Delegation of Nursing Care in the School Setting

History: The passage of PL 94-142 in 1975 as well as the Individuals with Disabilities Act (IDEA) of 1990, Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act have contributed to removing barriers that have hindered students' access to education. These laws, which protect the rights of handicapped persons, provide an education within the least restrictive environment for all students, regardless of physical and mental disabilities. They obligate local districts to provide related services, such as health services, to those not eligible for special education, including those who previously may not have been able to attend public school due to special health care needs. Therefore, the role of the Certified School Nurse has expanded, becoming more complex, as tertiary prevention is incorporated into the comprehensive health services presently being provided for students in public schools.

Rationale: It is the legal responsibility of the local school boards and school administrators to provide for the health and safety of all students in the school setting. This includes the provision of necessary, related health care services by qualified staff. Although school administrators have the legal authority, according to educational law, to decide which staff will perform certain tasks in the school setting, legally they cannot be responsible for deciding the level of care required by an individual student with special health care needs. The person providing that care must be chosen by following the statutory and regulatory authority of the New Jersey Nurse Practice Act by which all Certified School Nurses are licensed. Therefore, it is the Certified School Nurse who must determine the qualifications of unlicensed assistive personnel and the level of care to be provided by them based on her/his independent assessment of the student. This decision is not made by parents, physicians or community providers (NASN, 1995). In a statement adopted by the New Jersey Board of Nursing regarding P.L. 1997, c.368, it is made clear that a "school administrator who designates or attempts to compel a nurse to designate a particular employee, in violation of the principles set for the N.J.A.C. 13:37-6.2...may be subject to charges of practicing nursing without a license," and therefore "institutional policies cannot contradict state law" (American Nurses Association, 1994, p. 11).

Based on the New Jersey Nurse Practice Act, the Certified School Nurse, a registered professional nurse, determines whether care should be provided by a licensed nurse or delegated to trained and properly supervised unlicensed assistive personnel. She/he "... must use nursing assessment and professional judgment in deciding which procedures in the school setting may be delegated. In determining when to delegate nursing practice, a case management plan and/or an Individualized Health Care Plan needs to be developed" (NASN Position Statement on Delegation).

Conclusion: It is the position of the New Jersey State School Nurses Association that delegation of selected nursing tasks may be necessary and appropriate in some instances. The Certified School Nurse appropriately delegates those tasks following the New Jersey Board of Nursing Action Plan for RN delegation as outlined in N.J.A.C. 13:37-6.2 and nationally accepted standards of professional school nursing practice, in order to safely and adequately meet the needs of students requiring specialized health care in the school setting,

Committee: M. Avallone, S. Cohen, M. Leavy, C. McGotty, C. Paladino, and M. Suessman

May 16, 2000

References:

· American Nurses Association (1994). Registered professional nurses and unlicensed assistive personnel. Washington, D.C.: American Nurses Publishing.

· National Association of School Health Consultants (1995). Position Paper on delegation of school health services to unlicensed assistive personnel. Journal of School Nursing. (December 1995) 11 (4) l, 13-16.

· N.J.A.C. 13:37-6.2.

· N.J.A.C. 18A: 40-12.5 and 12.6.

· New Jersey Department of Law and Public Safety, Board of Nursing: (no date). Position statement on use of unlicensed, assistive personnel by registered nurses. Newark, NJ: Author.

· New Jersey Department of Law and Public Safety, Board of Nursing: (July 20, 1990). Decision making model algorithm, guideline for: Determining scope of nursing practice and making delegation decisions. Newark, NJ: Author.

· New Jersey Department of Law & Public Safety (1979). State of New Jersey Nursing Practice Act. Trenton. PL 1947, c.262 as amended. C. 45 S 11-23.

· P.L. 1997, c.368.

· Panetti, MJ & Schwab, N. (1996) Delegation and supervision in school settings-. Part II. Journal of School Nursing (April 1996) 12 (2) 19-26.

· Schwab, N. & Haas, M. (1995). Delegation and supervision in school settings-.Part I. Journal of School Nursing (February 1995) 11 (1) 26-34.