In addition to the competencies identified in WAC 246-841A-400, nursing assistants may perform additional delegated tasks under the supervision of a registered nurse in accordance with RCW 18.79.260.

(1) RCW 18.79.260 addresses general requirements for registered nurse delegation as well as requirements specific to certain care entities and settings, including home health or hospice agencies and community-based or in-home care settings, as defined in the statute.

(2) General requirements for registered nursing delegation that apply in all care settings include:

(a) In accordance with RCW 18.79.260 (3)(f), registered nurse delegation may include glucose monitoring and testing as a general allowance, including in hospitals and nursing homes.

(b) Delegated nursing care tasks described in this section are only for the specific patient receiving delegation.

(c) A nursing assistant may consent or refuse to consent to perform a delegated nursing care task. The nursing assistant is responsible for their own actions with the decision to consent or refuse to consent and the performance of the delegated nursing care task.

(d) Nursing assistants shall not accept delegation of, or perform, the following nursing care tasks:

(i) Administration of medication by injection, except for insulin injections as authorized in RCW 18.79.260 (3)(e);

(ii) Sterile procedures;

(iii) Central line maintenance;

(iv) Except as authorized in RCW 18.79.260 (3)(e) and (f), piercing or severing of tissues and acts requiring substantial skill; and

(v) Acts requiring nursing judgment.

(3) RCW 18.79.260 (3)(e) defines specific requirements for registered nurse delegation in community-based or in-home care settings. WAC 246-840-910 through 246-840-970 provide additional applicable requirements for compliance. Before performing any delegated task in these care settings:

(a) Nursing assistants-registered must show evidence as required by the department of social and health services of successful completion of both the basic caregiver training and designated nurse delegation core training from the department of social and health services to the registered nurse delegator.

(b) Nursing assistants-certified must show the registered nurse delegator evidence as required by the department of social and health services of successful completion of required nurse delegation core training. The training is provided by the department of social and health services.

(c) All nursing assistants registered and certified who may be completing insulin injections must show to the registered nurse delegator evidence as required by the department of social and health services of successful completion of nurse delegation special focus on diabetes training.

(d) All nursing assistants must meet any additional training requirements identified by the commission. Any exceptions to additional training requirements must comply with RCW 18.79.260 (3)(e)(v).