Cheryl Byrd, BSN, RN, CHNS

Edie Greenwood, BSN, RN, CHNS

1. The learner will describe the best practices and resources for

managing students in the school setting through collaboration in

the Care Coordination Principle.

2. The learner will review the fundamental values and boundaries of

duties in the school nursing profession with the Standards of

Practice.

School nursing, a specialized practice of nursing, protects and promotes

student health, facilitates optimal development, and advances academic

success. School nurses, grounded in ethical and evidence-based practice,

are the leaders who bridge health care and education, provide care

coordination, advocate for quality student-centered care, and collaborate

to design systems that allow individuals and communities to develop their

full potential. Adopted by the NASN Board of Directors February 2017.

https://www.nasn.org/advocacy/professional-practice-documents/position-statements/ps-role

• Clinician

• Advocate

• Collaborator

• Health Educator

• Liaison

NASN The Role of the 21st Century School Nurse position statement:

As an advocate for the individual student, the school nurse provides skills

and education that encourage self-empowerment, problem solving,

effective communication, and collaboration with others (ANA, 2015a).

Promoting the concept of self-management is an important aspect of the

school nurse role and enables the student to manage his/her condition and

to make life decisions (Tengland, 2012). The school nurse advocates for

safety by participating in the development of school safety plans to address

bullying, school violence, and the full range of emergency incidents that

may occur at school (Wolfe, 2013).

https://www.nasn.org/advocacy/professional-practice-documents/position-statements/ps-role

defines

nd Responsibilities Practice Guidelines, July 2018ARSBN School Nurse Roles a

Supervision Definition Continued

Supervision does not require the supervisor to physically be present

100% of the time, however, the supervisor must be able to critically

watch and direct the Licensed Practical Nurse’s. (LPN.’s) and/or

Unlicensed Assistive Person’s (UAP.’s) activities or course of action.

The amount of supervision required is directly related to the

individual LPN.’s or UAP.’s experience, skills and abilities and the

healthcare needs of the students being served.

ARSBN School Nurse Roles and Responsibilities Practice Guidelines, July 2018

ARSBN School Nurse Roles and Responsibilities Practice Guidelines, July 2018

ARSBN School Nurse Roles and Responsibilities Practice Guidelines, July 2018

ARSBN School Nurse Roles and Responsibilities Practice Guidelines, July 2018

ARSBN School Nurse Roles and Responsibilities Practice Guidelines, July 2018

Registered nurses, licensed practical nurses, and licensed psychiatric technician

nurses, within the parameters of their education and experience, are responsible

for all nursing care that a client receives under their direction. Assessment of the

nursing needs of a client, the plan of nursing actions, implementation of the plan,

and evaluation of the plan, under the direction of a registered professional nurse,

are essential components of nursing practice. Unlicensed personnel may be used to

complement the licensed nurse in the performance of nursing functions; but such

personnel cannot be used as a substitute for the licensed nurse.

https://www.arsbn.org/Websites/arsbn/images/Rules_Chapter5_Dec_2008.pdf

Delegation by registered nurses, licensed practical nurses, and licensed

psychiatric technician nurses must fall within the definitions of Arkansas

Code Annotated ∋17-87-102. Delegation must occur within the framework

of the job description of the delegatee and organizational policies and

procedures, and must be in compliance with the Arkansas Nurse Practice

Act. The Arkansas State Board of Nursing Rules, Chapter 5, Delegation,

governs the licensed nurse in delegating and supervising nursing tasks to

unlicensed personnel in all settings.

The decision to delegate nursing care rests with the judgment of RN,

LPN, LPTN, or APRN. Only a licensed nurse may determine that a

UAP or other school staff can safely deliver the care.

Factors to Consider:

• Complexity of the Child’s condition and the nursing care required.

• Dynamics of the student’s status or frequency that nursing care requirements change.

• Knowledge and Skills that are required to complete the task.

• Technology that is employed in providing the nursing care.

• Supervison-the amount that is required by the unlicensed assistive personnel (UAP) to whom the task is delegated.

School Nurse Roles and Responsibilities Practice Guidelines Revised July, 2018

More Factors to Consider:

• Availability of the licensed nurse for supervision. (Is the licensed nurse who delegated the task readily available in person or telephonic communications?)

• Safety and Infection control issues: Has the unlicensed UAP had the training and competency validation to safely perform the task and utilize infection control principles.

• Policies and Procedures school nurses are responsible for ensuring current policies and procedures are available and followed and accountable for maintaining current nursing practice standards.

Policies and Procedures

According to ARSBN Rules Chapter Five on Delegation policies and procedures are to:

• Recognize the criteria for delegation • The requirements for delegation of nursing tasks

• The degree of supervision required

• Recognize nursing tasks that can be delegated without prior assessment

• Recognize nursing tasks that SHALL NOT be delegated.

The Five Rights of Delegation

The licensed nurse recognizes that specific nursing tasks that MAY

be delegated provided the five rights of delegation are followed:

1. Right Task 4. Right Communication

2. Right Person 5. Right Supervision

3. Right Circumstance

http://arsbn.publishpath.com/Websites/arsbn/images/School%20Nurse%20Guidelines%202018%20%20Revision%20Updated%207.11.18.pdf

The tables on pages 22-26 of the “SN Roles and Responsibilities” will

determine to whom specific tasks may be delegated. Only the nurse

responsible for the student's nursing care my determine which

nursing tasks may be delegated to the UAP. These tasks can only be

delegated if the Five Rights of Delegation are met.

ARSBN School Nurse Roles and Responsibilities Practice Guidelines, July 2018

ARSBN School Nurse Roles and Responsibilities Practice Guidelines, July 2018

After assessment and consideration of the principles of delegation, the decision to delegate nursing care must be based on the following:

1. Student’s nursing care needs are stable.

2. Performance of the task does not pose a potential harm.

3. Task involves little or no modification.

4. Task has predictable outcome.

5. Task does not inherently involve ongoing assessments, interpretations, or decision making.

6. The UAP’s personal skills and competency levels.

7. The availability of supervision.

ARSBN School Nurse Roles and Responsibilities Practice Guidelines, July 2018

https://www.arsbn.org/Websites/arsbn/images/NURSEPRACTICEACT_2018.February2018.pdf

http://www.arkansased.gov/public/userfiles/Learning_Services/School_Health_Services/School_Nursing/Special_Health_Care_Needs

http://arsbn.publishpath.com/Websites/arsbn/images/School%20Nurse%20Guidelines%202018%20%20Revision%20Updated%207.11.18.pdf

https://www.nasn.org/advocacy/advocacy-skill-building

https://www.nasn.org/advocacy/advocacy-skill-building

https://www.nasn.org/advocacy/advocacy-skill-building

Five Ways a School Nurse Benefits the School

Attendance Academics Time Staff Wellness Accountability

https://www.nasn.org/advocacy/school-nurse-day

SNs care for the entire school population, especially the most vulnerable.

90.7% conduct screenings to identify students at risk and help them get the care needed.

92.8% decrease communicable disease outbreaks by tracking student immunization requirements.

SNs spend 19.4% of their time providing health education andoffering teacher support

https://higherlogicdownload.s3.amazonaws.com/NASN/3870c72d-fff9-4ed7-833f-215de278d256/UploadedImages/PDFs/Advocacy/2017_Workforce_Study_Infographic_School_Nursing_Practice.pdf

SNs spend 57.8% of their time providing direct services, including catheterizations, blood glucose testing, and tracheotomy suctioning.

93.2% of SNs give medications.

92.2% develop individual student care plans and coordinate with other health professionals to help improve health and academic outcomes.

94.9% address acute injuries and illnesses

https://higherlogicdownload.s3.amazonaws.com/NASN/3870c72d-fff9-4ed7-833f-215de278d256/UploadedImages/PDFs/Advocacy/2017_Workforce_Study_Infographic_School_Nursing_Practice.pdf

Arkansas SN Survey 2016-2017 survey:

157,694 students with at least one chronic health condition, which represents 33% of the total student population

38,145 students with a diagnosis of obesity – this is the first year obesity is greater than those with an Attention Deficit Disorder (ADD) /Attention Deficit Hyperactivity Disorder (ADHD) diagnosis

1,922,473 student encounters/office visits seen by a nurse and returned to class

16,903 school staff were administered First Aid and 27,763 were provided blood pressure checks

• One study of 18 school districts found the intensity of policies and programs in school health services was significantly related to graduation rate (Cook, 2006)

• The top 5 health problems of children in the United States are now mental health problems not physical problems (Slomski, 2012)

• Approximately one in five children and adolescents has a diagnosable mental health disorder in the course of a year. Five percent have impairment in functioning that is extreme (U.S.DHHS, 2000)

• Twenty percent (20%) of students may have undiagnosed mental health problems that cause difficulty with academic work (Puskar & Bernardo, 2007)

• School nurses spend 32% of their time providing mental health services (Foster et al., 2005)

SNs advocate for the health needs of their students anddevelop policies to keep students healthy, safe, and ready to

learn