If the school nurse is not employed during the summer school, there is no nurse coverage. All previous training and delegation is null and void if the nurse that provided the delegation is not available for ongoing supervision and assessment of student health status. If that school nurse is employed for the summer, then the initial training and delegation could be used if the nurse is comfortable with the staff training already provided. If a new nurse is hired, new training and delegation must be provided. Training and delegation does not transfer between nurses.
If there are students with special health care needs who attend summer school when the nurse contract is not actively employed, it is important for the district administrators and school nurse to plan for the following:
For the school nurse:
Obtain a list of students that will be attending summer school. The nurse reviews the list, identifies students with special health care needs, and determines the amount and degree of nurse training, delegation, and supervision that is appropriate/needed for those students.
Provide a description of student needs for health care to the district administrator, including the level of nursing care required and the recommended nursing coverage for those students. The nurse needs to clearly state the risk to the student and the risk to the district if a system of care is not in place for summer session.
Assess what health services are needed by a particular student and determine those services that can be safely delegated to unlicensed staff. Only a registered nurse is allowed to delegate tasks to unlicensed staff within the school setting. (NCQAC Advisory Opinion: Registered Nurse Delegation in School Settings, 2014)
Determine if the delegated nursing care can be safely supervised by an on-call, stand-by, off-campus contract or if the level of nursing care being delivered needs to have ongoing supervision by a nurse on site or in the district.
* “If delegation of [nursing tasks] by a school nurse to unlicensed school staff is based on the premise that the nurse will be immediately available in a crisis (i.e., one that can be reasonably anticipated), then delegation of the [nursing task] …away from the availability of the nurse to intercede in a crisis – will not be appropriate.”
Options that the nurse may recommend for summer nurse coverage based on the nursing needs of students:
▪ On-site nursing services.
▪ On-call nursing services. On-call is not just “available by phone.” It is a formal contract, and the nurse is paid a specific rate to be in “stand-by mode” and is available to come on site quickly if necessary. Note: this does not replace responsibility of unlicensed staff to initiate emergency medical services when indicated.
For the district administrator:
Provide the school nurse a list of students that will be attending summer school. Nurse will review list, identify students with special health care needs, then assess, determine and recommend the amount and degree of nurse training, delegation, and supervision that is appropriate/needed for those students. There needs to be a plan for on-going monitoring of late enrollments in summer school and those that may occur during the summer months when the school nurse is on leave.
Discuss the nurse’s recommendations for the delivery of health services during summer school based the registered nurse’s assessment of the students’ health care needs and nursing care needed based on their clinical judgment.
The district administrator makes the final decision to authorize nursing coverage for summer school based on student needs, nurse recommendations, and district resources.
When it is determined that nursing services for summer school are needed, options to consider for nursing coverage (on-call or on-site) may include:
▪ Extend the contract with their school nurse if that nurse chooses to work summer hours
▪ Contract with another nurse who wants summer hours
▪ Contract with a nursing agency for summer coverage
Negotiate a contract with a nurse or nursing agency based on district resources. There should be a written contract including a statement of work and salary; and the district administrator and nurse or contracting agency should sign the contract.
* Direct Reference:
▪ Schwab, N.C., and Gelfman, M.H.B. (2001) Legal Issues in School Health Services: A Resource for School Administrators, School Attorneys, and School Nurses. Sunrise River Press: North Branch, MN (pp 222-225).