Washington State
House of Representatives
Office of Program Research
BILL
ANALYSIS
Health Care & Wellness Committee
HB 1124
Brief Description: Concerning nurse delegation of glucose monitoring, glucose testing, and insulin injections.
Sponsors: Representative Cody.
Brief Summary of Bill
  • Allows a registered nurse to delegate glucose monitoring and testing to a registered or certified nursing assistant or a certified home care aide.
Hearing Date: 1/20/21
Staff: Kim Weidenaar (786-7120).
Background:

Nurse Delegation.
A registered nurse may delegate certain tasks within the nurse's scope of practice.  When delegating a task, the nurse must determine the competency of the individual to perform the tasks, evaluate the appropriateness of the delegation, and supervise the actions of the person performing the delegated task.  Registered nurses may only delegate the administration of medications in enumerated circumstances, including in-home health or hospice agencies or in community-based care settings.  When delegating insulin injections, the registered nurse must supervise and evaluate the person performing the delegated task weekly during the first four weeks and at least every 90 days thereafter.
 
"Community-based care setting" is defined to include community residential programs for people with developmental disabilities, adult family homes, and assisted living facilities.  "In-home care settings" include an individual's place of temporary or permanent residence, but does not include acute care or skilled nursing facilities, and does not include community-based care settings.
 
Nursing Assistants.
A nursing assistant is a person who assists in the delivery of nursing and nursing-related activities to patients in a health care facility.  Nursing assistants work under the direction and supervision of registered nurses or licensed practical nurses.  There are two levels of credentialing for nursing assistants:  registered nursing assistants and certified nursing assistants.  Applicants for nursing assistant registration must file within three days of employment.  Registered nursing assistants may not be assigned to provide care until the nursing assistant demonstrates the skills necessary to perform competently all assigned duties.  To become certified, a nursing assistant must successfully complete an approved training program and pass a competency evaluation.  Certification is required for nursing assistants working in a nursing home, but is voluntary for those working in other health care facilities unless required by law.
 
Home Care Aide Certification.
Most long-term care workers must become certified as home care aides within 200 days of being hired.  To become certified as a home care aide, a long-term care worker must complete 75 hours of training, pass a certification examination, and pass state and federal background checks.
Summary of Bill:

A registered nurse may delegate glucose monitoring and testing to a registered or certified nursing assistant or a certified home care aide.  The limitation on delegating certain tasks, including the administration of medications, only in community-based care settings or in-home care settings is removed.
 
The specified frequency with which a registered nurse must supervise and evaluate a person to whom the nurse has delegated insulin injections is eliminated.  Instead, the supervision and evaluation is governed by requirements and determinations by the Nursing Care Quality Assurance Commission.
Appropriation: None.
Fiscal Note: Available.
Effective Date: This bill takes effect 90 days after adjournment of the session in which the bill is passed, except for section 2, which because of a double amendment takes effect July 1, 2022.