Transcript Arkansas State Board of Nursing

Arkansas State Board of Nursing
School Health Services
and the Law
July 2007
School Health & the Law
• Arkansas and Federal laws
require schools provide free
education to Children with
Disabilities (in the least
restrictive environment)
vs
• Arkansas Nurse Practice
Act and ASBN Rules
regulate the practice
nursing
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
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”
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.
School Health & the Law
.
Education Laws
A.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”
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.
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)
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
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
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.
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.
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.)
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
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.
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.
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
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
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.
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.
• 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.
School Nurse Guidelines
•
•
•
•
•
•
•
•
Melanie Allen – Vilonia
Valerie Beshears – Ft. Smith
Margo Bushmiaer – Little Rock
Sandra Campbell–No Little Rock
Lisa Drake – Forrest City
Kathey Haynie – Bryant
Sandra Kinsey – England
Paula Smith – State School Nurse
Consultant
• Cassandra Harvey – Board
• Lori Eakin - Board
School Nurse Guidelines
• Issues identified
– Medication Administration
• Glucogon, Insulin, Diastat,
Versed, EpiPen
–
–
–
–
Clarify Healthcare Parapro
Training – who develops
Define supervision
Clarify LPN scope of practice
& supervision required
– Clarify Private Duty Nurse
accountability on campus
School Nurse Guidelines
• Changes agreed upon
– Delegation Chart – Change the
column heading “Student” to
“SELF”
– Emphasize Nurse has final say in
appropriate delegation regardless
of task on chart as a delegated
task
– Emphasize working within
Licensure Scope of Practice
– Develop guidelines for disposal
of unused meds/controlled
substances.
– Develop guidelines for security of
controlled substances & Rx meds
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.
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