BILL REQ. #: H-0918.1
State of Washington | 63rd Legislature | 2013 Regular Session |
Read first time 02/01/13. Referred to Committee on Health Care & Wellness.
AN ACT Relating to nurse delegation in adult day services; and reenacting and amending RCW 18.79.260.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 18.79.260 and 2012 c 164 s 407, 2012 c 13 s 3, and
2012 c 10 s 37 are each reenacted and amended to read as follows:
(1) A registered nurse under his or her license may perform for
compensation nursing care, as that term is usually understood, to
individuals with illnesses, injuries, or disabilities.
(2) A registered nurse may, at or under the general direction of a
licensed physician and surgeon, dentist, osteopathic physician and
surgeon, naturopathic physician, optometrist, podiatric physician and
surgeon, physician assistant, osteopathic physician assistant, advanced
registered nurse practitioner, or midwife acting within the scope of
his or her license, administer medications, treatments, tests, and
inoculations, whether or not the severing or penetrating of tissues is
involved and whether or not a degree of independent judgment and skill
is required. Such direction must be for acts which are within the
scope of registered nursing practice.
(3) A registered nurse may delegate tasks of nursing care to other
individuals where the registered nurse determines that it is in the
best interest of the patient.
(a) The delegating nurse shall:
(i) Determine the competency of the individual to perform the
tasks;
(ii) Evaluate the appropriateness of the delegation;
(iii) Supervise the actions of the person performing the delegated
task; and
(iv) Delegate only those tasks that are within the registered
nurse's scope of practice.
(b) A registered nurse, working for a home health or hospice agency
regulated under chapter 70.127 RCW, may delegate the application,
instillation, or insertion of medications to a registered or certified
nursing assistant under a plan of care.
(c) Except as authorized in (b) or (e) of this subsection, a
registered nurse may not delegate the administration of medications.
Except as authorized in (e) of this subsection, a registered nurse may
not delegate acts requiring substantial skill, and may not delegate
piercing or severing of tissues. Acts that require nursing judgment
shall not be delegated.
(d) No person may coerce a nurse into compromising patient safety
by requiring the nurse to delegate if the nurse determines that it is
inappropriate to do so. Nurses shall not be subject to any employer
reprisal or disciplinary action by the 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.
(e) For delegation in community-based care settings or in-home care
settings, a registered nurse may delegate nursing care tasks only to
registered or certified nursing assistants or home care aides certified
under chapter 18.88B RCW. Simple care tasks such as blood pressure
monitoring, personal care service, diabetic insulin device set up,
verbal verification of insulin dosage for sight-impaired individuals,
or other tasks as defined by the nursing care quality assurance
commission are exempted from this requirement.
(i) "Community-based care settings" includes: Community
residential programs for people with developmental disabilities,
certified by the department of social and health services under chapter
71A.12 RCW; adult family homes licensed under chapter 70.128 RCW;
((and)) assisted living facilities licensed under chapter 18.20 RCW;
and adult day health services administered or provided by contract by
the department directly or through contract with area agencies under
chapter 74.39A RCW. Community-based care settings do not include acute
care or skilled nursing facilities.
(ii) "In-home care settings" include an individual's place of
temporary or permanent residence, but does not include acute care or
skilled nursing facilities, and does not include community-based care
settings as defined in (e)(i) of this subsection.
(iii) Delegation of nursing care tasks in community-based care
settings and in-home care settings is only allowed for individuals who
have a stable and predictable condition. "Stable and predictable
condition" means a situation in which the individual's clinical and
behavioral status is known and does not require the frequent presence
and evaluation of a registered nurse.
(iv) The determination of the appropriateness of delegation of a
nursing task is at the discretion of the registered nurse. Other than
delegation of the administration of insulin by injection for the
purpose of caring for individuals with diabetes, the administration of
medications by injection, sterile procedures, and central line
maintenance may never be delegated.
(v) When delegating insulin injections under this section, the
registered nurse delegator must instruct the individual regarding
proper injection procedures and the use of insulin, demonstrate proper
injection procedures, and must supervise and evaluate the individual
performing the delegated task weekly during the first four weeks of
delegation of insulin injections. If the registered nurse delegator
determines that the individual is competent to perform the injection
properly and safely, supervision and evaluation shall occur at least
every ninety days thereafter.
(vi)(A) The registered nurse shall verify that the nursing
assistant or home care aide, as the case may be, has completed the
required core nurse delegation training required in chapter 18.88A or
18.88B RCW prior to authorizing delegation.
(B) Before commencing any specific nursing tasks authorized to be
delegated in this section, a home care aide must be certified pursuant
to chapter 18.88B RCW and must comply with RCW 18.88B.070.
(vii) The nurse is accountable for his or her own individual
actions in the delegation process. Nurses acting within the protocols
of their delegation authority are immune from liability for any action
performed in the course of their delegation duties.
(viii) Nursing task delegation protocols are not intended to
regulate the settings in which delegation may occur, but are intended
to ensure that nursing care services have a consistent standard of
practice upon which the public and the profession may rely, and to
safeguard the authority of the nurse to make independent professional
decisions regarding the delegation of a task.
(f) The nursing care quality assurance commission may adopt rules
to implement this section.
(4) Only a person licensed as a registered nurse may instruct
nurses in technical subjects pertaining to nursing.
(5) Only a person licensed as a registered nurse may hold herself
or himself out to the public or designate herself or himself as a
registered nurse.