The Arkansas Department of Education (ADE) has been informed by the Arkansas State Board of Nursing (ASBN) that it has promulgated the School Nurse Roles and Responsibilities Practice Guidelines (Guidelines) (September, 2007 Revision). This document defines the scopes of practice of the Advanced Practice Nurse (APN), Registered Nurse (RN), Licensed Practical Nurse (LPN), and Licensed Psychiatric Technician Nurse (LPTN) when practicing in the school setting. In addition the document defines nursing tasks that may be delegated by the school nurse to unlicensed assistive personnel (UAP) (i.e., school secretaries, administrative assistants, aides, etc.).
Ark. Code Ann. § 6-18-706 sets out the requirements for school districts to hire school nurses.
§ 6-18-706(b) defines “school nurse” as a licensed nurse engaging in school nursing activities. Neither the Guidelines nor state law prohibit employing an APN, RN, LPN or LPTN in the school nurse position(s). However, the LPN and LPTN are required by law to work under the direction of an APN, RN, licensed physician or licensed dentist (Ark. Code Ann. §17-87-102 (5) and (7)).
The Guidelines require each nurse employed in a school setting to practice within the scope of practice for the license level the nurse holds. These scopes of practice are set out in Ark. Code Ann. §17-87-102. Some school nursing duties, such as developing Individualized Healthcare Plans, may only be performed by an APN or RN (such as the following):
Ark. Code Ann. §6-18-1005 (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.”; and
Ark. Code Ann. §6-18-1005 (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.”
Other examples of duties which can only be performed by an APN or RN are listed in the ASBN Guidelines.
Therefore, according to the Guidelines and the above-quoted sections of the Arkansas Code, a RN or APN is required in the school setting to direct care and to perform the tasks and duties which require assessment, diagnosis and care planning. Directing care does not require the RN or APN to be physically present 100% of the time. However, according to the ASBN, the RN or APN must be able to critically watch and direct the LPN’s, LPTN’s and/or UAP’s activities or course of action. The RN or APN must be available as needed by the LPN, LPTN or UAP. The amount of direction required is directly related to the individual LPN’s, LPTN’s or UAP’s experience, skills and abilities and the healthcare needs of the students being served.
Licensed nurses may be assigned or delegated nursing tasks based upon their scope of practice, education, experience, and competency validation. Only licensed nurses may delegate nursing care tasks to unlicensed assistive personnel. Delegation is based upon the UAP’s education, experience and competency validation for the skills needed to perform the delegated tasks. The Guidelines define the criteria for delegation, and the nursing tasks that may be assigned or delegated to the LPN, LPTN, and UAP is set out at pages 19-21 of the Guidelines (see attached exhibit).
The School Nurse is held accountable, both professionally and legally, for practicing within their scope and for appropriate delegation.
Question or comments concerning this information should be directed to Ms. Deborah Jones, Assistant Director of Nursing Practice, at the ASBN Office, (501) 686-2700.