Question: If I am unsure about whether something falls within my legal scope of practice, how can I find out?

Answer: If the concern is related to school nursing, you can begin by calling our Center.  If you need additional assistance, you can contact the NYS Board for Nursing by mail at:

NY State Education Department, 89 Washington Ave.-Education Building, State Board for Nursing, Second Floor, West Wing, Albany NY 12234 or

by email at nursebd@mail.nysed.gov, or by telephone at 518-473-3817 ext. 120.

 

Question: Can a Licensed Practical Nurse (LPN) practice independently?

Answer:  Section 6902 of Article 139 of the Education Law and section 64.6 of the Regulations of the Commissioner of Education state that an LPN performs tasks and responsibilites under the direction of a registered professional nurse, nurse practitioner, physician, physician assistant, specialist assistant, dentist and podiatrist.  Under the direction of a registered professional nurse means that a registered professional nurse must be present on the premises or immediately available by telephone when professional services are given by a licensed practical nurse.  The degree of supervison should be appropriate to the circumstances. 

Question:  Who is permitted to perform the required screenings in school?

Answer:

Question:  Do school nurses need to wear an identification badge when providing nursing services in the school setting?

Answer:  All nurses must wear an identification badge indicating their name and professional title when practicing in a school.  This requirement is set out in §29.2 (a) (9) of the Rules of the Board of Regents and applies to all nurses practicing as an employee of a hospital, clinic, group practice or multi-professional facility or at a commercial establishment offering health services to the public.  We have confirmed with the Office of Professions that this requirement applies to schools.

Identification badges are available commercially and we are providing samples you can print out in our School Nurse Tool Kit at the bottom of the "Resources for SH Requirements" page.

Question:  What is the role of the school nurse in preparing for school emergencies?

Answer:  The Registered Professional Nurse has a vital role in each aspect of emergency planning and management.

• School nurses should assess potential emergency risks and assess the effectiveness of preparation through emergency trainings and practice activities.
• School nurses have unique knowledge of children with special health care needs, which are of utmost importance in the planning and responding phases of emergency management.
• The position of school nurses places them in a strategic position to assist in the short-term and long-term recovery phase following an emergency.
• School nurses must review and evaluate a school’s response to an emergency in concert with the school’s emergency team.

Question:  Is the school nurse responsible for the care and health issues of the school district employees in addition to the students?

Answer:  Every school nurse should check their job description to see if the care of staff members is included in their responsibilities.  Some districts include this in their nurses’ duties and some do not.  If it is not in your job description, this becomes an issue for your district’s Human Resources Department unless the staff member experiences an emergency medical concern. If you are an occupational health nurse, your responsibilities may be expanded.  In the event of an emergency, a school nurse should provide care as any RN would.

Question: Is there any guidance on superivision/evaluation of school nurses?

 Answer:  The National Association of School Nurses (NASN) has a Position Statement which addresses this issue. A link to it can be found in our SN Tool of the Week on the SN Tool Kit page.

Our office is currently working on an Evaluation Tool for use with school nurses and administrators.

Question:  Can an Emergency Medical Technician (EMT) function as a school nurse?

Answer: We often have EMTs wanting to perform the duties of a school nurse and an EMT cannot function as a school nurse – they are not licensed as such and are not qualified (it’s also a Class E felony to practice nursing without a license).  

 

An EMT works under a cooperative agreement with emergency medical services and they provide the guidance for care to the EMT.  An EMT, unless providing direct care as an official emergency responder at the moment that they are administering care, should present themselves to the school nurse and function as an unlicensed person would – as an “extra pair of knowledgeable hands” – but take direction from the school nurse.  The school nurse should be careful not to delegate anything to the EMT beyond what an unlicensed person should do.

 

An EMT may not substitute for a school nurse.

 

An EMT may be a very valuable colleague in an emergency as they often are a calming and knowledge partner in a stressful moment.  Again, the nurse must not delegate nursing duties to an non-nursing colleague.

Question:  Is there an orientation program for newer school nurses? 

Answer:  Yes!  The New York State Association of School Nurses will hold their 21^th Annual School Nurse Orientation at the Welch-Allyn Lodge in Skaneateles, New York from August 16 – 20, 2009.  More information can be found through our website on the Events page at: http://www.schoolhealthservicesny.com/events.cfm

Question: Is there any penalty for unlicensed school personnel practicing nursing? (i.e. administering medications outside of the guidelines, etc.)

Answer: Education Law states that the unauthorized practice of nursing is a Class E felony.  For more information please see page 8 of the Provision of Nursing Tasks document (the document name is linked to the reference).

Question: Where can I find a sample RN job description?

 Answer: A sample job description can be found in the School Health Services Handbook (page 27) found at: http://www.schoolhealthservicesny.com/uploads/Handbook%202005.pdf

Question: Can LPNs be expected to carry out the professional duties of a school nurse?

Answer: The scope of practice of the RN and LPN are not interchangeable.  The RN is the professional nurse in school settings who may independently, within the scope of practice of the Registered Professional Nurse, triage, assess students, interpret clinical data, develop nursing care plans, and make decisions regarding nursing care.  This can be found on our Laws and Guidelines page under the heading “School Nursing” in a documents titled, “Use of Licensed Practical Nurses and the Term “School Nurse” in School Settings.

Question:  If an LPN works outside of their scope of practice, would that action affect the RN's license?

Can notes be accepted from chiropractors?

The Office of Professions at the State Education Department has offered some guidance on the issue of chiropractic care for school age children.  School nurses are able to accept notes from chiropractors that relate to their scope of practice.  This would mean that a school nurse may accept a physical education excuse or scoliosis evaluation, but would not be able to accept a physical examination form or a note related to treatment of a communicable disease.

The information regarding scope of practice for chiropractors from the Office of Professions can be found at the following link: http://www.op.nysed.gov/article132.htm  

Is there a state guideline stating how many students a school nurse should be responsible for in New York?

No state guideline is available being that school nurses are not mandated in New York State.  Information is available in the form of a position statement from the National Association of School Nurses (www.nasn.org) on caseload assignments.

Are parent letters for common health conditions available anywhere?

Parent letters are available in our “School Nurse Tool Kit” on our website.  

Question: What should a school district do when they are unable to provide a substitute on a day when the school nurse is ill and unable to provide nursing coverage?

Answer: There is a universal shortage of substitute school nurses, so it is a good idea to develop a policy for coverage in the event that a school building does not have a nurse for a day.  On the legal front- school nurses are not mandated, so it's not a legal issue that a building does not have a nurse.

 

Things to consider when developing a policy:

·      The school administrator should be notified as soon as possible that the nurse is out for the day and that there isn't coverage for the school's Health Office.

·      The district should consider determining which nurses would act as coverage for which buildings in the event of an emergency or if consultation is needed. Medication administration guidelines must still be adhered to:  an unlicensed person may assist a self directed student in taking their dose of medicine, but a nurse must administer medications to all non self-directed students. 

·      Have the policy identify which staff members are trained and willing to administer epinephrine and glucagon.  Be sure that they know to access the medication and are notified that the nurse is not in the building.

·      Have a school policy set up for calling 911 for emergencies.

 

Guidelines must still be followed and a non licensed person cannot practice nursing for the day.  It's actually a Class E Felony to practice nursing without a license, so school staff and administration need to be careful not to cross the line in the care they can give.

 

Helpful documents on our Laws and Guidelines page (http://www.schoolhealthservicesny.com/laws_guidelines.cfm) include:

·      Provision of Nursing Tasks & Health-Related Activities in the School Setting for Students with Special Health Care Needs (March 1995)

·      Administration of Medication in the School Setting  Guidelines - Updated April 2002

·      Training of Unlicensed Individuals in the Injection of Glucagon in Emergency Situations - Memo (March 2004)

·      Use of Epinephrine Auto-Injector Devices in the School Setting - Memo  (June 2002)