What are the requirements for supervision when the registered nurse (RN) delegates administration of insulin injectable medications to treat Diabetes Mellitus to the nursing assistant-registered/nursing assistant-certified (NA-R/NA-C) or home-care aide-certified (HCA-C) in community-based* and in-home care settings?
The RN delegator must supervise this task at least every two weeks for one month, or more often if needed. It is a critical component that the RN has assessed the patient prior to delegation of tasks. The RN delegator must determine the level of supervision depending on the patient’s status, conditions, NA-R/NA-C or HCA-C competencies, or other factors. The RN delegator nurse must determine the level of supervision based on nursing judgment, considering the following levels of supervision (WAC 246-840-010):
- Direct Supervision means the licensed RN who provides guidance to nursing personnel and evaluation of nursing tasks is on the premises, is quickly and easily available, and has assessed the patient prior to the delegation of duties.
- Immediate supervision means the licensed RN who provides guidance to nursing personnel and evaluation of tasks is on the premises, is within audible and visible range of the patient, and has assessed the patient prior to the delegation of duties.
- Indirect supervision means the licensed RN who provides guidance to the nursing personnel and evaluation of nursing tasks is not on the premises but has given either written or oral instructions for the care and treatment of the patient and the patient has been assessed by the RN prior to the delegation of duties.
RCW 18.79.260: Registered Nurse—Activities Allowed—Delegation of Tasks
WAC 246-840-940: Community-Based and In-Home Care Nursing Delegation Decision Tree
WAC 246-840-950: How to Make Changes to Delegated Tasks
WAC 246-840-960: Rescinding Delegation
WAC 246-840-970: Accountability, Liability, and Coercion
*Community-based settings include adult family homes, assisted living facilities, and residential homes for individuals with developmental disabilities (RCW 18.79.260).
The HCA-C is allowed to work only in community-based*, in-home care settings, and enhanced service facilities. The following statutes and WACs are applicable to nurse delegation to the HCA-C:
RCW 18.88B.070: Nurse Delegated Tasks
WAC 246-980-130 Provision of Delegation of Certain Tasks to the HCA-C
WAC 246-980-140: Scope of Practice for Long-Term Care Workers