This bill amends existing Washington statutes governing nursing delegation and related home care and home health statutes (including changes to RCW 18.79.260, sections of chapters 18.88A and 18.88B, and RCW 70.127.010). It was introduced at the request of the Washington State Board of Nursing. The bill modifies current law rather than creating an entirely new code chapter. Substantive legal changes expand and clarify a registered nurse’s authority to perform and to delegate nursing tasks and set limits and procedures for delegation. Delegation may occur when the RN determines it is in the patient’s best interest; in community-based and in‑home care settings delegation is limited to patients with a “stable and predictable condition.” The law identifies nondelegable acts (including procedures that pierce or sever tissue, sterile procedures, central line maintenance, and other acts requiring nursing judgment) while allowing a limited exception for insulin injections with specified RN instruction, demonstration, supervision, and board-established evaluation intervals. The bill requires verification of training and certification before delegation, allows nursing assistant‑certified personnel and certified home care aides (when trained and delegated) to administer medications by subcutaneous injection and perform capillary blood sticks, and makes nurses, nursing assistants, and home care aides accountable for their own actions while providing immunity from liability when acting within delegation authority. The bill also includes protections against employer reprisal or disciplinary action for refusing unsafe delegation or for cooperating in investigations, and a narrow emergency-medication immunity where a prescribed medication for a specific emergency is available. The Board of Nursing is authorized to adopt rules to implement the changes and must adopt rules addressing appropriate delegation parameters by July 1, 2028. The act amends definitions in RCW 70.127.010 (including definitions for home care agency and home care services) and specifies that a home care agency where nurses delegate under RCW 18.79.260 is not a home health agency for that chapter. The text sets staggered effective and expiration dates for parts of the act (Section 1 expires June 30, 2027; Section 3 expires July 1, 2026; Section 2 takes effect June 30, 2027; Section 4 takes effect July 1, 2026; Section 6 takes effect July 1, 2028). Important portions of the bill text and the full content of several amended sections were not included in the provided extracts, and there is an unresolved inconsistency in practitioner terminology in the excerpts.

If enacted, this bill would make it easier for registered nurses to shift routine nursing tasks in homes and community settings onto trained nursing assistants and certified home care aides for patients whose conditions are stable and predictable. That would likely reduce some direct RN time on basic medication administration (including some subcutaneous injections like insulin when specific rules are met) and capillary blood sticks, while increasing demand for required core nurse-delegation training and certification for aides. Agencies and employers would need to verify training and change supervision practices, so they may face upfront training and administrative costs but could lower RN labor time for routine tasks; nurses remain responsible for assessing competency and supervising, and both nurses and aides gain liability protections when working within the new delegation rules and protections against employer reprisal for refusing unsafe delegation. The Department of Health, the Board of Nursing, home care and hospice agencies, RNs, nursing assistants, and home care aides are most affected: agencies will need to update policies, ensure certifications, and track supervision, and nurses will take on stronger oversight duties. The board must adopt implementing rules by July 1, 2028, and several sections of the act take effect or expire on different dates, so the exact scope and timing of changes are partly uncertain until the board issues rules and the remaining statutory text is clarified.