The School Nurse and School Health Services in Minnesota

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The School Nurse and School Health Services in
Minnesota
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MS 121A.21 School Health Services

• (a) Every school board must provide services to
  promote the health of its pupils.

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MS 121A.21 School Health Services

• (b) The board of a district with 1,000 pupils or
  more in average daily membership in early
  childhood family education, preschool disabled,
  elementary, and secondary programs must comply
  with the requirements of this paragraph.
• It may use one or a combination of the following
  methods

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MS 121A.21 School Health Services

• (1) employ personnel, including at least one
  full-time equivalent licensed school nurse
• (2) contract with a public or private health
  organization or another public agency for
  personnel during the regular school year,
  determined appropriate by the board, who are
  currently licensed under chapter 148 and who are
  certified public health nurses or
• (3) enter into another arrangement approved by
  the commissioner

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• The law is silent on school district under 1,000
• Students still have health needs - Assessment of
  student health needs is necessary
• Not just numbers of students with health needs
  but what type of support is necessary to be in
  school and be successful

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Categories of Nurses

• Advanced Practice Nurses
• Bachelor Prepared Nurses
• Associate Degree Nurses
• Licensed Practical Nurses

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Nurse Practice Act MS 148.171-148.285

• The law that regulates the practice of nursing in
  ALL settings in the State of Minnesota.

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Advanced Practice Nurse

• Subd. 3. Advanced practice registered nurse.
  "Advanced practice registered nurse," means an
  individual licensed as a registered nurse by the
  board and certified by a national nurse
  certification organization acceptable to the
  board to practice as a clinical nurse specialist,
  nurse anesthetist, nurse-midwife, or nurse
  practitioner.

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Professional Nursing (Registered Nurse)

•  Subd. 15. Practice of professional nursing.
• The "practice of professional nursing" means the
  performance for compensation or personal profit
  of the professional interpersonal service of

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• (1) providing a nursing assessment of the actual
  or potential health needs of individuals,
  families, or communities

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• (2) providing nursing care supportive to or
  restorative of life by functions such as
• skilled ministration of nursing care,
• supervising and teaching nursing personnel,
• health teaching and counseling,
• case finding, and
• referral to other health resources

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(3) evaluating these actions.

• 1. The health services provided to students and
  student outcomes.
• 2. The services others provided to the students.
• 3. The effectiveness and outcomes of the school
  health services program and its staff.

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The practice of professional nursing includes both

• independent nursing functions and
• delegated medical functions which may be
  performed
• in collaboration with other health team members,
  or
• may be delegated by the professional nurse to
  other nursing personnel.
• Independent nursing functions may also be
  performed autonomously.

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• The practice of professional nursing requires
  that level of special
• education,
• knowledge, and
• skill
• ordinarily expected of an individual who has
  completed an approved professional nursing
  education program

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MN Board of Nursing Rule 6321.0100

• "Supervision" means the guidance by a registered
  nurse for the accomplishment of a function or
  activity.
• The guidance consists of the activities included
  in monitoring as well as establishing the
  initial direction, delegating, setting
  expectations, directing activities and courses
  of action, critical watching, overseeing,
  evaluating, and changing a course of action.

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Bachelor Degree Nurses (BSN/RN)

• Four year degree Bachelors of Science in Nursing
  degree from a University or College Nursing
  Program
• Eligible for licensure as an RN by the Minnesota
  Board of Nursing
• The nursing curriculum contains public health
  courses and unit of study with a public health
  practicum
• Eligible for Public Health Certification of the
  Minnesota Board of Nursing
• Eligible for School Nurse Licensed from the
  Minnesota Board of Teaching

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Associate Degree Nurse (ADN/RN)

• Two year associate degree from a college
• Eligible for licensure as an RN by the Minnesota
  Board of Nursing
• Curriculum does not contain public health content
  
• NOT eligible for public health certification in
  Minnesota
• NOT eligible for School Nurse License from the
  Minnesota Board of Teaching

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Subd. 14. Practice of practical nursing. The
"practice of practical nursing" means the
performance for compensation or personal profit
of any of those services in

• observing and caring for the ill, injured, or
  infirm
• in applying counsel and procedure to safeguard
  life and health, and

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• in administering medication and treatment
  prescribed by a licensed health professional,
  which are commonly performed by licensed
  practical nurses and which require specialized
  knowledge and skill such as are taught or
  acquired in an approved school of practical
  nursing, but which do not require the specialized
  education, knowledge, and skill of a registered
  nurse.

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MN Board of Nursing Rule 6321.0100

• "Monitoring" means the periodic inspection by a
  registered nurse or licensed practical nurse of a
  directed function or activity and includes
• updating a supervisor of progress or
  accomplishment by the person monitored, and
• contacting a supervisor as needed for direction
  and consultation.
• watching during performance, checking, and
  tracking progress,

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Licensed Practical Nurse (LPN)

• Licensed Practical Nurse course (approx one year
  to 18 months in length)
• Eligible for licensure as an LPN by the Minnesota
  Board of Nursing
• NOT eligible for Public Health Certification by
  the Minnesota Board of Nursing
• NOT eligible for Licensure as a school nurse
  under the Minnesota Board of Teaching

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Licensed Practical Nurse

• Can give medications as ordered or delegated
• Can provide student care/treatments as directed
  by a student health plan and medical orders
  and/or as delegated by the LSN/RN
• Can follow written policies and procedures
• Can give and report important health and medical
  information to program supervisor/or LSN/RN

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Licensed Practical Nurse

• Can not do nursing assessment
• Can not delegate activities to others
• Can not supervise other health care staff
• Can not initiate health related teaching
• Can not plan or develop individual student health
  plans
• Can not be part of the IEP or due process

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Unlicensed Assistive Personnel

• No licensure or regulation
• Education mandate for training --- MS
  125A.08(b)(3) School district obligation
  Medical Assistance 9505.0335 Subp3 address
  educational paras training requirements under
  NCLB
• Training determined by and provided by school
  district or school district staff (licensed
  school nurse or registered nurse)

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Minnesota Board of TeachingSchool Nurse
Licensure 8710.6100 SCHOOL NURSE

• A candidate for licensure as a school nurse
  shall
• A. hold a baccalaureate degree in nursing from a
  regionally accredited college or university
• B. be currently registered in Minnesota to
  practice as a licensed registered nurse under the
  Board of Nursing and
• C. be currently registered in Minnesota as a
  public health nurse under the Board of Nursing.

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Scope of Practice

• See handout

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How are school health services provided in
Minnesota?
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Hiring Options for School Health

• ISD hire one or more licensed school nurses with
  support from clerical staff
• ISD hire one or more licensed school nurses with
  registered nurse support

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Hiring Options continued..

• ISD hire one or more licensed school nurse with
  unlicensed assistive personnel support
• ISD hire one or more licensed school nurses with
  LPN support

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Hiring Options continued

• ISD hire one or more licensed school nurse with
  varied levels of health services staff

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Options continued

• ISD hire one or more registered nurses with
  clerical support
• ISD hire a registered nurse with LPN support
• ISD hire a registered nurse with varied levels of
  health services staff
• These options are not in compliance with the
  MS 121A.21 if the district is over 1,000 students
  and MN Special Education Laws

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Contracting Options

• Contracting with an external health provider
  entity for a level of school health service
• Public health agency
• Educational services cooperative unit
• Local hospital
• Local medical center
• Local nursing home
• Private home care provider agency
• Private professional nurse

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Contracting Options continued

• Contract with external entity for limited or full
  time licensed school nurse /or other
  professional nurse staff, while school hires
  health services support staff

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Contracting Options continued

• Contracting with external entity to provide
  supervisory licensed school nurse and all other
  health services staff
• Consideration should be given to the availability
  of the supervising licensed school nurse and the
  ancillary staff

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Remember

• Monitoring the contract is important
• Periodic review of contractors
• Do not wait until the time for contract renewal
• Check with school staff

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Delivery of services

• All options should be based on a public health
  nursing assessment of all the health needs of the
  students
• Total student population system needs
• Number of General Education Students
• Special education students with IEPs and the
  plans that require health services
• Number Type of Chronically Ill Students
• Students with 504 plans
• Number of school buildings
• Capabilities and training needs of the licensed
  and unlicensed assistive health services
  personnel
• Driving distances
• Availability of emergency medical services

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Question

• Can a school district hire a two year Associate
  Degree Registered Nurse?

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Question

• Can an Licensed Practical Nurse provide nursing
  services independently?

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Issues

• Part time school nurse employment
• Delegation and supervision when the nurse is not
  on the payroll.
• On call

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Issues

• School Health Services policies and procedures
  must vary based on the levels of health services
  personnel employed.
• Licensed Practical Nurse /or Paraprofessional
  without LSN/RN supervision.

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Issues

• Schools need to provide for the health and safety
  of their student during summer school as they do
  during the school year or parents/guardian need
  to know about the difference.
• Parents/guardians believe that the same health
  service is provided in the summer as during the
  regular school year

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School sponsored activities

• Field trips
• health services must be a part of the planning

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School health services done well can influence
Educational Outcomes Positively