New and Revised Advisory Opinions

The Nursing Commission recently approved three advisory opinions.

What is an advisory opinion?

The Nursing Commission may issue advisory opinions in response to questions put to it by professional health associations, nursing practitioners and consumers concerning the authority of various categories of nursing personnel to perform particular acts. The opinion is advisory and intended for guidance only. An advisory opinion is not legally binding and does not have the force and effect of a duly promulgated regulation or a declaratory ruling by the Nursing Commission.

New Advisory Opinions

Advanced Registered Nurse Practitioner Scope of Practice: Repetitive Transcranial Magnetic Stimulation (rTMS)

The approval of the advisory opinion clarifies that it is in the scope of practice for ARNPs to provide this service. There are no specific guidelines in the law or rule related to rTMS. Completion of the Scope of Practice Decision Tree clarified that the ARNP with appropriate education and certification may safely provide this service. For questions and comments, please email

Death with Dignity (Aid-in-Dying): Role of the Nurse

RCW 70.245 Washington Death with Dignity Act, enacted in 2009, allows an eligible individual with a terminal diagnosis and prognosis to legally request and obtain medications from a qualified health care practitioner (Doctor of Medicine or Doctor of Osteopathy) to end their life. The WAC 246-978 Death with Dignity Requirements implements the law. See the Washington State Department of Health Death with Dignity Act webpage for common questions and answers containing general information about the Death with Dignity Act. The Nursing Commission approved the advisory opinion summarizing the roles and responsibilities in palliative and end-of-life care. For questions and comments, please email

Advisory Opinion Revision

Delegation of Blood Glucose Monitoring to Nursing Assistants or Home Care Aides in Community-Based Settings

The revision to the advisory opinion clarifies the scope of practice for Registered Nurse delegation of blood glucose monitoring in community-based settings. The nursing law and rule require the Nursing Assistant or Home Care Aide to complete the Washington State Department of Social and Health Services (DSHS) Diabetes Course prior to delegation of insulin administration. The revision recommends and encourages the Nursing Assistant or Home Care Aide to take the Diabetes Course, but clarifies that the Registered Nurse Delegator may delegate to a Nursing Assistant or Home Care Aide to perform blood glucose monitoring, without completion of the course, if the Nursing Assistant or Home Care Aide is not administering injectable insulin or non/insulin for treatment of diabetes. For questions and comments, please email

You may review all Nursing Commission advisory opinions on the Nursing Commission website.