Committee hears broad support for Board of Nursing rule allowing RN delegation to unlicensed assistants

The Joint Standing Committee on Health Coverage, Insurance and Financial Services heard extended testimony in favor of LD 2166, the Board of Nursing’s proposed Chapter 6 rule which creates a statutory framework for registered nurses to delegate selected supportive tasks to qualified unlicensed assistive personnel (UAPs).

Kim Esquivel, executive director of the Maine State Board of Nursing, told the committee the board engaged in extensive consensus-based rulemaking after the committee delayed prior adoption last year. She highlighted new elements added to the reproposed rule: a purpose section that clarifies delegation is permitted but not required or coercible; added definitions for activities of daily living; language addressing RN liability when UAPs deviate from instructions; and lists of commonly delegable supportive tasks such as ambulation and hygiene.

"The board did maintain language allowing the delegating nurse to be readily available to the UAP…either in person, by telephone, or through another form of telecommunication," Esquivel said, and emphasized that clinical judgment and patient safety remain central to any delegation decision.

Nursing associations, hospitals and rural providers testified that the rule modernizes practice and helps address workforce shortages, particularly in small hospitals and home-care settings. Lisa Harvey McPherson and Mikkel Neal described stakeholder involvement and said the rule adopts the national 'five rights' of delegation. Northern Light Health and home-care groups noted delegation can free RNs for higher-acuity work while preserving RN accountability.

Labor groups and the Maine State Nurses Association supported the revised rule but urged additional protections: elimination of delegation by telephone in many cases, employer-verified competence for UAPs, and explicit prohibitions on delegating to persons directed solely by a patient or family member. The AFL-CIO’s Adam Good said the rule now better protects nurses’ right to refuse unsafe delegation.

The committee closed the public hearing and scheduled work sessions to consider line edits and remaining stakeholder proposals.