RN delegation is given by a specific nurse, for a specific nursing task, for a specific patient, and to a specific NA-R/NA-C or HCA-C. The RN delegating the task retains the responsibility and accountability for the nursing care of the patient. RN delegation is used when the task is not within the NA-R/NA-C’s standards of practice and core competencies defined in Chapter 246-841A WAC or the HCA-C’s standards of practice (WAC 246-980-150) The RN may delegate a nursing task after determining that it is in the best interest of the patient. The following nursing care tasks may not be delegated by the registered nurse (RN) to the NA-R/NA-C (Chapter 246-841A WAC) or HCA-C WAC 246-980-150:, WAC 246-980-130:
- Medication administration
- Except in community-based* and in-home care settings
- Sterile procedures
- Central line maintenance
- Acts that require piercing or puncturing of the skin
- Except for performing capillary blood glucose tests (RCW 18.79.260, RCW 18.88A.210, Chapter 246-841A WAC)
- Except for administering insulin used to treat Diabetes Mellitus in community-based* and in-home care settings (RCW 18.79.260, RCW 18.88A.210, Chapter 246-841A WAC)
- Acts that require nursing judgment.
Tasks that may be delegated vary in specific settings as defined in the laws and rules. See below.
For RN delegation in all settings, please see RCW 18.79.260 (3)(a).
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).
It is within the scope of practice of the HCA-C to perform activities of daily living without direction and supervision of the RN. Other tasks that fall outside of the standards of practice of the HCA-C do require RN delegation. 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:
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