SB 476
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader
Senate Bill 476 (Senator Eckardt)
Education, Health, and Environmental Affairs Health and Government Operations
Health Occupations - Nurses - Delegation of Tasks
This bill specifies that an advanced practice registered nurse (APRN) may delegate a
nursing or other technical task to an assistant if (1) the assistant performs only the tasks
that the assistant is trained to perform and (2) the delegating APRN provides instruction to
and on-site supervision of the assistant performing the delegated task. The State Board of
Nursing (BON) must adopt regulations to (1) provide for the manner in which an APRN
delegates such tasks; (2) establish limitations on the authority of an APRN to delegate
nursing or other technical tasks; and (3) otherwise clarify the authority to delegate tasks.
The bill takes effect June 1, 2021.
Fiscal Summary
State Effect: None. The change is technical in nature and does not directly affect
governmental finances.
Local Effect: None.
Small Business Effect: None.
Analysis
Current Law: In general, an individual must be certified by BON to practice as a nursing
assistant or medication technician in the State, and an individual must be licensed by BON
to practice as a nurse in the State. However, an individual does not need to be licensed by
BON if the licensee (1) is authorized to practice a different health occupation; (2) provides
for the gratuitous care of friends, domestic partners, or family members; (3) performs
nursing assistant tasks while a nursing student enrolled in an accredited nursing program
practicing under the direct supervision of qualified faculty or preceptors; (4) performs
nursing assistant or medication technician tasks as a student, as specified; or (5) works as
a principal or school secretary, does not routinely administer medication, and has
completed training by the delegating nurse.
A registered nurse or a licensed practical nurse is not precluded from delegating a nursing
task to an unlicensed individual provided that the delegated nursing tasks does not become
a routine part of the unlicensed individual’s job duties.
Under Maryland regulations (COMAR 10.27.11.03) a nurse may delegate a nursing task
to an unlicensed individual, a certified nursing assistant, or a medication technician if
(1) the task is within the area of responsibility of the nurse delegating the task; (2) in the
judgement of the nurse, the task can be properly and safely performed without jeopardizing
client welfare; and (3) the task is one that a reasonable and prudent nurse would find is
within the scope of sound nursing judgement. The nurse must be the primary decision
maker when delegating nursing tasks and may not require the unlicensed individual,
certified nursing assistant, or medication technician to exercise nursing judgement or
intervention except in an emergency situation.
Additional Information
Prior Introductions: A similar bill, HB 936 of 2020, passed in the House but received no
further action from the Senate Education, Health, and Environmental Affairs Committee.
Designated Cross File: HB 95 (Delegate Krebs) - Health and Government Operations.
Information Source(s): Maryland Department of Health; Department of Legislative
Services
Fiscal Note History: First Reader - January 27, 2021
an/jc Third Reader - March 5, 2021
Analysis by: Amberly Holcomb Direct Inquiries to:
(410) 946-5510
(301) 970-5510
SB 476/ Page 2