1. Nursing Care on Out of State Field Trips Revisiting the Discussion on Individual State Guidance and Developments Ann Nichols, NC

2. Student Health Care Needs OUT-OF-STATE FIELD TRIPS NC School Health Nurse Consultants March 2014

3. Field trips, including out-of-state, are offered by schools to supplement the educational experience of students. School nurses are essential in the decision making process when determining the level of health care that must be provided in any extracurricular activity or field trip. Early planning for students with health care needs is important to ensure that students are not excluded from an activity and that they can participate safely.

4. Complicated National Issue Number of children attending school with special healthcare needs & complex medical conditions continue to increase (26.6%) (Van Cleave, Gortmaker, & Perrin, 2010) Federal laws protect all students’ rights to participate in field trips (Section 504 of the Rehabilitation Act 1973, Title II of the American Disabilities Act of 1990, IDEIA reauthorization in 2004) Delegation laws vary greatly by state (how care is given by non-nurse school staff) Confusion exists regarding nursing practice in ‘compact states’ Off-site delegation supervision is done in NC schools; not a component of the general delegation process in most states

5. School nurses are responsible for knowing & explaining scope of nursing practice First: Does the destination state allow nurses from another state to practice “temporarily”? Second: Does the destination state allow nurses from another state to delegate care in their state, without being physically present (off-site)? If yes, what can be delegated? May differ from home state.

6. Nursing Licensure Compact States (NLC) Allows nurses from NLC states to practice in another NLSC state with NC license while adhering to the guest state’s requirements Similar to use of a driver’s license Applies to RNs and LPNs Does not apply to unlicensed personnel or Advanced Practice RNs (APRN)

8. Advocacy from NASN NASN’s reported discussions with the National Council of State Boards of Nursing (NCSBN) concluded that school nurses need to contact each board of nursing prior to a field trip to request permission to practice nursing temporarily in that state. The growing number of school nurses contacting boards of nursing across the nation may encourage NCSBN to work on national recommendations. The desired outcome would be for each state to allow nursing care of students on out-of-state field trips to be completed in the same manner in which that care is managed in the state of origin.

9. Guidance Create a system for early notification of all out-of-state field trips (beginning of the year) Involve administration in planning process Discuss at early faculty meetings Brainstorm avenues to remove the need for nursing care and/or delegation of medications and/or procedures on trips, as possible. Some examples include… Can students self-carry asthma and severe allergy medication, and self-administer, if appropriate? Can the parent of a student attend field trip, possibly incentivized by offering to pay the parent cost (parents can be asked but not required)? Train staff that will be attending field trips in basic CPR and First Aid.

10. Guidance Contact the Board(s) of Nursing for states to which students with health care needs will travel, asking the questions as seen on slides 4 and 5. Based upon the response of the state board(s), create a plan for meeting the health needs of those students. Some examples include… School nurse may be asked to attend. Contract with an agency registered nurse to attend. Contract with a parent registered nurse to attend. Again, a willing parent may choose to attend and be responsible for the care.

11. Resources Modified from Current Issues in School Nursing – 2013, Cindy Galemore MSEd, BSN, RN, NCSN Erwin K, Clark S, Mercer SE. Providing Health Services for Children with Special Health Care Needs on Out-of-State Field Trips. NASN School Nurse. March 2014, 85-88 Schwab, N. & Gelfman, M. (Eds.) (2001). Legal issues in school health services: A resource for school administration, school attorneys, and school nurses. (pp. 222-225 and 502) North Branch, MN: Sunrise River Press. National Association of School Nurses, Issue Brief, School Sponsored Trips, Role of the School Nurse (2013). Selekman, Janice (2013) School Nursing: A Comprehensive Text. FA Davis Company, Philadelphia, (Copyright 2013 by NASN) http://education.ky.gov/districts/SHS/Pages/Field-Trips-and-Medication- Administration.aspx (Current information should be verified) Providing Health Services for Children With Special Health Care Needs on Out-of-State Field Trips, March 2014 NASN School NurseProviding Health Services for Children With Special Health Care Needs on Out-of-State Field Trips