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DELEGATION
GUIDELINES FOR
SCHOOL NURSES
October 2015
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
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 with
Chronic Health
Conditions
Discussing Health
Issues with Parents
706
529
337
Top Three Roles of School Nurses
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
Other School Nurse Roles
STUDENT DATA
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 2012-
2013 School Year
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
Chronic Diseases
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
Chronic Disease Management
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 Budgets
• 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
Need for Guidance
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 4 - References
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
Statutory requirements for students with diabetes
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
Withdrawing delegation
Section 3: Delegation Tools
Delegation Decision Tree
◦ 14 Prerequisites for Delegation
Delegation Task Table
Skills Checklist for Staff Training
Medication Administration Checklist
Training Verification Form for School Personnel to
Administer Medication
Section 3: Delegation Tools
Section 3: Delegation Tools
Section 3: Delegation Tools
Section 3: Delegation Tools
Next Steps
Organizational Endorsements
Document will be distributed to all
stakeholders in the school healthcare
setting
Thank You
Do You Have Any
Questions?
Conclusion
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