HB 1124
As Reported by House Committee On:
Health Care & Wellness
Title: An act relating to nurse delegation of glucose monitoring, glucose testing, and insulin injections.
Brief Description: Concerning nurse delegation of glucose monitoring, glucose testing, and insulin injections.
Sponsors: Representative Cody.
Brief History:
Committee Activity:
Health Care & Wellness: 1/20/21, 1/27/21 [DPS].
Brief Summary of Substitute Bill
  • Allows a registered nurse to delegate glucose monitoring and testing to a registered or certified nursing assistant or a certified home care aide.
Majority Report: The substitute bill be substituted therefor and the substitute bill do pass.Signed by 15 members:Representatives Cody, Chair; Bateman, Vice Chair; Schmick, Ranking Minority Member; Caldier, Assistant Ranking Minority Member; Bronoske, Davis, Harris, Macri, Maycumber, Riccelli, Rude, Simmons, Stonier, Tharinger and Ybarra.
Staff: Kim Weidenaar (786-7120).

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 Substitute Bill:

A registered nurse may delegate glucose monitoring and testing to a registered or certified nursing assistant or a certified home care aide. 
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 to be established by the Nursing Care Quality Assurance Commission in rule.

Substitute Bill Compared to Original Bill:

The substitute bill:

  • restores the current limitations on delegating certain tasks, including the administration of medications, only in community-based care settings or in-home care settings; and
  • clarifies that the supervision and evaluation requirements for insulin injections that are to be set by the Nursing Care Quality Assurance Commission must be set by rule.
Appropriation: None.
Fiscal Note: Available.
Effective Date of Substitute Bill: The 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.
Staff Summary of Public Testimony:

(In support) Over the summer, there was a work group looking at nurse delegation, but it became complicated with the number and types of requests.  Once it was clear there would be a remote session and that there would be some limitations, the work group was encouraged to just focus on exactly what needed to be done.  At the time some thought it was easier to put the glucose monitoring and testing piece into the Department of Social and Health Services' bill.  However, that complicated things and so this focused bill with a fairly tight title was moved forward.
Certified nursing assistants work under direction of registered nurses.  Under the current nurse delegation statutes, certified nursing assistants can only provide glucose monitoring and testing in specific settings, which excludes hospitals.  The only workaround to this prohibition is to have certified nursing assistants dually credentialed as medical assistants-registered.  This cost falls primarily to employers.  With this bill the cost and time needed to get a second credential will be eliminated, which will expedite care delivery.  These are simple tasks that many certified nursing assistants are already trained to do, and nurses often train family members how to perform these tasks as well.  This bill will facilitate care delivery.


(Opposed) None.

Persons Testifying: Representative Cody, prime sponsor; and Erin Allison, Washington State Nurses Association.
Persons Signed In To Testify But Not Testifying: None.