Nurse delegation is the single clearest way for a certified Home Care Aide in Washington to widen what they are allowed to do at work. It is also the topic caregivers get the most bad information about, usually from coworkers who half-remember a rule from a different state.
So here is what the law actually says.
What nurse delegation is
Washington law lets a registered nurse hand off specific nursing tasks to a certified Home Care Aide or a certified nursing assistant, for a specific client, when the RN decides that delegating is in that client's best interest (RCW 18.79.260).
Notice the shape of that sentence. It is not a blanket upgrade to your scope of practice. It is task-specific and client-specific. The RN determines your competency, evaluates whether delegation is appropriate at all, supervises you afterward, and stays accountable for their own part in the process. Nobody can pressure a nurse into delegating a task they judge unsafe, and a nurse cannot be disciplined or retaliated against for refusing.
The practical version: delegation moves with the client, not with you. New client means a new delegation and new on-site, client-specific teaching from the RN.
Where it applies
Delegation is allowed in community-based care settings and in-home care settings. That means:
- Adult family homes
- Assisted living facilities
- Certified community residential programs for people with developmental disabilities
- A client's own home, permanent or temporary
It is not allowed in acute care facilities or skilled nursing facilities.
There is one more condition that people skip: the client has to have a stable and predictable condition, meaning their clinical and behavioral status is known and they do not need an RN frequently present to evaluate them.
What can be delegated
Tasks an RN may delegate include glucose monitoring and testing, blood pressure monitoring, personal care services, setting up a diabetic insulin device, and verbally verifying insulin dosage for a client with vision impairment, along with other nursing care tasks for stable clients.
Medication administration is where it gets interesting, and where the training you take matters.
What can never be delegated
Under RCW 18.79.260, an RN may not delegate:
- Administration of medications, except where the statute specifically allows it
- Acts requiring substantial skill
- Piercing or severing tissue
- Acts requiring nursing judgment
- Administration of medication by injection
- Sterile procedures
- Central line maintenance
The insulin exception
Injections may never be delegated, with exactly one exception: insulin by injection, for the care of a client with diabetes.
When an RN delegates insulin injection, they have to instruct the caregiver on proper injection procedure and insulin use, demonstrate the procedure, then supervise and evaluate the caregiver. Once the RN determines the caregiver is competent to do it safely, ongoing supervision continues at an interval set by board rule.
That one exception is why our 3-hour Nurse Delegation: Special Focus on Diabetes course exists as a separate credential, and why diabetes-capable caregivers are in constant demand. A large share of long-term care clients are diabetic. A caregiver who can handle insulin under delegation solves a scheduling problem that otherwise requires a nurse visit.
What training you need before an RN can delegate to you
Two things have to be true before you perform any delegated nursing task in an adult family home or assisted living facility (WAC 388-112A-0550):
- You have completed the DSHS-designated nurse delegation core training, titled Nurse Delegation for Nursing Assistants and Home Care Aides.
- You are a certified Home Care Aide or a certified nursing assistant.
You also have to physically show your certificate of completion of core delegation training to the RN delegator before performing any delegated task (WAC 246-980-130). Keep a copy on your phone. You will be asked for it more than once.
And the RN's own verification checklist requires confirming that you hold an unrestricted credential and that you completed both basic caregiver training and core delegation training before performing any delegated task (WAC 246-840-930).
The sequence, in order:
- Get certified as an HCA
- Complete nurse delegation core training (ours is 9 hours, online self-study)
- Add the diabetes special focus course if you want insulin and glucose tasks (3 hours, online)
- Receive client-specific, on-site teaching from the RN delegator for each client
Skipping step 4 is the mistake that gets people in real trouble. Core training does not authorize you to do anything by itself. It makes you eligible to be taught.
Why bother
Three reasons, in the order caregivers usually care about them.
Pay. Delegation-trained caregivers are harder to replace and get first call on higher-paying assignments, particularly in adult family homes where the provider is trying to cover medication passes without a nurse on site.
Hours. Adult family homes and assisted living facilities schedule around who can do what. Being the person who can handle a glucose check and an insulin dose means you get scheduled.
Career direction. Delegation work is the closest a caregiver gets to clinical practice without going back to school. A lot of people discover through it that they want to go on to LPN or RN, and a lot of employers will help pay for that once you have proven yourself.
Common misunderstandings
"I took core delegation, so I can pass meds at any client." No. Delegation is per client, per task, taught on site by that client's RN delegator.
"My employer says I have to do it." An employer cannot force an RN to delegate, and an RN who thinks the delegation is unsafe is protected in refusing. If you are being pushed to perform a task nobody delegated to you, that is your license at risk, not theirs.
"Delegation is for facilities only." In-home settings count too, including a client's permanent or temporary residence.
Next step
If you are already certified, nurse delegation core is the highest-return 9 hours available to you. Add the diabetes course and you are qualified for the assignments most caregivers cannot take.
Both run online, both are DSHS-approved, and both are on our Programs page. Questions about which order to take them in, or whether your employer will reimburse them, call or text (907) 414-3347.