Royse City ISD

Registered Nurses in the School Setting

The Board of Nurse Examiners (BNE) believes that school nursing is a professional registered nursing (RN) specialty. School nursing involves the identification, prevention and intervention to remedy or modify students’ health needs. The RN has the educational preparation and critical thinking skills as well as clinical expertise which are essential to nursing in the school setting. These activities involve the comprehensive assessment of the nursing/health care needs of the student, the development of a plan of care, implementation of the plan, and evaluation of the outcomes. The provision of these services by the RN contributes directly to the students’ education and to the successful outcome of the educational process. These essential components of professional nursing practice are the responsibility of the RN in compliance with Rule 217.11(3)(A).

Vocational Nurses in the School Setting

The clinically intensive vocational nursing program curriculum prepares entry level nurses to provide direct patient care to acutely and chronically ill clients/patients in structured health settings (such as acute care and long-term care) who are experiencing conditions with predictable health outcomes. The Differentiated Entry Level Competencies (DELC) define a “structured” setting as “a geographical and/or situational environment where the policies, procedures, and protocols for provision of health care are established and in which there is recourse to assistance and support from the full scope of nursing expertise.” Thus, school settings do not qualify as “structured” healthcare settings, and LVN curriculum is not designed to provide competencies in complex independent judgment and decision-making skills.

The provision of nursing care when provided by a Licensed Vocational Nurse (LVN) in a school setting should be under the supervision of the RN. The RN, in compliance with the BNE’s Standards of Nursing Practice [Rule 217.11], assigns those aspects and activities to the LVN that are within the LVN’s educational preparation and demonstrated competency to provide. The RN monitors, coordinates, and evaluates the provision of health services necessary to meet individual student health needs essential in achieving educational objectives.

RN Delegation to Unlicensed Personnel

Due to the growing number of students entering the school system with special health care needs, the BNE recognizes that not all health-related services can be provided by a RN or LVN. Therefore, the RN may delegate tasks in the school setting in compliance with the BNE’s Delegation Rules 224 and 225. School is considered an independent living environment as defined in Rule 225; however, acute or emergency situations in the school setting may be delegated in accordance with Rule 224 as applicable. For example, emergency administration of Epi-pens, Glucagon, and Diastat may be administered by an unlicensed person under §224.6(4) in order to stabilize the child and prevent complications from delaying treatment. The decision to delegate a specific task is always at the discretion of the RN in accordance with §224.8(b)(1)(C) or §225.9(c).

Other Laws Impacting School Health Care

In a school setting, the administration of medication may be assigned to an unlicensed person by the public school official in accordance with the rules of the Texas Education Code. The RN’s obligation under §225.13 is to (1) verify the training of the unlicensed person, and (2) verify the competency of the UAP to perform the task. If the RN is unable to assure (1) and (2) have been met, the RN must (3) notify the public school official of the situation.

Summary:

Given the complexity, the current number, and the future projections of increasing numbers of children entering the school system with complex nursing and health-related needs, the BNE believes that the RN must establish a an individualized nursing care plan for each child as applicable. The RN may be assisted by LVNs and unlicensed assistive personnel in the delivery of services to ensure the delivery of safe, effective health care to the school children of Texas.

Understanding Delegation

Since school health services require the blending of two disciplines: education and health care, the terminology commonly used by one may have different meanings to the other. One term in particular is “delegate” (or its derivative “delegation”). From an administrative point of view, to delegate means to assign a task. An efficient supervisor often assigns (or delegates) administrative responsibilities to others. To a licensed health care provider to delegate means to grant legal authority for another person to perform a task which that person otherwise would not be permitted to do. The licensed person retains accountability for the outcome. Under the Texas Nurse Practice Act, a registered nurse may delegate certain tasks that are considered “nursing” services to unlicensed personnel.
FOR MEDICATION ONLY
Under TEC Section 22.052 (a), the task of administering medication may be assigned to a school employee by the principal as an administrative function.

What is the Law?

Federal law mandates that school districts provide health-related services to students with disabilities if the services are required by their Individual Education Plan (IEP).
The Texas Education Code (TEC) requires that school health services be provided by a physician, registered nurse, licensed vocational nurse or someone acting under delegated authority of a physician or registered nurse. The exception is the administration of medications and minor first aid. TEC Section 21.0003 (b) reads:
- A person may not be employed by a school district as an audiologist, occupational therapist, physical therapist, physician, nurse, school psychologist, associate school psychologist, social worker, or speech language pathologist unless that person is licensed by the state agency that licenses that profession. A person may perform specific services within those professions for a school district only if the person holds the appropriate credential from the appropriate state agency. (Emphasis added)
Licensed Vocational Nurses may not delegate to unlicensed personnel because the Vocational Nurse Act does not permit them to do so.
Nursing services may not be delegated to unlicensed personnel by a superintendent, principal, teacher, or parent. An unlicensed person who delegates is in violation of the Medical Practice Act and the Nurse Practice Act.

Important Facts

The registered school nurse (RN) or physician is responsible for deciding whether or not a specific procedure may be delegated.
Delegation cannot be forced by policy and procedure or job description.
Delegation should be both procedure-specific and student-specific.
The decision to delegate a procedure should be based on the stability of the student’s condition, the complexity of the task and the predictability of the procedure’s outcome.
(Rule 218, Board of Nurse Examiners)
The decision to delegate is made after a careful analysis of individual factors in each case.
Once the procedure has been delegated, only the individual to whom the procedure has been delegated shall perform the procedure. No subdelegation is permitted.
“Unlicensed” means someone not licensed by the state to provide health services. This could be a clerk, secretary, instructional aide, teacher, principal, or superintendent.
It is the RN’s responsibility to teach, verify competency and supervise the unlicensed person to whom the task is delegated.

Who May Provide Health Services in Schools?

Section 21.0003 (b) of the Texas Education Code (TEC) requires that school health services be provided by a licensed health care professional or someone acting under their legally delegated authority. The exception is the administration of medications and minor first aid.

References:

Texas Nurse Practice Act
Texas Education Code
Texas Medical Practice Act

Clinic Management

Campus Crisis Kit

Place in a container and have several in your building. Your teachers should be aware of where they are located and their contents. These kits are for emergencies and should be included in your drills. Please check contents periodically for complete contents and expiration dates.

1 box of gloves
1 mask for CPR
1 pkg. elastic gauze bandage (12)
1 pkg. general use sponges (50)
1 bottle of sterile water for irrigation
Ace wraps (1)
Telfa Adhesive Pad (5)
Blanket
Splint (1)
Tape (1)
Scissors (1)
Instant Ice Pack (1)
Personal Protection Kit
CPR Mask (1)
Band-Aids

First Aid

This section is coming soon!


Home Superintendent Leadership School Board Calendars About RCISD Human Resources Departments and Programs Activities Athletics Extended Day Program Weather Community Intranet Web Mail K-12 Planet Campuses	Health Services - Professional Issues Curriculum Business Operations Special Services Food Services Health Services Purchasing Technology Help Desk Policies Guidelines Communicable Diseases Professional Issues Immunization Medications Screenings Clinic Procedures Health Promotion and Education National Association of School Nurses Texas Board of Nurse Examiners Registered Nurses in the School Setting The Board of Nurse Examiners (BNE) believes that school nursing is a professional registered nursing (RN) specialty. School nursing involves the identification, prevention and intervention to remedy or modify students’ health needs. The RN has the educational preparation and critical thinking skills as well as clinical expertise which are essential to nursing in the school setting. These activities involve the comprehensive assessment of the nursing/health care needs of the student, the development of a plan of care, implementation of the plan, and evaluation of the outcomes. The provision of these services by the RN contributes directly to the students’ education and to the successful outcome of the educational process. These essential components of professional nursing practice are the responsibility of the RN in compliance with Rule 217.11(3)(A). Vocational Nurses in the School Setting The clinically intensive vocational nursing program curriculum prepares entry level nurses to provide direct patient care to acutely and chronically ill clients/patients in structured health settings (such as acute care and long-term care) who are experiencing conditions with predictable health outcomes. The Differentiated Entry Level Competencies (DELC) define a “structured” setting as “a geographical and/or situational environment where the policies, procedures, and protocols for provision of health care are established and in which there is recourse to assistance and support from the full scope of nursing expertise.” Thus, school settings do not qualify as “structured” healthcare settings, and LVN curriculum is not designed to provide competencies in complex independent judgment and decision-making skills. The provision of nursing care when provided by a Licensed Vocational Nurse (LVN) in a school setting should be under the supervision of the RN. The RN, in compliance with the BNE’s Standards of Nursing Practice [Rule 217.11], assigns those aspects and activities to the LVN that are within the LVN’s educational preparation and demonstrated competency to provide. The RN monitors, coordinates, and evaluates the provision of health services necessary to meet individual student health needs essential in achieving educational objectives. RN Delegation to Unlicensed Personnel Due to the growing number of students entering the school system with special health care needs, the BNE recognizes that not all health-related services can be provided by a RN or LVN. Therefore, the RN may delegate tasks in the school setting in compliance with the BNE’s Delegation Rules 224 and 225. School is considered an independent living environment as defined in Rule 225; however, acute or emergency situations in the school setting may be delegated in accordance with Rule 224 as applicable. For example, emergency administration of Epi-pens, Glucagon, and Diastat may be administered by an unlicensed person under §224.6(4) in order to stabilize the child and prevent complications from delaying treatment. The decision to delegate a specific task is always at the discretion of the RN in accordance with §224.8(b)(1)(C) or §225.9(c). Other Laws Impacting School Health Care In a school setting, the administration of medication may be assigned to an unlicensed person by the public school official in accordance with the rules of the Texas Education Code. The RN’s obligation under §225.13 is to (1) verify the training of the unlicensed person, and (2) verify the competency of the UAP to perform the task. If the RN is unable to assure (1) and (2) have been met, the RN must (3) notify the public school official of the situation. Summary: Given the complexity, the current number, and the future projections of increasing numbers of children entering the school system with complex nursing and health-related needs, the BNE believes that the RN must establish a an individualized nursing care plan for each child as applicable. The RN may be assisted by LVNs and unlicensed assistive personnel in the delivery of services to ensure the delivery of safe, effective health care to the school children of Texas. Understanding Delegation Since school health services require the blending of two disciplines: education and health care, the terminology commonly used by one may have different meanings to the other. One term in particular is “delegate” (or its derivative “delegation”). From an administrative point of view, to delegate means to assign a task. An efficient supervisor often assigns (or delegates) administrative responsibilities to others. To a licensed health care provider to delegate means to grant legal authority for another person to perform a task which that person otherwise would not be permitted to do. The licensed person retains accountability for the outcome. Under the Texas Nurse Practice Act, a registered nurse may delegate certain tasks that are considered “nursing” services to unlicensed personnel. FOR MEDICATION ONLY Under TEC Section 22.052 (a), the task of administering medication may be assigned to a school employee by the principal as an administrative function. What is the Law? Federal law mandates that school districts provide health-related services to students with disabilities if the services are required by their Individual Education Plan (IEP). The Texas Education Code (TEC) requires that school health services be provided by a physician, registered nurse, licensed vocational nurse or someone acting under delegated authority of a physician or registered nurse. The exception is the administration of medications and minor first aid. TEC Section 21.0003 (b) reads: A person may not be employed by a school district as an audiologist, occupational therapist, physical therapist, physician, nurse, school psychologist, associate school psychologist, social worker, or speech language pathologist unless that person is licensed by the state agency that licenses that profession. A person may perform specific services within those professions for a school district only if the person holds the appropriate credential from the appropriate state agency. (Emphasis added) Licensed Vocational Nurses may not delegate to unlicensed personnel because the Vocational Nurse Act does not permit them to do so. Nursing services may not be delegated to unlicensed personnel by a superintendent, principal, teacher, or parent. An unlicensed person who delegates is in violation of the Medical Practice Act and the Nurse Practice Act. Important Facts The registered school nurse (RN) or physician is responsible for deciding whether or not a specific procedure may be delegated. Delegation cannot be forced by policy and procedure or job description. Delegation should be both procedure-specific and student-specific. The decision to delegate a procedure should be based on the stability of the student’s condition, the complexity of the task and the predictability of the procedure’s outcome. (Rule 218, Board of Nurse Examiners) The decision to delegate is made after a careful analysis of individual factors in each case. Once the procedure has been delegated, only the individual to whom the procedure has been delegated shall perform the procedure. No subdelegation is permitted. “Unlicensed” means someone not licensed by the state to provide health services. This could be a clerk, secretary, instructional aide, teacher, principal, or superintendent. It is the RN’s responsibility to teach, verify competency and supervise the unlicensed person to whom the task is delegated. Who May Provide Health Services in Schools? Section 21.0003 (b) of the Texas Education Code (TEC) requires that school health services be provided by a licensed health care professional or someone acting under their legally delegated authority. The exception is the administration of medications and minor first aid. References: Texas Nurse Practice Act Texas Education Code Texas Medical Practice Act Clinic Management Health History (English) Health History (Espanol) Physicians Request for Specialized Care Confidential Information Notice For Release Of Confidential Information Health Folder Care Plans Clinic Referral Request for Immunizations and screening results from previous school Employee Health Form Blood Pressure Flow Sheet Substitute Teacher Emergency List Emergency Action Form Emergency Management Plan for Transportation Parent Contact Log Campus Crisis Kit Place in a container and have several in your building. Your teachers should be aware of where they are located and their contents. These kits are for emergencies and should be included in your drills. Please check contents periodically for complete contents and expiration dates. 1 box of gloves 1 mask for CPR 1 pkg. elastic gauze bandage (12) 1 pkg. general use sponges (50) 1 bottle of sterile water for irrigation Ace wraps (1) Telfa Adhesive Pad (5) Blanket Splint (1) Tape (1) Scissors (1) Instant Ice Pack (1) Personal Protection Kit CPR Mask (1) Band-Aids First Aid This section is coming soon!
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Health Services - Professional Issues