wa-law.org > bill > 2025-26 > HB 2425 > Original Bill
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.
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, 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.
A registered nurse may delegate tasks to other individuals in any setting where the registered nurse determines that it is in the best interest of the patient and within the nurse's scope of practice.
The delegating nurse shall:
a. Determine the competency of the individual to perform the tasks, including verifying certification or documentation where required by rule or law;
b. Evaluate the stability of the patient and the appropriateness of the delegation; and
c. Supervise the actions of the person performing the delegated task
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Except as authorized in subsection (7) of this section, a registered nurse may not delegate the administration of medications, tasks involving piercing or severing of tissues, or acts that require substantial skill. Acts that require nursing judgment may not be delegated.
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 board for refusing to delegate tasks or refusing to provide the required training for delegation if the nurse determines delegation may compromise patient safety.
The nurse is accountable for his or her own individual actions in the delegation process. Nurses acting within their delegation authority are immune from liability for any action performed in the course of their delegation duties.
If trained and delegated the task by a nurse, a nursing assistant-certified or home care aide, licensed under chapter 18.88A or 18.88B RCW, respectively, may administer medications, including those that pierce the skin through subcutaneous injections, and may perform capillary blood sticks.
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.
Education and training provided by a registered nurse to a caregiver who is a parent, guardian, or family member who is designated to provide care for a patient is not considered delegation of nursing care tasks, regardless of whether the caregiver is paid to complete the task.
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The board may adopt rules to implement this section.
By July 1, 2028, the board shall adopt rules to address appropriate delegation parameters.
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.
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, advanced practice registered nurse, 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.
A registered nurse may delegate tasks to other individuals in any setting where the registered nurse determines that it is in the best interest of the patient and within the nurse's scope of practice.
The delegating nurse shall:
a. Determine the competency of the individual to perform the tasks, including verifying certification or documentation where required by rule or law;
b. Evaluate the stability of the patient and the appropriateness of the delegation; and
c. Supervise the actions of the person performing the delegated task
.
Except as authorized in subsection (7) of this section, a registered nurse may not delegate the administration of medications, tasks involving piercing or severing of tissues, or acts that require substantial skill. Acts that require nursing judgment may not be delegated.
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 board for refusing to delegate tasks or refusing to provide the required training for delegation if the nurse determines delegation may compromise patient safety.
The nurse is accountable for his or her own individual actions in the delegation process. Nurses acting within their delegation authority are immune from liability for any action performed in the course of their delegation duties.
If trained and delegated the task by a nurse, a nursing assistant-certified or home care aide, licensed under chapter 18.88A or 18.88B RCW, respectively, may administer medications, including those that pierce the skin through subcutaneous injections, and may perform capillary blood sticks.
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.
Education and training provided by a registered nurse to a caregiver who is a parent, guardian, or family member who is designated to provide care for a patient is not considered delegation of nursing care tasks, regardless of whether the caregiver is paid to complete the task.
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The board may adopt rules to implement this section.
By July 1, 2028, the board shall adopt rules to address appropriate delegation parameters.
2.
Nursing assistants are accountable for their own individual actions in the delegation process. Nursing assistants accurately following delegation instructions from a nurse are immune from liability regarding the performance of the delegated duties.
2.
Nursing assistants are accountable for their own individual actions in the delegation process. Nursing assistants accurately following delegation instructions from a nurse are immune from liability regarding the performance of the delegated duties.
Nursing assistants shall be accountable for their own individual actions in the delegation process. Nursing assistants following delegation instructions from nurses performed in the course of their accurately written, delegated duties shall be immune from liability.
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. No facility or employer may discriminate or retaliate in any manner against a person because the person made a complaint or cooperated in the investigation of a complaint.
Liability, reprisal, or disciplinary action when administering medications in an emergency response situation if the patient has a prescribed and available medication for that specific type of emergency event.
The legislature recognizes that nurses have been successfully delegating nursing care tasks to family members and others for many years. The opportunity for a nurse to delegate nursing care tasks to home care aides certified under this chapter may enhance the viability and quality of health care services in community-based care settings and in-home care settings to allow individuals to live as independently as possible with maximum safeguards.
A certified home care aide who wishes to perform a nurse delegated task pursuant to RCW 18.79.260 must complete nurse delegation core training under chapter 18.88A RCW before the home care aide may be delegated a nursing care task by a registered nurse delegator.
Home care aides are accountable for their own individual actions in the delegation process. Home care aides accurately following delegation instructions from a nurse are immune from liability regarding the performance of the delegated duties.
Home care aides are not subject to :
Any employer reprisal or disciplinary action by the secretary for refusing to accept delegation of a nursing care task based on his or her concerns about patient safety issues. No facility or employer may discriminate or retaliate in any manner against a person because the person made a complaint about the nurse delegation process or cooperated in the investigation of the complaint.
Liability, reprisal, or disciplinary action when administering medications in an emergency response situation if the patient has a prescribed and available medication for that specific type of emergency event.
Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
"Administrator" means an individual responsible for managing the operation of an agency.
"Department" means the department of health.
"Director of clinical services" means an individual responsible for nursing, therapy, nutritional, social, and related services that support the plan of care provided by in-home health and hospice agencies.
"Family" means individuals who are important to, and designated by, the patient or client and who need not be relatives.
"Home care agency" means a person administering or providing home care services directly or through a contract arrangement to individuals in places of temporary or permanent residence. A home care agency where nurses delegate tasks of nursing under RCW 18.79.260 is not considered a home health agency for the purposes of this chapter.
"Home care services" means nonmedical services and assistance provided to ill, disabled, or vulnerable individuals that enable them to remain in their residences. Home care services include, but are not limited to: Personal care such as assistance with dressing, feeding, and personal hygiene to facilitate self-care; homemaker assistance with household tasks, such as housekeeping, shopping, meal planning and preparation, and transportation; respite care assistance and support provided to the family; or other nonmedical services or delegated tasks of nursing under RCW 18.79.260.
"Home health agency" means a person administering or providing two or more home health services directly or through a contract arrangement to individuals in places of temporary or permanent residence. A person administering or providing nursing services only may elect to be designated a home health agency for purposes of licensure.
"Home health services" means services provided to ill, disabled, or vulnerable individuals. These services include but are not limited to nursing services, home health aide services, physical therapy services, occupational therapy services, speech therapy services, respiratory therapy services, nutritional services, medical social services, and home medical supplies or equipment services.
"Home health aide services" means services provided by a home health agency or a hospice agency under the supervision of a registered nurse, physical therapist, occupational therapist, or speech therapist who is employed by or under contract to a home health or hospice agency. Such care includes ambulation and exercise, assistance with self-administered medications, reporting changes in patients' conditions and needs, completing appropriate records, and personal care or homemaker services.
"Home medical supplies" or "equipment services" means diagnostic, treatment, and monitoring equipment and supplies provided for the direct care of individuals within a plan of care.
"Hospice agency" means a person administering or providing hospice services directly or through a contract arrangement to individuals in places of temporary or permanent residence under the direction of an interdisciplinary team composed of at least a nurse, social worker, physician, spiritual counselor, and a volunteer.
"Hospice care center" means a homelike, noninstitutional facility where hospice services are provided, and that meets the requirements for operation under RCW 70.127.280.
"Hospice services" means symptom and pain management provided to a terminally ill individual, and emotional, spiritual, and bereavement support for the individual and family in a place of temporary or permanent residence, and may include the provision of home health and home care services for the terminally ill individual.
"Immediate jeopardy" means a situation in which the in-home services agency's noncompliance with one or more statutory or regulatory requirements has placed the health and safety of patients in its care at risk for serious injury, serious harm, serious impairment, or death.
"In-home services agency" means a person licensed to administer or provide home health, home care, hospice services, or hospice care center services directly or through a contract arrangement to individuals in a place of temporary or permanent residence.
"Person" means any individual, business, firm, partnership, corporation, company, association, joint stock association, public or private agency or organization, or the legal successor thereof that employs or contracts with two or more individuals.
"Plan of care" means a written document based on assessment of individual needs that identifies services to meet these needs.
"Quality improvement" means reviewing and evaluating appropriateness and effectiveness of services provided under this chapter.
"Service area" means the geographic area in which the department has given prior approval to a licensee to provide home health, hospice, or home care services.
"Social worker" means a person with a degree from a social work educational program accredited and approved as provided in RCW 18.320.010 or who meets qualifications provided in 42 C.F.R. Sec. 418.114 as it existed on January 1, 2012.
"Survey" means an inspection conducted by the department to evaluate and monitor an agency's compliance with this chapter.
(1) Section 1 of this act expires June 30, 2027.
(1) Section 2 of this act takes effect June 30, 2027.