RN Train-the-Trainer Course: Delegation Considerations - 5

RN Train-the-Trainer Course

Complete all of the following modules:

  1. Intro
  2. Checklist
  3. SD Board of Nursing's UDA Training Course
  4. Delegation Considerations
  5. Documentation Considerations
  6. Competency Assessment & Validation
  7. Additional Resources

Delegation Considerations

  1. South Dakota Specific Delegation Considerations
  2. Delegation Decision-Making
  3. South Dakota Administrative Rules Relating to Delegation
  4. Delegating Insulin Dose Determination
  5. Delegation Case Scenarios

5. Delegation Case Scenarios

Scenario #1

Kylie was recently diagnosed with type 1 diabetes and was prescribed insulin 4 times a day by insulin pen. She is in the 3rd grade and needs a dose administered during the school day. Since Kylie has not learned to give her own injections and her parents are not able to help her during the school day, the school principal asks the secretary to give Kylie's injections. The secretary has a niece with diabetes and the principal knows that she has given her niece insulin injections several times in the past. The secretary agrees to administer Kylie's insulin. The administrator calls the County Nurse, whom they have contracted with to conduct annual vision and hearing screenings, and asks the nurse to delegate this task to the secretary. He tells the nurse they intend to implement this on the first day of school.

Should the nurse delegate this task?

YES: Incorrect

Rationale: The nurse should refuse to delegate this task because the secretary has not completed the required training and is not listed on the South Dakota Board of Nursing's UDA Registry and the nurse has not completed the required training.

  • Since only RNs may delegate insulin administration to unlicensed persons, pursuant to ARSD §20:48:04.01:17, the administrator should verify that the County Nurse is licensed as a RN.
  • A registered nurse that has completed the South Dakota Board of Nursing's required training may only delegate insulin administration to a UAP that has completed the approved training and is listed on the South Dakota Board of Nursing's UDA Registry, pursuant to ARSD §20:48:04.01.

NO: Correct

Rationale: The nurse should refuse to delegate this task because the secretary has not completed the required training and is not listed on the South Dakota Board of Nursing's UDA Registry and the nurse has not completed the required training.

  • Since only RNs may delegate insulin administration to unlicensed persons, pursuant to ARSD §20:48:04.01:17, the administrator should verify that the County Nurse is licensed as a RN.
  • A registered nurse that has completed the South Dakota Board of Nursing's required training may only delegate insulin administration to a UAP that has completed the approved training and is listed on the South Dakota Board of Nursing's UDA Registry, pursuant to ARSD §20:48:04.01.

Scenario #2

Mr. Brown is a 78 year old widower with type 2 diabetes of 20 years duration. He has self-administered his own insulin with vial and syringe for the past 10 years. His blood glucose levels have been fluctuating significantly and he is less able to prepare appropriate meals for himself. His daughter comes to visit and determines that he cannot see the markings on the insulin syringe and sometimes he forgets to administer his evening dose of insulin. The family would like him to move into an assisted living center (ALC). The ALC administrator tells the family that the ALC has on staff a Registered Nurse and registered UDA that can administer Robert's insulin twice a day.

Should the nurse delegate this task?

YES: Correct

Rationale: The Registered Nurse will be delegating insulin administration appropriately to unlicensed assistive personnel (UAPs) who are listed on the South Dakota Board of Nursing's website as a UDA. The RN is also accountable to appropriately supervise, follow-up, and communicate with the UDA to make certain Mr. Brown receives his insulin doses appropriately.

NO: Incorrect

Rationale: Mr. Brown's insulin administration needs can be safely and appropriately delegated by the registered nurse to the trained unlicensed assistive personnel (UAPs) who are listed on the South Dakota Board of Nursing's registry as a UDA.

Scenario #3

Jane is 35 years old; she is diagnosed with bipolar disorder, depression and type 2 diabetes. She is taking oral diabetes medication and her doctor has now prescribed insulin at bedtime daily. Jane is enrolled in a community program that includes a weekly visit by a RN and daily visits by a nursing assistant. The nursing assistant is trained as a medication aide. The RN is teaching Jane to self-administer her insulin using an insulin pen. However Jane becomes very anxious and is not able to self-administer her insulin. The RN decides that since the nursing assistant/medication assistant visits Jane in the evening to set up her pills for the next day she will show the assistant how to use the insulin pen so the assistant can administer Jane's insulin.

Should the nurse delegate this task?

YES: Incorrect

Rationale: The nursing assistant is not listed on the South Dakota Board of Nursing's Registry as a UDA; and the nurse has not completed the required training.

While medication aides are required to complete a South Dakota Board of Nursing approved 20 hour Medication Administration Training Program (MATP) to administer medications they must additionally complete the required training to administer insulin and be listed on the Board of Nursing's UDA Registry.

(Note: If a UAP is only going to be administering insulin the UAP is not required to complete the 20 hour MATP. However, if the UAP will be administering other medications they must complete the MATP and be registered as a Medication Aide.)

NO: Correct

Rationale: The nursing assistant is not listed on the South Dakota Board of Nursing's Registry as a UDA; and the nurse has not completed the required training.

While medication aides are required to complete a South Dakota Board of Nursing approved 20 hour Medication Administration Training Program (MATP) to administer medications they must additionally complete the required training to administer insulin and be listed on the Board of Nursing's UDA Registry.

(Note: If a UAP is only going to be administering insulin the UAP is not required to complete the 20 hour MATP. However, if the UAP will be administering other medications they must complete the MATP and be registered as a Medication Aide.)

Scenario #4

A registered nurse divides her time between three rural schools. The RN delegates diabetes care tasks to three UDAs at the schools. All three UDAs are listed on the South Dakota Board of Nursing's UDA registry. Brock is a 10 year old student enrolled at the elementary school. The UDA at that school helps Brock at lunch time with daily carbohydrate counting and administering a bolus of insulin with his pump. Today after lunch Brock's glucose is 534 mg/dl. His insulin pump site is wet, suggesting his pump's infusion set is not working correctly. The UDA notifies the nurse. The nurse contacts Brock's parents but they are unable to come to the school to assist Brock. Brock says that he thinks he knows how to do a site change and he has extra pump supplies at school.

Should the nurse give approval for Brock to do his own site change and request the UDA to monitor and report back to the nurse?

YES: Incorrect

Rationale: While individuals may perform their own self-care, it is not advisable or safe to encourage individuals with questionable competence to provide their own care.

Additionally, the nurse should not delegate to an unlicensed person the oversight of a student's/individual's performance to change their infusion set for several reasons:

  • The task is too complex and there is a high risk of a poor outcome;
  • The task may require nursing judgment;
  • The nurse is not in the immediate area to assist the child or unlicensed person as needed.
  • The unlicensed person has not been deemed competent to perform the task. Therefore the unlicensed person would not be capable of safely overseeing the child's performance of the task.

This nurse should instead consult with the child's physician or parents to determine whether the child should be administered insulin via another method such as by syringe and vial. The nurse should also go to the school to assess and monitor the child, follow-up and administer appropriate interventions as needed, and evaluate the child afterward.

NO: Correct

Rationale: While individuals may perform their own self-care, it is not advisable or safe to encourage individuals with questionable competence to provide their own care.

Additionally, the nurse should not delegate to an unlicensed person the oversight of a student's/individual's performance to change their infusion set for several reasons:

  • The task is too complex and there is a high risk of a poor outcome;
  • The task may require nursing judgment;
  • The nurse is not in the immediate area to assist the child or unlicensed person as needed.
  • The unlicensed person has not been deemed competent to perform the task. Therefore the unlicensed person would not be capable of safely overseeing the child's performance of the task.

This nurse should instead consult with the child's physician or parents to determine whether the child should be administered insulin via another method such as by syringe and vial. The nurse should also go to the school to assess and monitor the child, follow-up and administer appropriate interventions as needed, and evaluate the child afterward.

Scenario #5

Kathy is a 54 year old who is transitioning to a group home for the developmentally disabled. She requires insulin injections at mealtime and bedtime. The RN and 3 unlicensed staff members at the facility are in the process of completing the required South Dakota Board of Nursing training. They have completed the on-line training, but still need to complete the competency skills checklist. Kathy is scheduled to move in today. The facility director tells the nurse to delegate the insulin administration to the UAPs "since they are almost done with the training."

Should the nurse delegate this task?

YES: Incorrect

Rationale: The registered nurse may not delegate the task of insulin administration to unlicensed persons until every component of training and competency validation are completed and the nursing assistants is listed on the South Dakota Board of Nursing's Registry as a Diabetes Assistant, pursuant to ARSD §20:48:04.01.

Until training is completed, the RN must administer all insulin injections to this patient. Alternatively, the facility may decline accepting this individual as a resident until their staff are listed as UDAs on the Board's registry.

NO: Correct

Rationale: The registered nurse may not delegate the task of insulin administration to unlicensed persons until every component of training and competency validation are completed and the nursing assistants is listed on the South Dakota Board of Nursing's Registry as a Diabetes Assistant, pursuant to ARSD §20:48:04.01.

Until training is completed, the RN must administer all insulin injections to this patient. Alternatively, the facility may decline accepting this individual as a resident until their staff are listed as UDAs on the Board's registry.

Page Updated: 6/1/2018 1:58:15 PM