Nursing; authorize nurses to delegate medication administration to unlicensed assistive personnel in outpatient clinical settings under certain conditions.

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To: Public Health and Human
Services
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Ford (73rd)

HOUSE BILL NO. 1057

AN ACT TO AUTHORIZE REGISTERED NURSES AND ADVANCED PRACTICE 1
REGISTERED NURSES LICENSED BY THE BOARD OF NURSING TO DELEGATE 2
MEDICATION ADMINISTRATION TO UNLICENSED ASSISTIVE PERSONNEL IN 3
OUTPATIENT CLINIC SETTINGS FOR PATIENTS WITH STABLE AND 4
PREDICTABLE HEALTH CONDITIONS, PROVIDED THAT CERTAIN CONDITIONS 5
ARE MET; TO REQUIRE THE REGISTERED NURSE OR ADVANCED PRACTICE 6
REGISTERED NURSE TO PROVIDE DIRECT, IN-PERSON SUPERVISION OF THE 7
UNLICENSED ASSISTIVE PERSONNEL; TO PROVIDE THAT THE REGISTERED 8
NURSE OR ADVANCED PRACTICE REGISTERED NURSE RETAINS THE 9
ACCOUNTABILITY FOR THE TOTAL NURSING AND ADVANCED PRACTICE NURSING 10
CARE OF THE INDIVIDUAL; TO REQUIRE THAT THE DELEGATION OF 11
MEDICATION ADMINISTRATION TO UNLICENSED ASSISTIVE PERSONNEL BE 12
PERSON-SPECIFIC; TO REQUIRE THE UNLICENSED ASSISTIVE PERSONNEL TO 13
BE ADEQUATELY TRAINED FOR THE TASK, TO HAVE DEMONSTRATED THAT THE 14
TASK HAS BEEN LEARNED, TO BE ABLE TO PERFORM THE TASK SAFELY IN 15
THE GIVEN NURSING SITUATION, AND TO HAVE APPROPRIATE SUPERVISION 16
AVAILABLE DURING THE TASK IMPLEMENTATION; TO REQUIRE THAT THE 17
DELEGATION OF MEDICATION ADMINISTRATION TO THE UNLICENSED 18
ASSISTIVE PERSONNEL BE AN ESTABLISHED POLICY OF THE PRACTICE 19
SETTING; TO PROHIBIT A REGISTERED NURSE OR ADVANCED PRACTICE 20
REGISTERED NURSE FROM DELEGATING THE ADMINISTRATION OF CERTAIN 21
DRUGS AND AGENTS; TO REQUIRE DOCUMENTED, FORMAL TRAINING OF 22
UNLICENSED ASSISTIVE PERSONNEL BY A REGISTERED NURSE OR ADVANCED 23
PRACTICE REGISTERED NURSE IN ORDER FOR THE NURSE TO BE AUTHORIZED 24
BY THE BOARD TO DELEGATE MEDICATION ADMINISTRATION; TO AMEND 25
SECTION 73-15-29, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT 26
VIOLATIONS OF THIS ACT ARE GROUNDS FOR THE BOARD OF NURSING TO 27
DISCIPLINE A NURSE; AND FOR RELATED PURPOSES. 28
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 29
SECTION 1. Introduction. Registered nurses and advanced 30
practice registered nurses licensed by the Board of Nursing may 31
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delegate medication administration in outpatient clinic settings 32
for patients with stable and predictable health conditions under 33
the specific conditions as provided for in this act. When 34
delegating to unlicensed assistive personnel, the registered nurse 35
or advanced practice registered nurse is authorizing the 36
unlicensed assistive personnel to perform a task that is normally 37
within the registered nurse's or advanced practice registered 38
nurse's scope of practice. Before agreeing to delegate tasks 39
including medication administration, the registered nurse or 40
advanced practice registered nurse is responsible for 41
understanding the rules of the board relative to delegating 42
nursing care and for achieving the competence to delegate and 43
supervise. 44
SECTION 2. Definitions. As used in this act, the following 45
terms shall be defined as provided in this section, unless the 46
context requires otherwise: 47
(a) "Administration of medication" or "medication 48
administration" means removal of an individual dose from a 49
previously dispensed or distributed, properly labeled container, 50
verifying the dose and medication with the prescriber's order, 51
giving the individual dose to the proper patient at the proper 52
time by the proper route and promptly recording the time and dose 53
given. 54
(b) "Delegation" means entrusting the performance of 55
selected nursing tasks by the registered nurse or advanced 56
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practice registered nurse to other competent nursing personnel in 57
selected situations. The registered nurse or advanced practice 58
registered nurse retains the accountability for the total nursing 59
care of the individual. The registered nurse or advanced practice 60
registered nurse is responsible for and accountable to each 61
consumer of nursing care for the quality of nursing care that he 62
or she receives, regardless of whether the care is provided solely 63
by the registered nurse/advanced practice registered nurse or by 64
the registered nurse/advanced practice registered nurse in 65
conjunction with other licensed or unlicensed assistive personnel. 66
(c) "Direct supervision" means the registered nurse or 67
advanced practice registered nurse is physically present in the 68
office or suite where the procedure, including medication 69
administration, is being performed at all times that the 70
unlicensed assistive personnel is on duty providing services. 71
This term also includes ongoing oversight, follow-up and 72
evaluation of the individual patient and the ongoing oversight, 73
follow-up and evaluation of competency of the unlicensed assistive 74
personnel. 75
(d) "Outpatient clinic setting" means a nonresidential 76
facility that provides treatment for health conditions that is 77
obtained on an outpatient basis, which allows patients to return 78
to and function in their usual environment. This term does not 79
include facilities such as hospitals, emergency rooms and 80
ambulatory surgical centers. 81
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(e) "Person-specific" means health care needs and 82
related factors in order to meet the unique needs of the specific 83
person receiving care. 84
(f) "Stable and predictable" means a situation in which 85
the person's clinical and behavioral status is determined by a 86
registered nurse or advanced practice registered nurse to be 87
non-fluctuating and consistent. A stable and predictable 88
condition involves long term health care needs that are 89
recuperative in nature, do not require the regular scheduled 90
presence or reassessment of a registered nurse or advanced 91
practice registered nurse, and is not characterized by rapid 92
changes. 93
(g) "Unlicensed assistive personnel" means an 94
unlicensed individual who is trained to function in an assistive 95
role to the registered nurse or advanced practice registered nurse 96
in the provision of patient activities as delegated by the nurse. 97
Unlicensed assistive personnel have no authority to provide 98
nursing care, despite any education or training, without the 99
delegation of such care and tasks from registered nurses or 100
advanced practice registered nurses. 101
SECTION 3. Responsibilities. Registered nurses and advanced 102
practice registered nurses licensed by the Board of Nursing may 103
delegate medication administration in outpatient clinic settings 104
provided that the following conditions are met: 105
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(a) The registered nurse or advanced practice 106
registered nurse has assessed the health status of the individual 107
immediately before the delegation, and the patient's health 108
condition is determined to be stable and predictable. 109
(b) The registered nurse or advanced practice 110
registered nurse provides direct supervision and retains the 111
accountability for the total nursing and advanced practice nursing 112
care of the individual and retains the responsibility to: 113
(i) Assess the patient; 114
(ii) Develop and implement the plan of care; 115
(iii) Determine that the medication administration 116
can be safely and legally delegated; 117
(iv) Ensure that the medication administration is 118
properly documented in the patient's record; 119
(v) Ascertain the training and competency of the 120
unlicensed assistive personnel to whom the registered nurse or 121
advanced practice registered nurse delegates the administration of 122
medication; and 123
(vi) Rescind the delegation if the patient's 124
condition changes, it is determined that the unlicensed assistive 125
personnel is not safe or competent to administer the medication, 126
or as otherwise determined by the registered nurse or advanced 127
practice registered nurse. 128
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(c) The delegation of medication administration to 129
unlicensed assistive personnel must be person-specific, and the 130
unlicensed assistive personnel must: 131
(i} Be adequately trained for the task; 132
(ii) Have demonstrated that the task has been 133
learned; 134
(iii) Be able to perform the task safely in the 135
given nursing situation; 136
(iv) Be safe for the person to carry out the task; 137
and 138
(v) Have appropriate supervision available during 139
the task implementation. 140
(d) The delegation of medication administration to the 141
unlicensed assistive personnel must be an established policy of 142
the practice setting and include all aspects of Section 7 of this 143
act at a minimum. The policy must be written, recorded and 144
available to all. 145
(e) The registered nurse or advanced practice 146
registered nurse and the unlicensed assistive personnel must be 147
employed by the same organization or otherwise be formally 148
accountable to the same institution or organization. 149
SECTION 4. Prohibitions and exceptions. (1) A registered 150
nurse or advanced practice registered nurse shall not delegate, 151
under any circumstances, the administration of: 152
(a) Drugs given by the intravenous route; 153
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(b) Blood and blood products; 154
(c) Investigational drugs; 155
(d) Cancer therapeutic agents; 156
(e) Total parenteral nutrition solutions; 157
(f) Drugs given through accessing an implanted device; 158
(g) Insulin; 159
(h) Oxygen; 160
(i) Controlled substances; 161
(j) Anesthetic agents other than simple anesthetics; or 162
(k) Any agents used in the provision of cosmetic and 163
aesthetic dermatological procedures. 164
(2) The delegation of medication administration is 165
person-specific and is in no way considered a certification or 166
skill that authorizes the unlicensed assistive personnel to use 167
the title or credentials of other professionals including licensed 168
persons. 169
(3) This act does not apply to inpatient facilities, 170
licensed emergency departments of a hospital, long-term care 171
facilities, residential facilities, or any other facility in which 172
a registered nurse is required to be present by statute or 173
administrative rule. 174
(4) This act does not apply to nursing students enrolled in 175
nursing programs approved by the Board of Nursing while practicing 176
under the direct supervision of qualified faculty and preceptors. 177
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(5) The registered nurse or advanced practice registered 178
nurse shall not delegate medication administration or any other 179
task if the intervention requires the registered nurse's or 180
advanced practice registered nurse's judgment to safely alter the 181
standard procedure in accordance with the needs of the patient; or 182
requires the consideration of a number of factors in order to 183
perform the procedure; or requires judgment to determine how to 184
proceed from one (1) step to the next. 185
(6) The registered nurse or advanced practice registered 186
nurse shall not delegate any responsibilities of delegating, 187
including, but not limited to, all provisions in Section 3 of this 188
act. 189
SECTION 5. Training. In order for a registered nurse or 190
advanced practice registered nurse to be authorized by the board 191
to delegate medication administration under this act, there must 192
be documented, formal training performed by a registered nurse or 193
advanced practice registered nurse of the unlicensed assistive 194
personnel. The formal training of the unlicensed assistive 195
personnel must include, at a minimum, didactic and demonstrated 196
competency in: 197
(a) Legal aspects of administering medication; 198
(b) Medical terminology; 199
(c) Proper documentation; 200
(d) Principles and rights of medication administration; 201
(e) Administration techniques; and 202
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(f) Patient consent. 203
SECTION 6. Organizational policy. Registered nurses or 204
advanced practice registered nurses and facilities that allow for 205
delegating medication administration to unlicensed assistive 206
personnel are responsible for ensuring that there is an approved 207
organizational policy in place that: 208
(a) Addresses and allows delegation of medication 209
administration to unlicensed assistive personnel; 210
(b) Establishes and provides for formal processes for 211
documenting and reporting medication errors as committed by the 212
unlicensed assistive personnel. Such provisions must provide for 213
remediation of the unlicensed assistive personnel, registered 214
nurse or advanced practice registered nurse, and system as 215
appropriate; 216
(c) Provides mechanisms for documenting in writing the 217
training and ongoing competency of the unlicensed assistive 218
personnel and ensures that the delegating registered nurse or 219
advanced practice registered nurse has access to such competence 220
information; 221
(d) Provides for a formally documented, written annual 222
review and re-assessment of competency of the unlicensed assistive 223
personnel on not less than an annual basis and ensures that the 224
delegating registered nurse or advanced practice registered nurse 225
has access to such competence information; 226
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(e) Provides for and recognizes that the decision to 227
delegate tasks including delegation of medication administration 228
in any specific situation is at the final discretion of the 229
registered nurse or advanced practice registered nurse who is 230
providing direct and immediate care to the patient; and 231
(f) Provides for documentation and review of other 232
pertinent procedures such as needle stick injuries, universal 233
precautions and infection control. 234
SECTION 7. Limitations. All unlicensed assistive personnel 235
who have been trained or otherwise recognized or authorized to 236
administer medication in another jurisdiction or under the 237
provisions of another statute or administrative rule in 238
Mississippi must meet the provisions of this act in order to 239
administer medication in outpatient clinic settings through the 240
delegation from registered nurses and advanced practice registered 241
nurses. 242
SECTION 8. Section 73-15-29, Mississippi Code of 1972, is 243
amended as follows: 244
73-15-29. (1) The board shall have power to revoke, suspend 245
or refuse to renew any license issued by the board, or to revoke 246
or suspend any privilege to practice, or to deny an application 247
for a license, or to fine, place on probation and/or discipline a 248
licensee, in any manner specified in this article, upon proof that 249
such person: 250
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(a) Has committed fraud or deceit in securing or 251
attempting to secure such license; 252
(b) Has been convicted of a felony, or a crime 253
involving moral turpitude or has had accepted by a court a plea of 254
nolo contendere to a felony or a crime involving moral turpitude 255
(a certified copy of the judgment of the court of competent 256
jurisdiction of such conviction or pleas shall be prima facie 257
evidence of such conviction); 258
(c) Has negligently or willfully acted in a manner 259
inconsistent with the health or safety of the persons under the 260
licensee's care; 261
(d) Has had a license or privilege to practice as a 262
registered nurse or a licensed practical nurse suspended or 263
revoked in any jurisdiction, has voluntarily surrendered such 264
license or privilege to practice in any jurisdiction, has been 265
placed on probation as a registered nurse or licensed practical 266
nurse in any jurisdiction or has been placed under a disciplinary 267
order(s) in any manner as a registered nurse or licensed practical 268
nurse in any jurisdiction, (a certified copy of the order of 269
suspension, revocation, probation or disciplinary action shall be 270
prima facie evidence of such action); 271
(e) Has negligently or willfully practiced nursing in a 272
manner that fails to meet generally accepted standards of such 273
nursing practice; 274
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(f) Has negligently or willfully violated any order, 275
rule or regulation of the board pertaining to nursing practice or 276
licensure; 277
(g) Has falsified or in a repeatedly negligent manner 278
made incorrect entries or failed to make essential entries on 279
records; 280
(h) Is addicted to or dependent on alcohol or other 281
habit-forming drugs or is a habitual user of narcotics, 282
barbiturates, amphetamines, hallucinogens, or other drugs having 283
similar effect, or has misappropriated any medication; 284
(i) Has a physical, mental or emotional condition that 285
renders the licensee unable to perform nursing services or duties 286
with reasonable skill and safety; 287
(j) Has engaged in any other conduct, whether of the 288
same or of a different character from that specified in this 289
article, that would constitute a crime as defined in Title 97 of 290
the Mississippi Code of 1972, as now or hereafter amended, and 291
that relates to such person's employment as a registered nurse or 292
licensed practical nurse; 293
(k) Engages in conduct likely to deceive, defraud or 294
harm the public; 295
(l) Engages in any unprofessional conduct as identified 296
by the board in its rules; 297
(m) Has violated any provision of this article; 298
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(n) Violation(s) of the provisions of Sections 41-121-1 299
through 41-121-9 relating to deceptive advertisement by health 300
care practitioners; * * * 301
(o) Violation(s) of any provision of Title 41, Chapter 302
141, Mississippi Code of 1972 * * *; or 303
(p) Violation(s) of any provision of Sections 1 through 304
7 of this act. 305
(2) When the board finds any person unqualified because of 306
any of the grounds set forth in subsection (1) of this section, it 307
may enter an order imposing one or more of the following 308
penalties: 309
(a) Denying application for a license or other 310
authorization to practice nursing or practical nursing; 311
(b) Administering a reprimand; 312
(c) Suspending or restricting the license or other 313
authorization to practice as a registered nurse or licensed 314
practical nurse for up to two (2) years without review; 315
(d) Revoking the license or other authorization to 316
practice nursing or practical nursing; 317
(e) Requiring the disciplinee to submit to care, 318
counseling or treatment by persons and/or agencies approved or 319
designated by the board as a condition for initial, continued or 320
renewed licensure or other authorization to practice nursing or 321
practical nursing; 322
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(f) Requiring the disciplinee to participate in a 323
program of education prescribed by the board as a condition for 324
initial, continued or renewed licensure or other authorization to 325
practice; 326
(g) Requiring the disciplinee to practice under the 327
supervision of a registered nurse for a specified period of time; 328
or 329
(h) Imposing a fine not to exceed Five Hundred Dollars 330
($500.00). 331
(3) In addition to the grounds specified in subsection (1) 332
of this section, the board shall be authorized to suspend the 333
license or privilege to practice of any licensee for being out of 334
compliance with an order for support, as defined in Section 335
93-11-153. The procedure for suspension of a license or privilege 336
to practice for being out of compliance with an order for support, 337
and the procedure for the reissuance or reinstatement of a license 338
or privilege to practice suspended for that purpose, and the 339
payment of any fees for the reissuance or reinstatement of a 340
license or privilege to practice suspended for that purpose, shall 341
be governed by Section 93-11-157 or 93-11-163, as the case may be. 342
If there is any conflict between any provision of Section 343
93-11-157 or 93-11-163 and any provision of this article, the 344
provisions of Section 93-11-157 or 93-11-163, as the case may be, 345
shall control. 346
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(4) If the public health, safety or welfare imperatively 347
requires emergency action and the board incorporates a finding to 348
that effect in an order, the board may order summary suspension of 349
a license pending proceedings for revocation or other action. 350
These proceedings shall be promptly instituted and determined by 351
the board. 352
(5) The board may establish by rule an alternative to 353
discipline program for licensees who have an impairment as a 354
result of substance abuse or a mental health condition, which 355
program shall include at least the following components: 356
(a) Participation in the program is voluntary with the 357
licensee, and the licensee must enter the program before the board 358
holds a disciplinary action hearing regarding the licensee; 359
(b) The full cost of participation in the program, 360
including the cost of any care, counseling, treatment and/or 361
education received by the licensee, shall be borne by the 362
licensee; 363
(c) All of the procedures and records regarding the 364
licensee's participation in the program shall be confidential, 365
shall not be disclosed and shall be exempt from the provisions of 366
the Mississippi Public Records Act of 1983; and 367
(d) A licensee may not participate in the program more 368
often than one (1) time during any period of five (5) years or 369
such longer period as set by the board. 370
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ST: Nursing; authorize nurses to delegate
medication administration to unlicensed
assistive personnel in outpatient clinical
settings under certain conditions.
(6) A nurse practitioner who provides a written 371
certification as authorized under the Mississippi Medical Cannabis 372
Act and in compliance with rules and regulations adopted 373
thereunder shall not be subject to any disciplinary action under 374
this section solely due to providing the written certification. 375
SECTION 9. This act shall take effect and be in force from 376
and after July 1, 2026. 377