School Nurse Practice and Delegation, Coordination and Oversight Presenters: Virginia deLorimier, RN Maine Board of Nursing Nancy Dube, RN Maine Department of Education

School Nursing; Delegation, Coordination and Oversight  Agenda Definitions, registered professional nurse, practical nurse, certified nursing assistant 5 rights of delegation Coordination and Oversight – Chapter 6 Comparison of Delegation/Coordination/Oversight School Nurse Position Statement Case Study

2102 Definitions 2. Professional Nursing Diagnosis (Assessment and Care Planning) Delegation (LPNs and CNAs) Supervision and Teaching Patient Teaching Coordination and Oversight

2102 Definitions 3. Practical Nursing Practices under the supervision of an RN or MD Practices in a structured health setting Reinforces student and family teaching LPN cannot do private duty nursing if hired independently by the family.

2102 Definitions 8. Certified nursing assistant. "Certified nursing assistant" means an individual whose duties are assigned by a registered professional nurse and who: A. Has successfully completed a training program or course with a curriculum prescribed by the board, holds a certificate of training from that program or course and is listed on the Maine Registry of Certified Nursing Assistants and Direct Care Workers o In order for the RN to delegate to a CNA the individual must be employed as a CNA

CERTIFIED NURSING ASSISTANTS- MEDICATIONS (CNA-M) o Experienced CNAs (take course after employment as a CNA for at least one year full time) o Administer selected non-injectable medications to patients who are 4 years of age and older. o This complex nursing task shall be performed under the direct on-site supervision of a licensed nurse. o CNA-M’s can only be employed in in long term care, state mental health institutions, county jails, state correctional facilities and assistive living settings.

Delegation  By rule the Board has defined delegation as the transferring to a competent individual authority to perform a selected nursing task in a selected situation.  RNs can delegate to CNAs, CNA-Ms, nursing students, graduate nurses awaiting first NCLEX examination.

NCSBN Delegation Guidelines Assess the Situation: student needs, setting, & resources Plan for specific task(s) to be delegated: required knowledge & skills, competence of staff, resources

NCSBN Delegation Guidelines Continued Assure Accountability: delegator for the performance of task(s) & delegatee accepts delegation to carry out task(s) correctly No one practices on your license Supervision: Clear directions & expectations, monitoring of performance of task, intervene as necessary, ensure appropriate documentation

NCSBN Delegation Guidelines Continued Evaluate the delegation process: student, performance of task, and obtain feedback Reassess the overall plan of care as needed

NCSBN 5 Rights of Delegation Right Task Right Circumstances Right Person Right Directions/Communication Right Supervision

Resources for Effective Delegation 32 M.R.S.A., CHAPTER 31 THE LAW REGULATING THE PRACTICE OF NURSING Rules/Chapter%204.pdf Chapter 5 REGULATIONS RELATING TO TRAINING PROGRAMS AND DELEGATION BY REGISTERED PROFESSIONAL NURSES OF SELECTED NURSING TASKS TO CERTIFIED NURSING ASSISTANTS – Chapter%205.pdf

Resources Continued NCSBN Guidelines For Delegation CNA Curriculum CNA-M Curriculum NCSBN Delegation Guidelines Articles in the Board Bulletin posted on the website:

Coordination and Oversight Chapter 6 REGULATIONS RELATING TO COORDINATION AND OVERSIGHT OF PATIENT CARE SERVICES BY UNLICENSED HEALTH CARE ASSISTIVE PERSONNEL Only an RN may coordinate and oversee patient services by Unlicensed Assistive Personnel (UAPs). RN 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.

Coordination and Oversight Continued Factors to be considered Acuity of the student Stability of the condition of the student Training and capability of the UAP nature of the tasks Setting in which care is to be delivered

Coordination and Oversight Continued Identify the needs of the students Identify the task Provide directions Determine the ability of the UAP to perform the task Monitor reporting and documentation UAP assigned to that nurse’s student reports directly o the nurse for the performance of nursing tasks Evaluate performance of the task and student outcome, and initiate corrective action when necessary

Delegation vs Coordination & Oversight Delegation Authority granted from Nurse Practice Act Responsible for action/inaction of staff Accountable for student outcome Only an RN can delegate An RN can only delegate to LPN, CNA/CNA-M, student nurse, and graduate nurse awaiting first NCLEX exam Coordination and Oversight Authority granted from Nurse Practice Act Accountability of unlicensed staff rests with someone else RN responsible for student safety Only an RN can coordinate and oversee Coordination and oversight is utilized in many settings where UAPs work.

School Nurse Position Statement  Board of Nursing updated this position statement  Content:

Accountability & Liability Accountability is the obligation and duty to perform in a manner that meets minimum standards of practice. Liability is a term in law to mean a person’s financial responsibility for such things as malpractice.

“The right thing to do and the hard thing to do are usually the same.” ― Steve Maraboli, Life, the Truth, and Being FreeSteve MaraboliLife, the Truth, and Being Free

Case Study # 1  Medically complex HS student with hx of seizure activity with multiple grand mal seizures occurring on a regular basis  Complex medication regimen including rectal and nasal medications  Multiple supports in place  School nurse is full-time in the building

What are the steps to take?  Considerations Health history Team? Care plan?  Contents? Training?  If yes, who?

Case Study # 2  Kindergarten student (age 6) with hx of febrile seizures. No known seizure activity since age 3. Parent notices “staring spells”. Consults specialist and Diastat is ordered.  Parent comes to school with medication insisting everyone be trained to give Diastat to her child.  School nurse is part-time

What are the steps to take?  Considerations Enough health history?  What is missing? Care plan?  Contents? Training?  If yes, who?

Wrap - Up  Issues?  Concerns?  Related topics?

School Nurse Role  Thank you!