PROPOSED RULES
(Nursing Care Quality Assurance Commission)
Original Notice.
Preproposal statement of inquiry was filed as WSR 08-14-158.
Title of Rule and Other Identifying Information: WAC 246-840-910, 246-840-920, 246-840-930, 246-840-940, 246-840-950, 246-840-960 and 246-840-970, nursing delegation; and WAC 246-841-405 Nursing assistant delegation.
Hearing Location(s): Department of Health, Town Center, Room 163, 101 Israel Road S.E., Tumwater, WA 98501, on January 27, 2009, at 11:00 a.m.
Date of Intended Adoption: January 27, 2009.
Submit Written Comments to: Terry J. West, Deputy Executive Director, Department of Health, Nursing Commission, P.O. Box 47864, Olympia, WA 98504, web site http://www3.doh.wa.gov/policyreview/, fax (360) 236-4738, by January 5, 2009.
Assistance for Persons with Disabilities: Contact Louise.lloyd@doh.wa.gov, (360) 236-4713, by January 5, 2009, TTY (800) 833-6388 or 711.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Nursing delegation rules already exist. Legislation was passed in 2008 (E2SHB 2668, chapter 146, Laws of 2008) that adds insulin injection as a health care task that can be delegated by a registered nurse (RN) to a nursing assistant. The proposed rule amendments allow for the delegation of insulin injections and establishes the training standards and the process that must be followed in order to delegate.
Reasons Supporting Proposal: RNs are currently performing insulin injections for patients and residents of community-based care settings and in-home care settings. The proposed rules will allow RNs to delegate the task of performing insulin injections to qualified nursing assistants. This will allow the RN to perform higher level health care tasks. This will allow more flexibility for the RN, the nursing assistant and the care facilities in which patients and residents reside. The proposed rules will allow people with disabilities to continue to reside in their own home or other home-like setting.
Statutory Authority for Adoption: RCW 18.79.110, 18.79.260, 18.88A.060, and 18.88A.210.
Statute Being Implemented: RCW 18.79.110, 18.79.260, 18.88A.060, and 18.88A.210.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Nursing care quality assurance commission, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Terry J. West, P.O. Box 47864, Olympia, WA 98504, (360) 236-4712.
No small business economic impact statement has been prepared under chapter 19.85 RCW. A small business economic impact statement was not prepared. The proposed rule would not impose more than minor costs on businesses in an industry. A copy of the statement may be obtained by contacting Terry J. West, P.O. Box 47864, Olympia, WA 98504, phone (360) 236-4712, fax (360) 236-4738, e-mail terry.west@doh.wa.gov.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Terry J. West, P.O. Box 47864, Olympia, WA 98504, phone (360) 236-4712, fax (360) 236-4738, e-mail terry.west@doh.wa.go[gov].
December 2, 2008
Paula R. Meyer, MSN, RN
Executive Director
OTS-1861.4
AMENDATORY SECTION(Amending WSR 04-14-065, filed 7/2/04,
effective 7/2/04)
WAC 246-840-910
Purpose.
((The purpose of)) This
((delegation protocol is to ensure that nursing care services
have)) rule defines a consistent standard of ((practice upon
which the public and profession may rely and to safeguard the
authority of)) nursing care with the delegation of nursing
tasks to nursing assistants. The registered nurse delegator
((to)) makes independent professional decisions ((regarding))
of the delegation of a nursing task. A licensed registered
nurse may delegate specific nursing care tasks to nursing
assistants ((who meet)) meeting certain requirements and
((provide)) providing care to individuals in a community-based
care setting ((as)) defined by RCW 18.79.260 (3)(e)(i) and to
individuals in an in-home care setting ((as)) defined by RCW 18.79.260 (3)(e)(ii). Before delegating a task, the
registered nurse delegator ((must)) determines that specific
criteria ((described in the protocol)) are met and ((ensure
that)) the patient is in a stable and predictable condition. Registered nurses delegating tasks are accountable to the
Washington state nursing care quality assurance commission. The registered nurse delegator and nursing assistant are
accountable for their own individual actions in the delegation
process. No person may coerce a registered nurse into
compromising patient safety by requiring the registered nurse
to delegate ((if the registered nurse delegator determines it
is inappropriate to do so)). Registered nurse delegators
shall not delegate the following care tasks:
(1) Administration of medications by injection (by intramuscular, intradermal, subcutaneous, intraosseous, intravenous, or otherwise) with the exception of insulin injections.
(2) Sterile procedures.
(3) Central line maintenance.
(4) Acts that require nursing judgment.
[Statutory Authority: RCW 18.79.110, 18.79.260 (3)(f), 18.88A.210, 2003 c 140. 04-14-065, § 246-840-910, filed 7/2/04, effective 7/2/04. Statutory Authority: Chapters 18.79 and 18.88A RCW. 02-02-047, § 246-840-910, filed 12/27/01, effective 1/27/02. Statutory Authority: Chapter 18.79 RCW. 96-05-060, § 246-840-910, filed 2/19/96, effective 3/21/96.]
(1) "Authorized representative" means a person
((authorized)) allowed to provide ((informed)) written consent
for health care on behalf of a patient who is not competent to
consent. Such person shall be a member of one of the classes
of persons as directed in RCW 7.70.065.
(2) "Coercion" means to force or compel another, by authority, to do something that he/she would not otherwise choose to do.
(3) "Complex task" means that a nursing task may become
more complicated because of ((the interrelationship between
the following criteria)):
(a) The patient's condition;
(b) The setting;
(c) The nursing care task(s) and involved risks; and
(d) The skill level required to perform the task.
The registered nurse delegator ((must identify))
identifies and facilitates additional training of the nursing
assistant prior to delegation in these situations. The
registered nurse delegator ((may)) decides if the task is not
delegable. In no case, may administration of medications by
injection with the exception of insulin injections, sterile
procedures and central line maintenance be delegated.
(4) "Medication assistance" as defined in chapter 246-888 WAC does not require delegation by a licensed nurse.
(5) "Nursing assistant" means a nursing
assistant-registered under chapter 18.88A RCW or a nursing
assistant-certified under chapter 18.88A RCW, ((who provides))
providing support and care to individuals served by certified
community residential programs for the developmentally
disabled, to individuals residing in licensed adult family
homes, to in-home care and to individuals residing in licensed
boarding homes.
(6) "Outcome" means the end result or consequence of an
action after following ((an established)) a plan of care.
(7) "Patient" means the individual ((recipient of))
receiving nursing ((actions)) care tasks. In the community
residential settings, the patient may ((also)) be ((referred
to as)) a client, consumer, or resident.
(8) "Personal care services" as defined in WAC
((388-15-202)) 388-106-0010 do not require delegation by a
licensed nurse.
(9) "Procedure" means a series of steps ((by which)) with
a desired result ((is obtained)); a particular course of
action or way of doing something.
(10) (("Protocol" means an explicit, detailed written
plan specifying the procedures to be followed in providing
care for a particular condition.
(11))) "Registered nurse delegation" means the registered nurse transfers the performance of selected nursing tasks to competent nursing assistants in selected situations. The registered nurse delegating the task retains the responsibility and accountability for the nursing care of the patient.
(((12))) (11) "Supervision" means the ((provision of))
guidance and evaluation by a registered nurse delegator for
the accomplishment of a nursing task or activity, ((as
outlined in this protocol,)) including the initial direction
of the task or activity; periodic inspection at least every
ninety days of the actual act of accomplishing the task or
activity; and the authority to require corrective action.
(((13))) (12) "Immediate supervision" means the
registered nurse delegator is on the premises ((and is)),
within audible and visual range of the patient and the patient
((has been assessed)) assessment by the registered nurse
delegator occurs prior to the delegation of duties to any care
giver.
(((14))) (13) "Direct supervision" means the registered
nurse delegator ((is)) on the premises, ((is)) quickly and
easily available and the patient ((has been assessed))
assessment by the registered nurse delegator occurs prior to
the delegation of the duties to any care giver.
(((15))) (14) "Indirect supervision" means the registered
nurse delegator is not on the premises ((but has previously
given)). The registered nurse delegator previously provided
written instructions for the care and treatment of the patient
((and the patient has been assessed by the registered nurse
delegator prior to the delegation of duties to any care giver.
If oral clarification of the written instructions is
required, it must be documented)). The registered nurse
delegator documents in the patient record the instruction to
the nursing assistant, observation of the delegated task, and
confirmation of the nursing assistant understanding the
directions.
(((16))) (15) "Stable and predictable condition" means
((a situation in which)) the registered nurse delegator
determines the patient's clinical and behavioral status is
((known through the registered nurse delegator's assessment to
be)) nonfluctuating and consistent((, including)). Stable and
predictable may include a terminally ill patient whose
deteriorating condition is ((predictable)) expected. Stable
and predictable may include a patient with sliding scale
insulin orders. The registered nurse delegator determines
((that)) the patient does not require ((their)) frequent
nursing presence and evaluation.
[Statutory Authority: Chapters 18.79 and 18.88A RCW. 02-02-047, § 246-840-920, filed 12/27/01, effective 1/27/02. Statutory Authority: Chapter 18.79 RCW. 96-05-060, § 246-840-920, filed 2/19/96, effective 3/21/96.]
ASSESS
(2) ((Determine that)) The setting allows delegation
because it is a community-based care setting as defined by RCW 18.79.260 (3)(e)(i) or an in-home care setting as defined by
RCW 18.79.260 (3)(e)(ii).
(3) Assess the patient's nursing care needs and determine
((that)) the patient's condition is ((in a)) stable and
predictable ((condition)). A patient may be stable and
predictable with an order for sliding scale insulin or
terminal condition.
(4) Determine ((that)) the task to be delegated is within
the delegating nurse's area of responsibility.
(5) Determine ((that)) the task to be delegated can be
properly and safely performed by the nursing assistant. The
registered nurse delegator ((shall assess)) assesses the
potential risk of harm for the individual patient. ((Potential harm may include, but is not limited to,
infection, hemorrhage, hypoxemia, nerve damage, physical
injury, or psychological distress.))
(6) Analyze the complexity of the nursing task and
determine the required training or additional training needed
by the nursing assistant to competently accomplish the task. ((The registered nurse delegator shall consider the
psychomotor and cognitive skills required to perform the
nursing task. More complex tasks may require additional
training and supervision for the nursing assistant.)) The
registered nurse delegator ((must identify)) identifies and
facilitates any additional training of the nursing assistant
((that is)) needed prior to delegation. The registered nurse
delegator ((must)) ensures ((that)) the task to be delegated
can be properly and safely performed by the nursing assistant.
(7) Assess the level of interaction required((,
considering)). Consider language or cultural diversity ((that
may affect)) affecting communication or the ability to
accomplish the task ((to be delegated, as well as methods))
and to facilitate the interaction.
(8) Verify that the nursing assistant:
(a) Is currently registered or certified as a nursing
assistant in Washington state ((and is in good standing))
without restriction;
(b) As required in WAC 246-841-405 (2)(a), nursing
assistants registered ((must complete)) have completed both
the basic caregiver training and core delegation training
before performing any delegated task;
(c) Has a certificate of completion issued by the
department of social and health services indicating completion
of the required core nurse delegation training; ((and))
(d) Has a certificate of completion issued by the department of social and health services indicating completion of diabetes training when providing insulin injections to a diabetic client; and
(e) Is willing and able to perform the task in the absence of direct or immediate nurse supervision and accept responsibility for their actions.
(9) Assess the ability of the nursing assistant to
competently perform the delegated nursing task in the absence
of direct or immediate nurse ((supervision to ensure that the
nursing task can be properly and safely performed by the
nursing assistant)).
(10) If the registered nurse delegator determines
delegation is appropriate, the nurse ((must)):
(a) ((Discuss)) Discusses the delegation process with the
patient or authorized representative, including the level of
training of the nursing assistant delivering care.
(b) Obtains ((patient)) written consent. The patient, or
authorized representative, must give written, ((informed))
consent to the delegation process under chapter 7.70 RCW. Documented verbal consent of patient or authorized
representative may be acceptable if written consent is
obtained within thirty days; electronic consent is an
acceptable format. (((c))) Written consent is only necessary
at the initial use of the nurse delegation process for each
patient and is not necessary for task additions or changes or
if a different nurse or nursing assistant will be
participating in the process.
PLAN
(11) Document in the patient's record the rationale for
delegating or not delegating nursing tasks.
(12) Provide specific, written delegation instructions to the nursing assistant with a copy maintained in the patient's record that includes:
(a) The rationale for delegating the nursing task;
(b) ((That)) The delegated nursing task is specific to
one patient and is not transferable to another patient;
(c) ((That)) The delegated nursing task is specific to
one nursing assistant and is not transferable to another
nursing assistant;
(d) The nature of the condition requiring treatment and purpose of the delegated nursing task;
(e) A clear description of the procedure or steps to follow to perform the task;
(f) The predictable outcomes of the nursing task and how to effectively deal with them;
(g) The risks of the treatment;
(h) The interactions of prescribed medications;
(i) How to observe and report side effects, complications, or unexpected outcomes and appropriate actions to deal with them, including specific parameters for notifying the registered nurse delegator, health care provider, or emergency services;
(j) The action to take in situations where medications and/or treatments and/or procedures are altered by health care provider orders, including:
(i) How to notify the registered nurse delegator of the change;
(ii) The process the registered nurse delegator ((will))
uses to obtain verification from the health care provider of
the change in the medical order; and
(iii) The process to notify the nursing assistant of whether administration of the medication or performance of the procedure and/or treatment is delegated or not;
(k) How to document the task in the patient's record;
(l) Document ((what)) teaching ((was)) done and ((that))
a return demonstration, or other method for verification of
competency((, was correctly done)); and
(m) ((A plan of nursing supervision describing how
frequently the registered nurse will supervise the performance
of the delegated task by the nursing assistant and reevaluate
the delegated nursing task.)) Supervision shall occur at
least every ninety days. With delegation of insulin
injections, the supervision occurs at least weekly for the
first four weeks, and may be more frequent.
(13) The administration of medications may be delegated
at the discretion of the registered nurse delegator ((but
never by)), including insulin injections. Any other injection
(((by)) intramuscular, intradermal, subcutaneous,
intraosseous, intravenous, or otherwise) is prohibited. The
registered nurse delegator ((must)) provides to the nursing
assistant written ((parameters)) directions specific to an
individual patient ((which includes guidelines for the nursing
assistant to follow in the decision-making process to
administer a medication and the procedure to follow for such
administration)).
IMPLEMENT
(14) Delegation requires the registered nurse delegator
teach the nursing assistant how to perform the task, including
return demonstration or other method of verification of
competency as determined by the registered nurse delegator.
(15) The registered nurse delegator is accountable and
responsible for the delegated nursing task. The registered
nurse delegator ((must)) monitors the performance of the
task(s) to assure compliance ((to)) with established standards
of practice, policies and procedures and ((to ensure))
appropriate documentation of the task(s).
EVALUATE
(16) The registered nurse delegator ((must)) evaluates
the patient's responses to the delegated nursing care and to
any modification of the nursing components of the patient's
plan of care.
(17) The registered nurse delegator ((must)) supervises
and evaluates the performance of the nursing assistant,
including direct observation or other method of verification
of competency of the nursing assistant ((to perform the
delegated nursing task)). The registered nurse delegator
((must also)) reevaluates the patient's condition, the care
provided to the patient, the capability of the nursing
assistant, the outcome of the task, and any problems.
(18) The registered nurse delegator ((must)) ensures safe
and effective services are provided. Reevaluation and
documentation ((must)) occurs at least every ninety days. Frequency of supervision is at the discretion of the
registered nurse delegator and may be more often based upon
nursing assessment.
(19) The registered nurse must supervise and evaluate the performance of the nursing assistant with delegated insulin injection authority at least weekly for the first four weeks. After the first four weeks the supervision shall occur at least every ninety days.
[Statutory Authority: RCW 18.79.110, 18.79.260 (3)(f), 18.88A.210, 2003 c 140. 04-14-065, § 246-840-930, filed 7/2/04, effective 7/2/04. Statutory Authority: Chapters 18.79 and 18.88A RCW. 02-02-047, § 246-840-930, filed 12/27/01, effective 1/27/02. Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-930, filed 6/18/97, effective 7/19/97; 96-05-060, § 246-840-930, filed 2/19/96, effective 3/21/96.]
| (1) | Does the patient reside in one of the following settings? A community-based care setting as defined by RCW 18.79.260 (3)(e)(i) or an in-home care setting as defined by RCW 18.79.260 (3)(e)(ii). | No -> | Do not delegate |
| Yes ↓ | |||
| (2) | Has the patient or authorized representative given consent to the delegation? | No -> | Obtain the written, informed consent |
| Yes ↓ | |||
| (3) | Is RN assessment of patient's nursing care needs completed? | No -> | Do assessment, then proceed with a consideration of delegation |
| Yes ↓ | |||
| (4) | Does the patient have a stable and predictable condition? | No -> | Do not delegate |
| Yes ↓ | |||
| (5) | Is the task within the registered nurse's scope of practice? | No -> | Do not delegate |
| Yes ↓ | |||
| (6) | Is the nursing assistant registered or certified and properly trained in the nurse delegation for nursing assistants? Is the nursing assistant trained in diabetes care and insulin injections when delegating insulin? | No -> | Do not delegate |
| Yes ↓ | |||
| (7) | Does the delegation exclude the administration of medications by injection other than insulin, sterile procedures or central line maintenance? | No -> | Do not delegate |
| Yes ↓ | |||
| (8) | Can the task be performed without requiring judgment based on nursing knowledge? | No -> | Do not delegate |
| Yes ↓ | |||
| (9) | Are the results of the task reasonably predictable? | No -> | Do not delegate |
| Yes ↓ | |||
| (10) | Can the task be safely performed according to exact, unchanging directions? | No -> | Do not delegate |
| Yes ↓ | |||
| (11) | Can the task be performed without a need for complex observations or critical decisions? | No -> | Do not delegate |
| Yes ↓ | |||
| (12) | Can the task be performed without repeated nursing assessments? | No -> | Do not delegate |
| Yes ↓ | |||
| (13) | Can the task be
performed
(( |
No -> | Do not delegate |
| Yes ↓ | |||
| (14) | Is appropriate supervision available? With insulin injections, the supervision occurs at least weekly for the first four weeks. | No -> | Do not delegate |
| Yes ↓ | |||
| (15) | There are no specific laws or rules prohibiting the delegation? | No -> | Do not delegate |
| Yes ↓ | |||
| (16) | Task is delegable | ||
[Statutory Authority: RCW 18.79.110, 18.79.260 (3)(f), 18.88A.210, 2003 c 140. 04-14-065, § 246-840-940, filed 7/2/04, effective 7/2/04. Statutory Authority: Chapters 18.79 and 18.88A RCW. 02-02-047, § 246-840-940, filed 12/27/01, effective 1/27/02. Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-940, filed 6/18/97, effective 7/19/97; 96-05-060, § 246-840-940, filed 2/19/96, effective 3/21/96.]
(a) The registered nurse delegator ((must verify))
verifies the change in medication or a new medication order
with the health care provider;
(b) If ((a change is made in)) the medication dosage or
type of medication changes or ((if a change is made in the
type of medication)) for the same problem (i.e., one
medication is deleted ((by the health care provider)) and
another is substituted) and the patient remains in a stable
and predictable condition, delegation ((may)) continues at the
registered nurse delegator's discretion; and
(c) If a new medication is added, the registered nurse
delegator ((must)) reviews the criteria and process for
delegation prior to delegating the administration of the new
medication to the nursing assistant. The registered nurse
delegator maintains the authority to decide if the new
medication can be delegated immediately, if a site visit is
warranted prior to delegation, or if delegation is no longer
appropriate. If delegation is ((to be)) rescinded, the
registered nurse delegator ((must)) initiates and participates
in developing an alternative plan to ((assure)) meet the needs
of the patient ((are met)).
(2) Treatments and/or procedures.
(a) The registered nurse delegator ((must verify))
verifies the change in the medical order with the health care
provider.
(b) The registered nurse delegator ((maintains the
authority to)) decides if the new treatment or procedure can
be delegated immediately, if a site visit is warranted prior
to delegation, or if delegation is no longer appropriate. If
rescinding delegation ((is to be rescinded)), the registered
nurse delegator ((must)) initiates and participates in
developing an alternative plan to ((assure)) meet the needs of
the patient ((are met)).
Transferring delegation to another registered nurse.
(3) ((A registered nurse may assume delegating
responsibilities from)) The registered nurse delegator ((for))
may transfer the delegation process((, provided)) to another
registered nurse. The registered nurse assuming
responsibility ((knows)) assesses the patient ((through their
assessment)), the skills of the nursing assistant, and the
plan of care. ((This may include a reevaluation of the
patient by the nurse assuming responsibility for delegation.))
The registered nurse ((assuming the responsibility for
delegation from another registered nurse delegator)) is
accountable and responsible for the delegated task. The
registered nurse delegator must document the following in the
patient's record((.)):
(a) The reason and justification for another registered nurse assuming responsibility for the delegation;
(b) The registered nurse assuming responsibility must agree, in writing, to perform the supervision; and
(c) ((That)) The nursing assistant and patient have been
informed of this change.
[Statutory Authority: Chapters 18.79 and 18.88A RCW. 02-02-047, § 246-840-950, filed 12/27/01, effective 1/27/02. Statutory Authority: Chapter 18.79 RCW. 96-05-060, § 246-840-950, filed 2/19/96, effective 3/21/96.]
(a) ((When)) The registered nurse delegator believes
patient safety is being compromised;
(b) ((When)) The patient's condition is no longer stable
and predictable ((as determined by the registered nurse
delegator));
(c) When the frequency of staff turnover makes delegation impractical to continue in the setting;
(d) ((When there is)) A change in the nursing assistant's
willingness or competency to do the task;
(e) When the task is not being performed correctly;
((or))
(f) When the patient or authorized representative
requests ((that)) rescinding the delegation ((be rescinded));
(g) When the facility's license lapsed; or
(h) When caregivers are not currently registered, certified, or have restrictions to practice.
(2) In the event delegation is rescinded, the registered
nurse delegator initiates and participates in developing an
alternative plan to ((ensure the)) provide continuity ((for
the provision)) of the task or assumes responsibility for
performing the task.
(3) The registered nurse delegator ((must)) documents the
reason for rescinding delegation of the task and the plan for
((ensuring continuity of)) continuing the task.
[Statutory Authority: Chapters 18.79 and 18.88A RCW. 02-02-047, § 246-840-960, filed 12/27/01, effective 1/27/02. Statutory Authority: Chapter 18.79 RCW. 96-05-060, § 246-840-960, filed 2/19/96, effective 3/21/96.]
(2) Under RCW 18.79.260 (3)(d)(iv), delegating nurses
acting within ((the protocols of)) their delegation authority
shall be immune from liability for any action performed in the
course of their delegation duties.
(3) Under RCW 18.88A.230(1), nursing assistants following written delegation instructions from registered nurse delegators for delegated tasks shall be immune from liability.
(4) Complaints regarding delegation of nursing tasks may be reported to the aging and adult services administration of the department of social and health services or via a toll-free telephone number.
(5) All complaints related to registered nurse
((delegation)) delegators shall be referred to the nursing
care quality assurance commission.
(6) All complaints related to nursing assistants performing delegated tasks shall be referred to the secretary of health.
(7) Under RCW 18.79.260 (3)(c), no person may coerce the registered nurse delegator into compromising patient safety by requiring the nurse to delegate if the registered nurse delegator determines it is inappropriate to do so. Registered nurse delegators shall not be subject to any employer reprisal or disciplinary action by the Washington nursing care quality assurance commission for refusing to delegate tasks or refusing to provide the required training for delegation if the nurse determines delegation may compromise patient safety.
(((7))) (8) Under RCW 18.88A.230(2), nursing assistants
shall not be subject to any employer reprisal or disciplinary
action by the secretary for refusing to accept delegation of a
nursing task based on patient safety issues.
[Statutory Authority: Chapters 18.79 and 18.88A RCW. 02-02-047, § 246-840-970, filed 12/27/01, effective 1/27/02. Statutory Authority: Chapter 18.79 RCW. 96-05-060, § 246-840-970, filed 2/19/96, effective 3/21/96.]
OTS-1862.2
AMENDATORY SECTION(Amending WSR 04-14-064, filed 7/2/04,
effective 7/2/04)
WAC 246-841-405
Nursing assistant delegation.
Provision
for delegation of certain tasks.
(1) Nursing assistants ((may)) perform tasks ((when))
delegated by a registered nurse for patients in
community-based care settings or in-home care settings((,))
each as defined in RCW 18.79.260 (3)(e).
(2) ((Any nursing assistant who receives authority to
perform a delegated nursing task must,)) Before performing any
delegated task:
(a) ((For)) Nursing assistants-registered((, provide to
the delegating nurse)) must show the certificate of completion
of both the basic caregiver training and core delegation
training ((as established by)) from the department of social
and health services to the registered nurse delegator.
(b) ((For)) Nursing assistants-certified((, provide to))
must show the ((delegating nurse the)) certificate of
completion of the core delegation training ((as established
by)) from the department of social and health services to the
registered nurse delegator.
(c) ((For)) All nursing assistants((,)) must comply with
all applicable requirements ((and protocol established by)) of
the nursing care quality assurance commission in WAC 246-840-910 through 246-840-970.
(d) ((For)) All nursing assistants, registered and
certified, who may be completing insulin injections must give
a certificate of completion of diabetic training from the
department of social and health services to the registered
nurse delegator.
(e) All nursing assistants((,)) must meet any additional
training requirements identified by the nursing care quality
assurance commission. Any exceptions to ((any such))
additional training requirements must ((adhere to)) comply
with RCW 18.79.260 (3)(e)(v).
(3) ((Any nursing assistant performing a)) Delegated
nursing care tasks ((pursuant to)) described in this
section((, shall perform the task)) are:
(a) Only for the specific patient ((who was the subject
of the)) receiving delegation;
(b) Only with the patient'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 246-840-970.
(4) A nursing assistant may consent or refuse to consent
to perform a delegated nursing care task ((and shall be)).
The nursing assistant is 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 by injection, with the exception of insulin injections;
(b) Sterile procedures;
(c) Central line maintenance;
(d) Acts that require nursing judgment.
[Statutory Authority: RCW 18.88A.060 and 2003 c 140. 04-14-064, § 246-841-405, filed 7/2/04, effective 7/2/04. Statutory Authority: Chapter 18.88A RCW. 96-06-029, § 246-841-405, filed 2/28/96, effective 3/30/96.]