FINAL BILL REPORT

ESHB 2473

C 208 L 12

Synopsis as Enacted

Brief Description: Creating a medication assistant endorsement for certified nursing assistants who work in nursing homes.

Sponsors: House Committee on Health Care & Wellness (originally sponsored by Representatives Green, Hinkle, Johnson, Van De Wege, Ryu and Roberts).

House Committee on Health Care & Wellness

House Committee on Health & Human Services Appropriations & Oversight

Senate Committee on Health & Long-Term Care

Background:

The Department of Health registers nursing assistants and certifies those who complete required education and training as determined by the state Nursing Care Quality Assurance Commission (Nursing Commission). Nursing assistants may assist in providing care to individuals under the direction and supervision of a licensed or registered nurse. Nursing assistants work in various health care facilities, such as hospitals, nursing homes, hospices, and other entities delivering health care services.

A registered nurse may delegate nursing care tasks that are within the nurse's scope of practice to other individuals where the nurse finds it to be in the patient's best interest. Before delegating a nursing care task, the registered nurse must determine the competency level of the person to perform the delegated task, evaluate the appropriateness of the delegation, and supervise the person performing the delegated task. With some exceptions, registered nurses may not delegate tasks requiring nursing judgment, substantial skill, the administration of medications, or the piercing or severing of tissues.

Summary:

A program is established to allow certified nursing assistants (CNA) to receive a medication assistant endorsement to administer, under registered nurse supervision, certain medications and treatments in a nursing home.

Medication Assistant Endorsement. Beginning July 1, 2013, a CNA may seek a medication assistant endorsement from the Department of Health. To be issued the endorsement, a CNA must:

• maintain his or her nursing assistant certification in good standing;

• complete the hours of documented work as a CNA that are required by the Nursing Commission;

• successfully complete an education and training program approved by the Nursing Commission;

• pass an examination approved by the Nursing Commission; and

• complete continuing competency requirements as defined by the Nursing Commission.

Permitted Additional Tasks. A CNA with a medical assistant endorsement may perform and document the following additional tasks:

• the administration of medications orally, topically, and through inhalation; and

• the performance of simple prescriber-ordered treatments, as defined by the Nursing Commission, which may include monitoring blood glucose and blood oxygen saturation, changing noncomplex clean dressings, and administering oxygen.

These additional tasks may be performed only (1) in a nursing home, (2) if supervised by a designated registered nurse who is on site and immediately accessible, and (3) if these additional tasks are the primary responsibility of the medication assistant during the time the tasks are performed. The registered nurse must assess the patient and determine whether it is safe for the CNA to administer the medications or treatment.

The Nursing Commission may adopt rules regarding the medication assistant's primary responsibilities and limiting the duties that a CNA may perform while functioning as a medication assistant.

Prohibited Tasks. A medication assistant may not:

• accept telephone or verbal orders from a prescriber;

• calculate medication dosages;

• inject any medications;

• perform any sterile task;

• administer medications through a tube;

• administer Schedule I, II, or III controlled substances; or

• perform any task that requires nursing judgment.

A medication assistant's employer may restrict, but not expand, the range of functions permitted for a medication assistant.

Votes on Final Passage: