1. Arkansas State Board of Nursing
School Health Services
and the Law
2016

2. School Health & the Law
Arkansas and Federal laws require schools provide free education to Children with Disabilities (in the least restrictive environment)
There are Arkansas and Federal laws that require the schools to provide “free education” to Children with Disabilities in the least restrictive environment.
Have you seen the commercial that starts out with a neighbor giving a little girl a “free puppy” Dad goes through all the expenses he has incurred and concludes “there’s no such thing as a free puppy”
NPA and ASBN rules Regulate the Practice of Nursing
Do these two sets of laws conflict with each other? No

3. School Health & the Law Education Laws
A.C.A. §
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”

4. School Health & the Law Education Laws A. C. A
School Health & the Law Education Laws A.C.A. § 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 § (10)(D) or other professional licensure statutes.” (a)(6)(B)(ii) “The regular classroom teacher shall not perform these tasks; and”

5. School Health & the Law Nurse Practice Act ASBN Rules
A.C.A. § Defines the Scopes of Practice
A.C.A. § Identifies the Exceptions to the Nurse Practice Act
ASBN Rules Chapter 5 – Establishes the rules for delegating to Unlicensed Assistive Personnel

6. School Health & the Law ASBN Position Statements
98-6 Scopes of Practice Decision Making Model
Board of Nursing School Nurse Practice Guidelines

7. 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.
Nurse Practice Act § (9)-(10)
ASBN Position Statement 98-6

8. School Health & the Law Application to School Nurses
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.

9. School Health & the Law Application to School Nurses
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.

10. 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.

11. 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 LPN’s experience, skills and abilities and the healthcare needs of the students being served.

12. School Health & the Law
A.C.A. § (10)(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.)

13. School Health & the Law Criteria for Delegation to UAP
Licensed Nurse delegating is responsible for the nursing care given to the client
Assessment of client’s 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 client’s welfare
RN employed by facility responsible for training

14. 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.

15. School Health & the Law
Supervision is determined by the licensed nurse and is dependent on:
Stability of the client’s condition
Training and capability of the UAP
Nature of the nursing task being delegated
Availability of the license nurse

16. School Health & the Law
Decisions to delegate nursing care to an unlicensed person is based upon:
Student’s 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

17. 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.

18. School Health & the Law. 2011 & 2015 Laws Amended A. C. A
School Health & the Law & 2015 Laws Amended A.C.A Exceptions to the Nurse Practice Act
11 (A) The administration of glucagon, insulin, or both to a student who is diagnosed with diabetes by
Trained volunteer school personnel designated as care providers in a health plan that covers diabetes management and is
Based on the orders of a treating physician,
Who have been trained by a licensed registered nurse employed by a school district or other healthcare professional to
Administer glucagon, insulin, or both to a child with diabetes in an emergency situation.

19. School Health & the Law A.C.A. § 6-18-707 Asthma Inhaler
Epinephrine Pen

20. 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.

21. 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

22. Complaints Received Most frequent complaints
Didn’t give my child their medication
Didn’t assess my child’s condition
Gave my child an immunization that was not needed

23. Disciplinary Actions Nurse Imposter
Administered wrong dose of insulin –

24. Current Issues Who can possess controlled substances
Medication storage/pre-set up
Nurse sending children home due to illness
Student self-trach suctioning