H.R. NO.













urging the department of commerce and consumer affairs to amend title 16, chapter 89, of the hawaii administrative rules to prohibit registered nurses from delegating the interpretation of diagnostic laboratory results to unlicensed assistive personnel.




     WHEREAS, section 457-7.5, Hawaii Revised Statutes, authorizes a registered nurse to delegate nursing care tasks, functions, and activities to unlicensed assistive personnel in a manner that is appropriate to the level of knowledge and skill of the unlicensed assistive personnel, as long as this delegation complies with applicable federal and state laws and does not include the practice-pervasive functions of assessment, evaluation, and nursing judgment; and


     WHEREAS, title 16, chapter 89, subchapter 15, Hawaii Administrative Rules, contemplates rules relating to the delegation of nursing care tasks to unlicensed assistive personnel, while section 16-89-2, Hawaii Administrative Rules, defines an "unlicensed assistive person" to mean an individual who is not licensed to practice nursing, but who provides tasks of nursing care delegated by a registered nurse; and


WHEREAS, section 16-89-100, Hawaii Administrative Rules, states that the intent of the Board of Nursing is for the delegation of tasks of nursing care to unlicensed assistive personnel to be the exception rather than the rule, unless a registered nurse can justify the need for delegation; and


WHEREAS, a July 22, 2019, article in Medical News Today noted that diagnostic errors happen across all areas of medicine and that researchers' findings showed the cause of most misdiagnoses to be clinical judgment failures; and


     WHEREAS, according to a February 22, 2020, article in Healthline, in the United States, twelve million people are affected by medical diagnostic errors each year, and an estimated forty thousand to eighty thousand people die annually from complications from these misdiagnoses; and


WHEREAS, the article further states that women and minorities are twenty to thirty percent more likely to be misdiagnosed; and


     WHEREAS, on September 15, 2020, the U.S. News & World Report reported that misdiagnosis due to miscommunication is not uncommon, and that as many as sixty-two percent of laboratory and thirty-six percent of imaging results are overlooked by health care providers; and


     WHEREAS, while these statistics are not focused on the area of delegation by registered nurses to unlicensed assistive personnel, they highlight the complexities associated with interpreting tests and diagnosing conditions, which fundamentally rely upon the assessment, evaluation, and judgment of trained medical professionals; and


     WHEREAS, misinterpreting diagnostic laboratory results can have adverse effects on patient safety and outcomes, increase patient anxiety, and reduce self-management efficacy; and


     WHEREAS, because of these issues, it is important that the person communicating test results and their meaning to patients be licensed; and


     WHEREAS, the National Council of State Boards of Nursing, in its "National Guidelines for Nursing Delegation", confirms that the licensed nurse cannot delegate nursing judgment or any activity that will involve nursing judgment or critical decision making, and further, that "Licensed nurses must be aware that delegation is at the nurse's discretion, with consideration of the particular situation."; and


WHEREAS, adopting rules that remove a registered nurse's discretion to delegate the function of interpreting diagnostic laboratory results to unlicensed assistive personnel will promote patient safety and accountability; now, therefore,

     BE IT RESOLVED by the House of Representatives of the Thirty-first Legislature of the State of Hawaii, Regular Session of 2021, that the Department of Commerce and Consumer Affairs is urged to amend title 16, chapter 89, of the Hawaii Administrative Rules to prohibit registered nurses from delegating the interpretation of diagnostic laboratory results to unlicensed assistive personnel; and


     BE IT FURTHER RESOLVED that a certified copy of this Resolution be transmitted to the Director of Commerce and Consumer Affairs.









Report Title: 

Registered Nurses; Delegation; Unlicensed Assistive Personnel; DCCA