SB 6107
In CommitteeSenate
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 updates Washington’s rules for how registered nurses can delegate nursing tasks to certified nursing assistants and home care aides in community and home settings. It specifies which tasks can and cannot be delegated, who must be trained, and adds legal protections for both nurses and support staff to ensure patient safety and accountability.
- Clarifies that registered nurses may delegate certain nursing tasks (e.g., insulin injections, blood glucose testing) to certified nursing assistants or home care aides in community-based or in-home settings, but only if the patient has a stable and predictable condition.
- Requires nurses to verify that support staff have completed required core and, where applicable, specialized diabetes nurse delegation training before delegating tasks.
- Prohibits delegation of high-risk tasks (e.g., sterile procedures, central line maintenance, medications by injection other than insulin) and tasks requiring nursing judgment.
- Grants legal immunity to nurses and support staff (e.g., nursing assistants, home care aides) who follow delegation protocols in good faith, and protects them from employer retaliation for refusing unsafe delegation.
- Defines 'community-based care settings' (e.g., adult family homes, assisted living) and 'in-home care settings' and specifies delegation rules apply only in those contexts—not in hospitals or skilled nursing facilities.
- States that training provided by nurses to family or designated caregivers (even if paid) is not considered delegation and is exempt from delegation rules.
Who is affected
- Registered nurses — Registered nurses gain clearer authority to delegate certain tasks to qualified support staff in community-based and in-home settings, while being protected from being forced to delegate if it risks patient safety.
- Certified nursing assistants and home care aides — Certified nursing assistants and home care aides may now accept delegation of specific nursing tasks (like insulin injections or blood glucose testing) after completing required training, and gain legal protections when following nurse instructions.
- Patients and clients in community-based or in-home care — Individuals receiving care in adult family homes, assisted living facilities, or at home benefit from clearer rules that help ensure safe, consistent delegation of care tasks by nurses.
- Family and designated caregivers — Families or designated caregivers who receive training from nurses to help with care (e.g., insulin administration) are explicitly excluded from being considered 'delegated' staff, preserving their legal status.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (5)
The bill explicitly permits certified nursing assistants and home care aides to perform insulin injections and capillary blood sticks—tasks previously ambiguous or restricted—allowing more people to receive necessary care at home or in community settings, reducing hospitalizations and preserving independence for seniors and people with disabilities.
HealthcarePeopleRef: RCW 18.79.260(7); RCW 18.88A.210(1); RCW 18.88B.070(1)The bill grants legal immunity and anti-retaliation protections to both nurses and support staff who refuse unsafe delegation—empowering frontline workers to uphold patient safety without fear of job loss or liability, a significant protection for low-wage workers who previously had little legal recourse.
Rights & LibertiesPeopleRef: RCW 18.79.260(5) and (6); RCW 18.88A.230(2); RCW 18.88B.070(4)The bill explicitly excludes training provided by nurses to family or designated caregivers (even if paid) from the delegation rules—preserving the ability of families to assist with insulin or glucose monitoring without triggering regulatory penalties, supporting informal caregiving networks that many low- and middle-income families rely on.
HealthcarePeopleRef: RCW 18.79.260(9); RCW 18.79.260(3)(e)(vii)(A)By clarifying that delegation applies in adult family homes, assisted living, and private residences—but not hospitals or skilled nursing facilities—the bill supports the state’s policy of aging in place, helping low-income seniors avoid costly institutional care and remain in familiar, less restrictive settings.
HousingPeopleRef: RCW 18.79.260(3)(e)(i)-(ii) (definitions of community-based and in-home settings); RCW 18.79.260(3)(e)(iv) (nurse discretion on delegation appropriateness)Standardizing delegation protocols—including mandatory core and diabetes-specific training—reduces variability in care quality and improves consistency across providers, which enhances patient safety and trust in home- and community-based care.
HealthcarePeopleRef: RCW 18.79.260(3)(e)(vi)(A) and (B); RCW 18.88A.210(2)(a); RCW 18.88B.070(2)(a)
Potential Concerns (5)
The bill imposes new training verification and certification requirements on certified nursing assistants and home care aides before they may perform delegated tasks (e.g., insulin injections), increasing administrative and training costs for home care agencies and adult family homes—many of which operate on thin margins and serve low-income clients.
Business & EmploymentPeopleRef: RCW 18.79.260(3)(e)(vii)(A) and (B); RCW 18.88A.210(2)(a); RCW 18.88B.070(2)(a)The requirement that delegation only apply to individuals with a ‘stable and predictable condition’ may exclude some vulnerable patients (e.g., those with fluctuating dementia, unstable diabetes, or complex medication regimens) from receiving delegated care, potentially forcing them into more expensive institutional settings or leaving families to provide high-risk care without formal support.
HealthcarePeopleRef: RCW 18.79.260(3)(e)(iii) (‘stable and predictable condition’ requirement); RCW 18.79.260(3)(e)(iv) (nurse discretion on delegation appropriateness)The bill mandates specialized diabetes training for insulin delegation, but does not fund or expand existing training infrastructure—potentially creating bottlenecks in training capacity, especially in rural areas, delaying care access for patients needing timely insulin management.
EducationLean peopleRef: RCW 18.79.260(3)(e)(vii)(A) and (B); RCW 18.88A.210(2)(a); RCW 18.88B.070(2)(a)While the bill provides legal immunity and anti-retaliation protections for support staff who refuse unsafe delegation, it does not allocate funding for legal defense or enforcement oversight—meaning low-wage workers may still fear retaliation despite the legal shield, especially in settings with limited oversight (e.g., small adult family homes).
Business & EmploymentPeopleRef: RCW 18.79.260(5) and (6); RCW 18.88A.230(2); RCW 18.88B.070(4)The bill requires the Washington State Board of Nursing to adopt rules by 2028, but provides no dedicated funding—shifting administrative burden to an already-constrained state agency and potentially delaying implementation, which could disrupt care continuity for agencies relying on updated delegation guidance.
Local GovernmentPeopleRef: RCW 18.79.260(10)(b) (rule adoption deadline: July 1, 2028); Fiscal Impact section
Who Is Most Affected
Home care aides and certified nursing assistants gain clear authority to perform specific clinical tasks (e.g., insulin injections) and legal protections against retaliation, but face new training and verification burdens that may delay task performance and increase their liability exposure if training is incomplete or misapplied.
Registered nurses gain clearer authority to delegate and legal immunity for delegation in good faith, but must now verify training and assess patient stability—adding time and administrative burden to their workflow, especially in under-resourced settings.
Patients in community-based or in-home care benefit from expanded access to essential tasks like insulin administration in familiar settings, supporting independence and reducing hospitalizations—but may be excluded if their condition is not deemed ‘stable and predictable,’ limiting access for those with complex or fluctuating needs.
Family and designated caregivers gain explicit legal clarity that their training from nurses is not considered delegation, preserving their ability to assist with medical tasks—even when paid—without triggering regulatory penalties, which is especially valuable for low-income families relying on informal care.
Adult family homes and small home care agencies benefit from clearer delegation rules that reduce regulatory ambiguity and support staffing flexibility, but face new costs for ensuring staff complete required training and for legal compliance—pressures that disproportionately affect small, under-resourced operators.