AGING AND DISABILITY SERVICES ADMINISTRATION

ADSA > Professionals > Nurse Delegation Program > Handouts

HANDOUTS FOR Nurse Delegation Classes for Registered Nurses

The following are the class materials used for the Nurse Delegation Class.  Download, print, and put these files in a ring binder in the order they appear below. Bring the ring binder with you to class.

Table of Contents

• TAB 1 Nurse Delegation Handout (PDF) – Required
• TAB 2 Nurse Delegation Law - Required (RCW 18.79.260(3)(e) Please scroll to and print section (3)(e)
• TAB 3 Nurse Delegation Rules - Required (WAC 246-840-910 to 970) Please print from section 910 through 970
• TAB 4 Medication Assistance Rules – Required (WAC 246-888)
• TAB 5 Sample Nursing Task Instruction Sheets – (20 pages) Optional
  • Additional Task Sheets/Job Aids for delegating insulin may be found on the previous page
• TAB 6 Self Directed Care Law – Required (RCW 74.39.050)
• TAB 7 Nurse Delegation Forms - Required
• 10-217 Nurse Delegation: Credentials and Training Verification
  • Word Format
  • PDF format
• 13-678, Nurse Delegation: Consent for Delegation Process (page 1)
  • Word Format
  • PDF Format
• 13-678, Nurse Delegation: Instructions for Nursing Task (page 2)
  • Word Format
  • PDF Format
• 13-678A Nurse Delegation: PRN Medication
  • Word Format
  • PDF Format
• 13-678B Nurse Delegation: Assumption of Delegation
  • Word Format
  • PDF Format
• 13-680 Nurse Delegation: Rescinding Delegation
  • Word Format
  • PDF Format
• 13-681 Nurse Delegation: Change in Medical Orders
  • Word Format
  • PDF Format
• 14-484 Nurse Delegation: Nursing Visit
  • Word Format
  • PDF Format
• TAB 8 Client Scenarios - Required
• Tab 9 Referral Form - Required
• TAB 10 Adult Family Home Rules - Optional (WAC 388-76-535 - 388-76-780)
• TAB 11 Boarding Home Rules - Optional (WAC 388-78A-2010 to 3230)
• TAB 12 Adult Family Home or Boarding Home Assessment Form – Optional
• TAB 13 DDD Rules - Optional
• Supported Living – WAC 388-101-1240
• Group Homes – WAC 388-101-1260
• Certified Settings - WAC 388-101-1440 to 1500
• DD Staff Training Requirements for Delegation - WAC 388-101-2410
• Voluntary Placement Program - WAC 388-826-0001 to 0250
• Waiver Programs in DDD - WAC 388-845-0001 to 4015
• TAB 14 Additional Documents For RN’s With A State Contract – Optional
  • Skin Observation Protocol Forms
    • SOP Pressure Sore Assessment (PDF)
    • SOP Basic Skin Assessment (Word)
  • Request for Additional Units forms (Word)
  • Aging
  • DDD
  • Contract Monitoring Chart Audit Form (Word)

OTHER REFERENCES TO BE DISTRIBUTED AT TRAINING

• RND Statewide Report
• Sample Chart and Sample Client Assessment
• Regional Phone List