The School Nurse is responsible for determining appropriate delegation of health-related tasks or coordination and oversight:
The Nurse Practice Act authorizes registered professional nurses to delegate tasks to licensed practical nurses and certified nursing assistants only.
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.
The School Nurse must exercise professional judgment in determining delegation or coordination/oversight activities.
The registered 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, Rules Ch. 6, (Regulations Relating to Coordination and Oversight of Patient Care Services by Unlicensed Health Care Assistive Personnel)
Substitute School Nurse
The qualifications needed to substitute for a school nurse are a current RN license in the State of Maine and a criminal history record check approval.
Recommended additional qualifications:
- Knowledge of child and adolescent growth and development
- Knowledge of nursing care for children and adolescents
- An understanding of school health policies and procedures
- Competency in emergency care
- Familiarity with community health resources
- Desire to work with children/adolescents
- Recent practice as a registered nurse.
The Role and Responsibilities of LPNs in the School Setting
Licensed Practical Nurses (LPNs) 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. LPNs can be a valuable addition to a school health services team. Meeting the healthcare needs of children with special healthcare needs in the school system is critical and a team consisting of both registered nurses and LPNs can ensure a safe and healthy educational experience.
- May assist the certified school nurse with specified health tasks
- 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)
- Must work under the direction of a registered nurse
- Must function within their scope of practice including medication administration.
The Role of Unlicensed Assistive Personnel
Unlicensed Assistive Personnel (UAP) are school personnel who do not hold a healthcare license but are trained to provide care to students under the direction and supervision of a school nurse. According to Maine nursing regulations, a registered professional nurse may coordinate and oversee unlicensed health care assistive personnel for specific tasks for specific patients, consistent with patient safety. Except as provided by 32 M.R.S.A. § 2102(2)(G), the registered professional 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. The National Association of School Nurses has a collection of resources on delegation in the school setting that may be helpful.
School nurses are encouraged to use the Decision Tree to determine if it is appropriate to coordinate and oversee a specific nursing task in a particular setting.