In May 2000, the Arkansas State Board of Nursing, in collaboration with the Arkansas School Nurses Association, issued its School Nurse Roles & Responsibilities Practice Guidelines (hereafter Guidelines), resulting in some changes that affected the information set forth in the 1996 ADE Resource Guide: Developing School Policies On Children With Special Health Care Needs (hereafter ADE Resource Guide). The standards set out in the May 2000 Guidelines issued by the Board of Nursing supersede previously developed guidelines, including any portions of the 1996 ADE Resource Guide which are in conflict with the new nursing guidelines, and any contained in the matrix in Chapter III, pages 131-138 delineating the roles and responsibilities of personnel for various health-care procedures. In the Guidelines, page 19, personnel identified in the school setting to perform naso-gastric feeding are the RN and LPN/LPTN; personnel identified to perform gastrostomy feeding are the RN, LPN/LPTN and Healthcare Paraprofessional. Pages 131-138 of the 1996 ADE Resource Guide shall be replaced with the Delegation of Specific Tasks on pages 19-21 of the Guidelines, May 2000. These pages are enclosed in the attachment.
Questions have been raised in reference to what constitutes invasive medical procedures and custodial health care services within the public school setting. Invasive medical procedures within the public school setting, as stated in Act 1565 of 1999 [Arkansas Code Annotated (ACA) 6-18-1005 (a)(6)(A)-(C)], means those procedures which require entry into the body. ACA 6-18-1005 (a) states, in part: "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 Arkansas Code Annotated Sec. 17-87-102 (2)(D) or other professional licensure statutes." Thus, a person qualified by virtue of Arkansas licensure to perform such procedures may do so. In the case of the school nurse, he/she is responsible for determining whether a task(s) is appropriate to delegate to another individual in a specific situation, with appropriate training, supervision, evaluation and monitoring.
Custodial health care services are referenced in the Guidelines on pages 41-42 G., Exclusions, Item 7, as "The performance in the school setting of nursing procedures necessary for students to achieve activities of daily living as cited in the Education of the Handicapped Act, [IDEA], 20 United States Code 1400-1485, and which are routinely performed by the student or the student's family in the home setting."
Any additional assistance or questions may be referred to Cassandra D. Green at (501) 682-4222.