DELEGATION GUIDELINES FOR SCHOOL NURSES October 2015
Presenters Jolene Bracale, MSN, RN Registered Nurse for 30 years Critical Care for 10 years School Nurse for 15 years Program Coordinator for Student Health Services at the Indiana Department of Education for 4 years Blayne Miley, JD Indiana State Nurses Association, Director of Policy & Advocacy Indiana State University, Adjunct Professor teaching Health Policy Leadership to DNP students
INDIANA CENTER FOR NURSING ACCESS TO CARE ADDITIONAL SUBCOMMITTEE MEMBERS Barbara Kelly, MSN, FNP-BC, RN Lindsey Minchella, MSN, RN, NCSN, FNASN Deb Robarge, BSN, RN, NCSN Cecelia Smith, MSN, ANP-BC, RN Carolyn Snyder, MS, BSN, RN
BACKGROUND INFORMATION
Data The Universal Language Source: www.abc.net.au
School Nurse Data Collected in May 2013 Voluntary Participation Represents 49.7% of Indiana Students Data Received from all Regions of the State, all Types of Schools, all Grade Levels
Geographic Distribution of Data by Region 21 % 37 % 42 % North Central South
School Nurse Data 3% School Nurses are 9% primarily employed by school corporations (88%) and local hospitals (9%) 88% School Corp. Local Hospital Other
Top Three Roles of School Nurses 800 706 700 600 529 500 400 337 300 200 100 0 Caring for the Ill or Injured Managing Students with Chronic Health Conditions Discussing Health Issues with Parents
Treatments Performed by School Nurses Catheterization Central Venous Line Care Administration of Emergency Medications Epinephrine, Glucagon, and Diastat Insulin Administration Nebulizer Treatment Shunt Care Tracheotomy Care/Cleaning Tube Feeding
Other School Nurse Roles Vision Screening Hearing Screening Immunization Verification Writing Individual Health Plans for Students Training for Health Aids, Teachers, Secretaries, Bus Drivers, Food Service, Custodians Educating and Counseling Students
STUDENT DATA
Types of Medicines for Students in Indiana Schools Total Medicine 12.5% = 141,159 Emergency Medicine 6.1% Long-Term Medicine 3.3% Short-Term Medicine 3.1% 0 50000 100000 150000
Emergency Medication Given at Least Once During the 2012-2013 School Year Out of 558,571 students reported on in this survey (49.7% of school population) Epinephrine = 45 Diastat = 37 Glucagon = 24
Chronic Diseases School Nurses were asked about 32 Different Chronic Diseases: 35.86% of Indiana Students had at least one of these 32 diseases = 402,385 Students in Indiana have at least one chronic health condition
Approximate Number of Students with Chronic Diseases (80,000 97,000) 100000 96950 87738 80737 80000 60000 40000 20000 0 Asthma Environmental Allergies ADD
Approximate Number of Students with Chronic Diseases (9,000 25,000) 0 20000 40000 Mental Health Disorders 25023 Migraines Severe Food Allergies Gastrointestinal Disorders 17787 14737 12660 Number of Students Seizures 9807
Approximate Number of Students with Chronic Diseases (4,000 8,000) 0 5000 10000 Orthopedic Disability Cardiac Conditions/Hypertension Hearing Disorders 6310 7786 7246 Number of Students Visually Impaired 5400 Substance Abuse 4829
Approximate Number of Students with Chronic Diseases (2,400 4,000) 0 1000 2000 3000 4000 Diabetes-Type 1 3716 Renal Condition Cerebral Palsy 2851 2814 Number of Students Chromosomal Conditions 2519 Neurologic Condition (traumatic brain injury) 2437
Approximate Number of Students with Chronic Diseases (900 2,300) 0 1000 2000 3000 Metabolic Conditions (hypo/hyperthyroidism) 2336 Blood Disorders/Bleeding Disorder 1497 Number of Students Diabetes-Type 2 1117 Rheumatic Arthritis or other Rheumatic Condition 974
Approximate Number of Students with Chronic Diseases (600 900) 0 200 400 600 800 1000 Sickle Cell Trait/Anemia Eating Disorder (bulimia/anorexia) Cancer 918 874 848 Number of Students Addison's Disease 701 Fetal Alcohol Syndrome 643
Approximate Number of Students with Chronic Diseases (100 600) 0 200 400 600 800 Spina Bifida 641 Cystic Fibrosis 321 Number of Students Multiple Sclerosis 117
Chronic Disease Management Requires Writing Individual Health Plans and Delegating Nursing Tasks to Others Nurses in Schools Need Guidance
SCHOOL ISSUES IMPACTING SCHOOL NURSING
School Budgets Legislative Funding Formula has caused many schools to cut costs that are not directly related to education Support Services are being deleted or outsourced Non-qualified personnel are assuming health roles
Need for Guidance School administrators and many health personnel are not aware of scope of practice laws, especially as it applies to the education setting As we just saw, many students in need of health care are enrolled in our schools School personnel need to be educated and nurses need to have guidance regarding how to articulate the need for qualified personnel and the need to deliver safe health care to students
DELEGATION DOCUMENT
Subcommittee Members Lindsey Minchella, Carolyn Snyder Deb Robarge Barbara Kelly CeCelia Smith Jolene Bracale Blayne Miley
Guidelines to Delegation for Indiana School Nurses CONTENTS Section 1 - State of Indiana Regulations Section 2 - Principles of Delegation for the School Nurse Section 3 - Delegation Tools Section 4 - References
Section 1: Regulations Definitions School Nurse Registered Nurse Licensed Practical Nurse Standards of Practice for RN, LPN from Indiana Administrative Code Violations RN s & LPN s subject to discipline by Board of Nursing Unlicensed personnel practicing nursing as an RN or LPN commit a class B misdemeanor Statutory requirements for students with diabetes
Section 2: Principles of Delegation Delegation: who, what, when, why, how Who is an Unlicensed Assistive Person Documentation Steps in the delegation process Training v. delegation v. assignment Withdrawing delegation
Section 3: Delegation Tools Delegation Decision Tree 14 Prerequisites for Delegation Delegation Task Table Skills Checklist for Staff Training Medication Administration Checklist Training Verification Form for School Personnel to Administer Medication
Section 3: Delegation Tools
Section 3: Delegation Tools
Section 3: Delegation Tools
Section 3: Delegation Tools
Next Steps Organizational Endorsements Document will be distributed to all stakeholders in the school healthcare setting
Conclusion Thank You Do You Have Any Questions? Source: www.createfamilyconnections.com