22
Best State Performance
15
US Value
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Indicator
Nurse Delegation
Family caregivers benefit from decision makers expanding the types of health maintenance tasks (e.g., giving medications, tube feedings, providing routine respiratory care) that registered nurses can delegate to home care aides. Nurse delegation helps family caregivers who may have to leave work during the day or hire a nurse to perform these routine tasks. Eleven states allow registered nurses to delegate a full range of a sample set of 22 tasks to home care aides. Some states, such as Indiana, allow registered nurses to delegate medication administration and other tasks to certified medication aides. Three states (Florida, Pennsylvania, and Rhode Island) do not permit delegation of any of the sample set of health maintenance tasks. Five states (Connecticut, Delaware, Massachusetts, Tennessee, and South Carolina) permit nurses to delegate only five or fewer tasks.
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Methodology
Methodology
This indicator is based on state policies that allow nurses to delegate some health maintenance tasks to other LTSS workers (out of 22 possible tasks), based on responses to a survey of State Boards of Nursing that asked which of the following tasks that can be performed by a direct care aide through delegation by a registered nurse.
- Oral medication
- PRN medication
- Pre-filled insulin/insulin pen
- Draw up insulin
- Other injectable medication
- Glucometer testing
- Medication through tubes
- Insertion of suppositories
- Eye/ear drops
- Non-sterile/clean
- Sterile
- Nasogastric tube feeding
- Gastrostomy tube feeding
- Administer enema
- Perform intermittent catheterization
- In-dwelling catheter care
- Perform ostomy care including skin care and changing appliance
- Perform nebulizer treatment
- Administer oxygen therapy
- Oral suctioning
- Tracheostomy suctioning
- Perform ventilator respiratory care
Scoring: States received 1 point for each of the 22 health maintenance tasks that can be delegated by a registered nurse to an LTSS direct care worker for a total of 22 points.
Current year 2022 data collected from AARP Public Policy Institute survey on nurse delegation in home settings. Ten state Boards of Nursing did not respond to the 2022 nurse delegation survey. 2019 survey responses were reused for New Hampshire, New Jersey, New Mexico, Tennessee, and Wisconsin. 2016 survey responses were reused for Arkansas and Idaho. 2013 survey responses were reused for Georgia, Minnesota, and Vermont.
Meaningful change over time for this indicator is defined as any increase or decrease in the number of tasks able to be delegated (not 10% change).
AARP PPI, “Survey on Nurse Delegation in Home Settings” (unpublished, Washington, DC: AARP Public Policy Institute, 2019, 2022).