RN Delegation of Insulin

WHCA has received several questions regarding the recent regulation change regarding frequency of RN visits upon initial delegation of insulin administration. This brief article aims to clear up this issue.

In July 2024, the Washington State Board of Nursing (WABON) changed the frequency of supervision of insulin injection from weekly for the initial four weeks, to “at least every two weeks for the first four weeks” (See WAC 246-840-930 subsection (19)).

The language pertaining to the frequency of supervision can be confusing, perhaps because “every two weeks” for the first month would result in an odd week.

Does this change mean the RN delegator supervises the delegated caregiver on the initial delegation visit, then two weeks later, then two weeks after that, resulting in three visits?  Or is the new language interpreted that the RN delegator supervises the process during the initial visit, then two weeks later, and then transitions to every 90 days – effectively ending with two visits in that first month?

Vicki McNealley of WHCA reached out to the DSHS nurse delegation program manager, as well as the WABON director of nursing practice to discuss.  The final verdict resulted in unanimous agreement that the language in the WAC is “not worded very well.”  But, the interpretation is as follows:

An initial visit, and another one two weeks later for a total of two visits in the first month.  The RN delegator can always conduct more supervisory visits should they feel them necessary.

If you or someone in your facility is interested in learning more about RN delegation, WHCA has published 15 free-access short videos on RN delegation, along with a document library featuring Word-based task sheets for easy personalization.  You can access those here.

For additional questions about nurse delegation, email Vicki McNealley or call 360-352-3304 extension 107.