Delegation Rules for Washington CNAs: Nurse Delegation Explained

Nurse delegation in Washington is the process by which a registered nurse (the "RN delegator") authorizes a Nursing Assistant-Certified (NA-C) or Home Care Aide to perform a specific nursing task for a specific client in a community-based setting, such as an adult family home, an assisted living facility, or a DSHS in-home care program. Before accepting a delegated task, the aide must hold an active credential, complete the DSHS-approved nurse delegation core training, and, for insulin, the additional diabetes-focused module. The RN must assess the client as stable and predictable, obtain the client's consent, teach and verify the task, and remain responsible for supervising it. Delegation does not apply in hospitals or nursing homes.

Why Washington has nurse delegation

Washington places tens of thousands of people who need nursing tasks in home-like settings rather than nursing homes. Adult family homes alone number in the thousands, and few have a nurse on site around the clock. Nurse delegation solves that by letting a nurse train and supervise the caregivers who are present, rather than requiring a nurse for every insulin dose or blood glucose check. The Department of Social and Health Services (DSHS) administers the program and approves the training; the Washington State Board of Nursing (WABON) sets the nursing standards the delegating RN must follow.

For the nursing assistant, delegation is the main way the base scope of practice grows in community settings. What the base scope includes is laid out in our Washington CNA scope of practice article.

Where delegation applies, and where it does not

If a task is requested in a setting from the bottom half of the table, it is not a delegated task no matter how it is described, and performing it exposes the aide to discipline.

What can be delegated

The tasks the rules allow an RN to delegate are procedures with predictable steps that do not require nursing judgment at the moment of performance. Common examples:

• Administering medications by oral, topical, eye, ear, inhaled, and similar routes.
• Blood glucose monitoring.
• Insulin injections, after the aide completes the diabetes-focused delegation training.
• Gastrostomy tube feedings and care as the RN specifies.
• Ostomy care.
• Non-sterile dressing changes.

The rules also list what may never be delegated, regardless of the client or the aide's experience:

• Injections other than insulin.
• Sterile procedures.
• Central line maintenance.
• Any task that requires nursing assessment or judgment while it is performed.

The aide's prerequisites

1. An active credential. NA-C or Home Care Aide, showing Active on the DOH Provider Credential Search. A Nursing Assistant-Registered (NAR) cannot accept delegation.
2. The DSHS-approved nurse delegation core training. A short course covering the delegation process, the aide's responsibilities, medication basics, and documentation, ending in a test.
3. The diabetes-focused module if the delegated task involves insulin.
4. Task-specific teaching by the delegating RN for the specific client, with the RN verifying that the aide can perform the task correctly before the first unsupervised time.

The core training is separate from the 108-hour NA-C curriculum and is not part of the state competency exam. Graduates of the CNA Traditional program at Huduma CNA Programs who plan to work in adult family homes usually complete the delegation course soon after certification; employers often arrange it.

The RN delegator's process

Delegation is the nurse's decision and the nurse's responsibility. The steps the rules require:

Two consequences follow. First, delegation is not portable. It attaches to one nurse, one client, and one task; a new client or a new home means a new delegation. Second, the aide may decline. Washington's rules allow a nursing assistant to refuse a delegated task they do not feel competent to perform, without it counting as insubordination.

The aide's responsibilities once delegated

• Perform the task exactly as taught, for that client only.
• Document each time the task is performed, in the record the RN specifies.
• Report changes in the client's condition, refusals, missed doses, and errors to the RN promptly.
• Never re-delegate the task to another caregiver.
• Stop and call the RN if anything about the client or the task differs from what was taught.

Medication errors under delegation are among the more frequent sources of complaints against nursing assistants. How the Department of Health handles them, and how disclosure and documentation affect the outcome, is covered in our article on Washington CNA disciplinary actions.

Delegation versus the medication assistant endorsement

New NA-Cs often confuse the two. Both allow medication tasks, but they are different tools for different settings.

An NA-C who moves from an adult family home to a nursing home cannot carry delegation across, and an endorsed medication assistant moving to an adult family home must be delegated like anyone else. The endorsement is explained in medication assistant endorsement for Washington CNAs.

What delegation means for pay and jobs

Adult family homes and assisted living employers prefer aides who already hold the delegation training because it shortens onboarding for clients on insulin and multi-drug regimens. Washington's statewide NA-C job-posting average was about $23.62 per hour in August 2026, and community-setting employers commonly cite delegation readiness as a reason for offering the higher end of their range. Many adult family homes hire Home Care Aides for the same delegated tasks, which is why HCAs who bridge to NA-C keep their delegation training and gain access to hospital and nursing home roles too. Details on that route are on the HCA–CNA Bridge program page.

Frequently asked questions

Can a Washington CNA give insulin under nurse delegation? Yes, in a community setting, after completing the delegation core training and the diabetes-focused module, for a client the RN has assessed as stable and predictable and has specifically delegated.

Does nurse delegation work in nursing homes? No. Nursing homes use the medication assistant endorsement. Delegation applies to adult family homes, assisted living, and DSHS in-home settings.

Who can delegate, an RN or an LPN? Only a registered nurse acts as the RN delegator. Licensed practical nurses may be involved in supervision under the delegator's direction but do not initiate delegation.

Does the delegation training expire? The core training itself is completed once. The delegation of any specific task must be re-authorized by the RN for each client and ends when the RN rescinds it.

Can a NAR or a nursing student accept delegated tasks? No. Delegation requires an active NA-C or Home Care Aide credential.

Delegation is the reason community-setting jobs ask for it by name in postings. If you are entering the field with that setting in mind, plan to complete the core training in your first weeks after certification, and check current class dates if you still need the NA-C itself.