A 2025 Update: The Authority for Certain Clinical Tasks Performed by Assistive Personnel in the Care of Patients in Hemodialysis and Home Dialysis Settings

Abstract

As staffing shortages and ongoing cost-containment measures continue to challenge organizations, the use of assistive personnel (AP) for patient care activities increases. Emphasis on safe and effective care delivery remains crucial when RNs delegate certain tasks and aspects of patient care. The principles of delegation according to American Nurses Association and the National Council of State Boards of Nursing include the responsibility and accountability of the registered nurse (RN) for patient care outcomes. Authority for delegation of clinical tasks in the chronic hemodialysis setting and home dialysis therapies varies greatly by state. The responsibility remains with the RN to oversee complex tasks despite the staff skill mix. While specific information from several states, although limited, was interpreted by this team as delegation, it remains the responsibility of each RN to know their individual state Nurse Practice Acts. This article provides an updated review of the states' current available positions on delegation of clinical tasks in hemodialysis with the addition of information on dialysis technicians or licensed practical nurses/licensed vocational nurses in home therapy when available.

Keywords: assistive personnel; delegation; dialysis technician; hemodialysis; home dialysis therapy; licensed vocational nurse (LVN); registered nurse.