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INFORMATIONAL LETTER NO: 27
POLICY CODE: JLC/GCAAB
TO: Superintendents, Dale Douglas (MSMA), and Dick Durost (Maine Principals Association)
FROM: J. Duke Albanese, Commissioner, Department of Education
DATE: November 20, 2002
SUBJECT: The School Nurse Role in Delegation or Coordination of Health-Related Tasks
The Maine School Health Advisory Committee has prepared the attached document, “School Nursing Role Definition in Delegation or Coordination and Oversight,” to help superintendents, principals, school staff, and school health personnel understand the differences in the role of the certified school nurse, the licensed practical nurse (LPN), and other individuals in the school setting who are assigned responsibility for health care.
The certified school nurse is a professional registered nurse meeting the certification requirements of the Department of Education. As part of the school education team, certified school nurses work under the direction of the principal and superintendent. Because it is not feasible in many schools to have a school nurse always present, schools must make use of appropriately trained ancillary personnel to meet students’ health-related needs.
The school administration is responsible for implementing policies and practices to ensure the safety of students. Therefore, it is important to ensure that:
· any staff assigned health-related tasks are working within their job descriptions,
· any unlicensed person performing health-related tasks receives appropriate training by a qualified professional, and that
· the unlicensed person performing health-related tasks is competent to carry out the assigned task.
The attached document provides information regarding health-related tasks that can be appropriately assigned to school staff when the school nurse is not available.
Questions concerning this material should be directed to the Maine School Health Advisory Committee, through DeEtte Hall, Department of Education, 23 State House Station, Augusta, ME 04333 or firstname.lastname@example.org.
I. Role of the Certified School Nurse
A. A Certified Professional School Nurse (RN) is one who is licensed by the Maine State Board of Nursing as a professional Registered Nurse and certified by the Department of Education as a school nurse.
A Certified School Nurse:
1. Manages the school health services under the direction of the Superintendent and Principal, and in compliance with school district policy.
2. Functions in accordance with the Standards of Professional School Nursing Practice, the Nurse Practice Act, and Federal and State statutes that impact school nursing practice.
3. Provides information to the school board and school administrators as they develop school health policies and procedures.
4. Provides health-related training to school personnel.
5. Provides preventive health services to students including health education, screening, consultation and referrals.
6. Provides nursing assessments and nursing diagnoses and develops plans of care for students needing health and nursing interventions.
7. Implements interventions within the plan of care directly, through delegation, or through the provision of oversight and coordination to other responsible staff based on consideration of health, safety, and welfare of the student.
8. Coordinates in-school health care with the student’s primary care physician, the school-based health center, and other providers/staff as necessary and appropriate.
B. The Certified School Nurse is responsible for determining appropriate delegation of health-related tasks or coordination and oversight:
1. The Nurse Practice Act authorizes registered professional nurses to delegate tasks to licensed practical nurses and certified nursing assistants only (32 M.R.S.A. §§ 2102 (2)(C), 2102(2)(D)).
2. Delegation and coordination/oversight of health-related tasks/services must be determined on an individual basis. Factors to be considered for delegation and/or coordination and oversight include safety, acuity of the student, stability of the condition of the student, training and capability of the staff, and nature of the task.
3. The Certified School Nurse must exercise professional judgment in determining delegation or coordination/oversight activities
4. The nurse shall not “coordinate and oversee unlicensed health care assistive personnel for health counseling, teaching or any task that requires independent, specialized nursing knowledge, skill or judgment” according to the Maine State Board of Nursing (MSBON) Rules Ch. 6, Regulations Relating to Coordination and Oversight of Patient Care Services by Unlicensed Health Care Assistive Personnel § 2 (1).
C. The Certified School Nurse is responsible for the coordination and oversight of unlicensed personnel. The School Nurse will:
1. Identify the student’s needs and develop/consult on the plan of care.
2. Identify the tasks to be performed by the unlicensed personnel.
3. Provide direction/training to the unlicensed personnel.
4. Determine the ability of the unlicensed staff to perform the task.
5. Monitor the designated staff’s reporting and documentation of the task.
6. Ensure that designated staff reports directly to the certified school nurse for the performance of the task.
7. Evaluate the performance of the task as it relates to the student outcome and initiate corrective action as appropriate within the school setting. (MSBON Rules Ch. 6 § 2(2)(B))
II. The Role and Responsibilities of Ancillary Personnel
A. School Staff who are licensed by the MSBON as Licensed Practical Nurses (LPN’s):
1. May assist the certified school nurse with specified health tasks.
2. Do not meet the professional requirements for licensure as a registered professional nurse (RN) and requirements for certification by the Maine Department of Education as a certified school nurse.
3. May assume health related responsibilities only when those responsibilities do not require independent, specialized nursing knowledge, skill, or judgment including assessment and evaluation of student health outcomes and only when those responsibilities have standardized protocols and procedures leading to a predictable outcome. 32 M.R.S.A. § 2102(2)(C).
4. Must work under the direction of a certified school nurse.
5. Must function within their scope of practice including medication administration.
B. Unlicensed Assistive Personnel1 are school staff not licensed to provide health-related services, including the independent administration of medication. School Staff who are Unlicensed Assistive Personnel:
1. May assist the certified school nurse in carrying out specified tasks that do not require independent, specialized nursing knowledge, skill, or judgment including assessment and evaluation of student health outcomes and health counseling or teaching. (Examples of appropriate tasks include assistance with vision and hearing screenings and supervised administration of medication.)
2. Must receive appropriate training on the specific task to be performed before accepting the task.
3. Must comply with policies, procedures, and health care plans as directed.
4. Must report to and receive oversight from the school nurse regarding assigned tasks.
5. Must carry out assigned tasks as directed and document all tasks.
Prepared by the Maine School Health Advisory Committee, April 2002.