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Nevada State
Board of Nursing |
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School Nurse Regulation NAC 632.226 Employment as school nurse: Duties; delegation of nursing care; requirements for administering medication to pupils. (NRS 632.120) 1. A registered nurse who is employed as a school nurse shall direct and provide school nursing services. 2. In carrying out a plan of nursing care for a pupil with special needs pursuant to NRS 391.208, a registered nurse who is employed as a school nurse may delegate nursing care to a qualified person. 3. A school nurse may delegate only those duties of nursing care that the Board has approved. The Board will maintain a list of the duties it has approved for delegation and provide a copy of the list to a school nurse or member of the general public upon request. 4. A licensed practical nurse who is employed by a school district to provide nursing care in a school may not delegate nursing care or assign duties relating to that care to another person. 5. A school nurse shall develop safe and effective procedures for the administration of medication to pupils that comply with nationally recognized standards and the laws of this State. 6. A school nurse may not administer medication to a pupil or delegate that duty to another person unless: (a) He has obtained written authorization from the parent or legal guardian of the pupil to administer the medication; (b) The medication is labeled; and (c) He verifies that the medication has been prescribed and dispensed by a person authorized to do so pursuant to chapter 453, 454 or 639 of NRS or the laws of another state or the District of Columbia. 7. A record of the medication administered to a pupil must be maintained at the school the pupil attends. The school nurse shall indicate in the record each time he, or a person to whom he delegated the duty, administers medication to the pupil. 8. As used in this section, “qualified person” means a person who is: (a) Certified or licensed by this State to provide nursing care to a pupil; (b) Willing to provide nursing care to a pupil and who the school nurse has determined has the knowledge and skill to provide that nursing care to the pupil in a safe and effective manner; or (c) Except as otherwise provided in this paragraph, exempt from the requirement of obtaining a license to practice nursing pursuant to subsection 1 of NRS 632.340 and whom the parent or legal guardian of the pupil designates as a person who may provide nursing care to the pupil. A parent or legal guardian may not designate a person who is employed by the school district in which the pupil attends school as a person who may provide nursing care to the pupil. (Added to NAC by Bd. of Nursing by R071-00, eff. 10-20-2000)
School Nurse Advisory Opinion Nevada State Board of Nursing Advisory Opinion All
students in public school districts deserve to have their health care needs met
to enhance optimum learning. In
addition, the Individuals With Disabilities Education Act (IDEA), mandates that
all disabled children be provided an education in the least restrictive
environment and the special health care needs of children shall be met.
An increasing number of children with exceptional health care
requirements are currently being mainstreamed into the school system.
It is the Board of Nursing's recommendation that School Nurses should
direct and/or provide school health services.
School Districts need to arrange for adequate personnel to provide care.
The
role, duty, responsibility, and employment of the School Nurse, must comply with
the Nurse Practice Act (NRS Chapter 632 and NAC 632) and NRS Chapter 391.207,
391.208, and 392.420.
The School Nurse is responsible for developing, implementing, evaluating, and revising the individualized health care plan for each student with special health care needs under his/her supervision.
A. Input for the individualized health care plan is gathered from a multi-disciplinary health team to include, but not limited to, the following:
1. The student's primary physician
2. The student's parent/guardian
3. The student, when able to communicate
4. Primary RN coordinating student's home care
5. Social worker, if involved
6. Designated school representative (per IDEA requirement)
7.
Student's teacher, school counselor and school psychologist 8.
Licensed nurses employed by the school district who provide care to the
student 9. Health care providers (example: Occupational or Physical Therapist, Vision Impaired Specialist, Hearing Impaired Specialist, Mental Health Counselor, etc.)
B. The individualized health care plan is based on the evaluation of a number of variables specific to each student and includes, but is not limited to, the following:
1. The stability of the student's medical condition including diagnosis, symptomatology, special alerts, emergent factors and educational implications for the student. Consideration should be given to the questions, "can the student's stability change dramatically to life-threatening within a few minutes/seconds?"
2. List of medications: type, dosage, interactions, toxicity, adverse reactions and route of administration the child receives, as prescribed by a qualified practitioner.
3. Utilization of PRN medications and over the counter medications.
4. The nature, frequency and complexity of prescribed treatments the child requires and assessment for PRN treatments.
5.
The complexity and acuteness of the observations and judgments the care
giver must make.
6. The specific student's ability to participate in the plan of care and communicate his/her needs to the caregiver.
7. Environment: To include physical plant and educational staff and alternate health care providers and any adaptations that are needed to accommodate the student because of the health care needs.
8. Level of preparation and experience of the designated direct care giver.
C. The individualized health care plan should include written policies and procedures addressing possible medical emergencies the student may experience while in the school setting. These policies and procedures should include:
1. Definition of a medical emergency for the specific student;
2. Designation of individuals to be notified when the emergency occurs;
3. Identification of person who will initiate and direct the action to be taken;
4. Specific action to be taken in this emergency;
5. Transport specifications (internal and external), who will provide it and to where; and
6. Format for documentation of actions taken in medical emergency.
D. Delegation
1. The School Nurse determines when it is appropriate to delegate or assign any portion of the provision of care. This delegation/assignment must occur in accordance with the standards of practice outlined in the Nurse Practice Act and the guidelines of this Advisory Opinion.
2. The School Nurse is solely responsible for the determination of when it is appropriate to delegate or assign nursing care to a qualified person. A "qualified person" is:
a. A person whose license/certification authorizes his/her practice; or
b. A willing person whom the School Nurse has determined has acquired and/or maintained knowledge, skill and ability to perform the care in a safe and effective manner required by the child.
3. This definition precludes the automatic utilization of the office manager, secretary or teacher as a qualified person. Only the School Nurse may delegate or assign nursing care. The School Administrator cannot legally delegate or assign nursing care. A Licensed Practical Nurse providing nursing care in a school may not delegate or assign nursing services to school personnel.
4.
A family member/friend, designated or identified by the student's parent or
legal guardian, is exempt from the regulations of the Nurse Practice Act and,
without delegation, training or supervision by the School Nurse, may perform
required care for the student unless employed by the school district. Developed: 01/90 Modified: 9/18/90 by Practice Committee Modified: 9/22/90 by School Nurses Modified: 01/91 after Superintendent's Mtg Modified: 04/26/91 by Practice Committee Approved:
06/13/91 by Practice Committee Adopted: 12/6/91 Reviewed: 02/26/99 Revision
Approved by Board 5/14/99 Revised: 11/17/04, 3/16/05, 1/25/06 Revision
Approved by Board 7/19/06 Revision Approved by Board 5/14/09 Revision Approved by Board 3/18/10
Medications To administer medications, the School Nurse must have written permission from parent/guardian, and medication must have been prescribed by licensed prescribing practitioner, labeled and dispensed by licensed dispensing practitioner/pharmacist. Administration must be accompanied by a reliable tracking system.
The Nevada State Board of Nursing recognizes the administration/assistance with medication is an issue of primary concern in school districts. School Nurses/School Districts are referred to the State Board of Pharmacy to work out a suitable mechanism for the accomplishment of this task. Any medication procedure developed must meet the standard requirement for the safe administration/assistance of medications.
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