Arkansas State Board of Nursing

1. Arkansas State Board of Nursing School Health Services and the Law September 2014

2. School Health & the Law • Arkansas and Federal laws require schools provide free education to Children with Disabilities (in the least restrictive environment) • Arkansas Nurse Practice Act and ASBN Rules regulate the practice nursing

3. School Health & the Law • RN Scope of Practice • The delivery of health care services which require assessment, diagnosis, planning, intervention, and evaluation • LPN/LPTN Scope of Practice • The delivery of health care services which are performed under the direction of the professional nurse, licensed physician, or licensed dentist, including observation, intervention, and evaluation. ASBN Position Statement 95-1 & 98-6

4. School Health & the Law • Education Laws • A.C.A. 6-18-1005 Student services program defined (a)(6)(A) “Students with special health care needs, including the chronically ill, medically fragile, and technology-dependent, and students with other health impairments shall have individualized health care plans”

5. School Health & the Law • ASBN Interpretation: • The School District is responsible for providing a person qualified to develop the individual health care plan (IHP.) • The person responsible for doing the IHP must have within their scope of practice Assessment, Diagnosis, and Planning, e.g., RN, APN, or Physician. • LPN scope of practice does not include assessment, diagnosis, or planning.

6. School Health & the Law .Education LawsA.C.A. 6-18-1005 Student services program defined (a)(6)(B)(i) “Invasive medical procedures required by students and provided at the school shall be performed by trained, licensed personnel who are licensed to perform the task subject to § 17-87-102 (6)(D) or other professional licensure statutes.” (a)(6)(B)(ii) “The regular classroom teacher shall not perform these tasks; and” 

7. School Health & the Law • Nurse Practice Act • A.C.A. § 17-87-102 (6)(D) “Practice of professional [Registered] nursing means…any act involving:… (D) The delegation of certain nursing practices to other personnel as set forth in regulations established by the board:…” • ASBN Interpretation • Only Registered Nurses may provide nursing care or delegate to qualified individuals certain nurse practices as defined in the ASBN Rules & School Nurse Roles and Responsibilities Practice Guidelines.

8. School Health & the Law • ASBN Interpretation • Each Licensed Nurse must practice within the scope of practice of their license. • LPN/LPTN must work under the direction of an RN, APN, licensed physician or licensed dentist. A.C.A. §17-87-102(5)

9. School Health & the Law .Act 1204 of 2011Amends A.C.A. 17-87-103 Exceptions to the Nurse Practice Act 11 (A) The administration of Glucagon to a student who is suffering from diabetes by trained volunteer school personnel • Trained by licensed nurse employed by school • Parent/Guardian sign authorization • Volunteer/Nurse Trainer not liable for damages • Regular Classroom Teacher may volunteer to be trained & give Glucagon

10. School Health & the Law • LPN under the direction of an RN, APN, Physician may perform (School Nurse Guidelines) • N/G Feeding/Monitoring • Gastrostomy Feeding/Monitoring • TPN & Monitoring • Clean Intermittent/Sterile Cath • Ventricular Peritoneal Shunt Monitoring • Mechanical Vent Monitoring • Mechanical Vent Ambu Bag • Intermittent/Continuous O2 • Central Line Cath management

11. School Health & the Law • LPN under the direction of an RN, APN, Physician may perform (School Nurse Guidelines)(cont) • Peritoneal Dialysis • Medication Administration • Ostomy Care & Irrigation • Pharyngeal/Trach Suctioning • Screening, growth, v/s, vision hearing, scoliosis • Blood & Urine Glucose testing • Seizure Precautions • Pressure Ulcer Care • Sterile/Non-sterile dressings

12. School Health & the Law • Supervision • Merriam-Webster “a critical watching and directing (as of activities or a course of action.)” • American Nurses Association “is the active process of directing, guiding, and influencing the outcome of an individual's performance of an activity” Adopted by National Association of State School Nurse Consultants.

13. School Health & the Law • Supervision does not require the RN, APN, licensed physician or licensed dentist to physically be present 100% of the time. • The amount of supervision required is directly related to the individual LPN’s experience, skills and abilities and the healthcare needs of the students being served.

14. School Health & the Law • A.C.A. § 17-87-102 (6)(D) allows the RN to “delegate certain nursing practices to other personnel as set forth in regulations…” • ASBN Rules Chapter 5 on Delegation sets forth the regulations regarding delegation of nursing task to unlicensed assistive personnel (UAP.)

15. School Health & the Law • Criteria for Delegation to UAP • Licensed Nurse delegating is responsible for the nursing care given to the client • Assessment of client’s needs prior to delegation (IHP + update) • Task must be one a reasonable & prudent nurse would delegate • Does not require UAP to use nursing assessment, judgment, evaluation or teaching skills • Does not jeopardize client’s welfar • RN employed by facility responsible for training

16. School Health & the Law • Criteria for Delegation (cont) • Written procedures for task • UAP competency is documented • Delegating nurse is readily available in person or by telecommunication • Licensed nurse is responsible for documentation • The licensed nurse adequately supervises the performance of the nursing task.

17. School Health & the Law • Supervision • Merriam-Webster “a critical watching and directing (as of activities or a course of action.)” • American Nurses Association “is the active process of directing, guiding, and influencing the outcome of an individual's performance of an activity” Adopted by National Association of State School Nurse Consultants.

18. School Health & the Law • Supervision is determined by the licensed nurse and is dependent on: • Stability of the client’s condition • Training and capability of the UAP • Nature of the nursing task being delegated • Availability of the license nurse

19. School Health & the Law • Decisions to delegate nursing care to an unlicensed person is based upon: • Student’s nursing care needs are stable • Delegation of task does not pose a potential harm • Task involves little/no modification • Task has predictable outcome • Task does not require assessment, interpretation or decision making • UAPs skills and competency • Availability of supervision

20. School Health & the Law • Accountability vs Civil Liability • The ASBN holds the nurse accountable for appropriate delegation of nursing tasks and supervision of the UAP. • The UAP is accountable for their own actions. • May not absolve the nurse of Civil Liability.

21. School Health & the Law • Insect Sting Emergency Treatment Act • A.C.A. § 20-13-401 • Allows parent, camp counselor, scout leader, school teacher, chaperone to be trained is use of emergency epinephrine by a physician. • To administer epinephrine to an individual they are responsible for if they have an allergic reaction to an insect sting and other allergic reactions. • School Nurse Guidelines • Allows UAP to be trained and delegated the task of administering epinephrine to a student with a Rx in an emergency situation.

22. School Health & the Law • More children with more complex healthcare needs are attending school • The practice of nursing is regulated by the Nurse Practice Act and is not always understood by school administrations who are in the business of education.

23. School Health & the Law • Immediate reactions are to decrease the requirements regarding the provision of Nursing Care • An alternate solution is to increase the number of qualified licensed nurses in order to provide the quality nursing care that our children deserve

24. Complaints Received Most frequent complaints Didn’t give my child their medication Didn’t assess my child’s condition Gave my child an immunization that was not needed

25. Disciplinary Actions • Nurse Imposter • Administered wrong dose of insulin –

26. Current Issues