Guest Post: Time for Nurse Delegation Bill to Pass

By: Beverly Pavasaris, President, Brockton VNA
President, Home Care Alliance of Massachusetts

Once again this legislative session, the Home Care Alliance of Massachusetts has filed a bill (An Act Relative to Home Health & Hospice Aides) to allow nurses working in home health agencies and hospices to delegate the administration of certain medications to home health aides. Before this would occur, the home health agencies would need to provide training, certify competency skills and  establish documentation protocols according to the nurse delegation model developed by the National Council of State Boards of Nursing. Such regulations, according to the bill, will be drafted by the state’s Board of Registration in Nursing in collaboration with the Massachusetts Department of Public Health and with nursing input.

In past legislative sessions, I have testified in support of this bill as a creative and progressive solution to removing existing barriers that obstruct home health patients from getting needed care. Our legislation recognizes the changing scope of work that can be safely provided by paraprofessionals with appropriate nurse oversight and helps prepare our state for the aging of our population and growth in clients living at home with medical condition that are stable and predictable.

If this bill were to pass we would by no means be in the forefront of this issue.  A number of states, including Oregon and Washington, and most recently Connecticut , have addressed at-home medication delegation, resolving that the need for assistance with managing and administering medications should not drive citizens into nursing homes. Aside from the improved efficiency of care, Connecticut anticipates a $28 million savings per year from their effort to allow certified home health aides to assist nurses with certain tasks.

An obstacle to getting this bill passed has been lack of support from the state’s professional nursing organization: MNA. The Alliance has met with them on numerous occasions and assured them that this bill is intended to keep nurses, who are uniquely qualified to promote the health of patients in their homes, closely involved in the administration of medication.  They remain unconvinced.

At this time, the Board of Registration in Nursing is looking at revising their own delegation regulations to prepare for possible delegation of medication administration in the home. But we need the Legislature to act, and we would like to show them that we have nursing support.

Please get involved.  If you belong to MNA, let them know you support this.   If you would like to testify or set up a legislative meeting on this issue, contact James Fuccione,

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Author: Pat Kelleher

Pat Kelleher is Executive Director of the Home Care Alliance of Massachusetts.

4 thoughts on “Guest Post: Time for Nurse Delegation Bill to Pass”

  1. What medications can safely be administered by an aide and under whose license? The more we attempt to dilute the caliber of skilled nursing and treat medication administration as just a med pass the greater risk all patients are placed at for adverse reactions and questionable medication efficacy. I do not support an effort to diminish the value of a registered nurse assessment and replace that skill with a med pass. Debra Walsh RN Able Home Care

    1. I understand the concerns raised about whether a nurse delegation bill will place patients at greater risk or diminish the value of an RN assessment as these have been my concerns also. However my understanding of the bill that the HCA is supporting is that there are many safeguards in place to minimize these risks. Here is an outline of those safeguards I see as important:
      1) The delegation of medication administration permitted will be limited to medications which are oral, ophthalmic, otic, topical, internasal, transdermal, suppository, prefilled, or products which are administered by inhalation. Administration of medications by intramuscular, subcutaneous, intradermal, intraosseous, intravenous will not be permitted.
      2) Nurse delegation will be an option and not mandatory.
      3) Tasks would be evaluated on a case-by-case basis and would be performed according to the “Five Rights of Delegation.” The Board of Registration in Nursing presents this framework for delegation decision-making and accountability based on a model which identifies the five (5) key elements of any delegated act:
      •Right Task
      •Right Circumstances
      •Right Person
      •Right Direction/Communication
      •Right Supervision/Evaluation
      The Five (5) Rights of Delegation clarify the critical components of the delegation decision-making process. The Five Rights delineate professional and legal accountability for nurses at all levels, from nursing service administrators to staff nurses. For more info on this go to:
      4) The nurse would still be performing assessments and would make the delegation judgment on both the difficulty of the task and the confidence in the home health aide. This would allow the RN to work at the top of his/her license.
      In a rapidly changing health care environment such as we have in Massachusetts we have an obligation to take down barriers that prevent patients from staying safely at home, where they most want to be. Delegation of the administration of some medications to aides in certain situations and with the safeguards noted above is in my opinion a good step in removing one such barrier.

  2. I strongly disagree with this effort to pass a bill that in my opinion would dilute the value of a skilled nursing licence.For many years nurses have fought to be recognized as the skilled professionals that we are.The skilled observation and assessment provided by the RN cannot be replaced and under my licence I would never agree to delegate medication administration to an aide.I have heard the arguments for and against and see little in this bill that bodes well for our nurses in the future.

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