HOUSE BILL REPORT
HB 2667
This analysis was prepared by non-partisan legislative staff for the use of legislative members in
their deliberations. This analysis is not a part of the legislation nor does it constitute a
statement of legislative intent.
As Reported by House Committee On:
Health Care & Wellness
Title: An act relating to delegation of nursing tasks to care for persons with diabetes.
Brief Description: Allowing the delegation of nursing tasks to care for persons with diabetes.
Sponsors: Representatives Morrell, McCoy, Green, Hunt, Wallace, Cody, Pedersen and Kenney.
Brief History:
Health Care & Wellness: 1/23/08, 1/30/08 [DPS].
Brief Summary of Substitute Bill |
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HOUSE COMMITTEE ON HEALTH CARE & WELLNESS
Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. Signed by 11 members: Representatives Cody, Chair; Morrell, Vice Chair; Hinkle, Ranking Minority Member; Alexander, Assistant Ranking Minority Member; Barlow, Condotta, Green, Moeller, Pedersen, Schual-Berke and Seaquist.
Staff: Chris Blake (786-7392).
Background:
Nursing assistants may either be registered or certified by the Department of Health
depending on their education and training. Nursing assistants may assist in providing care to
individuals as delegated by and under the supervision of a registered nurse. Nursing
assistants working in community-based or in-home care settings may provide additional
nursing care tasks upon completion of the Department of Social and Health Service's (DSHS)
basic core nurse delegation training.
Registered nurses may delegate nursing care tasks that are within the nurse's scope of practice
to other individuals where the nurse finds it to be in the patient's best interest. Before
delegating a nursing care task, the registered nurse must determine the competency of the
person to perform the delegated task and evaluate the appropriateness of the delegation. The
registered nurse must supervise the person performing the delegated task.
Registered nurses may not generally delegate acts requiring substantial skill or the
administration of medications unless the delegation is to a nursing assistant working in a
community-based or in-home care setting. The administration of medications by injection,
sterile procedures, and central-line maintenance may never be delegated to a nursing assistant
in a community-based or in-home care setting.
Summary of Substitute Bill:
The set up of diabetic insulin devices and verbal verification of insulin dosage for
sight-impaired individuals are considered "simple care tasks" which do not require delegation
from a registered nurse.
Upon delegation by a registered nurse, a nursing assistant may administer insulin by injection
to people with diabetes in community-based or in-home care settings. The delegating nurse
must provide instruction and a demonstration to the nursing assistant in the use of insulin and
proper injection procedures. The delegating nurse must provide regular supervision and
evaluation of each nursing assistant's performance.
Prior to providing care to individuals with diabetes who may require the administration of
insulin, nursing assistants must, in addition to other delegation training and credentialing
requirements, submit a certificate to the delegating nurse that documents the completion of
specialized diabetes nurse delegation training approved by the DSHS. The training must
include instruction regarding diabetes, insulin, and proper injection procedures.
The Nursing Care Quality Assurance Commission (Commission), in cooperation with the
DSHS, must develop a monitoring system for insulin administered by injection by nursing
assistants. The monitoring system must contain information reported by delegating nurses,
including the number of nursing assistants administering insulin by injection; the number of
patients being served; the number of injections administered; the number, type, and outcome
of any inappropriately administered insulin; and other relevant information. The
Commission shall report findings and recommendations to the Governor and the Legislature
by November 15, 2012. The act expires on June 1, 2013.
Legislative findings are made stating that over 15 percent of people over 65 years old have
diabetes and that current limitations on delegation authority limit the ability of people to
remain in their homes or in home-like settings. The stated legislative intent is to authorize
registered nurses to delegate the administration of insulin injections for elderly persons so
that they may continue to reside in their homes or home-like settings.
Substitute Bill Compared to Original Bill:
The substitute bill requires the Commission to establish a monitoring system for insulin
administered by injection by nursing assistants. The monitoring system shall include
information reported by delegating nurses. The Commission must report to the Governor and
the Legislature on the findings from the monitoring system by November 15, 2012. The act
expires on June 1, 2013.
The substitute bill includes the requirement that instruction in sliding scale insulin orders be
included in the nursing assistants' training.
Appropriation: None.
Fiscal Note: Available.
Effective Date of Substitute Bill: The bill takes effect 90 days after adjournment of session in which bill is passed.
Staff Summary of Public Testimony:
(In support) This bill only applies to stable diabetics and nursing assistants with training.
New technology simplifies the administration of insulin. The primary reason that people
cannot "age in place" is because they cannot have their diabetes managed at home. There are
not enough nurses available to come to the homes of all of the patients who need insulin.
The bill has adequate oversight and protections for nursing assistant to perform these
functions. Allowing nursing assistants to administer insulin will result in cost savings by
keeping people in their homes. A recent study has showed that medication error rates were
lower when administered by nursing assistants than when administered by uncredentialed
persons or registered nurses.
(In support with amendments) In addition to certified nursing assistants, the bill should
include registered nursing assistants. The nurse delegation process has several safeguards
regarding patient assessment and nursing assistant skill and training. The bill should include
all diabetes medication. The public has asked for the ability for nursing assistants to be able
to administer insulin injections.
(Opposed) None.
Persons Testifying: (In support) Representative Morrell, prime sponsor; Tammie Warnke,
Washington State Nursing Association; Gary Weeks, Washington Health Care Association;
and Julie Peterson, Association of Housing and Services for the Aging.
(In support with amendments) Daniela Ionesi and Daniel Simnioniw, Washington State
Residential Care Council of Adult Family Homes; and Leslie Emerick, Home Care
Association of Washington and Washington Hospice and Palliative Care Organization.