with the delegating nurse, documentation requirements, and when to contact the RN.

Special Focus on Diabetes (for Insulin Delegation)

Caregivers administering insulin must complete additional diabetes-focused training covering diabetes disease process, blood glucose monitoring, insulin types and administration, and hypoglycemia/hyperglycemia recognition. The American Diabetes Association provides resources for diabetes education.

Task-Specific Training

For each delegated task, the RN delegator provides hands-on training including demonstration, return demonstration, written protocols, and competency verification.

Where can I get delegation training?

Core delegation training and diabetes-focused training are available through DSHS-approved training providers. You can find approved providers through the DSHS Training website. Training is available both in-person and online through various providers throughout Washington State.

Contact us if you need recommendations for local training options in your area. We work with many facilities throughout the Seattle metropolitan area and can suggest convenient training resources.

How does the delegation process work?

The nurse delegation process follows a systematic approach to ensure safety and compliance:

1. Initial Contact and Scheduling

Contact us to discuss your needs. We'll gather information about your facility, patients requiring delegation, and caregiver credentials, then schedule an on-site visit.

2. Patient Assessment

Our RN delegator conducts a comprehensive assessment of each patient, including medical history review, current condition evaluation, medication review, and determination of stability/predictability.

3. Caregiver Verification and Training

We verify caregiver credentials and training status, then provide task-specific training for each delegated task. Training includes demonstration, return demonstration, and competency verification.

4. Documentation

We complete all required documentation including informed consent, delegation records, medication/task protocols, and training verification.

5. Ongoing Oversight

Reassessments are conducted at least every 90 days, with additional visits as needed for changes in condition, medications, or caregivers.

How long does the delegation process take?

Initial delegation typically takes 1-2 hours per patient, including assessment, training, and documentation. The timeline from first contact to completing delegation is usually 1-2 weeks, depending on:

• Our current scheduling availability
• Caregiver training status (core delegation training must be completed first)
• Complexity of care needs
• Number of patients requiring delegation

For urgent situations—such as a new resident requiring immediate medication administration—we offer expedited scheduling when possible. Contact us to discuss your timeline.

How often must patients be reassessed?

Per WAC requirements, patients must be reassessed at least every 90 days. However, reassessment is also required when:

• There are changes in patient condition
• Medications are added, changed, or discontinued
• New caregivers need to receive delegation
• The RN determines more frequent oversight is needed

The RN delegator may determine that more frequent reassessment is appropriate based on the patient's stability and care complexity. We schedule reassessments proactively to ensure continuous compliance.

What documentation is required for nurse delegation?

Required documentation includes:

• Patient Assessment: Comprehensive assessment documenting patient condition, stability, and appropriateness for delegation
• Informed Consent: Signed consent from patient or legal representative acknowledging delegation
• Delegation Record: Specific documentation of which tasks are delegated to which caregivers
• Caregiver Training Verification: Documentation that caregivers have completed required training and demonstrated competency
• Protocols: Written step-by-step protocols for each delegated task
• Reassessment Records: Documentation of ongoing reassessments and any changes

All documentation must be maintained at the facility and available for state surveys. Our documentation system is designed to meet all WAC requirements while being organized for easy reference.

What does "stable and predictable" mean for delegation?

A patient is considered "stable and predictable" when:

• Their condition is consistent and expected
• They respond predictably to care interventions
• No significant changes in condition are anticipated
• Emergency nursing intervention is unlikely to be needed

The delegating RN makes this determination during the patient assessment. If a patient is not stable and predictable—for example, if their condition is rapidly changing or requires frequent nursing judgment—delegation may not be appropriate.

The Centers for Medicare & Medicaid Services (CMS) provides guidance on patient assessment that informs our evaluation process.

How much do nurse delegation services cost?

Our fees vary based on the type and complexity of services needed. Factors that affect pricing include:

• Number of patients requiring delegation
• Types of delegated tasks (standard medication vs. insulin vs. specialized care)
• Number of caregivers requiring training
• Frequency of reassessments required
• Location within our service area

We provide transparent pricing with no hidden fees. Contact us for a personalized quote based on your specific situation. We'll provide clear information about initial delegation costs and ongoing reassessment fees.

Does insurance cover nurse delegation services?

Nurse delegation services are typically a business expense for care facilities rather than a healthcare service covered by patient insurance. However, coverage varies by situation:

• Facility Expense: Most adult family homes and assisted living facilities treat delegation fees as an operational cost
• Private Pay: For private in-home care, families may pay directly for delegation services
• Medicaid Waivers: Some Medicaid waiver programs may include provisions for delegation services—check with your case manager

Contact us to discuss your specific situation and payment options.

What happens if there's a problem with a delegated task?

If issues arise with delegated tasks, the caregiver should:

1. Stop the task if patient safety is at risk
2. Provide any necessary immediate care within their scope
3. Contact the delegating RN as soon as possible
4. Document the situation

We provide clear protocols for when caregivers should contact the RN, including signs and symptoms that require immediate notification. Our team is available for consultation and support between scheduled visits.

Can delegation be revoked?

Yes, delegation can be revoked at any time by the delegating RN if:

• The patient's condition changes and they are no longer stable/predictable
• The caregiver demonstrates inability to safely perform delegated tasks
• Safety concerns arise
• The patient or representative withdraws consent

If delegation is revoked, alternative care arrangements must be made for tasks that were previously delegated.