Reducing the Risks of Delegation

Abstract

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.

Flying by the seat of their pants: A grounded theory of school nurse case management

“…However, nurse participants described conducting these actions in the practice context of inadequate resources and lack of knowledge of state-wide tools that would support case management. Others have described the lack of resources for training and support for SNCM (Brackney & Cutshall, 2015;Wang & Volker, 2013 Plans (Shannon & Kubelka, 2013). The nurses in this study described the complex work needed to 'master the plans'.…”

The Role of the 21st-Century School Nurse

“…Current school health practice models and school nurse workloads may require school nurses to delegate health care tasks to unlicensed assistive personnel in order to support the health and safety needs of students (Shannon & Kubelka, 2013). However, the availability of school nurses to work directly with students to assess symptoms and provide treatment increases students' time in the classroom and parents' time at work (Lineberry & Ickes, 2015).…”

Unlicensed Assistive Personnel

“…When the school nurse determines the appropriateness of using a UAP and conducts the proper documented training and supervision, the UAP can contribute to the health care needs of students in schools (Resha, 2010;Shannon & Kubelka, 2013). Tasks that may be performed by and delegated to UAP are dependent on state nurse practice laws.…”

“…The UAP must agree to function according to the written instructions of the school nurse. Informing the UAP of the laws that cover and protect them, including state and federal laws and statutes as well as district guidelines and policies, is critical to protect all parties from harm and liability (Shannon & Kubelka, 2013). The capacity of school nurses to effectively provide required supervision of multiple UAP must be considered before using UAP (Hootman, 2013).…”

“…In order to protect the UAP, the school, and the health and safety of students, the school nurse must follow the scope and standards of school nursing, which include carrying out the steps of nursing delegation, thereby setting the boundaries within which UAP can safely and legally function (ANA, 2013). To facilitate a better understanding of the school nurse role and the impact of UAP coverage, communication is needed between school nurses, school administrators, school personnel, and families (Bobo, 2014;Shannon & Kubelka, 2013…”