Insulin given by nursing assistant?

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Hi everyone!

I work at a day program for adults with developmental disabilities. An RN is required to work at this program to administer medications and handle the nursing issues. I have a client I check blood sugars on and administer insulin to based on a sliding scale, each day at noon. He is a brittle diabetic and fluctuates between blood sugars of 40 to 450 any given day. I am going on vacation shortly. After giving almost 3 months notice for the vacation, I was told that there is an RN coming in to cover me, but she will leave before lunch time. The organization is apparently planning on having a supposed nursing assistant check the blood sugar and administer the insulin! Does this sound absolutely ridiculous to anyone else? The RN subbing for me is simply going in to package up the oral medications and have the unlicensed, probably non-MAP certified staff that are working with the clients give them their medications. And it is up to the nursing assistant to care for the diabetic in my absence? What is he going to sign in the medication charts? Make up his credentials? Craziness! Would you say anything or report this? Or just let it go because it will happen while I'm away and it is not my choice? Thanks!

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Specializes in Critical Care & ENT.

I've never heard of anything like this before. I know some places have UAP trained to assist with medication passes. However, usually when it comes to high alert medications, they LPN or RN is responsible for that. I would probably bring it to the attention of your manager. If they are non-clinical, then you may have to explain it in a little more detail. However, present the question to them and see what they are willing to say is an acceptable solution. Is there another person in management that is a LPN or RN that could oversee the insulin coverage. I'm sure this may even be a risk management issue. How often does the patient get their blood sugar checked? AC/HS?

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MC1906- Thanks for the response. I am the only nurse at our facility. There is no other medical type person available, and the issue is that the 3 people that manage the place came to the solution of using someone who happens to work for us as a job coach, who is supposedly a nursing assistant, to handle the insulin. I told my direct supervisor I have a problem with this.

The other two directors really wish they could get rid of the nursing position all together and try to limit my responsibilities as much as possible, but I'm required by a relatively new federal law to be there. One director even transcribed the orders for the insulin without allowing me, as the RN, to review the orders and do it and she keeps me as uninvolved as possible. She tracks the diabetic's carb intake daily and determines if she will give him a glucose drink on her own. I've asked multiple time for an order for this glucose drink and she insists she lost it. I have to fix the transcribed orders constantly because of spelling errors and her inability to distinguish between brand names and generic names. I cover myself as thoroughly as possible and know that I am doing the best I can without having to get into daily arguments with this woman. She is the type that loves conflict and loves to blame others for mistakes.

I agree that insulin is high alert, and sometimes even requires co-signing! This particular client was just hospitalized for receiving too much insulin as his residence and they expect an unlicensed person to handle it. I know it's not rocket science for anyone give a few units of insulin, but it's against the law in this circumstance.

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In adult foster homes, whoever runs the homes can check sugars give insulin. They don't have to be medical people. I don't know about your program.

If your diabetic is developmentally delayed to the point of having a guardian, that person should certainly know who is giving the insulin and glucose drinks.

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I have read too many horror stories concerning this type of home in my area. I would not continue to work there under these circumstances. If something goes very, very wrong because of what this other woman is doing, don't you think for one minute that she would not hesitate to throw you under the bus? Find a job where your nursing license is not being usurped by a non-nurse.

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Specializes in Critical Care & ENT.

The more I hear the more I am becoming concerned. Caliotter hit it right on the nose...do you want to still work there? I would be careful fixing orders, in terms of rewriting them since you did not orginally take the order from the physician. I would only seek an order clarification from the physician and put my name on that. Since this is a new mandate they may feel threatened by your presence and want to limit what you know and do. There must be a reason for this. I would leave there ASAP. Good luck..keep us posted!

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Thank you all for the advice. I agree about leaving..I've been there almost a year and that's too long already. I don't doubt that the organization would not support me in the event of a problem and I know that they are not interested in letting me do my job or work to my potential. You're right, I think they are threatened by having a RN in the program.

I'm fed up and have been looking elsewhere; actually trying to relocate. I told them that I was getting a license in another state because I needed them to fill out paperwork, and the best part is the director requested I give at least 3 to 4 months warning before I leave! HA! Two weeks it is. Thank you again for your replies.

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Specializes in Critical Care & ENT.

I'm glad that your looking! Sometimes you have to get out before things get really bad. At anytime, the state agencies can come in and do an investigation. They are there to fact find and find other facts.

Curious: why did you have to have them fill out paper work when filing for another license? What state requires that?

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I'm getting my license in Georgia. For an application by endorsement they require at least 500 hours of clinical R.N. experience to get a license. The HR departments at any current or past jobs need to fill out a form stating that you were employed as an R.N. for 'x' amount of hours and seal it up for you to send in with your application. You also need fingerprints in person on site in GA.

I'll hopefully be out of my current position within a month or two. I can't stand the way they do things. I feel badly for the next nurse that comes in..I'm the second longest lasting nurse (certainly not what I wanted to hear), so on average I think they only last a few weeks or months. You can only stand someone else (lacking any health care experience whatsoever) doing your job for you for a short time before you feel worthless. Thank you for your support!

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What, OMG! Well, as a nurse your duties includes advocating for your patient. So speak up before somebody makes a fatal errow.

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Specializes in Developmental Disabilities.
MC1906- Thanks for the response. I am the only nurse at our facility. There is no other medical type person available, and the issue is that the 3 people that manage the place came to the solution of using someone who happens to work for us as a job coach, who is supposedly a nursing assistant, to handle the insulin. I told my direct supervisor I have a problem with this.

The other two directors really wish they could get rid of the nursing position all together and try to limit my responsibilities as much as possible, but I'm required by a relatively new federal law to be there. One director even transcribed the orders for the insulin without allowing me, as the RN, to review the orders and do it and she keeps me as uninvolved as possible. She tracks the diabetic's carb intake daily and determines if she will give him a glucose drink on her own. I've asked multiple time for an order for this glucose drink and she insists she lost it. I have to fix the transcribed orders constantly because of spelling errors and her inability to distinguish between brand names and generic names. I cover myself as thoroughly as possible and know that I am doing the best I can without having to get into daily arguments with this woman. She is the type that loves conflict and loves to blame others for mistakes.

I agree that insulin is high alert, and sometimes even requires co-signing! This particular client was just hospitalized for receiving too much insulin as his residence and they expect an unlicensed person to handle it. I know it's not rocket science for anyone give a few units of insulin, but it's against the law in this circumstance.

Seriously, I would report this person to the BON for practicing without a license.

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Specializes in US Army.

I think a few regulating bodies need to be notified of the conditions at that facility... The current situation is downright scary. What's the source of their funding?

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