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The BNE recognizes that the youth of Texas are our most valuable natural resource. The BNE acknowledges that although students come to school with complex and diverse health care needs, they should be provided an education in the least restrictive environment. The BNE recognizes that the school children of Texas have the right to receive safe, appropriate, specialized health services that may be required to assure the child's inclusion in the school environment.
Registered Nurses in the School Setting
The Board of Nurse Examiners (BNE) believes that school nursing is a professional registered nursing (RN) specialty. School nursing involves the identification, prevention and intervention to remedy or modify students' health needs. The RN has the educational preparation and critical thinking skills as well as clinical expertise which are essential to nursing in the school setting. These activities involve the comprehensive assessment of the nursing/health care needs of the student, the development of a plan of care, implementation of the plan, and evaluation of the outcomes. The provision of these services by the RN contributes directly to the students' education and to the successful outcome of the educational process. These essential components of professional nursing practice are the responsibility of the RN in compliance with Rule 217.11(3)(A).
Vocational Nurses in the School Setting
The clinically intensive vocational nursing program curriculum prepares entry level nurses to provide direct patient care to acutely and chronically ill clients/patients in structured health settings (such as acute care and long-term care) who are experiencing conditions with predictable health outcomes. The Differentiated Entry Level Competencies (DELC) define a "structured" setting as "a geographical and/or situational environment where the policies, procedures, and protocols for provision of health care are established and in which there is recourse to assistance and support from the full scope of nursing expertise." Thus, school settings do not qualify as "structured" healthcare settings, and LVN curriculum is not designed to provide competencies in complex independent judgment and decision-making skills.
The provision of nursing care when provided by a Licensed Vocational Nurse (LVN) in a school setting should be under the supervision of the RN. The RN, in compliance with the BNE's Standards of Nursing Practice [Rule 217.11], assigns those aspects and activities to the LVN that are within the LVN's educational preparation and demonstrated competency to provide. The RN monitors, coordinates, and evaluates the provision of health services necessary to meet individual student health needs essential in achieving educational objectives.
RN Delegation to Unlicensed Personnel
Due to the growing number of students entering the school system with special health care needs, the BNE recognizes that not all health-related services can be provided by a RN or LVN. Therefore, the RN may delegate tasks in the school setting in compliance with the BNE's Delegation Rules 224 and 225. School is considered an independent living environment as defined in Rule 225; however, acute or emergency situations in the school setting may be delegated in accordance with Rule 224 as applicable. For example, emergency administration of Epi-pens, Glucagon, and Diastat may be administered by an unlicensed person under §224.6(4) in order to stabilize the child and prevent complications from delaying treatment. The decision to delegate a specific task is always at the discretion of the RN in accordance with §224.8(b)(1)(C) or §225.9(c).
Other Laws Impacting School Health Care
In a school setting, the administration of medication may be assigned to an unlicensed person by the public school official in accordance with the rules of the Texas Education Code. The RN's obligation under §225.13 is to (1) verify the training of the unlicensed person, and (2) verify the competency of the UAP to perform the task. If the RN is unable to assure (1) and (2) have been met, the RN must (3) notify the public school official of the situation.
Summary:
Given the complexity, the current number, and the future projections of increasing numbers of children entering the school system with complex nursing and health-related needs, the BNE believes that the RN must establish a an individualized nursing care plan for each child as applicable. The RN may be assisted by LVNs and unlicensed assistive personnel in the delivery of services to ensure the delivery of safe, effective health care to the school children of Texas.
(Adopted 11/1996; revised 11/1997; revised 01/2003; revised 01/2005)
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