Arkansas State Board of Nursing

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Arkansas State Board of Nursing

• School Health Services
• and the Law
• September 2014

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School Health the Law

• Arkansas and Federal laws require schools provide
  free education to Children with Disabilities (in
  the least restrictive environment)
• Arkansas Nurse Practice Act and ASBN Rules
  regulate the practice nursing

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School Health the Law

• RN Scope of Practice
• The delivery of health care services which
  require assessment, diagnosis, planning,
  intervention, and evaluation
• LPN/LPTN Scope of Practice
• The delivery of health care services which are
  performed under the direction of the professional
  nurse, licensed physician, or licensed dentist,
  including observation, intervention, and
  evaluation.
• ASBN Position Statement 95-1 98-6

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School Health the Law

• Education Laws
• A.C.A. 6-18-1005
• Student services program defined
• (a)(6)(A)
• Students with special health care
• needs, including the chronically ill,
• medically fragile, and technology-dependent,
• and students with other health impairments
• shall have individualized health care plans

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School Health the Law

• ASBN Interpretation
• The School District is responsible for providing
  a person qualified to develop the individual
  health care plan (IHP.)
• The person responsible for doing the IHP must
  have within their scope of practice Assessment,
  Diagnosis, and Planning, e.g., RN, APN, or
  Physician.
• LPN scope of practice does not include
  assessment, diagnosis, or planning.

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School Health the Law . Education
LawsA.C.A. 6-18-1005 Student services program
defined

• (a)(6)(B)(i)
• Invasive medical procedures required by students
  and provided at the school shall be performed by
  trained, licensed personnel who are licensed to
  perform the task subject to 17-87-102 (6)(D) or
  other professional licensure statutes.
• (a)(6)(B)(ii)
• The regular classroom teacher shall not perform
  these tasks and 

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School Health the Law

• Nurse Practice Act
• A.C.A. 17-87-102 (6)(D)
• Practice of professional Registered nursing
  meansany act involving
• (D) The delegation of certain nursing practices
  to other personnel as set forth in regulations
  established by the board
• ASBN Interpretation
• Only Registered Nurses may provide nursing care
  or delegate to qualified individuals certain
  nurse practices as defined in the ASBN Rules
  School Nurse Roles and Responsibilities Practice
  Guidelines.

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School Health the Law

• ASBN Interpretation
• Each Licensed Nurse must practice within the
  scope of practice of their license.
• LPN/LPTN must work under the direction of an RN,
  APN, licensed physician or licensed dentist.
• A.C.A. 17-87-102 (5)

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School Health the Law .Act 1204 of
2011Amends A.C.A. 17-87-103 Exceptions to the
Nurse Practice Act

• 11 (A) The administration of Glucagon to a
  student who is suffering from diabetes by trained
  volunteer school personnel
• Trained by licensed nurse employed by school
• Parent/Guardian sign authorization
• Volunteer/Nurse Trainer not liable for damages
• Regular Classroom Teacher may volunteer to be
  trained give Glucagon

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School Health the Law

• LPN under the direction of an RN, APN, Physician
  may perform (School Nurse Guidelines)
• N/G Feeding/Monitoring
• Gastrostomy Feeding/Monitoring
• TPN Monitoring
• Clean Intermittent/Sterile Cath
• Ventricular Peritoneal Shunt Monitoring
• Mechanical Vent Monitoring
• Mechanical Vent Ambu Bag
• Intermittent/Continuous O2
• Central Line Cath management

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School Health the Law

• LPN under the direction of an RN, APN, Physician
  may perform (School Nurse Guidelines)(cont)
• Peritoneal Dialysis
• Medication Administration
• Ostomy Care Irrigation
• Pharyngeal/Trach Suctioning
• Screening, growth, v/s, vision hearing, scoliosis
• Blood Urine Glucose testing
• Seizure Precautions
• Pressure Ulcer Care
• Sterile/Non-sterile dressings

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School Health the Law

• Supervision
• Merriam-Webster
• a critical watching and directing (as of
  activities or a course of action.)
• American Nurses Association
• is the active process of directing, guiding, and
  influencing the outcome of an individual's
  performance of an activity
• Adopted by National Association of State School
  Nurse Consultants.

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School Health the Law

• Supervision does not require the RN, APN,
  licensed physician or licensed dentist to
  physically be present 100 of the time.
• The amount of supervision required is directly
  related to the individual LPNs experience,
  skills and abilities and the healthcare needs of
  the students being served.

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School Health the Law

• A.C.A. 17-87-102 (6)(D) allows the RN to
  delegate certain nursing practices to other
  personnel as set forth in regulations
• ASBN Rules Chapter 5 on Delegation sets forth the
  regulations regarding delegation of nursing task
  to unlicensed assistive personnel (UAP.)

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School Health the Law

• Criteria for Delegation to UAP
• Licensed Nurse delegating is responsible for the
  nursing care given to the client
• Assessment of clients needs prior to delegation
  (IHP update)
• Task must be one a reasonable prudent nurse
  would delegate
• Does not require UAP to use nursing assessment,
  judgment, evaluation or teaching skills
• Does not jeopardize clients welfar
• RN employed by facility responsible for training

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School Health the Law

• Criteria for Delegation (cont)
• Written procedures for task
• UAP competency is documented
• Delegating nurse is readily available in person
  or by telecommunication
• Licensed nurse is responsible for documentation
• The licensed nurse adequately supervises the
  performance of the nursing task.

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School Health the Law

• Supervision
• Merriam-Webster
• a critical watching and directing (as of
  activities or a course of action.)
• American Nurses Association
• is the active process of directing, guiding, and
  influencing the outcome of an individual's
  performance of an activity
• Adopted by National Association of State School
  Nurse Consultants.

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School Health the Law

• Supervision is determined by the licensed nurse
  and is dependent on
• Stability of the clients condition
• Training and capability of the UAP
• Nature of the nursing task being delegated
• Availability of the license nurse

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School Health the Law

• Decisions to delegate nursing care to an
  unlicensed person is based upon
• Students nursing care needs are stable
• Delegation of task does not pose a potential harm
• Task involves little/no modification
• Task has predictable outcome
• Task does not require assessment, interpretation
  or decision making
• UAPs skills and competency
• Availability of supervision

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School Health the Law

• Accountability vs Civil Liability
• The ASBN holds the nurse accountable for
  appropriate delegation of nursing tasks and
  supervision of the UAP.
• The UAP is accountable for their own actions.
• May not absolve the nurse of Civil Liability.

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School Health the Law

• Insect Sting Emergency Treatment Act
• A.C.A. 20-13-401
• Allows parent, camp counselor, scout leader,
  school teacher, chaperone to be trained is use of
  emergency epinephrine by a physician.
• To administer epinephrine to an individual they
  are responsible for if they have an allergic
  reaction to an insect sting and other allergic
  reactions.
• School Nurse Guidelines
• Allows UAP to be trained and delegated the task
  of administering epinephrine to a student with a
  Rx in an emergency situation.

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School Health the Law

• More children with more complex healthcare needs
  are attending school
• The practice of nursing is regulated by the Nurse
  Practice Act and is not always understood by
  school administrations who are in the business of
  education.

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School Health the Law

• Immediate reactions are to decrease the
  requirements regarding the provision of Nursing
  Care
• An alternate solution is to increase the number
  of qualified licensed nurses in order to provide
  the quality nursing care that our children
  deserve

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Complaints Received

• Most frequent complaints
• Didnt give my child their medication
• Didnt assess my childs condition
• Gave my child an immunization that was not needed

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Disciplinary Actions

• Nurse Imposter
• Administered wrong dose of insulin

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Current Issues