This bill amends existing Washington laws governing nursing delegation (including RCW 18.79.260, RCW 18.88A.210, RCW 18.88A.230, RCW 18.88B.070, and RCW 70.127.010) to revise when and how registered nurses may delegate nursing tasks, to revise related duties and protections for nursing assistants and certified home care aides, and to authorize rulemaking to implement those changes. It is an amendment of existing statutes rather than the creation of a new criminal offense. Substantive legal changes include expanded delegation authority for registered nurses to administer medications, treatments, tests, and inoculations under the general direction of specified licensed practitioners and to delegate tasks in any setting when the RN determines delegation is in the patient’s best interest and within the RN’s scope. Delegating RNs must verify the delegate’s competency, evaluate patient stability and appropriateness of delegation, and supervise performance. The bill preserves limits on delegation (for example, prohibiting delegation of certain medication administration, procedures that pierce or sever tissue, or acts requiring substantial skill or nursing judgment except as noted in specified subsections). If trained and delegated by a nurse, nursing assistants and certified home care aides may administer medications including subcutaneous injections and perform capillary blood sticks but may not administer intramuscular or intravenous medications. The bill also allows delegation to medical assistants credentialed under chapter 18.360 RCW. The amendments establish accountability and liability rules: RNs, nursing assistants, and home care aides are accountable for their own actions in delegation, but persons who accurately follow written delegation instructions or who act within delegation authority are granted immunity from liability; nurses, nursing assistants, and home care aides are protected from employer reprisal or disciplinary action for refusing delegation based on patient safety concerns, and emergency administration of a prescribed available medication is protected from liability and reprisal. Procedural provisions and omissions in the provided text: the Board of Nursing must adopt rules implementing appropriate delegation parameters by January 1, 2028, and the Board and Department of Health may adopt necessary rules; sections 1 through 5 of the act take effect January 1, 2028. The extracted materials are incomplete in places: the amendment to RCW 18.88B.070 is truncated, the header references creation of a new section and an amendment to RCW 70.127.010 whose full text is not provided here, and the identity of the referenced "secretary" is not defined in the provided excerpts.

If enacted, the bill lets registered nurses more freely delegate many routine nursing tasks across settings, including allowing trained nursing assistants and credentialed home care aides to give some medications (for example subcutaneous injections) and perform capillary blood sticks, while still prohibiting intramuscular or intravenous medication by those aides. That will likely shift routine, noncomplex work out of the hands of RNs into in‑home and community settings, enabling agencies to expand services and potentially lower direct RN labor costs, but it also increases responsibilities for RNs to verify competency, supervise delegates, and document delegation decisions. Assistants and home care aides gain legal protection when they accurately follow written instructions and can refuse unsafe delegations without employer discipline, which reduces individual legal risk but may require more training and clear policies from employers. The Department of Health and the Washington State Board of Nursing must write implementing rules, with key provisions taking effect January 1, 2028, so agencies and employers will need to invest in training, supervision, and policy changes ahead of that date. Primary impacts fall on registered nurses (more oversight duties and continued accountability), nursing assistants and certified home care aides (expanded duties and protections), and home care/home health agencies (operational and training costs, revised staffing models, and new compliance responsibilities). Important details are missing from the provided text—specific exceptions referenced in subsections (7) and (8), the full training requirement language for home care aides, and the exact identity of the “secretary”—so some implementation responsibilities and limits remain unclear.