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"But it's just eyedrops!" The Importance of RN Delegation

If you call our office looking for care, you can be sure that you will hear us ask about what sort of daily tasks are involved in you or your loved one's care. We will ask about medications and whether or not you or your loved one is able to take those medications themselves. If not, we know that we will be looking at something called nurse delegated caregiving. Things as simple as As a consumer it can be difficult to understand all of the terminology that is thrown around in the home healthcare world, and nurse delegation is one of those frequently used terms. So, what exactly does RN Delegation mean and what sort of benefits does it offer to the consumer?

A basic definition of RN Delegation is the entrustment of any non-judgment related, medical task, usually performed by a nurse, to a CNA. The CNA must have their ability to perform the skill verified by a registered nurse and the nurse must then sign documents allowing the Care Specialist to work under their license. RN Delegation is a big deal. It acts as a safety measure and checkpoint for client care, as the nurse’s license can be jeopardized if they do not trust the skills of the caregiver that they are delegating. Even tasks as simple as eyedrops have to be delegated, because it is technically a medication being administered to a client. This can be frustrating, because delegation does change the hourly cost of caregiving slightly. However, when we understand that the true purpose behind RN delegation is to keep people safe and well cared for. So, what can and must be delegated?

According to Washington State Law the following tasks MUST be delegated by a registered nurse:

  • Administration of oral, topical, inhaled medications, suppositories, and eye drops

  • Bowel programs

  • In and out catheters (straight catheter)

  • Tube feedings

  • Colostomy care

  • Blood glucose monitoring and Insulin pen injections

  • Simple non-sterile dressing changes

Furthermore, there is a standard process that nurses must follow in order to delegate a caregiver. First, all nurses must perform under the direction of a supervising physician. So, orders for the service must be obtained from the client’s primary care provider. After orders are received, the RN must also request consent for delegation from the physician. Following consent, the RN completes a nursing assessment and writes a plan of care for the individual receiving care. Within the plan of care, specific instructions are written regarding the delegated task(s). All caregivers providing delegated care are required to take a delegation course and must be certified, as well. Once the RN verifies that the caregiver is capable and competent at performing the delegated skill, the caregiver is able to complete the task for the client without the direct supervision of the RN. Washington State requires that all delegated caregivers have their skills verified every 90 days to ensure that the plan of care is being followed and that any necessary changes to the plan of care are made and consequently followed. It might seem like a very complicated process, but all of these checks and balances are what make RN Delegation so beneficial to the client. If a home care company or caregiver is doing any of the aforementioned tasks without RN Delegation, that is huge red flag and a major safety concern.

In the end, RN delegation is extremely helpful to the client, because rather then pay for a nurse to perform a skill day in day out, they can have their usual caregiver perform the task and save money in the process. Most importantly, it ensures that all instructions regarding a client’s care are being properly followed and protects against dangerous, and potentially even fatal, mistakes.

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