It depends. The NA-R/NA-C (WAC 246-980-140) or HCA-C (WAC 246-980-140) may perform personal care and assist patients with bathing, oral care, and skin care. However, the rules do not specifically address nail care. The Washington State Board of Nursing (WABON) determines that because it is not specifically addressed in the core competencies/scope of practice, that RN delegation is required for the NA-R/NA-C or HCA-C to perform routine foot and nail care.
However, WABON determines that RN delegation to the NA-R/NA-C or HCA-C to perform foot and nail care is not allowed for a patient with diabetes or a patient with other conditions resulting in poor circulation in any setting because of the risk for injury.
Further, WAC 388-106 Long-Term Care Services stipulates that it is not within the scope of practice of a NA-R, NA-C, or HCA-C to perform foot care on a patient with diabetes or a patient with poor circulation even through the nurse delegation process. This rule applies to long-term care services administered directly or through contract by the Washington State Department of Social and Health Services (DSHS) and identified in WAC 388-106-0015.
When nurse delegation is allowed, the RN must follow the 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 nurse delegation to the HCA-C in addition to those 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