Delegation from nurse to healthcare support worker of insulin administration to patients with type 2 diabetes in community nursing services: a qualitative study

Background: In some UK community services, healthcare support workers give insulin injections to stable patients with type 2 diabetes who are unable to self-care. This occurs under delegation from a registered nurse and within organisational governance frameworks that include training and competency assessment of healthcare support workers. Delegation is a complex process influenced by team relationships, role clarity and the quality of supervision. Literature on the delegation of insulin injections is limited to local evaluation. This is an important topic given predicted increases in patients with diabetes requiring assistance with medication and workforce shortages in community nursing.

Aim: To explore stakeholder perspectives on the benefits and/or disadvantages of the delegation of insulin injections to healthcare support workers in community nursing services

Methods: A qualitative study involving interviews with 34 stakeholders across three case sites in England, including: patients and relatives (n = 7), healthcare support workers (n = 8), registered nurses (n = 10), senior managers/clinicians (n = 9)

Results: This is the first independent research on this topic. Delegation was accepted by stakeholders on condition that appropriate training, supervision and governance is in place. To meet demand, services were reliant on the contribution of healthcare support workers providing insulin injections. Benefits included: job satisfaction and career development for support workers, flexible team working, increased service capacity and care continuity. However, there were concerns over potential missed care, remuneration and task shifting if delegation is not adequately monitored.

Conclusion: Delegation of insulin administration is set to continue and requires regular review and monitoring to ensure patient safety is maintained.