TX HHS Form 8509. Unlicensed Personnel Tracking of Delegated Tasks

Form 8509 is used in healthcare settings to document tasks that a Registered Nurse (RN) delegates to unlicensed personnel. Although the form itself appears brief, it plays an important regulatory role: it creates a written trail of responsibility, clarifies who performed what task, and ensures that delegation follows state nursing rules. This type of documentation protects patients, unlicensed staff, and supervising nurses by establishing accountability and showing compliance with delegation standards.

Purpose of the Form

The primary purpose of Form 8509 is to record specific clinical or care-related tasks assigned by an RN to an unlicensed employee. Many states require such documentation as part of their regulatory structure for nursing delegation. Delegation is only permitted when the task is appropriate for unlicensed staff, when the staff member has demonstrated competence, and when an RN maintains accountability for oversight.

Explanation of Key Sections

Employee Information

The form begins with the employee’s printed name and signature. This ensures that the individual acknowledges receiving the delegated tasks. It also prevents confusion when several unlicensed personnel work within the same department.

Date

The date field documents when the delegation occurred. This is important because certain tasks are authorized only for a specific shift or care episode. RNs, auditors, or regulators may later need to confirm whether delegation was current and appropriate at the time the task was performed.

Tasks Delegated

Here the RN lists specific tasks delegated to the employee. Tasks may include assistance with daily living, routine vital signs, specimen collection, non-invasive monitoring, or other activities that fall within the permitted scope of unlicensed staff. If tasks are detailed in a separate attachment, the form notes that all required elements of delegation must still be documented.

Typical omissions in this section include:

• Failure to describe the task clearly (e.g., “monitor patient” instead of “record temperature every 4 hours”).
• Not referencing the patient or context when needed.
• Using internal abbreviations that later reviewers may not understand.

Delegated By (RN’s Signature)

This field contains the RN’s signature, confirming that the nurse has evaluated the task, the employee’s competence, and the safety conditions. Legally, this signature shows that the RN remains accountable for the delegation and oversight.

When This Form Must Be Used

• When an RN assigns clinical or patient-care tasks to unlicensed staff.
• During onboarding or reassignment of unlicensed staff to new duties.
• Whenever state nursing rules require written documentation of delegation.

The form is generally not required for administrative or clerical tasks that do not involve patient care.

Who May Complete the Form

• Registered Nurses (RNs) — the only personnel authorized to delegate clinical tasks.
• Unlicensed employees — they sign the form to acknowledge receipt of delegated tasks.

Typical Supporting Documents

• Competency checklists for unlicensed personnel
• Training records
• Patient-specific care instructions when applicable
• Separate task sheets or delegation logs

Practical Tips for Completing the Form

• Describe tasks clearly and specifically; avoid vague wording.
• Verify that the employee has completed competency training before delegating.
• Attach supplemental documentation when delegating multiple or complex tasks.
• Ensure all dates and signatures are completed at the time of delegation.

Examples of Real Situations Where This Form Is Needed

• A long-term care facility assigns a certified nursing assistant to record daily vital signs for several residents.
• An in-home care provider authorizes a caregiver to assist with mobility and transfers following RN evaluation.
• A rehabilitation center delegates routine specimen collection to trained unlicensed personnel.
• A hospital outpatient clinic schedules an aide to perform non-invasive monitoring during patient intake.

Detailed FAQ

What is the purpose of Form 8509?

It documents which tasks an RN delegates to unlicensed personnel and provides a written record for compliance and accountability.

Who signs the form?

The unlicensed employee signs to acknowledge the tasks, and the RN signs to authorize the delegation.

Does the form replace competency training?

No. It only records the tasks; training and competency validation must already be completed.

Is this form required for every shift?

Only when new tasks are being delegated or when regulations require written delegation for specific duties.

What happens if the form is incomplete?

Incomplete documentation may result in audit issues, regulatory non-compliance, or confusion over who was assigned specific tasks.

Can tasks be listed on a separate sheet?

Yes, as long as all required elements of delegation are included and attached to the form.

Does the employee need to sign again if tasks change?

Yes. Any new set of delegated tasks requires updated documentation and signatures.

Micro-FAQ (Short Answers)

• Purpose: Track tasks delegated by an RN to unlicensed staff.
• Who completes: RN delegates; employee signs acknowledgment.
• When required: When clinical tasks are assigned to unlicensed personnel.
• Attachments: Competency records, task lists, training logs.
• Submitted to: Kept in facility or personnel records; not sent to a state agency.
• Legal effect: Creates a record of delegation and RN accountability.
• Deadline: Completed at the time of delegation.

Related Forms

• Delegation Flow Sheet
• Competency Validation Checklist
• Nursing Task Assignment Log
• In-Service Training Record

Form Details

• Form Name: Unlicensed Personnel Tracking of Delegated Tasks
• Form Number: 8509
• Edition: June 2014-E
• Purpose: Documentation of RN delegation to unlicensed staff