Download Code of Ethics for School Nursing and more Summaries Medical ethics in PDF only on Docsity!
Chapter 1
Wisconsin Department of Public Instruction
School Nursing
Introduction
School nursing in the United States has existed for decades for the purpose of supporting the educational mission of schools by preventing, removing, and/or reducing barriers to student learning. In recent years, school nurses have become increasingly more integral to America’s schools. The deepening of that relationship has been motivated and supported, in great part, by legal initiatives such as Section 504 of the Rehabilitation Act of 1973, the Individuals with Disabilities Education Act (IDEA and IDEA reauthorization of 2006), and its predecessor, Public Law 94-142. Each of these helped to make the distinct missions of schools and school nursing more complementary.
While more recent laws are now on the books and numerous excellent nursing-preparation programs exist in the United States, a limited number of nurse-training programs include a specialty with a focus on school nursing. Thus, nurses who undertake school nursing after graduation or upon leaving traditional hospital/clinic work are often unprepared for and overwhelmed by the unique demands of professional practice in the school environment. A nurse’s related frustration can be heightened by the unique distinctions between the mission of schools and the mission of providing health care.
Nursing education teaches nurses to understand and support their profession within a variety of traditional health care settings, where the mission of intervening to preserve and promote good health is consistent with the mission of nursing. A school’s mission, however, focuses on and promotes academic learning, both creative and disciplined. The nurse’s focus within a school system is to mitigate the effects of students’ health concerns on their ability to learn. When the effects of a student’s health conditions are managed during the school day, that student is able to come to school and learning is optimized. Many studies have documented the benefits of school nurse practice in reducing absenteeism (Allen, G. 2003; Weismuller, P., et al. 2007).1, 2
This chapter gives an overview regarding the school nurse and the practice of school nursing. Important Parallels History of School Nursing School Nursing Definition Role of School Nursing Framework of Nursing Practice Code of Ethics Scope and Standards Culturally Competent Staffing o Patterns, Ratios, and Roles o Health Care Personnel for the School Setting o Special Needs vs. Private Duty Nursing o School Nurses Practicing Below Their Licensure
Chapter 1
Wisconsin Department of Public Instruction
School Nurse Education, Certification, and Licensure o Preparation and Education o Certification o Licensure o DPI School Nurse Licensure o Wisconsin Licensure Program Content Guidelines Funding o Special Education Categorical Aid o Medicaid Reimbursement for School-Based Services o High Cost Categorical Aide o Local Funding Evaluation of School Nursing Programs and Policies o Coordinated School Health Programs o Wellness Policies o Response to Intervention o Positive Behavioral Interventions and Supports Conclusion
Important Parallels
As with any profession, school nurses must rise to the challenge of balancing professional responsibilities with the quest to fulfill personal goals. Knowing how the professional responsibilities of different positions will interact with one’s own job can make that balancing act even more fruitful. When nurses and teachers understand each other’s work, they have the opportunity to eliminate confusion and more fully understand how their work interacts to support the development of competence and academic success in children.
Just as nurses have different styles and approaches to help promote the healthy development of children and youth, teachers have different styles and strategies for helping children learn. Those styles are usually defined or influenced by a unique mix of factors from the realm of profession and practice.
Both the nursing and teaching professions are influenced and shaped by outside forces and concepts, including licensing, credentialing, education degree programs, and by standards of professional practice and conduct. Such measuring devices help define the professions as a whole and involve or affect large groups of people.
Conversely, practice embodies the inner forces that drive the individual: background, training, personal style, and individual strengths and weaknesses. These factors help shape the individual’s performance and behavior within the professional role.
History of School Nursing
The disciplines of school and public health nursing have their roots in England in the late 19th century. Through transatlantic contact between the Secretary of London’s School Nursing
Chapter 1
Wisconsin Department of Public Instruction
contract for service with other agencies or organizations will want to have a contract or memorandum of understanding that outlines the nurse’s duties and responsibilities.
Role of the School Nurse
The role of the school nurse has evolved and follows the school nursing definition. The National Association of School Nurses has developed seven roles of the school nurse. The role of the school nurse includes: providing direct care to students and staff; providing leadership for the provision of health services; providing screening and referral for health conditions; promoting a healthy school environment; promoting health; serving in a leadership role for health policies and programs; and serving as a liaison between school personnel, family, community, and health care providers.
The school nurse may take on additional roles based on the unique population demographic and community health needs.
Provides Direct Care to Students and Staff
School nurses provide the knowledge and skill for provision of direct health care in the school setting. Direct care involves the provision of care for accidental injury, illness management, medication administration, and nursing procedures. The nurse acts as a health care resource person in the planning for emergency care and disaster preparedness in the schools. Delegation of nursing tasks to others involves training, competency validation, supervision, consultation, and evaluation by the school nurse. The nurse is instrumental in providing a system for care to assure that the health needs of the students are addressed during the school day and at all school-sponsored events.
Provides Leadership for the Provision of Health Services
School nurses should provide information and leadership regarding the model of school nursing care employed at the local level. The model of school nursing practice provides information regarding the role of nursing personnel, which may include registered nurses, licensed practical nurses, nursing assistants, and unlicensed assistive personnel. The school should develop job descriptions with responsibilities, duties, and qualifications for each level of nursing personnel employed by the school district. School nurses are involved in the organization and implementation of education and training of nursing personnel. School nurses can also be instrumental in the annual review and evaluation of emergency nursing services by the school board.
Provides Screening and Referral for Health Conditions
School nurses are involved in the development of local policies and procedures for health appraisals in the school setting. The school nurse participates in the identification and referral of
Chapter 1
Wisconsin Department of Public Instruction
health concerns that affect an individual’s health and ability to learn. Examples of health assessments in the school setting include: developmental, physical, hearing, vision, growth, blood pressure, and scoliosis screening. School nurses may provide information on health resources to referred students and families. The school nurse makes appropriate referrals to the medical providers for further assessment and treatment as necessary. Documentation of significant findings and implementation of necessary school accommodations minimizes the impact of the student’s learning.
Promotes a Healthy School Environment
School nurses provide technical support and guidance in the development of policies and procedures related to environmental health. This may include blood borne pathogen training, immunization compliance, communicable disease management, injury prevention, air quality, pest management, and animal policies that impact the health of the school environment. The school nurse can help provide the ongoing surveillance to the obstacles to health and strategies to improve the health of the school environment.
Promotes Health
School nurses provide individual and group health-related education of students and school personnel regarding preventative health promotion measures and management of health conditions. In order to promote health, school nurses develop health and education plans for children with acute and chronic health needs in the school. Nurses provide emergency and individual health care plans to outline how school nursing services will be provided during the school day. The school nurse provides essential health information for educational plans indicating how the child’s health condition impacts their ability to learn.
Serves in a Leadership Role for Health Policies and Programs
In accordance with Wis. Admin. Code PI 8.01(2)(g) or Standard G, a registered nurse licensed in Wisconsin must be involved in the development of policies that address emergency nursing services in school districts. The policies for emergency nursing services must include protocols for dealing with student accidental injury, illness, and medication administration. The statutory definition of a professional nurse and the Standards of Practice of the Registered Nurse in Wis. Stats. ch. 441 or the Nurse Practice Act defines further leadership roles. (See Chapter 2 for more information regarding definitions.) The school nurse is a leader on the coordinated school health team, providing knowledge and skills for the development and implementation of a coordinated school health program.
Serves as a Liaison between School Personnel, Family, Community, and Health Care Providers
The school nurse is the communication conduit between schools and health care providers and community health care organizations. The school nurse guards the confidentiality of all students and families, sharing only the health information with the school staff that have an educational need to know. The health information shared should only be the essential information needed to provide for the health and safety of the student. Communication with the family is provided by school conference, written communication, emails, telephone calls, and home visits. The school
Chapter 1
Wisconsin Department of Public Instruction
Chapter 1
Wisconsin Department of Public Instruction
Public Health Intervention Wheel-School Nurse Applications
Individual, School Community, and System Interventions
Disease and Health Event Investigation
Student assessments Disease surveillance Foodborne illness and environmental investigations Outreach (^) Parent-teacher conference Options for reproductive care NASN eyeglass program DentalGive a Kid a Smile Newsletters Community primary and specialty care providers Community service organizations Screening Screening programs for students: hearing, vision, blood pressure, scoliosis, dental, and growth Screening program for staff: blood pressure, cholesterol, blood sugar Referral and Follow-Up
Medical Mental health Dental Child protection services Case Management (^) Individualized Education Plans (IEP) Section 504 evaluations Individual and emergency action plans Chronic disease management Liaison between the school, parent, medical, and community health organizations Delegated Function Nursing tasks Procedures Medication administration Health Teaching Classroom presentations Small groups (i.e. asthma, hygiene, and high risk groups) 1:1 nurse/student teaching Presentation to parent teacher organizations Newsletters, student newspapers, announcements, parent notifications Counseling 1:1 nurse/student counseling Small group Parent-child counseling Consultation Teacher referrals Pupil Services staff Student service teams School’s medical advisor
Chapter 1
Wisconsin Department of Public Instruction
Code of Ethics for School Nursing
The National Association of School Nurses has established a Code of Ethics for the practice of school nursing. The code is centered on three aspects of school nursing: client care, professional competency, and professional responsibilities.
School nurses are advocates for the care of students and professionals working in the school setting. The school nurse intervenes to provide positive outcomes for illness prevention and health promotion and case management in collaboration with other school and health professionals. The services of school nurses are provided with dignity and respect. Each individual needs to be provided with equal service regardless of socioeconomic status, race, gender, sexual orientation, disability, culture, and religious beliefs.
The school nurse must maintain and enhance their professional knowledge and skill to provide safe and competent nursing care. School nurses also need to be knowledgeable regarding the federal and state laws as they affect school health and nursing practice. Nurses are accountable for nursing actions and judgment in their school nursing practice. The responsibilities of the professional school nurse are embedded in the expansion of knowledge and improvement in the standards of practice in school nursing through collaboration and research.^14 Adapted from National Association of School Nursing, Code of Ethics, 2002.
Scope and Standards of School Nursing Practice
The scope of practice statement is a description of the school nursing practice. Initially, the scope of practice was written by Donna Mazyck and Leslie Cooper. In 2011, the standards of school nursing practice were modeled after the language in the American Nurses Association Nursing: Scope and Standard of Practice (ANA, 2011). This template was carefully modified to reflect the practice of school nursing. In 2004, the National Association of School Nurses Board of Directors submitted the scope and standard for school nursing for review by the American Nurses Association’s (ANA) committee on Nursing Practice Standard and Guidelines. Six Standards of School Nursing^14 :
Standard 1 AssessmentThe school nurse collects comprehensive data pertinent to the client’s health or the situation. Standard 2 DiagnosisThe school nurse analyzes the assessment data to determine the diagnosis or treatment. Standard 3 Outcome IdentificationThe school nurse identifies expected outcomes for a plan individualized to the client and situation. Standard 4 PlanningThe school nurse develops prescribed strategies and alternatives to attain expected outcomes. Standard 5 ImplementationThe school nurse implements the identified plan.
Standard 6 EvaluationThe school nurse evaluates progress toward attainment of outcomes.
The standards go on to address the performance of school nursing.
Chapter 1
Wisconsin Department of Public Instruction
Standard 7 Ethics—The school nurse practices ethically.
Standard 8 Education—The school nurse attains knowledge and competency that reflect current nursing practice.
Standard 9 Evidence-based Practice and Research—the school nurse integrates evidence and research findings into practice.
Standard 10 Quality of Practice—The school nurse contributes to quality nursing practice.
Standard 11 Communication—The school nurse communicates effectively in a variety of formats in all areas of nursing practice.
Standard 12 Leadership—The school nurse demonstrates leadership in the professional practice setting and the profession
Standard 13 Collaboration—The school nurse collaborates with the healthcare consumer, family and others in the conduct of nursing practice.
Standard 14 Profession Practice Evaluation—The school nurse evaluates one’s own nursing practice in relation to professional practice standards and guidelines, relevant statutes rules and regulations.
Standard 15 Resource Utilization—The school nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible.
Standard 16 Environmental Health—The school nurse practices in an n environmentally safe and healthy manner.
Standard 17 Program Management—The school nurse manages school health services.
Culturally Competent
With the United States and Wisconsin becoming much more diverse, school nurses need to continue to work on becoming culturally competent. The Transcultural Nursing website states, “to be culturally competent the nurse needs to understand his/her own world views and those of the patient, while avoiding stereotyping and misapplication of scientific knowledge.” Awareness of personal biases can identify areas where the nurse may need more knowledge and skills. The school nurse needs to be creative and flexible in the application of culturally sensitive interventions for the provision of health care in the school setting. Culturally competent nursing practice can lead to better health care outcomes and academic achievement.
School nurses can also be advocates for the school building and district to become culturally competent. Cross, T., B Bazron., K. Dennis, and M. Isaacs. 1989 Toward a Culturally
Chapter 1
Wisconsin Department of Public Instruction
descriptions might include required training, education, experience, certification requirements, working relationship and communication patterns, principal responsibilities and duties, and evaluation procedures (sample job descriptions in appendix). If nursing services are provided by a contracted service with a third party agency or service, a contract or memorandum of understanding may be developed that includes many of the aspects of a job description including substitute or back-up provisions for the nurse and any other health services staff. The job description, contract, or memorandum of understanding becomes the school district’s legal documentation of the expectations of the nursing services staff.
According to the generally accepted guidelines^5 by the American Nurses Association (ANA) and the National Association of School Nurses (NASN), the recommended full-time nurse-to- student ratio is:
1:750 in general school populations 1:225 in mainstreamed populations 1:125 for student populations with complex health care needs 1:1 for a student who requires daily and continuous professional nursing services
In addition to the population groups noted above, other population groups can make unique demands on school nurses. These populations include students: in early childhood; classified as “at risk”; from low-income families; from families with limited English proficiency; with special educational needs; and with physical, psychological, and social problems.^5
Consistent with the guidance of the American Nurses Association^6 and NASN (2015),^7 the Wisconsin Board of Nursing (1992) recommends nurse-to-student ratios that take into consideration the quality and complexity of the health needs of students, the availability of nurses and assistive personnel to provide care, and the need to ensure adequate supervision of assistive personnel. Administrative personnel should consider their own liability in observing and supporting safe nurse-to-student ratios.
The American Academy of Pediatrics (AAP) supports having a “full time nurse in every school as the best means of ensuring a strong connection with each student’s medical home.”^8 Physicians see the school nurse as the health care representative on site. AAP fully recognizes the relationship between health and learning and the school nurse’s role in promotion of every student’s well being and academic success.^9
Since student health issues have a greater impact on the educational mission of the school than ever before, school nurses and other school staff members must work cooperatively in addressing such issues. To help school nurses and others coordinate such efforts, it is important to outline each person’s role, responsibilities, and lines of authority to provide effective care.
Chapter 1
Wisconsin Department of Public Instruction
Health Care Personnel in the School Setting
School Health Personnel Title and Description
Legal Requirements Recommendations Health-Related Activities
Health services coordinator
None (^) Coordinated health services program Leadership for health initiative Health services policies and procedures Budget Work with administration regarding school nurse staff Advance practice nurse
Licensed RN Prescriptive authority, Nurse Practioner Certification
Current CPR/AED and First Aid Certification
Advanced physical assessment Prescribe authority (optional) Other school nurse activities listed below School nurse (Wis. Adm. Code PI 34.01(52m)
Licensed RN
Course in public health
Current CPR/AED and First Aid Certification
Physical and health assessment Participation in Section 504 accommodation plan, and individual education plans Assessment of impact of health issues on ability to learn Direct care of injury and illness Identification, assessment, planning, intervention, and evaluation of student health concerns Nursing procedures and training Screening and referral Health education and curriculum recommendations
Chapter 1
Wisconsin Department of Public Instruction
School Health Personnel Title and Description
Legal Requirements Recommendations Health-Related Activities
Documents care and referral to school nurse and health care provider Reinforces teaching by nurse and primary health provider Maintains confidentiality of health issues and records School health assistant
Current CPR/AED and First Aid Certification
Under the direction of a nurse: Provides basic first aid Assists with monitoring, reporting, and documenting Provides appropriate follow-up referrals to school nurse Assists with maintenance of immunization and health record Administers medication and carries out nursing procedures Helps maintain health office supplies and equipment Maintains confidentiality of health issues and records Medical advisor Licensed physician (Wis. Adm. Code 8.01(2)(g)3)
Volunteer or contracted service
Review and approve standing orders Review policies and protocols Accidental injury Illness Medication administration Provide consultation issues
Chapter 1
Wisconsin Department of Public Instruction
School Health Personnel Title and Description
Legal Requirements Recommendations Health-Related Activities
Communicable or contagious disease Students with special health care needs School district administrator
DPI Certification (^) Collaborate with school nurse regarding health care mission Supervision of school personnel Policy role Assist with health services resources Liaison between school nurse and school board Health classroom teacher
DPI Teacher Certification—Health
Teaches health curriculum Classroom teacher DPI Teacher Certification Bachelor’s degree in education
Identifies health and safety concerns in the classroom and school Refers students to health services with health and education concerns Implements health related programs Participates in IEP meetings
See Chapter 2, School Nursing and Health Services Laws, regarding the legal definitions of school and licensed practical nurse.
Special Needs Nurse vs. Private Duty Nursing
There are two different mechanisms for employing nurses to care for an individual student or small group of students with complex health needs. Districts can either hire a special needs nurse or contract with a third party to provide the nursing service.
School districts may hire nurses, usually called special needs nurses, who only provide care for an individual student or small group of students. The special needs nurse’s job description outlines nursing and educational duties and relationship and responsibilities of communication between the special needs nurse and the school nurse, district, parents, and medical providers.
Chapter 1
Wisconsin Department of Public Instruction
degree from an accredited college or university. The American Academy of Pediatrics (AAP)^8 supports these recommendations and the goal of professional preparation and selection of school nurses to facilitate and provide school health services.
Certification
Certification in school nursing is not required. However, it does help ensure that the school nurse possess the core knowledge for competent practice beyond the licensure as a registered nurse.^13
The National Board for the Certification of School Nurses is an independent organization which develops, administers, and evaluates a national certification examination for school nurses. Successful completion of the examination will result in the school nurse earning the credential of Nationally Certified School Nurse. Certification is then renewed every five years with successful completion of continuing education requirements or retests with a passing score. The National Association of School Nurses has developed a book, School Nursing Certification Revie w ,^12 to assist a school nurse in preparing for the examination.
Licensure
State law requires a nurse to be a registered nurse licensed under Wis. Stat. ch. 441 through the Wisconsin Department of Regulation and Licensing, and to complete a course in public health nursing in order to practice school nursing in Wisconsin. A Wisconsin Department of Public Instruction (DPI) school nursing license is not required by state law. However, DPI licensure is available under Wis. Admin. Code PI 34.31(2). Please see the University of Wisconsin-Madison requirements for the institution endorsement that leads to DPI school nursing licensure. Following completion of an approved higher education program in school nursing and upon receiving the institutional endorsement, the school nurse can apply for a school nurse license by submitting an application form and fee to the DPI.
The school district must provide school nurses holding an Initial Educator License with ongoing orientation, support seminars on the standards, mission and goals of the school district, a qualified mentor, and shall designate an administrator to serve on the school nurse’s professional development plan (PDP) team. A nurse with an Initial Educator License must create and successfully complete a PDP for their license renewal. The PDP is a three- to five- year process of planned professional growth and the evidence of that growth on student learning. In the PDP process, the school nurse would develop professional goals, objectives, and timelines with appropriate collaboration and evaluation to advance his/her school nursing practice. School nurses who were licensed through the DPI as professional school nurses before August 1, 2004, have the option of completing either six semester credits of course work in five years or a PDP for license renewal.^13
Chapter 1
Wisconsin Department of Public Instruction
Professional Development Plan at a Glance
Educator’s Name: _________________________ Educator’s Phone Number: ____________ Educator’s Address: ____________________________________________________________ Educator’s SS#: ___________________________ Educator’s Fax Number: ______________ Educator’s E-mail: _____________________________________________________________ Educator’s School District: __________________ School Year Plan Submitted: ___________ Current Educational Assignment: ____________ No. of Years in Current Assignment: _____ No. of Years of Educational Experience: ______________________ Licensure Renewal Date: ___________________ License(s) to Be Renewed: ____________
Present Licensure Stage : Initial Educator, Professional Educator, or Master Educator Licensure Stage Sought : Professional Educator Professional Licensure Category : Teacher Administrator Pupil Services
Step I: Preparing to Write the Plan: SELF-REFLECTION
Step II: Writing the Plan: COMPONENTS
If you have identified more than one goal in your plan, follow Step II, A–E, for each goal: A. Description of School and Teaching/Administrative/Pupil Services Situation B. Description of the Goal(s) to be Addressed C. Rationale for Your Goal(s) and Link to Self-Reflection, Educational Situation, and Standard(s) D. Plan for Assessing and Documenting Achievement of Your Goal(s) E. Plan to Meet Your Goal(s): Objectives, Activities and Timeline, and Collaboration
Date goal(s) (including Step II, A–E) submitted to the PDP Team: ______________________ Date goal(s) approved/not approved by the PDP Team: _______________________________
Step III: Annual Review of Your Plan (To be completed in years two, three, and four of the licensure cycle.) A. Completion dates for objectives and activities completed during each year B. Reflection summary of your growth made throughout the year C. Description of any revisions made in your goal(s), objectives, or activities
Step IV: Documentation of Completion of Your Plan (To be completed at the conclusion of the licensure cycle.) A. Three to five pieces of evidence B. Reflection and summary of your professional growth and its effect on student learning
Also include your Annual Reviews and, for the initial educator, your approved and signed Goal Approval Form.
Date plan submitted to the PDP Team: ____________________________________________ Date plan verified/not verified by the PDP Team: ___________________________________
