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Nursing Practice > You Asked Us Online
Last modified March 7, 2005
Nursing Standards
Outreach Program
Teaching a personal support worker
Q
I am a nurse in a long-term care facility. One of my clients receives daily insulin injections. Today, the Director of Care asked me to teach the personal support worker (PSW) to give the injection. As a nurse, can I do that?
A
The Regulated Health Professions Act (RHPA) authorizes nurses and other regulated health professionals to perform specific controlled acts that are considered to be potentially harmful if performed by unqualified persons. Injecting insulin is a controlled act authorized to nursing.
The RHPA does provide an exception that allows someone who is not a member of a regulated profession, such as a PSW, to perform specific controlled acts, such as those that are a routine activity of living. A procedure would be considered a routine activity of living if, over time, the need, response and outcome of the procedure is known. This definition may apply to a client with diabetes who receives a regular (not sliding scale) dose of insulin to regulate his/her blood sugars.
Before teaching this procedure, it is important to assess the stability of the client, the risks to the client of the PSW performing the procedure, and possible resources or supports available to the PSW should she/he need them. These client-specific factors will determine if it is appropriate for the PSW to provide the care.
In your situation, the client’s diabetes should be stable, and he/ she should receive the same dose of insulin every day. The injection should be part of the client’s daily routine and put the client at minimal risk. If the insulin injection for this client meets the criteria of a routine activity of living, the PSW can be taught to administer the insulin.
Before teaching, identify a PSW who can and wants to learn how to perform the procedure safely. Create and implement a learning plan that is based on teaching techniques and your knowledge, skill and judgment of insulin injections.
When teaching is complete, you will need to determine that the PSW has learned the skill and is now competent to provide this type of care. Direct observation of the PSW completing the skill is recommended. Ongoing determination of the PSW’s competency specific to this skill is necessary for continued client safety.
As well, the nurse must ensure there is a mechanism in place to monitor the stability of the client’s condition and confirm that the insulin injections remain a routine activity of living. Your facility and/ or director may have performance policies that monitor the PSW’s competence.
For more information, see the College guidelines Utilization of Unregulated Care Providers and Working with Unregulated Care Providers, and the reference document RHPA: Scope of Practice, Controlled Acts Model. All of these documents are available free on the website at www.cno.org.
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