Nursing Assistant

CPR is considered a basic core competency for the NA-R/NA-C, but the type of CPR and first aid certification is not specified in Chapter 246-841A WAC. The requirement for CPR is generally described in facility laws and rules. Most do not specify what type of CPR. The employer or institution can require the type of CPR required to work in a particular setting.

Yes. Chapter 246-841A WAC describes the core competencies of the NA-R/NA-C, that includes allowing the NA-R/NA-C to perform CPR independently.

Yes. Chapter 246-841A WAC describes the core competencies of the NA-R/NA-C, that includes allowing the NA-R/NA-C to perform the Heimlich maneuver independently.

It depends. The NA-R/NA-C may independently follow instructions in Section A of the POLST Form indicated “CPR/Attempt Resuscitation” or “Do Not Attempt Resuscitation (DNAR) – Allow Natural Death” when a patient is non-responsive or has no heartbeat. The NA-R/NA-C may follow directions in section B of the POLST Form within their core competencies (Chapter 246-841A WAC) under the direction and supervision of the RN or LPN. Some tasks (not in the NA-R/NA-C’s core competencies) identified in Section B of the POLST Form may require RN delegation (e.g., tube feedings, selective medications, oxygen administration, continuous positive airway pressure (CPAP) procedures, or airway suctioning). See the Portable Order for Life Sustaining Treatment (POLST) Advisory Opinion and the Portable Orders for Life Sustaining Treatment (POLST) | Washington State Department of Health Website for more information.

It depends. The laws and rules do not permit the registered nurse (RN) to delegate administration of injectable epinephrine to the NA-R/NA-C in any setting. However, the NA-R/NA-C may administer epinephrine if the facility or employer is an “authorized entity” pursuant to RCW 70.54.440. This statute allows authorized facilities or employers to obtain stock epinephrine injectors with a prescription in the name of the entity and identify employees, who have completed required training, to administer epinephrine via autoinjectors. See the Washington State Department of Health’s Epinephrine Autoinjectors and Anaphylaxis Training and Reporting for Authorized Entities Frequently Asked Questions  for more information.

No. The laws and rules do not permit the RN to delegate administration of injectable glucagon to NA-R/NA-C in any setting.

Yes, in some settings. The laws and rules allow the RN to delegate administration of intranasal glucagon to NA-R/NA-C only in community-based (adult family homes, assisted living facilities, and residential homes for individuals with developmental disabilities) and in-home care settings.

The following statute and WACs are applicable to nurse delegation in community-basedand in-home care settings: 

RCW 18.79.260: Registered Nurse—Activities Allowed—Delegation of Tasks 

WAC 246-840-910: Purpose  

WAC 246-840-920: Definitions 

WAC 246-840-930: Criteria 

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 

Yes. Although the laws and rules do not allow the registered nurse to delegate injectable naloxone for a suspected opioid drug overdose to the NA-R/NA-C, the NA-R/NA-C may administer injectable naloxone to anyone that they suspect is having an opioid overdose in any setting (RCW 69.41.095) when prescribed by an authorized health care practitioner. See the Washington State Board of Nursing’s Prevention and Treatment of Opioid-Related Overdoses Advisory Opinion and the Overdose Prevention, Recognition, and Response | Washington State Department of Health Website for more information.

Yes. The NA-R/NA-C the NA-R/NA-C may administer intranasal naloxone to anyone that they suspect is having an opioid overdose in any setting (RCW 69.41.095) without registered nurse (RN) delegation when prescribed by an authorized health care practitioner. Administration of intranasal naloxone may also be delegated (although it is not required) by the RN in community-based (adult family homes, assisted living facilities, and residential homes for individuals with developmental disabilities) and in-home care settings, because in these settings the RN may delegate medication administration if it does not involve puncturing of the skin. See the Washington State Board of Nursing’s Prevention and Treatment of Opioid-Related Overdoses Advisory Opinion and the Overdose Prevention, Recognition, and Response | Washington State Department of Health Website for more information.

POLST is a set of portable medical orders, executed by an adult patient (or legal surrogate) and the patient's medical provider, to guide medical treatment based on the patient's current medical condition and goals.

POLST is usually for persons with serious illness or frailty. The “rule of thumb” is to recommend POLST for patients if their provider would not be surprised if they die within a year. Advanced care planning is thoughtful conversations between health care professionals, the patient and/or surrogate.

It is within the scope of the appropriately prepared and competent LPN to discuss end-of-life care with the patient or surrogate under the direction of an authorized health care practitioner or under the direction and supervision of the registered nurse (RN).

For more information and resources on POLST, go to:

• Advisory Opinion: Portable Order for Life Sustaining Treatment (POLST) (PDF)
• DOH: Portable Orders for Life Sustaining Treatment (POLST)
• WSMA: Advance Care Planning
• WSMA: POLST Form & Brochure

Opioid antagonists reverse the effects of an opioid overdose. Naloxone (Narcan®) is the current standard of treatment for opioid overdose. The Food and Drug Administration (FDA) approves administration by intravenous, intramuscular, or subcutaneous routes; a hand-held auto-injector (Evzio®) for intramuscular or subcutaneous injection; and, in 2018, approved the first generic Naloxone Hydrochloride nasal spray. These are legend drugs, and not categorized as a controlled substance. Naloxone has not been shown to produce tolerance or cause physical or psychological pain. It will produce withdrawal symptoms. Severity and duration of the withdrawal relate to the dose of naloxone and the degree and type of opioid dependency. See the Washington State Department of Health Overdose Education and Naloxone Distribution Webpage for more information.

RCW 69.41.095 does not require the Nursing Assistant to carry an opioid antagonist, such as naloxone. For more information, go to the Washington State Department of Health Overdose Education and Naloxone Distribution Website.

The Nursing Assistant may administer an opioid antagonist (such as naloxone) by injection or by the intranasal route. The Nursing Assistant must have a valid prescription, either in the Nursing Assistant's name, in the name of an entity, in the name of a person/patient, or following a standing order approved by an authorized health care practitioner. For more information, go to the Washington State Department of Overdose Education and Naloxone Distribution Website.

RCW 69.41.095 allows the Nursing Assistant, or any person, to carry and administer an opioid antagonist (such as naloxone) to a person suspected of experiencing an opioid overdose in any setting. The Nursing Assistant must have a valid prescription, either in the Nursing Assistant's name, in the name of an entity, in the name of a person/patient, or following a standing order approved by an authorized health care practitioner.

The Nursing Assistant may get a prescription from a pharmacist with a Collaborative Drug Therapy Agreement (CDTA), or use the Washington State Department of Health Statewide Standing Order to Dispense Naloxone. Anyone can take this standing order to a pharmacy to get a prescription. The Nursing Assistant may also get a prescription in their own name from their health care practitioner. For more information, go to the Washington State Department of Health Overdose Education and Naloxone Distribution Website.

RCW 69.41.095 allows the Nursing Assistant with a prescription, or following standing orders, to possess, store, deliver, distribute, or administer an opioid antagonist (such as naloxone) to a person at risk of experiencing an opioid related overdose. For more information, go to the Washington State Department of Health Overdose Education and Naloxone Distribution Website.

The Nursing Assistant is not required to have a specific training course or certification. Stop Overdose.com offers education, resources, and technical assistance for individuals, professionals, and communities in Washington State who want to learn to prevent and respond to overdose and improve the health of people who use drugs. An employer or institution may have specific training or certification requirements. For more information and training resources, go to the Washington State Department of Health Overdose Education and Naloxone Distribution Website.

RCW 69.41.095 allows the Nursing Assistant to have a prescription for an opioid antagonist (such as naloxone) in the Nursing Assistant's name to carry and administer in the non-work setting. The Nursing Assistant may carry and administer an opioid antagonist in a suspected opioid overdose whether the person is a family member, friend, stranger, or a patient. For more information, go to the Washington State Department of Health Overdose Education and Naloxone Distribution Website.

RCW 69.41.095 provides an exception to the nursing delegation laws and rules and does not require Registered Nursing delegation to the Nursing Assistant to administer naloxone. The Nursing Assistant may administer an opioid antagonist (such as naloxone) to an assigned patient by intranasal spray or injection without delegation. This may be done for the patient with a prescription, using an entity's prescription, or done using the Nursing Assistant's personal naloxone prescription. Any person or entity may lawfully possess, store, deliver, distribute, or administer an opioid overdose reversal medication with a prescription or standing order. For more information, go to the Washington State Department of Health Overdose Education and Naloxone Distribution Website.

The nursing assistant-registered (NA-R)/nursing assistant-certified (NA-C) is not required to take telemedicine training. It is not within the scope of practice of the NA-R/NA-C to function as a clinical provider for the purpose of diagnosis, consultation, or treatment. The NA-R/NA-C must function under the direction and supervision of a nurse. The NA-R/NA-C may function in the role of telepresenter to facilitate the visit including supporting communications, clinical (within their scope of practice), and technical workflows through the tele-encounter process.

RCW 43.70.495 requires health care professionals who provide clinical services through telemedicine independently or under the direction of an authorized health care practitioner to complete telemedicine training. “Telemedicine” as defined in RCW 70.41.020(13) means, “the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment [but] does not include the use of audio-only telephone, facsimile, or email.”