School Nurse Practice and Delegation, Coordination and Oversight

Presenters:Virginia deLorimier, RN Maine Board

of NursingNancy 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 healthsetting

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

oIn order for the RN to delegate to a CNA the individual must be employed as a CNA

CERTIFIED NURSING ASSISTANTS-MEDICATIONS (CNA-M)

oExperienced CNAs (take course after employment as a CNA for at least one year full time) oAdminister selected non-injectable medications to patients who are 4 years of age and older. oThis complex nursing task shall be performed under the direct on-site supervision of a licensed nurse.oCNA-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 CircumstancesRight PersonRight Directions/CommunicationRight Supervision

Resources for Effective Delegation

32 M.R.S.A., CHAPTER 31 THE LAW REGULATING THE PRACTICE OF NURSING

http://www.maine.gov/boardofnursing/Administrative/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 –

http://www.maine.gov/boardofnursing/Administrative/Rules/Chapter%205.pdf

Resources Continued

NCSBN Guidelines For DelegationCNA CurriculumCNA-M CurriculumNCSBN Delegation GuidelinesArticles in the Board Bulletin posted

on the website: www.maine.gov/boardofnursing

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 studentStability of the condition of the

student Training and capability of the UAP nature of the tasksSetting 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 delegateAn 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 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!