Delegation
High School Nurse to student ratios and
School Nurses working more than one
building create environment where indirect
supervision and delegation become
necessary
Delegation
Five steps of delegation (NCSBN):
1. Assess the situation
2. Plan for the activity
3. Assure appropriate account ability
4. Supervise performance of activity
5. Evaluate entire delegation process
Giving permission for a qualified non-nurse to
complete a specific task in a specific situation
Delegation
• ANA: “…the use of UAP personnel to perform
delegated nursing tasks in the school setting is
appropriate only if the SN is in control of the
decision to delegate a health care task…”
• NCSBN: “Boards of Nursing should articulate
clear principles for delegation augmented by
clearly defined guidelines for delegation
decisions” and “UAP are equipped to assist –
not replace – the nurse”
Nurse Practice Act
• It shall be the responsibility of the Registered
Professional Nurse to determine which
nursing procedures unlicensed direct care staff
will be allowed to perform, and which
unlicensed staff will be allowed to perform
them. The RPN shall exercise professional
judgement as to when delegation is unsafe.
Nurse Practice Act
• Professional misconduct, such as the
unauthorized practice of nursing, or
authorizing unqualified unlicensed individuals
to perform nursing tasks, are a Class E felony
• Subject to penalties that range from
reprimand, to revocation of license, and/or
fines up to $10,000
• Health Assessment, Insulin Administration in
question
The Individuals with Disabilities
Education Act (IDEA) - 1975
• Requires states to provide special education
services at public expense
• If deemed eligible for special ed, shall receive
related services, as appropriate; includes
assistive technology, medical services for
evaluation purposes, school health services,…
• School health services = “provided by a
qualified school nurse or other qualified
person”
Section 504: Rehabilitation Act
1973
• Prohibits schools that receive any federal
funding to discriminate against students who
qualify as ‘handicapped’ – must provide
access to all programs, prohibits exclusion
• Diabetic students are eligible for
accommodations under 504 because diabetes
significantly impacts body functioning and
affects school performance (‘other health
impaired’)
Americans with Disabilities Act
1990
• Reaffirms the civil rights of individuals with
disabilities and extends their right of access to
the ‘full range of services provided by both the
public and private sectors’
• Extended Section 504 to apply to daycares,
nurseries, elementary & secondary schools,
colleges – regardless of whether they receive
federal funding or not
A4987 / S4473
• “…trained diabetes care personnel…may perform
diabetes care functions including, but not limited to:
checking and recording blood glucose levels and
ketone levels, or assisting a pupil with such checking
and recording such levels, responding to blood glucose
levels that are outside the pupils’ target range;
administering glucagon and other emergency
treatments, as prescribed; administering insulin or
assisting a pupil in administering insulin through the
insulin delivery system the student uses; providing oral
diabetes medications; & following instructions
regarding meals, snacks, and physical activity”
A4987/S4473
• “A licensed health care professional, school
personnel or…school shall be protected from
liability for civil damages…when providing the
activities described by this section”
Lack of State Board of Nursing clarification or
guidance memo specifying parameter for DM
task delegation
How bills change DM care at school
• Transfers elements of nursing supervision and
assessment, in addition to the administration
of insulin, to a non-nurse school employee
• The professional with the full training,
knowledge and appropriate licensure would
no longer be primary contact regarding
diabetic care
Ramifications of the bills for school
staff
• Principals, administrators & parents will likely influence
some staff delegations – Since nurses are supposed to
determine appropriate delegation, this could be
practicing nursing without a license
• Teachers realize delegated health care tasks are outside
of their license parameters – they are at risk for
professional misconduct, liability – have the right to
refuse to take responsibility for these tasks
• Nurses risk license revoke and fines if delegation is not
clarified by BON
SAFETY
• Original reason for the Nurse Practice Act – to
protect the public and ensure patient safety
Questions regarding laws, guidelines & procedures:
New York Statewide School Health Services Center
www.schoolhealthservicesny.com
585-247-7667
Helpful Links
• Americans with Disabilities Act
http://www2.ed.gov/about/offices/list/ocr/do
cs/hq9805.html
• Understanding the Differences Between IDEA
and Section 504
http://www.ldonline.org/article/6086
• National Council of State Boards of Nursing
http://www.ncsbn.org/index.htm
links
• American Nurses Association: “Registered
Professional Nurses & Unlicensed Assistive
Personnel”
http://www.nasn.org/PolicyAdvocacy/PositionPa
persandReports/NASNPositionStatementsFullVie
wtabid/462/ArticleId/116/Unlicensed-AssistivePersonnel-The-Role-of-the-School-Nurse-Revised2011
• National Association of School Nurses
www.nasn.org
links
• Nursing Guide to Practice
www.op.nysed.gov/prof/nurse/nurse-guideApril09.pdf
• ANA Joint Statement on Delegation
www.ncsbn.org/Delegation_joint_statement_NC
SBN-ANA.pdf
• New York Statewide School Health Services
www.schoolhealthservicesny.com
• Legal Issues in School Health Services, Schwab &
Gelfman, 2001