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The Illinois Nurse Practice Act: Implications for School Nurse Delegation

Robin Adair Shannon, DNP, RN, PEL‐CSN, NCSN, PHNA‐BC

University of Illinois at Chicago College of Nursing

Conflict of Interest Statement 

• I have no financial or personal conflicts of interest to disclose. 

Disclaimer:

IANALObjectives• Define delegation and key related terms.

• Identify the position of NASN on delegation and how it is supported by the Framework for 21st Century Nursing Practice and School Nursing Standards of Practice.  

• State the stipulations of the Illinois Nurse Practice Act related to delegation and other applicable state laws. 

• Describe the principals of nursing delegation applied to school nursing practice.  

• Outline decision making processes regarding what nursing tasks can and cannot be delegated. 

FAPE: Our Obligation 

• Section 504 of the Rehabilitation Act of 1973• Individuals with Disabilities in Education Improvement Act (2004)

• Student rights = Civil Rights

National Council of State Boards of Nursing & ANA National Guidelines on Nursing Delegation 

“Delegation is an essential nursing skill”. 

“When certain nursing care needs to be delegated, it is imperative that the delegation process and the jurisdiction NPA be clearly understood so that it is safely, ethically and effectively carried out”. 

(NCSBN & ANA, 2019, p. 1)

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It is the position of the National Association of School Nurses (NASN) that, when necessary and permitted by law, the registered professional school nurse…can implement safe and effective delegation of nursing tasks to unlicensed assistive personnel (UAP) at school. Delegation is an important practice component of the Care Coordination principle within NASN’s Framework for 21st Century School Nursing Practice (NASN, 2016, p. 1).

Definitions

•Delegation (school nurse): The assignment of the performance of a nursing activity to a non‐nurse. The school nurse, who, after assessment of the individuals’ capabilities, makes a prudent decision regarding the advisability of delegation (ANA & NASN, 2019, p. 88). 

Definitions

• Accountability: to be answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard…. (ANA, 2015, p. 41). 

• Delegated responsibility:  A nursing activity, skill or procedure that is transferred from  a licensed nurse to a delegatee (NCSBN & ANA, 2019, p. 2).  

• Assignment: The routine care, activities and procedures that are within the authorized scope of practice of the RN … or part of the routine functions of the assistive personnel (AP = UAP) (NCSBN & ANA, 2019). 

Laws, Regulations, Rules, & Guidance 

• Federal laws referee the Illinois State Board of Education (ISBE) v. Illinois Board of Nursing 

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ISBE Administrative Code. Section 226.800 Personal Guidancek) Personnel Not Holding Educator LicensureNothing in this subsection (k) authorizes individual student aides or others who do not hold an appropriate professional license to perform any nursing activity, as nursing activity may be defined in the Nurse Practice Act [225 ILCS 65] and rules governing that Act (68 Ill. Adm. Code 1300), including any procedures and duties requiring a medical order (e.g., tube feedings, catheterizations, administration of medications, tracheal suctioning, tube insertions, blood draws, dressing changes), except as may be otherwise authorized under State law.

(Source: Amended at 40 Ill. Reg. 2220, effective January 13, 2016)

http://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID=1312&ChapterID=24

(225 ILCS 65/50-5) (was 225 ILCS 65/5-5)(Section scheduled to be repealed on January 1, 2028)Sec. 50-5. Legislative purpose.

The practice of professional and practical nursing in the State of Illinois is hereby declared to affect the public health, safety, and welfare and to be subject to regulation and control in the public interest. It is further declared to be a matter of public interest and concern that the practice of nursing, as defined in this Act, merit and receive the confidence of the public and that only qualified persons be authorized to so practice in the State of Illinois. This Act shall be liberally construed to best carry out these subjects and purposes.(Source: P.A. 95-639, eff. 10-5-07.)

"Registered professional nursing practice"means a scientific process founded on aprofessional body of knowledge thatincludes, but is not limited to, theprotection, promotion, and optimization ofhealth and abilities, prevention of illnessand injury, development and implementationof the nursing plan of care, facilitationof nursing interventions to alleviatesuffering, care coordination, and advocacyin the care of individuals, families,groups, communities, and populations.

No person shall practice or offer to practice advanced, professional, or practical nursing in Illinois or use any title, sign, card or device to indicate that such a person is practicing professional or practical nursing unless such person has been licensed under the provisions of this Act.

(225 ILCS 65/50-75)(Section scheduled to be repealed on

January 1, 2028)Sec. 50-75. Nursing delegation by a

registered professional nurse.

(a) For the purposes of this Section:"Delegation" means transferring to a

specific individual the authority to perform a specific nursing intervention in a specific situation.

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"Stability" means a registered professional nurse or advanced practice registered nurse has determined that the individual's clinical status and nursing care needs are consistent.

"Predictability of outcomes" means that a registered professional nurse or advanced practice registered nurse has determined that the patient's or individual's clinical status is stable and expected to improve or the patient's or individual's deteriorating condition is expected to follow a known or expected course.

(b) This Section authorizes a registered professional nurse or advanced practice registered nurse to:

(1) delegate nursing interventions to other registered professional nurses, licensed practical nurses, and other unlicensed personnel based on the comprehensive nursing assessment that includes, but is not limited to:

(A)the stability and condition of the patient;(B) the potential for harm;(C) the complexity of the nursing intervention to be delegated;(D) the predictability of outcomes; and(E) competency of the individual to whom the nursing intervention is delegated;

(b) This Section authorizes a registered professional nurse or advanced practice registered nurse to:

(3) in community-based or in-home care settings, delegate the administration of medication (limited to oral or subcutaneous dosage and topical or transdermal application) to unlicensed personnel, if all the conditions for delegation set forth in this Section are met;

(b) This Section authorizes a registered professional nurse or advanced practice registered nurse to:

(4) refuse to delegate, stop, or rescind a previously authorized delegation; or

(5) in community-based or in-home care settings, delegate, guide, and evaluate the implementation of nursing interventions as a component of patient care coordination after completion of the comprehensive patient assessment based on analysis of the comprehensive nursing assessment data; care coordination in in-home care and school settings may occur in person, by telecommunication, or by electronic communication.

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(c) This Section prohibits the following:(1) An individual or entity from

mandating that a registered professional nurse delegate nursing interventions if the registered professional nurse determines it is inappropriate to do so. Nurses shall not be subject to disciplinary or any other adverse action for refusing to delegate a nursing intervention based on patient safety.

(c) This Section prohibits the following:

3) A registered professional nurse from delegating nursing judgment, the comprehensive patient assessment, the development of a plan of care, and the evaluation of care to licensed or unlicensed personnel.

(c) This Section prohibits the following:

4) A licensed practical nurse or unlicensed personnel who has been delegated a nursing intervention from re-delegating a nursing intervention. (Source: P.A. 100-513, eff. 1-1-18.)

(b) This Section authorizes a registered professional nurse or advanced practice registered nurse to:

(3) in community-based or in-home care settings, delegate the administration of medication (limited to oral or subcutaneous dosage and topical or transdermal application) to unlicensed personnel, if all the conditions for delegation set forth in this Section are met;

Delegation: Care of Students with Diabetes Act

http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=3284&ChapterID=17

The IL NPA specifically omits inhalation, IM, or intranasal as medication routes that can be delegated.

What about???

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Public Act 099-0843

• 105 ILCS 5/22-30 Self administration and self-carry of asthma medication and epinephrine auto-injectors; administration of an opioid antagonist; asthma episode emergency response protocol )

http://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=099‐0843&GA=99

www.isbe.net/Pages/School‐Health‐Issues.aspx

What about rescue meds for seizures? 

• Illinois Seizure Smart School Act (7/1/2020)• Similar to the Diabetic Care Aide Act

http://www.ilga.gov/legislation/BillStatus.asp?DocNum=1475&GAID=15&DocTypeID=HB&LegId=115899&SessionID=108&GA=101

So How Do I Delegate “Safely”? 

Follow the Principles of Delegation to reduce risks!  

National Council of State Boards of Nursing & American Nurses Association. (2019). National guidelines for nursing delegation. 

https://www.ncsbn.org/NGND‐PosPaper_06.pdf

(NCSBN & ANA, 2019) 

Employer/Nurse Leader Responsibilities

• Employer: Identify a nurse leader responsible for oversight of delegated responsibilities for the facility. 

•Nurse leader: Determine which nursing responsibilities may be delegated, to whom and under what circumstances.

•Delegatees: Demonstrate knowledge and competency on how to perform a delegated responsibility. 

(NCSBN & ANA 2019)

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Employer/Nurse Leader Responsibilities

• Employer & Nurse Leader: • Develop policies and procedures for delegation. • Communicate information about delegation to both RNs and UAP and educate them about what responsibilities can be delegated.  

• Periodically evaluate the delegation process.• Promote a positive culture and work environment for delegation.

(NCSBN & ANA 2019)

Licensed Nurse Responsibilities 

1. Determine when and what to delegate based on the practice setting, the patients’ needs and condition, the state/jurisdiction’s provisions for delegation, and the employer policies and procedures regarding delegating a specific responsibility.

2. Communicate with the delegatee who will be assisting in  providing patient care.

(NCSBN & ANA 2019)

Licensed Nurse Responsibilities 

3.  Be available to the delegatee for guidance and questions, including assisting with the delegated responsibility, if necessary, or performing it him/herself if the patient’s condition or other circumstances warrant doing so.

4. Follow up with the delegatee and the patient after the delegated responsibility has been completed.

5. Provide feedback information about the delegation process and any issues regarding delegatee competence level to the nurse leader. 

(NCSBN & ANA 2019)

Delegatee Responsibilities

1. Accept only the delegated responsibilities that he or she is appropriately trained and educated to perform and feels comfortable doing given the specific circumstances in the health care setting and patient’s condition. 

2. Maintain competency for the delegated responsibility.

Delegatee Responsibilities

3. Communicate with the licensed nurse in charge of the patient.

4. Be accountable for carrying out the delegated responsibility correctly and completing timely and accurate documentation per facility policy. 

5 Rights of Delegation 

•Right task•Right circumstance

•Right person •Right directions and communication

•Right supervision and evaluation 

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ANA’s Principles for Delegation by Registered Nurses to Unlicensed Assistive Personnel.  https://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principlesofdelegation.pdf

Health AND Educational Plans

• Individualized Healthcare Plans• Emergency Action Plans

• 504 Plans  or 

• Individual Education Programs • Nursing goals and objectives• Nursing service minutes  

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Procedure Skills Checklists Reduce the Risks of Delegation • Demonstrate accountability and competence of both RNs, LPNs, & UAPs

• Promote standardized approach to the unique student needs

• Step‐by‐step instructions for easy reference

• Document training of UAP by SN

• Document achieved competence of UAP (return demonstration)

• Provide a schedule to monitor, evaluate, reinforce, and remediate skills

(Shannon & Kubelka, 2015)

ReferencesAmerican Nurses Association. (2012). ANA’s principles for delegation. Retrieved from file:///Z:/IASN/IASN%20conf%202019/ANAprinciplesofdelegation%202012.pdf

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursebooks.org.

American Nurses Association & National Association of School Nurses. (2017). Definition: Delegation. In School nursing: Scope and standards of practice (3rd ed). (p. 88). Silver Springs, MD: ANA & NASN. 

Combe, L., & Clark, Y. (2019). Management of school health staff. . In J. Selekman, R. A. Shannon, & C. F. Yonkaitis (Eds.), School nursing: A comprehensive text (3rd ed.) (pp. 936‐957). Philadelphia, PA: F. A. Davis Company.  

Individuals with Disabilities Education Improvement Act of 2004, 20 U.S. C. § 1400 (2004). Retrieved from http://idea.ed.gov/download/statute.html

Illinois General Assembly. 2016. Public Act 099‐0843. Amendment to Illinois School Code (105 ILSC 5/22‐30). Retrieved from http://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=099‐0843&GA=99

Illinois Joint Committee on Administrative Rules. (2016). Administrative Code, Part 226: Special education. Retrieved from http://www.ilga.gov/commission/jcar/admincode/023/023002260I08000R.html

ReferencesIllinois Nurse Practice Act. (2018). Retrieved from http://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID=1312&ChapterID=24

National Association of School Nurses. (2015). Framework for 21st century school nursing practice. Retrieved from https://www.nasn.org/nasn/nasn‐resources/professional‐topics/framework

National Association of School Nurses. (2019). Nursing delegation in the school setting. Retrieved from https://www.nasn.org/nasn/advocacy/professional‐practice‐documents/position‐statements/ps‐delegation

National Council of State Boards of Nursing & American Nurses Association. (2019). National guidelines for nursing delegation. Retrieved from https://www.ncsbn.org/NGND‐PosPaper_06.pdf

Shannon, R. A., & Kubelka, S. (2013). Reducing the risks of delegation: Use of procedure skills checklists for unlicensed assistive personnel in schools, Part 2. NASN School Nurse, 28(5), 222‐226. doi:10.1177/1942602X13490030 

Shannon, R. A., & Kubelka, S. (2013). Reducing the risks of delegation: Use of procedure skills checklists for unlicensed assistive personnel in schools, Part 1. NASN School Nurse, 28(4), 178‐181. doi:10.1177/1942602X13489886

Vocational Rehabilitation Act of 1973 (Pub. L. 93‐112). Retrieved from https://www.gpo.gov/fdsys/pkg/STATUTE‐107/pdf/STATUTE‐107‐Pg718.pdf

Thank You for all You Do for the Kids!

Questions/Comments? 

Robin Adair Shannon

University of Illinois at Chicago College of Nursing

rshann2@uic.edu

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