Delegation
Position:
It is the position of the Oregon School Nurses Association that;
All students are entitled to safe and effective management of their
special health care needs while at school.
A registered nurse, knowledgeable in school nursing, must individualize
and supervise the health care at school to safely meet student's special
health needs.
Only a registered nurse, in accordance with Oregon's Nurse Practice Act,
can determine whether, and to what level, non-nurses may be involved at
school in a student's specialized health care.
Definition:
Delegation is a term used in many fields, but holds a unique
place and meaning in the practice of nursing. It is a complex legal and
clinical process. It means authorizing and supervising a person in
the performance of a task of skilled nursing care while retaining
accountability for the outcome. (Oregon Nurse Practice Act Div 47,
ANA, 1994;NASSNC, 2000; NCSBN, 1995; NASN, 2005)
The Issue:
Many Oregon students are impacted by health conditions that affect their
health, safety, and learning at school.
Growing numbers of Oregon students depend upon help with medical
assistive devices and procedures during the school day such as clean
intermittent catheterization, gastrostomy tube feeding, suctioning,
oxygen administration, tracheostomy care, postural drainage, nebulizer
use, and blood sugar regulation and management via blood glucose
monitoring and insulin administration. This assistance allows them full
access and participation in their educational setting. (ODE)
Federal legislation, Oregon Statutes, and other case law determinations
obligate schools to provide school health services necessary for a
student's access to a free and appropriate education. (Section 504; OLS;
Cedar Rapids)
A registered nurse, knowledgeable in school nursing, is uniquely
qualified to assess a student's individualized health care need,
develop an individualized health care plan for school, determine
which healthcare tasks can safely be delegated, and evaluate
treatment outcomes.
The responsibility for the delegation of nursing tasks in the school
setting rests solely with the registered nurse. (Mitts) Delegation
may occur when the nurse cannot provide a student's necessary
treatment but such delegation may not be appropriate for all
students or all school settings. The nurse delegates procedures/tasks
based on the needs and condition of the student, stability and acuity of
the student's condition, potential for harm, complexity of the task, and
predictability of the outcome (ANA, 2001; NASN 2005).
Other considerations include consistent available staff, a setting void
of distracting interruption and the ability of the registered nurse to
adequately supervise given staffing levels and travel distances. When
the registered nurse determines appropriate, the implementation aspect
of the nursing process can be delegated, but not assessment, diagnosis,
outcome identification, planning or evaluation. (ANA & NASN, 2001)
Rationale:
The Individuals with Disabilities Education Act (IDEA) and Section 504
of the Rehabilitation Act provide students needing health services the
right to remain in school and to have their health care needs met to
enhance optimum learning. (504; Schwab and Gelfman, 2001)
Student's health needs may not be safely managed without professional
nursing assessment, development of individualized health care plans and
evaluation of treatment outcomes. In accordance with Oregon Revised
Statutes 678.010 to 678.410, state licensure is required for the
practice of professional nursing. (ORS)
The Oregon Department of Justice determined the responsibility for
delegation of nursing tasks in the schools are the sole responsibility
of the registered nurse. (DOJ)
The Oregon State Board of Nursing ruled that provided school health
services adhere to established standards of professional nursing
practice. (Mitts)
The Supreme Court has upheld the school districts obligation to provide
school health services as provided by a qualified school nurse. (Cedar
Rapids)
Bibliography
American Nurses Association [ANA] (1994). Registered professional
nurses and unlicensed assistive personnel. Washington, DC; Author.
American Nurses Association [ANA] (2001). The Code of Ethics. Washington
DC; Author.
Cedar Rapids Community School District v. Garret F [Cedar Rapids].
119S.Ct.992,29 IDELR 996 (U.S.199). http://supct.law.cornell.edu/supct/html/96-1793.ZS.html.
Department of Justice, General Counsel Division: [DOJ] DOJ file No.
581020-GE0111-05.
National Association of School Nurses [NASN] (2005). Clarification on
the process of delegating in the school setting; Ensuring Safe effective
care for students. Washington DC: Author
http://www.nasn.org/Portals/0/statements/consensusdelegation.pdf
National Association of School Nurses and American Nurses Association
[NASN & ANA] (2001). Scope and Standards of professional school
nursing practice. Washington DC: American Nurses Publishing.
National Association of State School Nurse Consultants [NASSNC] (2000).
NASSNC Position Statement- Delegation of school health services. Kent,
OH; Author.
National Council of State Boards of Nursing [NCSBN] (1995).
Delegation: Concepts and decision-making process. Chicago, IL:
Author.
National Council of State Boards of Nursing [NCSBN] (1997). Delegation
decision-making tree. Chicago, IL: Author.
Oregon Department of Education [ODE] School Support Services. pg 7-12.
http://ode.state.or.us/groups/supportstaff/hklb/schoolnurses/medicallyfragile.pdf
Oregon Department of Educations [ODE] Annual Report Card 2004. pg 58
http://ode.state.or.us/data/annreportcard./rptcard2004.pdf
Oregon Nurse Practice Act [Div 47]. Division 47. Sections
851-047-0000-0030
http:www.Oregon.gov/OSBN/pdfs/npa/Div47.pdf
Oregon Legislative Statutes [ORS]. (2005) 343.146
http://landru.leg.state.or.us/ors/343.html
Oregon State Board of Nursing. (1988) [Mitts] Declaration Ruling on a
petition filed by Hillsboro Union High School District No. 3., Assistant
Superintendent of Personnel Gerry C. Elstun for Hillsboro Union High
School District No.3., Linda Potts, and Mary M. Elskamp RN and by Carol
Mitts.
Rehabilitation Act of 1973 [Section 504] (1973). 29 U.S.C 794;
Regulation at 34 C.F.R. 104. http://www.dol.gov/oasam/regs/statutes/sec504.htm
Schwab N.,Gelfman,M. [Schwab] (2001). Discrimination in schools: 504,
ADA, and Title IX Legal Issues in School Health Services: A resource
for school administrators school attorneys school nurses . pg
335-371 eds. Sunrise River Press: North Branch MN
Position:
It is the position of the Oregon School
Nurses Association that all students are entitled to a safe and healthy
school environment and that management of special health care needs must
be individualized and directed by a registered nurse knowledgeable in
the practice of school nursing.
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