Washington State Nurse Delegation Regulations

Nurse delegation in Washington State is governed by Washington Administrative Code (WAC) Chapter 246-840, Sections 910 through 970. These WAC nurse delegation regulations establish the legal framework that allows registered nurses to delegate specific nursing tasks to trained caregivers in community-based settings. Understanding these regulations is essential for adult family home owners, assisted living administrators, and anyone involved in delegated care.

Overview of WAC 246-840 Nurse Delegation Requirements

The Washington State Department of Health developed these regulations to expand access to nursing care while maintaining patient safety. Under the WAC 246-840 delegation framework, registered nurses can delegate certain nursing tasks to nursing assistants and home care aides who have received appropriate training and demonstrated competency.

The delegation process is not simply assigning tasks—it requires careful assessment, structured training, ongoing supervision, and thorough documentation. The delegating RN retains accountability for the appropriateness of the delegation decision, while the caregiver performing the task is accountable for their own actions within the scope of the delegation.

Key WAC Sections Explained

WAC 246-840-910: Purpose and Scope

This foundational section defines the purpose of nurse delegation rules and establishes that delegation is permitted to expand access to nursing care in community settings. According to the Washington State Department of Health, the rules apply specifically to delegation from RNs to nursing assistants and home care aides in non-institutional settings.

The section explicitly states that delegation is intended to benefit patients who require nursing tasks but whose conditions are stable and predictable. This stability requirement is central to all delegation decisions—if a patient's condition is volatile or unpredictable, delegation may not be appropriate.

WAC 246-840-920: Definitions

Understanding the regulatory definitions is critical for compliance. Key terms include:

• Complex task: A nursing task that requires training beyond basic caregiver skills, including tasks that involve potential for harm if performed incorrectly
• Direct supervision: The RN is physically present and immediately available to observe and direct the caregiver
• Indirect supervision: The RN is available by phone and makes periodic on-site visits but is not continuously present
• Nursing assistant: An individual certified or registered under chapter 18.88A RCW who provides delegated nursing care
• Stable and predictable: The patient's clinical condition is not expected to change significantly and care needs can be anticipated

WAC 246-840-930: Criteria for Delegation

This section outlines the structured approach RN delegators must follow when evaluating whether to delegate. The ASSESS, PLAN, IMPLEMENT, EVALUATE framework requires the RN to:

Assess: Evaluate the patient's health status, stability, and predictability of care needs. Determine whether the task can be safely delegated based on the specific patient circumstances. The National Council of State Boards of Nursing (NCSBN) provides additional guidance on delegation assessment principles.

Plan: Develop written delegation instructions specific to the patient, including step-by-step procedures, parameters for when to contact the RN, and emergency protocols.

Implement: Provide training to the caregiver on the specific task for the specific patient. Verify competency through return demonstration before the caregiver performs the task independently.

Evaluate: Monitor the delegation through ongoing supervision, periodic patient assessments, and regular competency verification. Modify or discontinue delegation if circumstances change.

WAC 246-840-940: Nursing Task Delegation Requirements

This section specifies the procedural requirements for delegating specific nursing tasks. Requirements include:

• Written delegation instructions for each patient and each task
• Patient-specific training that addresses the individual's unique needs and circumstances
• Competency verification documented through skills checklists and return demonstrations
• Clear parameters for when the caregiver must contact the RN
• Emergency protocols and contact information
• Documentation of all training, competency verification, and supervision activities

WAC 246-840-970: Accountability and Responsibility

This critical section defines the accountability of each party in the delegation process:

RN Accountability: The delegating registered nurse is accountable for the decision to delegate, the adequacy of training provided, the appropriateness of supervision, and ongoing evaluation. The RN does not assume accountability for the actions of the caregiver but is responsible for ensuring the delegation framework is sound.

Caregiver Accountability: Nursing assistants and home care aides are accountable for their own actions when performing delegated tasks. They must perform tasks as trained, report concerns or changes to the RN, and refuse to perform tasks they have not been trained to do or do not feel competent to perform.

Facility Accountability: Adult family homes and assisted living facilities must ensure they have policies supporting appropriate delegation, maintain required documentation, and facilitate communication between caregivers and delegating RNs.

Tasks That Cannot Be Delegated Under WAC 246-840

Per WAC 246-840-910, certain nursing functions are explicitly excluded from delegation due to safety concerns. These non-delegable tasks include:

• Administration of medications by injection (with the specific exception of insulin under established protocols)
• Sterile procedures including wound packing, sterile dressing changes, and catheter insertion
• Central line maintenance and any procedures involving vascular access devices
• Acts requiring nursing judgment during implementation where the caregiver would need to make clinical decisions
• Care for unstable patients whose conditions are unpredictable or rapidly changing
• Physical, psychological, or social assessment that requires professional nursing evaluation

Where Nurse Delegation is Permitted in Washington

Nurse delegation under WAC 246-840 is specifically permitted in the following community-based settings:

• Adult family homes (AFH): Licensed residential care facilities serving up to six adults. The DSHS Adult Family Home program regulates these facilities.
• Assisted living facilities: Licensed facilities providing personal care and supportive services to residents
• In-home care settings: Private homes where individuals receive care from home care aides
• Community residential programs: Facilities serving individuals with developmental disabilities

Delegation is not permitted in hospitals, skilled nursing facilities, or other settings where licensed nursing staff are required to provide direct care. In these settings, care must be provided by licensed nurses rather than through delegation.

RN Delegator Qualifications

Not every registered nurse is automatically qualified to delegate. Under WAC requirements and Washington State Nursing Care Quality Assurance Commission standards, delegating RNs must:

• Hold a current, unrestricted Washington State RN license
• Have completed approved nurse delegation training
• Demonstrate competency in the tasks being delegated
• Maintain knowledge of current delegation regulations
• Carry appropriate professional liability insurance

Documentation and Record-Keeping Requirements

Comprehensive documentation is essential for regulatory compliance and patient safety. Required documentation includes:

• Initial patient assessment documenting stability and appropriateness for delegation
• Written delegation instructions specific to each patient and task
• Training records including dates, content covered, and trainer signature
• Competency verification checklists signed by both RN and caregiver
• Ongoing supervision notes documenting RN visits and observations
• Any modifications to the delegation plan
• Communication logs between caregivers and the delegating RN

All delegation documentation must be maintained for a minimum of six years in accordance with Washington State record retention requirements.

Consequences of Non-Compliance

Failure to comply with WAC nurse delegation regulations can result in serious consequences including:

• Disciplinary action against the RN's nursing license
• Citations and fines against the care facility
• Facility license revocation in severe cases
• Legal liability if patient harm occurs
• Exclusion from Medicare and Medicaid programs

Frequently Asked Questions About WAC Nurse Delegation