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School Nurse Practice and Delegation, Coordination and Oversight
Presenters:Virginia deLorimier, RN Maine Board
of NursingNancy Dube, RN Maine Department
of Education
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School Nursing; Delegation, Coordination and Oversight Agenda
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
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2102 Definitions 2. Professional Nursing
Diagnosis (Assessment and Care Planning) Delegation (LPNs and CNAs) Supervision and Teaching Patient Teaching Coordination and Oversight
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2102 Definitions 3. Practical Nursing
Practices under the supervision of an RN or MD
Practices in a structured healthsetting
Reinforces student and family teaching
LPN cannot do private duty nursing if hired independently by the family
.
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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
oIn order for the RN to delegate to a CNA the individual must be employed as a CNA
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CERTIFIED NURSING ASSISTANTS-MEDICATIONS (CNA-M)
oExperienced CNAs (take course after employment as a CNA for at least one year full time) oAdminister selected non-injectable medications to patients who are 4 years of age and older. oThis complex nursing task shall be performed under the direct on-site supervision of a licensed nurse.oCNA-M’s can only be employed in in long term care, state mental health institutions, county jails, state correctional facilities and assistive living settings.
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Delegation
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.
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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
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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
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NCSBN Delegation Guidelines Continued
Evaluate the delegation process: student, performance of task, and obtain feedback
Reassess the overall plan of care as needed
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NCSBN 5 Rights of Delegation
Right Task Right CircumstancesRight PersonRight Directions/CommunicationRight Supervision
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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
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Resources Continued
NCSBN Guidelines For DelegationCNA CurriculumCNA-M CurriculumNCSBN Delegation GuidelinesArticles in the Board Bulletin posted
on the website: www.maine.gov/boardofnursing
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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.
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Coordination and Oversight Continued
Factors to be considered Acuity of the studentStability of the condition of the
student Training and capability of the UAP nature of the tasksSetting in which care is to be
delivered
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Coordination and Oversight Continued
• 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
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Delegation vs Coordination & Oversight
Delegation
Authority granted from Nurse Practice Act
Responsible for action/inaction of staff
Accountable for student outcome
Only an RN can delegateAn RN can only delegate to
LPN, CNA/CNA-M, student nurse, and graduate nurse awaiting first NCLEX exam
Coordination and Oversight
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.
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School Nurse Position Statement
Board of Nursing updated this position statement
Content:
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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.
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“The right thing to do and the hard thing to do are usually the same.” ― Steve Maraboli, Life, the Truth, and Being Free
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Case Study # 1
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
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What are the steps to take?
Considerations
Health history Team? Care plan?
Contents? Training?
If yes, who?
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Case Study # 2
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
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What are the steps to take?
Considerations
Enough health history? What is missing?
Care plan? Contents?
Training? If yes, who?
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Wrap - Up
Issues?
Concerns?
Related topics?
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School Nurse Role
Thank you!