The
Division of Elementary and Secondary Education (DESE) and the Arkansas State
Board of Nursing (ASBN) work in partnership to assist school administrators in
meeting the State’s school nursing requirements. The School Nurse Roles
and Responsibilities: Practice Guidelines are derived from the Arkansas Nurse Practice Act
(NPA) A.C.A §17-87-102 and administered by the Arkansas State Board of
Nursing. The NPA is legislatively created for the public, to safeguard life and
health of Arkansans.
On September 9, 2021, the ASBN released updated School Nurse Roles and Responsibilities:
Practice Guidelines. The attached document defines the scopes of practice
of the Advanced Practice Registered Nurse (APRN), Registered Nurse (RN),
Licensed Practical Nurse (LPN), and Licensed Psychiatric Technician Nurse
(LPTN) when practicing in the school setting.
The
Guidelines require each nurse employed in a school setting to work within the
scope of practice for the license held. The scopes of practice are
defined in Ark. Code Ann. § 17-87-102. Certain school nursing duties may
only be performed by an APRN or RN, such as developing individualized
healthcare plans. Ark. Code Ann. § 6-18-701(f)(1) states “A public school
student with special healthcare needs, including without limitation a student
who has a chronic illness, is considered medically fragile, or who is dependent
on technology, shall have an individualized healthcare plan that is developed
in collaboration with the school nurse.” Ark. Code Ann. § 6-18-701(f)(2)
states “An invasive medical procedure required by the public school student and
provided at the public school shall be performed by trained and licensed healthcare provider who is licensed to perform the task under § 17-87-102
(10)(D) or other professional licensure statutes…." Other examples
of duties, which can only be performed by an APRN or RN, are listed in the ASBN
Guidelines.
Therefore,
according to the School Nurse Guidelines and Arkansas law, an RN or APRN in the
school setting is required to provide direct care and to perform the tasks and duties
which require assessment, diagnosis and health care planning. Directing
care does not require the RN or APRN to be physically present 100% of the time.
However, according to the ASBN, the RN or APRN must be able to critically
watch and direct the LPN’s, LPTN’s and/or unlicensed assistive personnel’s
(UAP) activities or courses of action. The RN or APRN must be available
as needed by the LPN, LPTN or UAP. The amount of direction required is
directly related to the individual LPN’s, LPTN’s or UAP’s experience, skills
and abilities and the healthcare needs of the students being served.
The
School Nurse Guidelines define the criteria for delegation, and the nursing
tasks that may be assigned or delegated to the LPN, LPTN, and UAP, on pages
22-25. The school nurse is held accountable, both professionally and
legally, for practicing within this scope of practice and for appropriate
delegation.
Key
updates for district personnel:
- Delegation of nasal glucagon administration - The ASBN has added existing policy language regarding nasal glucagon administration as an allowable task delegated for emergency use for diabetics. The training requirements for glucagon and insulin administration for emergency use has not changed. For more details regarding training for task delegation, reference the ASBN - Insulin & Glucagon Administration Training Programs-Arkansas Department of Health. (Guidelines, Pg. 24)
- Delegation of oral-controlled substance prescription – The ASBN has added existing policy language regarding oral-controlled substance prescription to allow a parent or guardian to delegate to a designated, trained school volunteer to administer an oral-controlled substance prescription in the unavailability of the school nurse. The following statement was added to the nursing task delegation chart, “a parent or guardian to delegate to the designated trained school volunteer to administer in the unavailability of the school nurse”. (Guidelines, Pg. 23)
- Delegation of nasal-controlled substances (prefilled single use vial only) – The ASBN has added existing policy language regarding nasal-controlled substance prescription (prefilled single use vial only) to allow a parent or guardian to delegate to a designated, trained school volunteer to administer a nasal-controlled substance prescription in the unavailability of the school nurse. The following statement was added to the nurse task delegation chart, “a parent or guardian to delegate to the designated trained school volunteer to administer in the unavailability of the school nurse”. (Guidelines, Pg. 24)
- UAP Minimum Qualifications - The ASBN has modified the minimum qualifications to REQUIRE (previously stated as recommended) the UAP who provides nursing care to students to hold the following minimum qualifications prior to providing care (Guidelines, Pg. 12):
- High school diploma or the equivalent.
- Demonstrate proficiency reading, writing, and basic math skills.
- Current certification in Cardiopulmonary Resuscitation (CPR) with Automated External Defibrillator (AED) and First Aid.
- Successfully completed training and competency validation in performing nursing tasks to be delegated by a nurse.
- Physical examination and immunization requirements – The ASBN has added references regarding physical examination and immunization requirements for public and private school students, for student health record maintenance purposes. (Guidelines, Pg. 30)
Questions
or comments concerning the school nurse scope of practice and delegation may be
directed to Cheria McDonald, BSN, RN, NCSN at cheria.mcdonald@ade.arkansas.gov or 501-683-3586.