Nursing Care Quality Assurance Commission Washington State Department of Health. Nursing Standards and Scope of Practice

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1 Nursing Care Quality Assurance Commission Washington State Department of Health Nursing Standards and Scope of Practice

2 Deborah Carlson, MSN, RN Nursing Care Quality Assurance Commission Associate Director of Nursing Practice POB Olympia WA

3 To understand the regulations for safe nursing practice in the school setting Describe the legal framework for the practice of school nursing Describe nursing roles and responsibilities related to nursing standards and scope of practice in the school setting 3

4 Regulates competency & quality of professional 4

5 Purpose Identifies responsibility and accountability Violations may be ground for disciplinary action The nurse shall be responsible and accountable for the quality of nursing care given Responsibility cannot be avoided by accepting orders or direction of another person WAC 5

6 Communication Documentation Advocacy Understand nursing laws and rules Functioning within your legal and individual scope of practice Following HIPAA and FERPA laws 6

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10 State regulations allow RNs and LPNs to delegate certain tasks defined by setting Transfers a nursing task to UAP Nurse retains responsibility & accountability for delegated care Nurse supervises performance of the UAP Nurse may rescind delegation Delegation Requires Teamwork 1 0

11 Take responsibility and be accountable Determine whether delegation is appropriate Use nursing judgment considering the student s condition, UAP competence, and degree of supervision required Delegate tasks (but not nursing judgment) to competent UAP Communicate/verify comprehension and acceptance of delegation 1 1

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13 RCW 28A.210 Apply to public (including charter schools) Apply to private schools Specific only to medication administration and catheterization Does not apply to: Tribal Schools Schools for the Blind, Deaf, and Sensory Handicapped Juvenile Residential Schools 1 3

14 Only a RN may delegate tasks to non-credentialed UAP in school settings Students condition must be: Stable and predictable Legal exceptions: Anaphylaxis Intranasal medications for seizures 1 4

15 Only school RNs can delegate nursing tasks School RNs cannot delegate to volunteers, parents, or non-school employees No person may coerce a school RN into delegating a task if the RN determines it is not safe or appropriate 1 5

16 Clean, intermittent bladder catheterization or assisted catheterization Requirements School must have policies Training and documentation of training UAP may refuse 1 6

17 Oral Topical Eye drops Ear drops Nasal spray (if a school nurse is not available) Epinephrine Auto-injector for anaphylaxis Intranasal medication for seizures 1 7

18 Law does not require schools to accommodate use of medical marijuana School may permit a qualified minor to consume marijuana on school grounds in accordance with school policy 1 8

19 Law requires authorization Medical marijuana is not a medication Nurses may only administer prescribed legend drugs and controlled substances Washington Supreme Court Decision Law does not legalize the medical use of marijuana It only provides qualified patients with an affirmative defense to criminal prosecution Federal offense 1 9

20 PDA is a volunteer (may be a school district employee) arranged by the parent/guardian PDA may give care for students with seizures and diabetes School RN does not delegate care to a PDA 2 0

21 Communication The nurse is required to communicate significant changes in patient status to appropriate health team members Documentation The nurse is required to document in essential patient records nursing care given and patient response WAC (3)(a)(b) 2 1

22 Delegate only tasks within the nurse s scope of practice Determine competency of the UAP Evaluate appropriateness Supervise actions of the UAP 2 2

23 School UAP must submit a letter indicating they are willing to give medications or perform nursing care not previously recognized in law 2 3

24 School Registered Nurse Delegation Decision Tree Does the school RN understand the principles of delegation and the delegation process? No Yes Has the school RN performed a nursing assessment of the student's health care needs? No Yes Does the school or school district policy support delegation of the task? No Yes Is the student's condition stable and predictable? No Yes Is the delegation of task legally supported? No Yes Is the task within the demonstrated competence of the delegating school RN? Yes Has the appropriate training been provided to the UAP about the task? Yes Does the UAP have demonstrated competence to perform the task? Yes Is the UAP willing and avaiable to perform the task? Yes Can the task be done without requiring nursing judgment? No No No No No DO NOT DELEGATE Yes Can the task be done according to exact, unchanging directions? No Yes Can the task be done without requiring repeated assessments and complex nursing skills? Yes No Is the school RN able to appropriately supervise performance of the task? No Yes Is the school RN willing to accept the consequences of delegating the task? Yes No 2 4

25 Employment supervision Supervision of nursing care Supervision of delegated care: Provide guidance and evaluation for the specific task Initial direction of task Periodic inspection of the actual act Authority to require corrective action 2 5

26 Indirect Immediate Direct 2 6

27 RN has the authority to rescind delegation: Significant change in student s status UAP lacks competency Change in school nurse assignment School nurse is no longer employed or under contract Develop alternative plans to ensure continuity Document delegation and actions taken 2 7

28 Delegation authority cannot be transferred to another RN RN assuming delegation authority must undertake new delegation to the UAP 2 8

29 Individual health Plan May have a PDA Students may perform blood glucose testing, give insulin, treat hypo-or hyperglycemia Must have an individual emergency plan 2 9

30 A health care practitioner must develop a written treatment plan for managing asthma or anaphylaxis Student may be authorized to self-carry medication Schools must require backup medications to be kept at school 3 0

31 Epinephrine Auto-injectors School Supply Prescription for a specific student May be delegated May use stock inventory for a student with a prescription Standing orders for non-specific students must be approved by a medical provider with prescriptive authority Cannot be delegated Inventory may be carried by nurse or trained UAP 3 1

32 May delegate to UAP to give nasal sprays (including controlled substances) only if a licensed nurse is not on the premises Law requires summoning emergency medical assistance as soon as practical whenever a nasal spray is administered by a UAP PDA may administer nasal spray for seizures 3 2

33 ESHB 1671 Law allows RNs and LPNs to dispense, distribute, possess, and deliver opioid overdose medication following standing orders Nursing Commission Advisory Opinion Draft 3 3

34 Failure to protect patients from unsafe practices Delegating care inappropriately/unsafely Failing to supervise delegated care Violating confidentiality laws Failing to document Failing to give medications or treatments following acceptable standards Failing to use nursing process 3 4

35 Nursing Law: LPN and RN Rule = NCQAC Practice Website: tificates/nursingcommission/practiceinformati on Medical Marijuana Information: rijuana/medicalmarijuana OSPI Health Services Information: es.aspx RCW 28A.210 Health-Screening and Requirements: =28A.210 Opioid Overdose Medication Law: S.SL.pdf 3 5

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