AN ACT Relating to nursing delegation;
HB 2425 revises Washington’s nursing delegation laws to expand and clarify when registered nurses may delegate certain nursing care tasks to other workers, especially in home care, home health, hospice, and community-based care settings. The bill amends multiple sections of state law to define delegation standards, require nurses to assess patient stability and delegate only within scope of practice, and specify which tasks may or may not be delegated. It also creates new provisions addressing training, supervision, documentation, liability, and protections against retaliation when nurses or care workers refuse unsafe delegation.
The bill specifically authorizes delegation to nursing assistants, certified nursing assistants, home care aides, and, in some cases, medical assistants, with added requirements for core delegation training and specialized diabetes-related training before insulin injections may be delegated. It also allows certain delegated tasks such as glucose monitoring, blood pressure checks, capillary blood sticks, and some medication administration by injection under defined conditions, while continuing to prohibit delegation of more complex or higher-risk acts such as intravenous or intramuscular medication administration, sterile procedures, and central line maintenance. The bill further directs the Board of Nursing and the Department of Health to adopt rules to implement the new framework.
HB 2425 changes the scope of Washington nursing practice and home- and community-based care regulation by expanding statutory authority for registered nurses to delegate more tasks to trained aides and assistants. It amends RCW provisions governing nursing delegation, home care services, home health agencies, hospice agencies, and related licensing and training requirements, and it creates new rulemaking authority for the Board of Nursing and the Department of Health. The bill affects registered nurses, nursing assistants, home care aides, medical assistants, home health/hospice providers, and patients receiving care in homes, assisted living, adult family homes, and community residential programs.
The available voting record shows strong support: the House Health Care & Wellness Committee recommended the first substitute bill do pass by a 16-0 vote. The bill text itself frames the changes as a patient-safety measure that also improves access to care and supports independent living for people receiving services in home and community settings. Overall, the sentiment appears favorable and pragmatic, with the legislation presented as a modernization of delegation rules rather than a major policy overhaul.
The main points of contention are centered on patient safety, professional judgment, and the limits of delegation. The bill emphasizes that delegation remains discretionary for the registered nurse and prohibits coercion or retaliation against nurses who refuse to delegate when they believe it would compromise safety. It also draws clear lines around tasks that cannot be delegated, such as IV/IM medication administration, sterile procedures, and central line care, suggesting concern about overexpansion of delegated duties. Another likely tension is the added training burden on nursing assistants and home care aides, especially for insulin administration, balanced against the bill’s goal of expanding care capacity in home and community settings.