School Nursing

The Maine State Board of Nursing and Maine Association of School Nurses collaborated to provide guidelines for nursing practice in the educational setting.

The registered professional school nurse strengthens and facilitates the educational process by promoting and protecting the health and wellness of all students. School nurses minimize health related barriers to learning, assess the health care needs, and link the health service program with education and support services.

History:

Maine has experienced an increase in the number and complexity of students with health conditions coming to school due to the advances in medicine, health and science.  Medically complex children requiring the skills of a professional registered nurse in nursing assessment, diagnosis and intervention during the school day have increased.

Roles and Responsibilities:

This Position Statement delineates nursing roles and responsibilities for the safe delivery of health care in the educational setting.

The registered professional nurse practicing as a school nurse:

  1. Develops a nursing care plan for every student with identified health care needs requiring nursing assessment, intervention or supervision. The nurse bases decisions about the plan of care and appropriate level of personnel based on:
    1. the stability of the child's medical condition
    2. the complexity and acuteness of the observations and judgments the caregiver must make during the school day
    3. the nature, frequency and complexity of prescribed treatments the child requrie
    4. the number, types, routes of administration and potential for adverse reactions of medications the child receives in school
    5. the need to assess the child for PRN medications and treatments
    6. the child's ability to communicate his or her needs to the caregiver
    7. the knowledge base and proficiency of psychomotor skill required of the direct care provider
    8. the level of preparation and experience of the direct caregiver
  2. Ensures that the student and his/her family provide input to the decision-making related to provision of health care in school.
  3. Plans and implements a written individualized health care plan, which supports the students Individual Educational Plan (IEP) or Section 504 plan.
  4. Ensures that the necessary and appropriate resources are available to all persons who are responsible for providing school health care before a child is placed in the educational setting.
  5. Collaborates with the school administration and develops protocols to address the coordination of services provided by private caregivers or agencies that are providing care in the educational setting.
  6. Coordinates and oversees unlicensed assistive personnel (UAPs) to ensure appropriate personnel are assigned to specific health tasks and provides the training for the task to be done.  Any task requiring nursing assessment or judgment cannot be assigned to a UAP.
  7. Ensures that there are written guidelines or protocols addressing possible medical emergencies a child may experience in the education setting. Protocols and guidelines should include:
    1. The definition of a medical emergency for a child
    2. Individuals to be notified when an emergency occurs
    3. Identification of the person who will initiate and direct the action to be taken in the absence of the registered nurse
    4. Specific action to be taken in an emergency
    5. Identification of transport needs, who will provide transport, and the designated destination

The registered nurse practicing as a school nurse is the coordinator/facilitator of nursing care in the school, and may not necessarily be the direct care provider, for children who are technology dependent. In coordinating or facilitating care, the registered nurse:

  1. Evaluates the admission of a specific child to ensure placement of the child in a safe, accessible classroom within the school
  2. Assesses the school and community environment and necessary resources to ensure a safe educaiton setting
  3. Ensures that school personnel have the health care information necessary to create an environment in the classroom which is conducive to learning

Resources:

The practice of school nursing is a nursing specialty recognized by the Department of Education in Title 20-A Section 6403-A. School Nurse available at: http://www.mainelegislature.org/legis/statutes/20-A/title20-Asec6403-A.html

The Law Regulating the Practice of Nursing (Nurse Practice Act) available at:
http://www.mainelegislature.org/legis/statutes/32/title32ch31sec0.html

June 16, 1993
Revision approved by the Board on December 10, 2014