DELEGATION
GUIDELINES FOR
SCHOOL NURSES
Presenters
Blayne Miley, JD
Indiana State Nurses
Association, Director of
Policy & Advocacy
Indiana State University,
Adjunct Professor
teaching Health Policy
Leadership to DNP
students
Jolene Bracale, MSN, RN
Registered Nurse for 30
years
•
Critical Care for 10 years
•School Nurse for 15 years
•Program Coordinator for
Student Health Services at
the Indiana Department of
Education for 4 years
INDIANA CENTER FOR NURSING
ACCESS TO CARE
ADDITIONAL SUBCOMMITTEE MEMBERS
•
Barbara Kelly, MSN, FNP-BC, RN
•
Lindsey Minchella, MSN, RN, NCSN, FNASN
•Deb Robarge, BSN, RN, NCSN
•
Cecelia Smith, MSN, ANP-BC, RN
•Carolyn Snyder, MS, BSN, RN
BACKGROUND
INFORMATION
Data – The Universal Language
School Nurse Data
•
Collected in May 2013
•
Voluntary Participation
•
Represents 49.7% of Indiana Students
•
Data Received from all Regions of
the State, all Types of Schools, all
Grade Levels
Geographic Distribution of
Data by Region
37 %
42 %
21 %
North
Central
South
School Nurse Data
School Nurses are
primarily employed
by school
corporations
(88%) and local
hospitals (9%)
88%
9%
3%
School
Corp.
Local
Hospital
Other
0 100 200 300 400 500 600 700 800
Caring for the Ill or
Injured Managing Students withChronic Health Conditions
Discussing Health Issues with Parents 706
529
337
Catheterization
Central Venous Line
Care
Administration of
Emergency
Medications –
Epinephrine,
Glucagon, and Diastat
Insulin
Administration
Nebulizer Treatment
Shunt Care
Tracheotomy
Care/Cleaning
Tube Feeding
Treatments Performed by
School Nurses
•
Vision Screening
•
Hearing Screening
•
Immunization
Verification
•
Writing Individual
Health Plans for
Students
•
Training for Health
Aids, Teachers,
Secretaries, Bus
Drivers, Food
Service, Custodians
•
Educating and
Counseling
Students
0 50000 100000 150000 Short-Term Medicine Long-Term Medicine Emergency Medicine Total Medicine 3.1% 3.3% 6.1% 12.5% = 141,159
Types of Medicines for Students
in Indiana Schools
Out of 558,571 students reported on in this survey (49.7% of school population)
Epinephrine = 45
Diastat = 37
Glucagon = 24
Emergency Medication Given
at Least Once During the
School Nurses were asked about 32 Different Chronic
Diseases:
35.86%
of Indiana Students had at
least one of these 32 diseases =
402,385 Students
in Indiana have
at least one chronic health condition
0 20000 40000 60000 80000 100000 Asthma Environmental Allergies ADD 96950 87738 80737
Approximate Number of Students with
Chronic Diseases (80,000 – 97,000)
0 20000 40000
Mental Health Disorders Migraines Severe Food Allergies Gastrointestinal Disorders Seizures 25023 17787 14737 12660 9807 Number of Students
Approximate Number of Students
with Chronic Diseases (9,000 – 25,000)
0 5000 10000 Orthopedic Disability Cardiac Conditions/Hypertension Hearing Disorders Visually Impaired Substance Abuse 7786 7246 6310 5400 4829 Number of Students
Approximate Number of Students
with Chronic Diseases (4,000 – 8,000)
3716 2851 2814 2519 2437 0 1000 2000 3000 4000 Diabetes-Type 1 Renal Condition Cerebral Palsy Chromosomal Conditions Neurologic Condition (traumatic brain injury)
Number of Students
Approximate Number of Students
with Chronic Diseases (2,400 – 4,000)
0 1000 2000 3000 Metabolic Conditions (hypo/hyperthyroidism) Blood Disorders/Bleeding Disorder Diabetes-Type 2
Rheumatic Arthritis or other Rheumatic Condition 2336 1497 1117 974 Number of Students
Approximate Number of Students
with Chronic Diseases (900 – 2,300)
0 200 400 600 800 1000
Sickle Cell Trait/Anemia Eating Disorder (bulimia/anorexia)
Cancer
Addison's Disease
Fetal Alcohol Syndrome
918 874 848 701 643 Number of Students
Approximate Number of Students
with Chronic Diseases (600 – 900)
641 321 117 0 200 400 600 800 Spina Bifida Cystic Fibrosis Multiple Sclerosis Number of Students
Approximate Number of Students
with Chronic Diseases (100 – 600)
•
Requires Writing Individual Health
Plans and Delegating Nursing Tasks to
Others
•
Nurses in Schools Need Guidance
SCHOOL ISSUES
IMPACTING SCHOOL
NURSING
•
Legislative Funding Formula has caused many
schools to cut costs that are not directly related
to education
•
Support Services are being deleted or outsourced
•
Non-qualified personnel are assuming health roles
•
School administrators and many health personnel are not
aware of scope of practice laws, especially as it applies to
the education setting
•
As we just saw, many students in need of health care are
enrolled in our schools
•
School personnel need to be educated and nurses need to
have guidance regarding how to articulate the need for
qualified personnel and the need to deliver safe health care
to students
DELEGATION
DOCUMENT
Subcommittee Members
•
Lindsey Minchella,
•
Carolyn Snyder
•
Deb Robarge
•
Barbara Kelly
•
CeCelia Smith
•
Jolene Bracale
•
Blayne Miley
Guidelines to Delegation for
Indiana School Nurses
CONTENTS
Section 1 - State of Indiana Regulations
Section 2 - Principles of Delegation for the School Nurse
Section 3 - Delegation Tools
Section 1: Regulations
Definitions
◦
School Nurse
◦
Registered Nurse
◦
Licensed Practical Nurse
Standards of Practice for RN, LPN from Indiana
Administrative Code
Violations
◦
RN’s & LPN’s subject to discipline by Board of Nursing
◦
Unlicensed personnel practicing nursing as an RN or LPN commit
a class B misdemeanor
Section 2: Principles of Delegation
Delegation: who, what, when, why, how
Who is an Unlicensed Assistive Person
Documentation
Steps in the delegation process
Training v. delegation v. assignment
Section 3: Delegation Tools
Delegation Decision Tree
◦
14 Prerequisites for Delegation
Delegation Task Table
Skills Checklist for Staff Training
Medication Administration Checklist
