Washington State Board of Nursing Updates Nurse Delegation Requirements
Insulin Administration Visit Timeline, and Introduction of Blood Glucose Monitoring Delegation in Skilled Nursing Facilities
WHCA is pleased to announce updates to the nurse delegation regulations in Washington that will ease timelines for assisted living providers and expand blood glucose monitoring delegation to all care settings, including skilled nursing facilities.
The Washington State Board of Nursing (Board) filed a CR-103 Permanent Rule as WSR 24-13-079 on June 17, 2024, in response to Substitute House Bill (SHB) 1124 (chapter 14, Laws of 2022) now codified as RCW 18.79.260. The permanently adopted amendments include:
- FOR ASSISTED LIVING FACILITY NURSE DELEGATORS: changing the interval of time required for registered nurse (RN) supervision and evaluation of the delegated task of insulin injections in WAC 246-840-930 and 246-840-940 from weekly to every two weeks for the first four weeks of delegating insulin injections.
- FOR SKILLED NURSING PROVIDERS: adding new rule sections, WAC 246-840-835 and 246-840-935, to reflect the RN’s authority to delegate blood glucose monitoring and testing beyond community-based and in-home care settings, to all settings where work is performed by registered nursing assistants (NA-Rs) and certified nursing assistants (NA-Cs) credentialed under chapter 18.88A RCW.
- The stringent nurse delegation training and testing requirement, nor the standardized visit and documentation timelines associated with the community-based RN delegation regulations, do not appear to be required in the skilled nursing facility setting.
- RCW 18.79.206 (3)(a)(i)(ii)(iii)(iv) allows the RN to delegate to NA-R or NA-C blood glucose monitoring. The RN must:
- Determine the NA-R or NA-C is competent to perform the task; and
- Evaluate that the delegation is appropriate; and
- Supervise the delegation of the task; and
- Delegate only if the blood glucose monitoring is within the RN’s scope of practice.
Permanent amendments to WAC 246-840-930 and 246-840-940 and addition of WAC 246-840-835 and 246-840-935 becomes effective July 18, 2024.
A copy of the adopted rules and the concise explanatory statement are attached:
Questions on assisted living delegation updates? Please email Vicki McNealley or call 360-352-3304 extension 107. Questions on skilled nursing facility delegation of blood glucose monitoring? Email Elena Madrid or call 360-352-3304 extension 105.
