PROPOSED RULES
Original Notice.
Exempt from preproposal statement of inquiry under RCW 34.05.310(4).
Title of Rule: WAC 246-841-405 Nursing assistant delegation.
Purpose: The proposed rules allow nursing assistants to accept more tasks and also allow this specific delegation in an in-home care setting. This allows people to stay at home rather than go to a nursing home.
Other Identifying Information: The proposal implements chapter 140, Laws of 2003, also, these rules were adopted under emergency rule which expires July 2, 2004.
Statutory Authority for Adoption: RCW 18.88A.060, [18.88A.]140 and chapter 140, Laws of 2003.
Statute Being Implemented: RCW 18.88A.200 - [18.88A.]230.
Summary: This proposal allows delegation of specific nursing care tasks to nursing assistants providing care to individuals in an in-home care setting. It also removes a list of specific tasks that can be delegated and replaces it with tasks that can not be delegated.
Reasons Supporting Proposal: Legislation was passed in May 2003. This legislation allows nursing assistants to accept delegation in the in-home care setting. The proposal is necessary to make the rules consistent with current law.
Name of Agency Personnel Responsible for Drafting: Kendra Pitzler, 310 Israel Road S.E., Tumwater, WA 98401 [98501], (360) 236-4723; Implementation and Enforcement: Paula Meyer, 310 Israel Road S.E., Tumwater, WA 98401 [98501], (360) 236-4713.
Name of Proponent: Department of Health, Nursing Care Quality Assurance Commission, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: The proposed rule allows delegation of specific nursing care tasks to nursing assistants providing care to individuals in an in-home care setting. The proposal removes a list of specific tasks that can not be delegated.
Purpose: The proposed rules allow delegation of nursing tasks for in-home care settings, and delegation of application, instillation, or insertions of medications by an RN employed by a home health or hospice agency. This allows people to stay at home rather than go to a nursing home.
Anticipated Effects: This rule allows registered nurses to delegate to nursing assistants in the in-home care setting. There will be greater utilization of nursing assistants in this setting.
Proposal Changes the Following Existing Rules: This rule change will add "in-home care setting" to the list of settings that specific nurse delegation can take place. It also removes a list of specific tasks that can be delegated and replaces it with the tasks that can not be delegated.
No small business economic impact statement has been prepared under chapter 19.85 RCW. RCW 19.85.025(3) exempts from the small business economic impact statement rules that meet the criteria of RCW 34.05.310(4). These rules are exempt under RCW 34.05.310 (4)(c) because the rule adopts without material change RCW 18.79.260.
RCW 34.05.328 does not apply to this rule adoption. This rule is not legislatively significant under RCW 34.05.328 (5)(a)(iii) because it adopts without material change Washington state statute (RCW 18.79.260). The proposed rule's content is explicitly and specifically dictated by statute.
Hearing Location: Department of Health, Point Plaza East, 310 Israel Road S.E., Olympia, WA 98504-7864, on June 8, 2004, at 1:00 p.m.
Assistance for Persons with Disabilities: Contact Kendra Pitzler by May 24, 2004, TDD (800) 833-6388 or (360) 236-4723.
Submit Written Comments to: Kendra Pitzler, P.O. Box 47864, Olympia, WA 98504-7864, e-mail Kendra.pitzler@doh.wa.gov, fax (360) 236-4738, by June 4, 2004.
Date of Intended Adoption: July 2, 2004.
March 5, 2004
Cheryl Payseno, Chair
Nursing Care Quality Assurance Commission
OTS-6413.4
AMENDATORY SECTION(Amending WSR 96-06-029, filed 2/28/96,
effective 3/30/96)
WAC 246-841-405
Nursing assistant delegation.
Provision
for delegation of certain tasks.
(1) Nursing assistants may accept delegation of, and
perform ((the following)) tasks((,)) when delegated by a
registered nurse((,)) for ((residents in certified community
residential programs for the developmentally disabled,
residents in licensed adult family homes, and to residents of
licensed boarding homes contracting to provide assisted living
services:
(a) Oral and topical medications and ointments;
(b) Nose, ear, eye drops, and ointments;
(c) Dressing changes and urinary catheterization using clean techniques;
(d) Suppositories, enemas, and ostomy care in established and healed condition;
(e) Blood glucose monitoring; and
(f) Gastrostomy feedings in established and healed condition)) individuals in community-based care settings or in-home care settings, each as defined in RCW 18.79.260 (3)(e), but only where the individual has a stable and predictable condition as defined in RCW 18.79.260 (3)(e)(iii).
(2) Any nursing assistant who receives authority to
perform ((such)) a delegated nursing task must, before
((performing)) commencing any delegated task:
(a) For nursing assistants-registered, ((complete))
provide to the delegating nurse a copy of the certificate of
completion of both the basic caregiver training and core
delegation training as established by the department of social
and health services.
(b) For nursing assistants-certified, ((complete))
provide to the delegating nurse a copy of the certificate of
completion of the core delegation training as established by
the department of social and health services.
(c) For all nursing assistants, comply with all
applicable requirements and protocol established by the
nursing care quality assurance commission in WAC 246-840-910
through ((246-840-980)) 246-840-970.
(d) For all nursing assistants, meet any additional training requirements identified by the nursing care quality assurance commission. Any exceptions to any such training requirements must adhere to RCW 18.79.260 (3)(e)(v).
(3) Any nursing assistant performing a delegated nursing care task pursuant to this section, shall perform the task:
(a) Only for the specific ((resident)) individual who was
the subject of the delegation;
(b) Only with the resident's consent; and
(c) In compliance with all applicable requirements and
protocols established by the nursing care quality assurance
commission in WAC 246-840-910 through ((246-840-980))
246-840-970.
(4) A nursing assistant may consent or refuse to consent
to perform a delegated nursing care task ((listed in
subsection (1) of this section,)) and shall be responsible for
their own actions with regard to the decision to consent or
refuse to consent and the performance of the delegated nursing
care task.
(5) Nursing assistants shall not accept delegation of, or perform, the following nursing care tasks:
(a) Administration of medication, except as authorized by RCW 18.79.260 (3)(b) or (e), and never by injection;
(b) Sterile procedures;
(c) Central line maintenance;
(d) Acts that require nursing judgment;
(e) Acts that require substantial skill, except as authorized by RCW 18.79.260 (3)(e);
(f) Piercing or severing of tissues except as authorized by RCW 18.79.260 (3)(e).
[Statutory Authority: Chapter 18.88A RCW. 96-06-029, § 246-841-405, filed 2/28/96, effective 3/30/96.]