As a Registered Nurse Delegator I can provide nurse delegation to Adult Family Homes as well as private homes.  Nurse Delegation is a service mandated by the Washington Administrative Code “WACs” and is regulated by the Department of Health and Human Services under the Department of Social and Health Services.  The law reads that a caregiver practicing at the nursing assistant level oflicensing ( often referred to as Long-Term Care Worker’s or LTCW’s) must be nurse delegated prior to administering medications or performing certain tasks to residents that are either not physically and/or mentally competent to do so for themselves. The RND provides training, supervision and a layer of support to the LTCW and at the same time endeavors to provide the utmost of safety to the resident as the LTCW takes on these important tasks.  The law also reads that because a nurse is actually giving the LTCW permission to administer the medication or perform the certain task under his/her own registered nursing license that the nurse must teach each LTCW with each resident that the delegation happens.  This process helps to make this a safe situation where all questions are answered and all parties feel comfortable with the outcome.  The RND provides on-going monitoring of that resident with supervisory updates at least every 90 days, or more often, if there is a change in condition or a change in a new LTCW providing care to that resident.  The RND also constantly monitors each delegated resident for changes in condition.  This ongoing monitoring may alert the RND to a situation or condition where the client is no longer “stable and predictable” and perhaps may no longer be appropriate for the Adult Family Home level of care.