SHB 2425
In CommitteeHouse
Nursing delegation
Concerning nursing delegation.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill clarifies and expands the rules for how registered nurses can delegate tasks to certified nursing assistants and home care aides in community and home settings. It strengthens nurse authority and accountability, sets clear training requirements for support staff, and protects both nurses and staff from being forced into unsafe delegation practices.
- Registered nurses may delegate certain nursing tasks (e.g., insulin injections, glucose testing) to certified nursing assistants or home care aides in community-based or in-home settings, but only after verifying training and patient stability.
- Nurses must assess the competency of individuals performing delegated tasks, supervise their work, and retain full accountability for delegation decisions.
- Nurses are protected from employer retaliation if they refuse to delegate tasks they believe could compromise patient safety.
- Certified nursing assistants and home care aides must complete specific training (including diabetes-specific training for insulin injections) before performing delegated tasks, and gain liability protection when following instructions accurately.
- Family members or designated caregivers receiving training from nurses are not considered formal delegation and are exempt from delegation rules and liability.
- The bill prohibits delegation of high-risk tasks like sterile procedures, central line maintenance, or medications requiring injection (except insulin) to non-nurse staff.
Who is affected
- Registered nurses — Registered nurses gain clearer authority to delegate certain tasks to qualified support staff, but remain fully accountable for delegation decisions and patient safety. They are protected from employer retaliation for refusing unsafe delegation requests.
- Certified nursing assistants and home care aides — Certified nursing assistants and home care aides may perform delegated tasks (e.g., insulin injections, blood glucose testing) only after completing required training and under nurse supervision. They gain liability protection when following delegation instructions accurately.
- Family and informal caregivers — Families or caregivers designated by the patient can receive training from nurses to help with care (e.g., insulin administration) without being considered formal delegation—meaning they are not subject to the same rules or liability as paid staff.
- Community-based and in-home care agencies — Agencies providing in-home or community-based care (e.g., adult family homes, assisted living, home care agencies) must ensure staff meet training and delegation requirements, and cannot force staff to accept unsafe delegations.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (5)
Explicitly protects nurses, nursing assistants, and home care aides from employer retaliation when refusing unsafe delegation—reducing coercion and improving frontline worker autonomy, which is strongly associated with reduced medical errors and better patient outcomes.
Public SafetyPeopleRef: Sec. 1(5); Sec. 3(2); Sec. 6(4)(a)Standardizes and expands delegation of insulin injections and glucose monitoring to trained non-nurse staff in community and home settings—increasing access to essential diabetes care for seniors and people with disabilities who rely on home- or community-based services, reducing hospitalizations and ER visits.
HealthcarePeopleRef: Sec. 1(3)(e)(v); Sec. 1(3)(e)(vii)(A); Sec. 3(2)(b); Sec. 6(2)(b)Exempts family and designated caregivers from formal delegation rules, allowing nurses to train them without liability—supporting informal caregiving, reducing reliance on paid staff, and enabling continuity of care for vulnerable individuals (e.g., children with complex medical needs, elderly with dementia).
HealthcarePeopleRef: Sec. 1(9); Sec. 1(3)(e)(vii)(A)Grants immunity from liability to certified nursing assistants and home care aides who accurately follow nurse delegation instructions—encouraging participation in delegated care and reducing legal risk for frontline workers, especially important in under-resourced settings.
Rights & LibertiesPeopleRef: Sec. 3(2); Sec. 6(3); Sec. 1(3)(e)(vii)(A)Mandates standardized training (core + diabetes-specific) before delegation—improving consistency, safety, and quality of care across providers and settings, and increasing confidence among patients, families, and employers.
HealthcarePeopleRef: Sec. 1(3)(e)(vii)(A); Sec. 3(2)(a)(i); Sec. 6(2)(a)(i)
Potential Concerns (5)
Mandates new training requirements for certified nursing assistants and home care aides (e.g., core delegation training, diabetes-specific training), which may increase staffing costs and administrative burdens for home care and community-based agencies—particularly small or under-resourced providers—especially if training is not subsidized or reimbursed.
Business & EmploymentRef: Sec. 1(3)(e)(vii)(A); Sec. 3(2)(a)(i); Sec. 6(2)(a)(i)Prohibits employer retaliation for refusal to delegate unsafe tasks, which strengthens worker protections but may increase liability exposure and compliance costs for agencies that rely on high-volume delegation models or lack robust safety oversight protocols.
Business & EmploymentLean peopleRef: Sec. 1(5); Sec. 3(2); Sec. 6(4)(a)Requires the Washington State Board of Nursing to adopt rules by July 1, 2028, and verifies certification of home care aides per RCW 18.88B.070—implying administrative and oversight costs for the state board and Department of Health, though the fiscal impact summary suggests these are modest and offset by improved outcomes.
Local GovernmentRef: Sec. 1(10)(b); Sec. 1(3)(e)(vi)(B)Limits delegation to patients with a “stable and predictable condition,” potentially excluding vulnerable individuals with complex or fluctuating needs (e.g., advanced dementia, unstable diabetes, psychiatric crises) from accessing delegated care—even if trained staff are available—reducing access for those most in need of community-based support.
HealthcarePeopleRef: Sec. 1(3)(e)(iii); Sec. 1(3)(e)(vii)(A)Requires nurses to personally demonstrate and supervise insulin injection training and competency—increasing time, liability exposure, and opportunity cost for nurses, which may reduce delegation frequency or deter participation, especially in rural or workforce-short areas.
HealthcarePeopleRef: Sec. 1(3)(e)(v); Sec. 1(3)(e)(vii)(A); Sec. 3(2)(b); Sec. 6(2)(b)
Who Is Most Affected
Registered nurses gain clearer authority and liability protections, but face increased responsibility and time demands for training and supervision—net positive for autonomy and safety, but may increase burnout if staffing is not adjusted.
Certified nursing assistants and home care aides gain new scope of practice, liability protection, and training pathways—net positive for career advancement and job security, especially for those in community-based roles.
Family and informal caregivers benefit from legal clarity and expanded ability to assist with medical tasks (e.g., insulin) without formal delegation—reducing stress and out-of-pocket costs, especially for low-income families lacking paid support.
Community-based and in-home care agencies face new training and supervision obligations, but may benefit from improved care continuity, reduced turnover, and ability to meet growing demand for home- and community-based services—net mixed, with small agencies likely more strained than larger ones.
Patients with stable chronic conditions (e.g., diabetes) gain safer, more accessible care in their homes—reducing institutionalization and improving quality of life; those with unstable or complex needs may be excluded due to the “stable and predictable condition” requirement.