A Guide for School Nurse Practice By Laura Case, MSN, RN, NCSN

 No planners had any conflicts of interest  No presenters had any conflicts of interest  There is not commercial or sponsorship support for this activity.

 Define the Role of the Board of Nursing  Review the NM Nurse Practice Act  Review the rules of Nursing Delegation  Review the Decision Tree for Nursing Delegation  Review Components of Delegation

 Purpose is to protect the citizens of the state of New Mexico by licensing Nurses and certifying Hemodialysis Technicians and Medication Aides; regulating education programs for licensees and certificate holders; regulating practice; taking complaints and disciplining licensees and certificate holders who violate the law and rules.  Reports directly to the Executive office of the Governor.  Supported solely by self-generated fees and is a fully self-funded agency.  Seven-member board appointed by the Governor which consists of 4 licensed nurses and 3 public members  5 Advisory Committees  Advanced Practice  Hemodialysis Technician Advisory Committee  Medication Aide Advisory Committee  Nursing Practice Advisory Committee  Nursing Education Advisory Committee

 Part 1 General Provision  Part 2 Nursing Licensure  Part 3 Nursing Educational Programs  Part 4 Hemodialysis Technicians  Part 5 Medication Aides  Part 6 Nurse Licensure Compact  Part 7 Trial Program for Medication Aides to serve Persons in Licensed Nursing Facilities (Repealed)  Part 8 Trial Program for Medication Aides to Serve Students in Public Schools (Repealed)  Part 9 Management of Chronic Pain with Controlled Substances  Part 10 Management of Medical Records  Part 20 Hearing Requirements for Certified Nurse Aids

 C (2)…(r) inappropriate delegation of medication administration, evaluation and nursing judgment to non-licensed persons;

 D (2)…“delegation”, the transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability of the delegation;

 A “Administrator” means the operating officer of an agency. This includes, but is not limited to a licensed nursing facility or a school superintendent

 B (1) (2)  Authorized functions of the medication aide - medication aides who have been certified by the NM board of nursing may under the supervision/direction of a registered nurse administer routine medications. (1) The medications must have been ordered by a person authorized in the state to prescribe medications. (2) The medication must be prepared by the person who will administer it. (a) EXCEPTION: School medication aides may administer auto injector epinephrine to school staff and students during school hours in an emergency life threatening situation. (b) School medication aides must receive training in the administration of auto injector epinephrine by the nurse educator. The nurse educator must document the training.

 B The nurse shall assign/delegate to licensed and unlicensed persons only those nursing actions which that person is prepared, qualified or licensed or certified to perform.  (1)The nurse is accountable for assessing the situation and is responsible for the decision to delegate or make the assignment.  (2)The delegating nurse is accountable for each activity delegated, for supervising the delegated function or activity, and for assessing the outcome of the delegated function or activity.  (3)The nurse may not delegate the specific functions of nursing assessment, evaluation and nursing judgment to non-licensed persons.

 B  ADDING :  (4) Registered Nurses engaged in school nursing practice may delegate medication administration to competent unlicensed adults.  A  DELETING:  “or a school superintendent”  B. (2)  DELETING:  (a) AND (b)

 Administration of routine medications  Administration of emergency medications  Administering G-tube feedings  Special procedures  Classroom/ Field Trip monitoring Asthma  Classroom/Field Trip monitoring of Diabetes and seizure disorders

 Right task  Right circumstances  Right person  Right directions and communication  Right supervision

 Underestimating the complexity of the student’s health care needs  Lacking knowledge and experience of nursing delegation  Going it alone  Working with School administrators who do not understand nursing delegation  No school polices that support nursing delegation

 Standardized training  Skills check list demonstration/documentation that skills are proficient for safety  UAP is comfortable performing the task?  Nurse is comfortable with UAP’s ability?  If the UAP ever becomes uncomfortable with the delegated task – It is his/her responsibility to let the nurse know they need additional training and/or review of skills check list

 Identify 1 problem with case presented. Mitts, Carol v. Hillsboro Union High School District No. 3 et. al. (1990) A health aide sought to obtain a declaratory relief and money damages and to prevent the school district, assistant superintendent, school nurse, parent and student’s physician from “compelling and/or conspiring to compel” her to unlawfully practice medicine or nursing. The part-time school nurse acquiesced to the school principal’s directive when he assigned the school’s health aide to perform daily clean intermittent catheterization (CIC) for a new student with myelodysplasia (spina bifida) after training by the parent and assigned the nurse to supervise the health aide in performing this procedure. The court asked the Oregon State Board of Nursing to issue a declaratory ruling on the question of whether CIC could be lawfully delegated to a trained unlicensed person.

 Health Assistant did not want to perform procedure  Training performed by parent  Nurse accepted the principals assessment of the student’s health care needs in the school – this was below applicable standards of nursing practice  Principal, other school authorities were practicing nursing without a license  Nurse failed to use the nursing process and did not complete her own assessment of the students needs.

 Barnes, J. (2006) Centers for American Nurses. Legal Aspects of Delegation retrieved on 4/15/10 from  NASN Position Statement on Delegation retrieved on 4/19/10 from  Schwab, N. & Gelfman, M. (2001)  NASN: Principles for Practice, Nursing Delegation to Unlicensed Assistive Personnel in the School Setting. Legal Issues in School Health Services. Lincoln: Authors Choice Press.  Standards for the School Nurse retrieved on 4/19/10 from