Role of the School Nurse
In 2016, the National Association of School Nurses defined school nursing as:
“A specialized practice of nursing that advances the well-being, academic success, and life-long achievement and health of students.”
The American Academy of Pediatrics, Healthy People 2020, The American Federation of Teachers, The National Association of School Nurses, and the School Nurse Organization of Washington all recognize the contributions of the school nurse to student well-being and academic success.
The role of the school nurse is broad, as defined above, and makes significant contributions to healthy youth and the Whole School, Whole Community, Whole Child model pictured below. (Developed by the ASCD (Association for Supervision and Curriculum Development) and Centers for Disease Control and Prevention)
This manual focuses on the delivery of the Health Services component of the model. It guides the planning of school health services to align with the basic mandates of federal and state law.
•Professional Registered Nurses use a public health, population-based practice to manage resources appropriately for primary and secondary prevention as well as targeted care for students with critical health care needs.
•Nursing practice in school is autonomous and unique, addressing both physical and mental health needs of students and staff.
•Services include health promotion, access or referrals to health care providers, prevention and control of communicable diseases, chronic disease management, emergency care, mental health support, and educational opportunities for students, staff, families, and the community.
School nurse practice is regulated by many layers of legislation, professional boards, guidance from administrative agencies, and professional practice standards.
Throughout this manual, there are references to the various regulations depicted above to clarify specific requirements of school health services. The documents below are essential for school nurses to follow and school administrators to understand:
•School Nursing: Scope and Standards of Practice, 3rd edition (2017) National Association of School Nurses and American Nurses Association; Nurses Books Org. The Publishing Program of the American Nurses Association, Silver Spring, MD.
•Code of Professional Conduct (2014) State of Washington; Chapter 181-87 WAC, Professional Educator Standard Board and Office of Professional Practices at OSPI.
Delegation of nursing care by the school nurse to unlicensed school staff holds the most risk for:
Student health and safety
Registered nurse’s professional practice
In effect, during delegation, the registered nurse transfers nursing tasks to an unlicensed person. Registered nurses do not transfer nursing care, but rather nursing tasks and therefore must still supervise the Unlicensed Assistive Personnel (UAP). The registered nurse provides delegation because the nurse is unable to be on site to provide the task. The registered nurse maintains the responsibility of ongoing clinical supervision and accountability for nurse delegation. For more information about registered nurse delegation in the school setting, see page 32.
The Law Relating to Nursing Care and Regulation of Health Professions—Uniform Disciplinary Act RCW 18.79 and RCW 18.130 define registered nurse practice in the state of Washington and specifically regulate nurse delegation.
•Washington State Nursing Care Quality Assurance Commission
•National Association of School Nurses
•National Association of School Nurses
Position Statement: School Nurse Workload: Staffing for Safe Care, 2018
•School Nurse Resource Guide
•United States Department of Health and Human Services
Healthy People 2030 https://health.gov/healthypeople
•American Academy of Pediatrics
Position Statement: The Role of the School Nurse in Providing School Health Services
•Washington State Nursing Care Quality Assurance Commission and
Office of the Superintendent of Public Instruction
Staff Model for the Delivery of School Health Services (2000) http://www.k12.wa.us/HealthServices/pubdocs/SchHealth.pdf
• OSPI Health Services