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Arkansas State Board of Nursing

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Arkansas State Board of Nursing ... Medication Administration Ostomy Care ... delegation of nursing task to unlicensed assistive personnel ... – PowerPoint PPT presentation

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Title: Arkansas State Board of Nursing


1
Arkansas State Board of Nursing
  • School Health Services
  • and the Law
  • September 2014

2
School Health the Law
  • Arkansas and Federal laws require schools provide
    free education to Children with Disabilities (in
    the least restrictive environment)
  • Arkansas Nurse Practice Act and ASBN Rules
    regulate the practice nursing

3
School Health the Law
  • RN Scope of Practice
  • The delivery of health care services which
    require assessment, diagnosis, planning,
    intervention, and evaluation
  • LPN/LPTN Scope of Practice
  • The delivery of health care services which are
    performed under the direction of the professional
    nurse, licensed physician, or licensed dentist,
    including observation, intervention, and
    evaluation.
  • ASBN Position Statement 95-1 98-6

4
School Health the Law
  • Education Laws
  • A.C.A. 6-18-1005
  • Student services program defined
  • (a)(6)(A)
  • Students with special health care
  • needs, including the chronically ill,
  • medically fragile, and technology-dependent,
  • and students with other health impairments
  • shall have individualized health care plans

5
School Health the Law
  • ASBN Interpretation
  • The School District is responsible for providing
    a person qualified to develop the individual
    health care plan (IHP.)
  • The person responsible for doing the IHP must
    have within their scope of practice Assessment,
    Diagnosis, and Planning, e.g., RN, APN, or
    Physician.
  • LPN scope of practice does not include
    assessment, diagnosis, or planning.

6
School Health the Law . Education
LawsA.C.A. 6-18-1005 Student services program
defined
  • (a)(6)(B)(i)
  • Invasive medical procedures required by students
    and provided at the school shall be performed by
    trained, licensed personnel who are licensed to
    perform the task subject to 17-87-102 (6)(D) or
    other professional licensure statutes.
  • (a)(6)(B)(ii)
  • The regular classroom teacher shall not perform
    these tasks and 

7
School Health the Law
  • Nurse Practice Act
  • A.C.A. 17-87-102 (6)(D)
  • Practice of professional Registered nursing
    meansany act involving
  • (D) The delegation of certain nursing practices
    to other personnel as set forth in regulations
    established by the board
  • ASBN Interpretation
  • Only Registered Nurses may provide nursing care
    or delegate to qualified individuals certain
    nurse practices as defined in the ASBN Rules
    School Nurse Roles and Responsibilities Practice
    Guidelines.

8
School Health the Law
  • ASBN Interpretation
  • Each Licensed Nurse must practice within the
    scope of practice of their license.
  • LPN/LPTN must work under the direction of an RN,
    APN, licensed physician or licensed dentist.
  • A.C.A. 17-87-102 (5)

9
School Health the Law .Act 1204 of
2011Amends A.C.A. 17-87-103 Exceptions to the
Nurse Practice Act
  • 11 (A) The administration of Glucagon to a
    student who is suffering from diabetes by trained
    volunteer school personnel
  • Trained by licensed nurse employed by school
  • Parent/Guardian sign authorization
  • Volunteer/Nurse Trainer not liable for damages
  • Regular Classroom Teacher may volunteer to be
    trained give Glucagon

10
School Health the Law
  • LPN under the direction of an RN, APN, Physician
    may perform (School Nurse Guidelines)
  • N/G Feeding/Monitoring
  • Gastrostomy Feeding/Monitoring
  • TPN Monitoring
  • Clean Intermittent/Sterile Cath
  • Ventricular Peritoneal Shunt Monitoring
  • Mechanical Vent Monitoring
  • Mechanical Vent Ambu Bag
  • Intermittent/Continuous O2
  • Central Line Cath management

11
School Health the Law
  • LPN under the direction of an RN, APN, Physician
    may perform (School Nurse Guidelines)(cont)
  • Peritoneal Dialysis
  • Medication Administration
  • Ostomy Care Irrigation
  • Pharyngeal/Trach Suctioning
  • Screening, growth, v/s, vision hearing, scoliosis
  • Blood Urine Glucose testing
  • Seizure Precautions
  • Pressure Ulcer Care
  • Sterile/Non-sterile dressings

12
School Health the Law
  • Supervision
  • Merriam-Webster
  • a critical watching and directing (as of
    activities or a course of action.)
  • American Nurses Association
  • is the active process of directing, guiding, and
    influencing the outcome of an individual's
    performance of an activity
  • Adopted by National Association of State School
    Nurse Consultants.

13
School Health the Law
  • Supervision does not require the RN, APN,
    licensed physician or licensed dentist to
    physically be present 100 of the time.
  • The amount of supervision required is directly
    related to the individual LPNs experience,
    skills and abilities and the healthcare needs of
    the students being served.

14
School Health the Law
  • A.C.A. 17-87-102 (6)(D) allows the RN to
    delegate certain nursing practices to other
    personnel as set forth in regulations
  • ASBN Rules Chapter 5 on Delegation sets forth the
    regulations regarding delegation of nursing task
    to unlicensed assistive personnel (UAP.)

15
School Health the Law
  • Criteria for Delegation to UAP
  • Licensed Nurse delegating is responsible for the
    nursing care given to the client
  • Assessment of clients needs prior to delegation
    (IHP update)
  • Task must be one a reasonable prudent nurse
    would delegate
  • Does not require UAP to use nursing assessment,
    judgment, evaluation or teaching skills
  • Does not jeopardize clients welfar
  • RN employed by facility responsible for training

16
School Health the Law
  • Criteria for Delegation (cont)
  • Written procedures for task
  • UAP competency is documented
  • Delegating nurse is readily available in person
    or by telecommunication
  • Licensed nurse is responsible for documentation
  • The licensed nurse adequately supervises the
    performance of the nursing task.

17
School Health the Law
  • Supervision
  • Merriam-Webster
  • a critical watching and directing (as of
    activities or a course of action.)
  • American Nurses Association
  • is the active process of directing, guiding, and
    influencing the outcome of an individual's
    performance of an activity
  • Adopted by National Association of State School
    Nurse Consultants.

18
School Health the Law
  • Supervision is determined by the licensed nurse
    and is dependent on
  • Stability of the clients condition
  • Training and capability of the UAP
  • Nature of the nursing task being delegated
  • Availability of the license nurse

19
School Health the Law
  • Decisions to delegate nursing care to an
    unlicensed person is based upon
  • Students nursing care needs are stable
  • Delegation of task does not pose a potential harm
  • Task involves little/no modification
  • Task has predictable outcome
  • Task does not require assessment, interpretation
    or decision making
  • UAPs skills and competency
  • Availability of supervision

20
School Health the Law
  • Accountability vs Civil Liability
  • The ASBN holds the nurse accountable for
    appropriate delegation of nursing tasks and
    supervision of the UAP.
  • The UAP is accountable for their own actions.
  • May not absolve the nurse of Civil Liability.

21
School Health the Law
  • Insect Sting Emergency Treatment Act
  • A.C.A. 20-13-401
  • Allows parent, camp counselor, scout leader,
    school teacher, chaperone to be trained is use of
    emergency epinephrine by a physician.
  • To administer epinephrine to an individual they
    are responsible for if they have an allergic
    reaction to an insect sting and other allergic
    reactions.
  • School Nurse Guidelines
  • Allows UAP to be trained and delegated the task
    of administering epinephrine to a student with a
    Rx in an emergency situation.

22
School Health the Law
  • More children with more complex healthcare needs
    are attending school
  • The practice of nursing is regulated by the Nurse
    Practice Act and is not always understood by
    school administrations who are in the business of
    education.

23
School Health the Law
  • Immediate reactions are to decrease the
    requirements regarding the provision of Nursing
    Care
  • An alternate solution is to increase the number
    of qualified licensed nurses in order to provide
    the quality nursing care that our children
    deserve

24
Complaints Received
  • Most frequent complaints
  • Didnt give my child their medication
  • Didnt assess my childs condition
  • Gave my child an immunization that was not needed

25
Disciplinary Actions
  • Nurse Imposter
  • Administered wrong dose of insulin

26
Current Issues
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