Transcript School Nurse Practice and Delegation

School Nurse Practice and
Delegation, Coordination and
Oversight
Presenters:
Virginia deLorimier, RN Maine Board
of Nursing
Nancy Dube, RN Maine Department
of Education
School Nursing; Delegation,
Coordination and Oversight
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Agenda
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Definitions, registered professional
nurse, practical nurse, certified nursing
assistant
5 rights of delegation
Coordination and Oversight – Chapter 6
Comparison of
Delegation/Coordination/Oversight
School Nurse Position Statement
Case Study
2102 Definitions 2. Professional
Nursing
Diagnosis (Assessment and
Care Planning)
Delegation (LPNs and CNAs)
Supervision and Teaching
Patient Teaching
Coordination and Oversight
2102 Definitions 3. Practical
Nursing
Practices under the supervision of an RN or
MD
Practices in a structured health
setting
Reinforces student and
family teaching
LPN cannot do private duty nursing if hired
independently by the family
2102 Definitions 8. Certified
nursing assistant.
"Certified nursing assistant" means
an individual whose duties are
assigned by a registered professional
nurse and who:
A. Has successfully completed a
training program or course with a
curriculum prescribed by the board,
holds a certificate of training from
that program or course and is listed
on the Maine Registry of Certified
Nursing Assistants and Direct Care
Workers
o In order for the RN to delegate to a
CNA the individual must be
employed as a CNA
CERTIFIED NURSING ASSISTANTSMEDICATIONS (CNA-M)
o Experienced CNAs (take course
after employment as a CNA for at
least one year full time)
o Administer selected non-injectable
medications to patients who are 4
years of age and older.
o This complex nursing task shall be
performed under the direct on-site
supervision of a licensed nurse.
o CNA-M’s can only be employed in
in long term care, state mental
health institutions, county jails,
state correctional facilities and
assistive living settings.
Delegation
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By rule the Board has defined
delegation as the transferring to a
competent individual authority to
perform a selected nursing task in a
selected situation.
RNs can delegate to CNAs, CNA-Ms,
nursing students, graduate nurses
awaiting first NCLEX examination.
NCSBN Delegation Guidelines
Assess the Situation: student needs,
setting, & resources
Plan for specific task(s) to be
delegated: required knowledge &
skills, competence of staff,
resources
NCSBN Delegation Guidelines
Continued
Assure Accountability: delegator for the
performance of task(s) & delegatee
accepts delegation to carry out task(s)
correctly No one practices on your
license
Supervision: Clear directions &
expectations, monitoring of performance
of task, intervene as necessary, ensure
appropriate documentation
NCSBN Delegation Guidelines
Continued
Evaluate the delegation process:
student, performance of task, and
obtain feedback
Reassess the overall plan of care as
needed
NCSBN 5 Rights of Delegation
Right
Right
Right
Right
Right
Task
Circumstances
Person
Directions/Communication
Supervision
Resources for Effective Delegation
32 M.R.S.A., CHAPTER 31 THE LAW REGULATING THE
PRACTICE OF NURSING
http://www.maine.gov/boardofnursing/Administrative/
Rules/Chapter%204.pdf
Chapter 5 REGULATIONS RELATING TO TRAINING
PROGRAMS AND DELEGATION BY REGISTERED
PROFESSIONAL NURSES OF SELECTED NURSING TASKS
TO CERTIFIED NURSING ASSISTANTS –
http://www.maine.gov/boardofnursing/Administrative/Rules/
Chapter%205.pdf
Resources Continued
NCSBN Guidelines For Delegation
CNA Curriculum
CNA-M Curriculum
NCSBN Delegation Guidelines
Articles in the Board Bulletin posted
on the website:
www.maine.gov/boardofnursing
Coordination and Oversight
Chapter 6 REGULATIONS RELATING TO COORDINATION
AND OVERSIGHT OF PATIENT CARE SERVICES BY
UNLICENSED HEALTH CARE ASSISTIVE PERSONNEL
Only an RN may coordinate and oversee patient
services by Unlicensed Assistive Personnel (UAPs).
RN shall not coordinate and oversee unlicensed health
care assistive personnel for health counseling,
teaching or any task that requires independent,
specialized nursing knowledge, skill or judgment.
Coordination and Oversight Continued
Factors to be considered
Acuity of the student
Stability of the condition of the
student
Training and capability of the UAP
nature of the tasks
Setting in which care is to be
delivered
Coordination and Oversight Continued
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Identify the needs of the students
Identify the task
Provide directions
Determine the ability of the UAP to perform the task
Monitor reporting and documentation
UAP assigned to that nurse’s student reports
directly o the nurse for the performance of
nursing tasks
Evaluate performance of the task and student
outcome, and initiate corrective action when
necessary
Delegation vs Coordination & Oversight
Delegation
Coordination and
Oversight
Authority granted from
Nurse Practice Act
Responsible for
action/inaction of staff
Accountable for student
outcome
Only an RN can delegate
An RN can only delegate to
LPN, CNA/CNA-M, student
nurse, and graduate
nurse awaiting first
NCLEX exam
Authority granted from
Nurse Practice Act
Accountability of unlicensed
staff rests with someone
else
RN responsible for student
safety
Only an RN can coordinate
and oversee
Coordination and oversight is
utilized in many settings
where UAPs work.
School Nurse Position Statement
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Board of Nursing updated this
position statement
Content:
Accountability & Liability
Accountability is the obligation and
duty to perform in a manner that
meets minimum standards of
practice.
Liability is a term in law to mean a
person’s financial responsibility for
such things as malpractice.
“The right thing to do
and the hard thing to do
are usually the same.”
― Steve Maraboli, Life,
the Truth, and Being
Free
Case Study # 1
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Medically complex HS student with
hx of seizure activity with multiple
grand mal seizures occurring on a
regular basis
Complex medication regimen
including rectal and nasal
medications
Multiple supports in place
School nurse is full-time in the
building
What are the steps to take?
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Considerations
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Health history
Team?
Care plan?
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Contents?
Training?
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If yes, who?
Case Study # 2
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Kindergarten student (age 6) with
hx of febrile seizures. No known
seizure activity since age 3. Parent
notices “staring spells”. Consults
specialist and Diastat is ordered.
Parent comes to school with
medication insisting everyone be
trained to give Diastat to her child.
School nurse is part-time
What are the steps to take?
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Considerations
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Enough health history?
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Care plan?
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What is missing?
Contents?
Training?
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If yes, who?
Wrap - Up
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Issues?
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Concerns?
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Related topics?
School Nurse Role
 Thank
you!