Confidentiality of Health Information


Delegation of School Health Services


Medicaid Reimbursement for School Nursing Services


Position Description: State School Nurse Consultant


Position Papers

NASSNC requires that the National Association of State School Nurse Consultants be acknowledged as author
of any NASSNC position papers that are reproduced and/or distributed.

• School nursing services are essential for the health, rehabilitation and well being of the student population in order for them to benefit from educational programs and to maximize energy for learning;

• Both the volume and range of nursing services that must be provided at schools has increased dramatically over the past decade.

As a result, certain aspects of student care may need to be delegated to licensed practical nurses (LPNs) or unlicensed assistive personnel (UAPs). In order to ensure quality and the safe provision of services as necessary for students with health and nursing care needs, NASSNC believes these services should either be directly provided by school nurses who are licensed registered nurses (RNs) and or delegated by the RN to qualified paraprofessionals or unlicensed assistive personnel (UAPs) in accordance with the state nurse practice act. The RN must determine which student care activities may be delegated, under what circumstances it is appropriate to delegate aspects of student care, and by whom the delegated portions of care can safely be provided. The RN is responsible for the assessing, planning, training, supervising, and evaluation of the unlicensed assistive personnel (UAPs).

Rationale

More students with special health care needs are now attending school and placing new demands on school districts. As a result, local school boards must provide sufficient staff and resources to safely meet the needs of students with chronic or urgent health care needs by providing a level of school health nursing services previously not required. Ancillary staff may be useful in some settings in meeting these growing needs. However, safe care for students must be the priority. When all or a certain part of a student=s nursing care is delegated by a RN, the performance of the activity or procedure is transferred to another person, but the RN retains the accountability for the outcome. This is similar to the assignment of certain tasks to a classroom assistant while the teacher retains responsibility for the learning outcome.

School administrators are legally responsible for the safety of all students, including the provision of required health services by qualified staff. They have certain responsibilities regarding the educational placement of students but they cannot legally be responsible for deciding the level of nursing care required by an individual student with special health care needs. The RN, based on his or her knowledge, and in accordance with the state's nurse practice act and related state rules and regulations, is responsible for determining whether care should be provided by a licensed nurse or delegated to a trained and supervised unlicensed assistive personnel. Use of non-qualified school staff risks harm to students. In addition, non-licensed school staff can be held liable for their actions if they practice nursing or medicine without a license authorizing such practice.

By professional and legal mandate, RNs are ultimately responsible for the quality of nursing they provide and are personally and professionally liable for all errors in nursing judgment. If the RN's actions violate the requirements of the nurse practice act, the state board of nursing can take disciplinary action against the RN, including revocation of his/her license to practice nursing.

Definitions

Delegation "the transfer of responsibility for the performance of an activity from one individual to another, with the former retaining accountability for the outcome" (American Nurses' Association (ANA), 1994, p. 11).

Summary

The National Association of State School Nurse Consultants believes that schools have an obligation to ensure the quality and safe provision of school nursing services as necessary for the health, rehabilitation and well being of students with health impairments. Therefore, services should be provided by qualified nursing personnel and with utmost regard for protecting the student. School nursing services should either be directly provided by licensed professional (RN) school nurses or delegated by the RN to qualified paraprofessionals or trained unlicensed assistive personnel (UAPs). In either case, the RN retains accountability for the outcome.

References

• American Nurses' Association (1994). Registered Professional Nurses & Unlicensed Assistive Personnel. Washington, DC: American Nurses Publishing.
• National Council of State Boards of Nursing, (1995). Delegation: Concepts and Decision Making Process. Chicago, Illinois.
• Harrison, Barbara S., Faircloth, J. and Yaryan, L. (1995). The Impact of Legislation and Litigation on the Role of the School Nurse. Nursing Outlook 43 (2), 57-61.
• National Council of State Boards of Nursing website at www.ncsbn.org

Approved: July 1995 || Revised: September 1998, April 2000