Reducing the risks of delegation: use of procedure skills checklists for unlicensed assistive personnel in schools, Part 1.

School nurses are challenged by federal civil rights laws and the standards of school nursing practice to care for a burgeoning population of students with special health care needs. Due to the realities of current school nurse-to-student ratios, school nurses are frequently responsible for directing unlicensed assistive personnel (UAPs) to support the health and safety needs of students, where State Nurse Practice Acts, state legislation, and local policy mandates allow. The delegation of health care tasks to UAPs poses many professional, ethical, and legal dilemmas for school nurses. One strategy to reduce the risks of delegation is through the use of procedure skills checklists, as highlighted by the experience of one large urban school district. Part 1 of this two-part article will explore the scope of the problem and the principles of delegation, including legal and ethical considerations.

Creating and using index scores in the analysis of school policy implementation and impact.

BACKGROUND: Epidemic increases in childhood obesity and associated health risks are resulting in efforts to implement school policies related to nutrition and physical activity (NPA). With multicomponent policy efforts, challenges exist in characterizing the extent of policy change across the breadth of NPA policies. METHODS: Aggregated policy indices were created to characterize NPA policy implementation in Arkansas public schools from 2004 through 2009. Index scores are presented by year, domain, and school level. RESULTS: Both mean and median index scores increased over time, with greater changes seen in nutrition than in physical activity policy scores. The composite index score was heavily dependent on the nutrition index score and, thus, is relatively less useful for the purposes of our evaluation. Policy index scores varied by school level, rurality, enrollment size, and percentage of students eligible for federal meal programs. CONCLUSIONS: The policy index approach facilitates the consideration of the effect of school policy change in a holistic, aggregated way. School characteristics influence policy adoption, and thus, should be taken into consideration in the promotion of policy change.

Patient advocacy in the community and legislative arena.

Nurses have hundreds of patient experiences upon which to draw in order to impact public policy. It is our obligation to strengthen skills that enable us to influence public policy so we can better serve patients. This article provides examples of how nurses can translate their hands-on experience with patients into steps that will influence policy. We begin by describing advocacy and providing examples of how nurses can advocate in the community, specifically in economic matters and the educational and healthcare systems. Then we describe the process for advocating in the legislative arena. We conclude by noting that the public needs the voice of nursing in public policy and that now is the time to move forward to advocate for patients in these various arenas.

NASN position statement: health care reform.

The National Association of School Nurses supports health care reform legislation passed in 2010 in the form of the Patient Protection and Affordable Health Care Act, PL 111-14. This legal framework for health care addresses some of the documented needs and goals pertinent to the healthcare of our nation's school students.

School wellness policies: opportunities for change.

School districts are required to comply with a 2004 federal mandate to guide nutrition and physical activity environments of schools by developing and implementing wellness policies. The purposes of this article are to (a) discuss the implications of the federal mandate and (b) analyze policies from nine school districts in one large suburban county in Minnesota to assess for compliance, comprehension, and strength. Policy analysis was guided by a coding system that reflected the federal mandate. Only one district met all federal requirements; policy statements from most districts analyzed were nonspecific. Evidence from this analysis supports previous research indicating that many school wellness policies are not comprehensive, lack strength, and do not fully comply with the intent of the federal mandate. School nurses, as stakeholders in school environments, must identify and utilize collaborative opportunities to impact policy development and implementation regarding school nutrition and physical activity environments.

Key components of a school-located vaccination clinic: lessons learned from fall 2009.

The 2009 H1N1 influenza A virus vaccination campaign focused on use of school-located vaccination (SLV) clinics because of the ability of SLV to reach targeted populations. Large numbers of children are found in schools, and schools are conveniently located throughout communities. Communities are generally familiar with and trust schools, and school facilities can generally accommodate mass vaccination clinics. School nurses are familiar with the health of individual students and may be available to assist in vaccination activities. In addition, schools have access to parental contact information, which can facilitate communications. Challenges faced by local health departments (LHDs) and schools in implementing 2009 H1N1 SLV clinics, including disruption of educational activities, locating adequate staff, tailoring immunization activities to meet the needs of each school district, and transportation and administration of vaccine, are explored.

Developing a policy for delegation of nursing care in the school setting.

School nurses are in a unique position to provide care for students with special health care needs in the school setting. The incidence of chronic conditions and improved technology necessitate care of complex health care needs that had formerly been managed in inpatient settings. Delegation is a tool that may be used by registered nurses to allow unlicensed assistive personnel to perform appropriate nursing tasks and activities while keeping in mind that the registered nurse ultimately retains accountability for the delegation. The legal parameters for nursing delegation are defined by State Nurse Practice Acts, State Board of Nursing guidelines, and Nursing Administrative Rules/Regulations. Delegation becomes more challenging when carried out in a non-health care setting. School administrators may not be aware of legal issues related to delegation of nursing care in the school setting. It is crucial for school nurses to have a working knowledge of the delegation process. Development of a specific delegation policy will ensure that delegation is carried out in a manner providing for safe and appropriate care in the school setting.

Acceptance of the use of diazepam rectal gel in school and day care settings.

This study was conducted to identify how often parents of children with epilepsy encounter barriers to the use of diazepam rectal gel in day care or school settings and how these barriers affect the child and family. Sixty-four parents completed an 18-item questionnaire documenting their experience with asking their child's school to administer diazepam rectal gel. No data regarding its actual use in the school was obtained. Forty-three parents (68%) had asked their school to administer diazepam rectal gel; 35 (81%) reported school agreement, and 8 (19%) reported refusal. In 5 of these refusals, the cited reason was legal concerns, and in 5 cases the refusal had some adverse effect on their family's life. Most children prescribed diazepam rectal gel do not encounter resistance to its use in school and day care settings. Barriers to its use are usually due to legal concerns and significantly affect the family's quality of life.

Medication administration practices in Pennsylvania schools.

As a result of various health concerns, children are receiving an increased number of medications while at school. In Pennsylvania, the School Code mandates a ratio of 1 certified school nurse to 1,500 students, which may mean that 1 school nurse is covering 3-5 buildings. This implies that unlicensed personnel are administering medications, a violation of licensing laws in Pennsylvania. The purpose of this study was to determine the policies and practices that Pennsylvania public schools have in place regarding medication administration. The sample consisted of 314 state-certified school nurses who returned a 71-question survey. Findings indicated that school nurses are very concerned about issues related to medication administration. Additional findings identified the lack of standing orders to administer over-the-counter medications, the increase in medication errors when the school nurse had responsibility for multiple buildings, and the lack of understanding of the ramifications of the Nurse Practice Act on school nursing practice in regard to delegation. Recommendations for practice include development of detailed policies and procedures and collaboration among all stakeholders in the development of policies that address legal issues.