Nursing Delegation of Insulin Administration

Nursing Delegation of Insulin Administration

Houston Community College ADN Program

RNSG 1247 Fall 2010

The Texas Nurse Practice Act (2009) points out that some tasks that are considered

nursing tasks in the acute setting are considered as support services in the independent

environment to help client to maintain their health (p.188). RN's working in an independent living environment may delegate tasks to unlicensed assistive personnel to help a client achieve optimal health benefits. These skills may include tasks such as vital signs, hygienic care, socialization care, and insulin administration.

Insulin administration may be delegated to an unlicensed person according to

rule 225.10 (12) in the Texas Nurse Practice Act (2009). Rule 225.10 (12) states that insulin can

be administered subcutaneously, nasally, or via insulin pump in accordance with rule 225.11 (b)

(p.196). In this situation the RN can delegate the task of administering insulin because the

client's condition is stable and predictable.

The criteria that the RN needs to consider prior to making a decision to delegate is listed

in § 225.9 and § 225.11 (b) of the Texas Nurse Practice Act (2009). Rule 225.9 states:

(a) When determining whether to delegate a nursing task or those ADLs or HMAs

requiring delegating, the RN, in addition to the assessment under § 225.6 of this

title (relating to RN Assessment of the Client), shall:

(1) Determine that the task does not require the unlicensed person to exercise

nursing judgment;

(2) verify the experience and competency of the unlicensed person to perform the

task, including the unlicensed person's ability to recognize and inform the RN of

client changes related to the task. The RN must have either:

(A) instructed the unlicensed person in the delegated task; or

(B) verified the unlicensed person's competency to perform the nursing task

based on personal knowledge of the training, education, experience and/ or

certification/ permit of the unlicensed person.

(3) determined in consultation with the client or the client's responsible adult, the

level of supervision and frequency for supervisory visits required, taking into

account:

(A) the stability of the client's status;

(B) the training, experience, and capability of the unlicensed person to whom the

nursing task is delegated;

(C) the nature of the nursing task being delegated;

(D) the proximity and availability of the RN to the unlicensed person when the

task is performed; and

(E) the level of participation of the client or client's responsible adult; and

(4) consider whether the five rights of delegation (right task, person, circumstance,

direction, communication, and supervision) can be met.

(b) The RN or another RN qualified to supervise the unlicensed person shall be

available, in person or by telecommunications when the unlicensed person is

performing the task.

(c) If the RN is employed, the employing entity must have a written policy

acknowledging that the final decision to delegate shall be made by the RN in

consultation with client or client's responsible adult (Texas Nurse Practice Act 2009

p.194-95).

In addition to all previous criteria listed, Rule 225.11 (b) states that when delegating

administration of insulin subcutaneously, nasally, or via insulin pump the RN must:

(1) arrange to be available on call for consultation/intervention 24 hours each day;

(2) provide teaching of all aspects of insulin administration, subcutaneously,