It depends. The RN is allowed to delegate some laboratory tests to the NA-R/NA-C or HCA-C, with some limitations. The RN delegation laws prohibit the NA-R/NA-C or HCA-C from performing activities that involve piercing or puncturing of the skin EXCEPT for capillary blood glucose (CBG) tests. The law allows RN delegation of CBG tests to the NA-R/NA-C in any setting where health care is provided. HCA-s are only allowed to work in community-based settings*, in-home care settings, and enhanced service facilities.
There are many laboratory tests regulated under the Clinical Laboratory Improvement Amendments of 1988 (CLIA), called waived tests. Waived tests include those cleared by the Food and Drug Administration (FDA) for home use and tests approved for waiver under the CLIA criteria. CLIA requires that waived tests be simple and a low risk for errors. They are often called over-the-counter tests. The RN may delegate CLIA-waived laboratory tests that do not involve piercing or puncturing of the skin without an order from an authorized health care practitioner for screening purposes based on nursing assessment. CBG tests are CLIA-waived.
Examples of other CLIA-waived laboratory tests that the NA-R/NA-C or HCA-C may perform under RN delegation (that do not involve piercing or puncturing the skin) include:
- Urine dipstick tests
- Urine drug tests
- Fecal occult blood tests
- Urine pregnancy test
- Rapid strep tests
- COVID-19 rapid tests
CLIA-waived laboratory tests require the employer/facility to have a Medical Test Site Waiver (MTSW) issued by the Washington State Department of Health. This is not required if a patient is self-testing. Medical Test Site Licensing Applications | Washington State Department of Health
The RN may also delegate diagnostic laboratory tests to the NA-R/NA-C or HCA-C if they do not involve using nursing judgment or piercing/puncturing of the skin (except for CBG tests). An example is the COVID-19 polymerase chain reaction (RT-PCR). Diagnostic lab tests, such as this, require the RN to have an order from an authorized health care practitioner for screening purposes.
Examples of CLIA-waived laboratory tests that cannot be delegated to the NA-R/NA-C or HCA-C in any setting (as they involve piercing of the skin) to perform include:
- Prothrombin/international normalized ratio (PT/INR)
- Hemoglobin/Hematocrit
The RN must follow the nurse delegation process outlined in RCW 18.79.260 (3)(a) to determine if delegation is appropriate.
In addition, the following statute and WACs are applicable to nurse delegation in community-based* and in-home care settings:
RCW 18.79.260: Registered Nurse—Activities Allowed—Delegation of Tasks
WAC 246-840-940: Community-Based and In-Home Care Nursing Delegation Decision Tree
WAC 246-840-950: How to Make Changes to Delegated Tasks
WAC 246-840-960: Rescinding Delegation
WAC 246-840-970: Accountability, Liability, and Coercion
*Community-based settings include adult family homes, assisted living facilities, and residential homes for individuals with developmental disabilities (RCW 18.79.260).
The HCA-C is allowed to work only in community-based*, in-home care settings, and enhanced service facilities. The following statutes and WACs are applicable to delegation to the HCA-C in addition to the statute and WACs noted above:
RCW 18.88B.070: Nurse Delegated Tasks
WAC 246-980-130 Provision of Delegation of Certain Tasks to the HCA-C
WAC 246-980-140: Scope of Practice for Long-Term Care Workers