1. A. An APRN may not delegate nursing and technical tasks to an assistant which shall, by law or regulation, be performed only by an individual that is required to be licensed, certified, registered, or otherwise recognized pursuant to any State laws.

2. B. An APRN may delegate nursing and technical tasks, consistent with national guidelines for nursing delegation established by the National Council of State Boards of Nursing and the approved policies and procedures of the site, in the following categories:

   1. (1) Surgical technical tasks that the delegating APRN directly orders while present and personally performing the surgery in the same surgical field; and
   2. (2) Nonsurgical technical tasks while the assistant is under the delegating APRN’s direct supervision or on-site supervision.

3. C. Except as provided in §§B(1) and D of this regulation, an APRN shall provide at minimum on-site supervision when delegating nursing or technical tasks to an assistant, including, but not limited to, the following:

   1. (1) Patient preparation for physical examination;
   2. (2) Patient history interview;
   3. (3) Collecting and processing specimens, such as performing phlebotomy, inoculating culture media, pregnancy tests; dipstick and microscopic urinalysis, and microbiology including rapid streptococcal testing and throat cultures;
   4. (4) Preparing and performing laboratory tests that the APRN is satisfied the assistant is trained and qualified to perform under State and Clinical Laboratory Improvement Amendments regulations;

   5. (5) Clinical tests including, but not limited to:

      1. (a) Application of tuberculin skin tests;
      2. (b) Electrocardiography;
      3. (c) Administering basic pulmonary function tests; and
      4. (d) Visual field tests;
   6. (6) Transmitting prescriptions to a pharmacy;
   7. (7) Preparing and administering oral drugs;
   8. (8) Preparing and administering injections limited to intradermal, subcutaneous, and intramuscular within the deltoid, gluteal, or vastus lateralis muscles including small amounts of local anesthetics;
   9. (9) Establishing a peripheral intravenous line; and
   10. (10) Injecting fluorescein-like dyes for retinal angiography.
4. D. When delegating injecting intravenous drugs or contrast materials to an assistant, an APRN shall provide direct supervision.
5. E. An APRN who is authorized to dispense prescription medication under Health Occupations Article, Title 8, Annotated Code of Maryland may delegate only mechanical acts involved in dispensing a drug.

6. F. An APRN may not delegate to an assistant any act that requires the exercise of clinical judgment by an APRN, including, but not limited to:

   1. (1) Conducting physical examinations;
   2. (2) Administering any form of anesthetic agent or agent of conscious sedation other than topical anesthetics or small amounts of local anesthetics;
   3. (3) Initiating independently any form of treatment, except for cardiopulmonary resuscitation or other forms of emergency treatment authorized to be performed by non-clinicians under State law;
   4. (4) Establishing a diagnosis or giving clinical advice; and
   5. (5) Providing physical therapy.

Authority: Health Occupations Article, §§8-205 and 8-6A-02, Annotated Code of Maryland

Effective date:

Regulations .01 — .06 adopted as an emergency provision effective August 26, 2025 (52:20 Md. R. 999); adopted permanently effective October 27, 2025 (52:21 Md. R. 1024)