Manual For School Health Programs


Chapter 2: School Health Services

The school nurse is an integral part of the educational process in a school district and delivers essential services. The school nurse assists children and youth in developing their full potential in health and education. While the instructional staff assumes the major responsibility for teaching children, the school nurse provides supportive professional and specialized health services for the school staff and the students.

“Nurses play multiple roles in acute care, community, and public health settings, through which they can influence the medical and social factors that drive health outcomes, health equity, and health care equity,” according to the National Academies of Sciences, Engineering, and Medicine. The report goes on to say, “school nurses, for example, are frontline health care providers, serving as a bridge between the health care and education systems and other sectors as well as links to broader community health issues through the student populations they serve.”

(National Academies of Sciences, Engineering, and Medicine, 2021, p. 2)

Scope and Standards of Practice for Professional School Nursing

A task force developed standards for school nursing practice in 1983 to inform school nurses, school administrators, families, students, school board members, and the public about the practice of school nursing (Yonkaitis & Reiner, 2022). The American Nurses Association, the American Public Health Association, the National Association of Pediatric Associates and Nurse Practitioners, the American School Health Association, and the National Association of School Nurses were represented on the task force. The National Association of School Nurses and the American Nurses Association last revised the standards in 2022.

All school nurses should obtain a personal copy of the School Nursing: Scope and Standards of Practice.

The standards define the personal responsibility of the school nurse. School districts should use the standards to develop job descriptions and quality assurance tools. The document includes the competencies needed in each area to meet the standard and can serve as a blueprint for professional development to attain the competencies. There are two categories: 1) Standards of School Nursing Practice and 2) Standards of Professional Performance. Review the School Nursing: Scope and Standards of Practice for more information on the competencies and how to use them within a job description or activities.

Table 2. Standards of School Nursing Practice

Standards of School Nursing Practice

StandardNurse Activity
1. AssessmentThe school nurse collects pertinent data and information relative to the student, family, group, school community, or population.
2. DiagnosisThe school nurse analyzes assessment data of the student, family, group, school community, or population to describe actual or potential diagnoses.
3. Outcomes IdentificationThe school nurse articulates measurable expected outcomes for a plan individualized to the student, family, school community, or population.
4. PlanningThe school nurse develops a collaborative course of action that prescribes strategies to attain expected, measurable outcomes that address the student, family, group, school community, or population.
5. ImplementationThe school nurse executes an agreed-upon plan/intervention for the student, family, group, school community, or population.
5A. Coordination of CareThe school nurse aligns care for the student, family, group, school community, or population.
5B. Health Teaching and Health PromotionThe school nurse employs strategies to improve the health and safety of students, families, groups, school communities, or populations.
6. EvaluationThe school nurse systematically appraises progress toward the attainment of student and school population goals and outcomes.

Table 3. Standards of Professional Performance

Standards of Professional Performance

StandardNurse Activity
7. EthicsThe school nurse integrates ethics into all aspects of practice.
8. AdvocacyThe school nurse demonstrates advocacy in all roles and settings.
9. Respectful and Equitable PracticeThe school nurse practices cultural humility and inclusiveness.
10. CommunicationThe school nurse effectively conveys information in all areas of practice.
11. CollaborationThe school nurse collaborates with students, families, and key stakeholders.
12. LeadershipThe school nurse leads within their professional practice setting and the profession.
13. EducationThe school nurse seeks knowledge and competence that reflects current nursing practice and promotes innovative, anticipatory thinking.
14. Scholarly InquiryThe school nurse integrates scholarship, evidence, and research findings into practice.
15. Quality of PracticeThe school nurse contributes to quality nursing practice.
16. Professional Practice EvaluationThe school nurse appraises one’s own and others’ school nursing practice.
17. Resource StewardshipThe school nurse utilizes appropriate resources to plan, provide, and sustain evidence-based nursing services that are safe, effective, financially responsible, and used judiciously.
18. Environmental HealthThe school nurse practices in a manner that advances environmental safety, justice, and health.

School Health Services Personnel

School health teams include a variety of school health services personnel. The size of the district or school may determine how many health team members there are as well as their roles. . The following are suggested health team members. (See Appendix 2A, 2B, and 2C)

Consulting Physician/Medical Advisory Committee

The American Academy of Pediatrics and the American Medical Association encourages school districts to obtain the services of a local physician(s) to provide guidance for the school health program. School nursing personnel can function in expanded roles with standing orders and protocols (collaborative agreements) from physicians, thus enabling better management of illness and injury in the school setting. Having a physician to consult regarding health and safety issues enhances the district’s ability to protect and maintain the health status of students and staff. Physician services are often provided as a community service, but some school districts may choose to employ or contract with a physician for a specified number of hours per school year. A written contract with a physician allows for scheduled time for the school and improves the quality and consistency of the consulting service. Medical advisory committees assist schools in looking at all aspects of the school health program and making recommendations to the school nurse or School Health Advisory Committee.

Qualifications (Minimum Standards)
  1. Currently licensed as a health care professional in Missouri, such as a physician or advanced practice nurse.
  2. Have knowledge of the school-age child, medical-legal issues regarding children and adolescents, and an interest in students’ health and education.
General Responsibilities
  1. Consult with school personnel as necessary.
  2. Serve as a resource for medical information related to the school-age child and adolescent.
  3. Advise in the development of policies and procedures for the health services program.
  4. Support the district health services policies, procedures, and programs.
  5. Meet with health services staff annually.
  6. Sign-off on emergency protocols and standing orders as needed and appropriate.

Registered Professional Nurse (RN)

Qualifications
  1. Currently licensed to practice in the state of Missouri.
  2. Currently certified in CPR/basic life support.
General Responsibilities
  1. Comply with the code of ethics of the nursing profession and uphold and implement school rules, state laws, administrative regulations, and board of education policies.
  2. Provide leadership in assessing, planning, implementing, and evaluating a school health program.
  3. Act as manager for the district health services program:
    1. Utilize the nursing process to address students' special health concerns. This includes developing emergency and health care plans for students with special needs.
    2. Manage the school health office, including maintaining school health records.
    3. Provide a system for preventing and controlling communicable diseases, including pandemic events.
    4. Manage a safe medication administration program.
    5. Assess, plan, and implement age-appropriate screening programs and follow-up on referrals for identified health needs.
    6. Assist in training, supervising, and evaluating paraprofessionals/unlicensed assistive personnel (UAP) working in the health program.
    7. Provide support and resources for the health instruction program.
    8. Assist in monitoring the school health environment to assure health and safety (i.e., participate in crisis intervention planning, develop emergency action plans for students with special health care needs, monitor injury reporting system, etc.).
    9. Liaise between home, school, and community health care providers.
  4. Participate as a member of the school health team, assisting others in carrying out health-related programs (i.e., physical education, school food service, guidance and counseling, employee wellness activities, and family and community involvement).
  5. Responsible for the identification and reporting of suspected child abuse and neglect.
  6. Participate as the health professional in staffing meetings, evaluation of students with special health care needs, and student assistance teams.
  7. Provide leadership in developing/mobilizing community-based school health advisory groups; network with community agencies to identify physical and mental health needs of children, youth, and families; and collaborate to develop programs to meet the identified needs.
  8. Maintain professional competence through in-service and professional activities (e.g., membership in professional organizations related to school nursing and school health).

The Missouri Nurse Practice Act allows for the delegation of nursing tasks that do not require nursing assessments to properly trained and supervised UAPs. The Missouri Nurse Practice Act implies that if the RN determines the learning needs of the person to whom they are delegating a task, teaches the information needed, assesses the mastery of the tasks, and periodically monitors and supervises the performance, the RN may use his/her professional judgment in delegation. The RN maintains control over the delegated activities. The RN who supervises UAPs must use their professional judgment regarding the level of performance and the ability of the individual when delegating nursing tasks. They should not delegate nursing tasks to an individual for whom they have no authority for evaluation and supervision.

Educational Preparation

A basic nursing program (diploma or associate degree) will prepare the nurse to provide basic nursing functions to assess, plan, intervene, and evaluate health conditions. A nurse with a baccalaureate or master’s level of education brings additional skills to the school setting for assessing, planning, and intervening in population-based programs and for participating in formal health instruction activities.

Reporting

The school nurse reports to the health services coordinator and/or the building principal. In all health-related matters, the school nurse works under the supervision of the school nurse coordinator, the school physician, and/or the school district health officer. In areas without a nurse supervisor or coordinator, the school nurse reports health-related matters to the principal or designee.

Terms of Employment

The school will specify the number of days worked in a school year and the number of hours per day.

Evaluation

Job performance is evaluated in accordance with the board of education/superintendent’s policy for employee evaluation. Developing an evaluation tool using the School Nursing: Scope and Standards may provide a framework for evaluation based on the responsibilities of school nursing rather than those in the education field. A nurse should evaluate clinical practice.

Licensed Practical Nurse (LPN)

Qualifications
  1. Currently licensed to practice in the state of Missouri.
  2. Currently certified in CPR/basic life support.
General Responsibilities
  1. Participate in implementing a school health program.
  2. Participate in the maintenance of school health records.
  3. Triage of illness and injury in school setting according to protocols and school district policy.
  4. Perform health screening according to protocols and school district policy.
  5. Administer medications and treatments according to school district policy.
  6. Identify and report suspected abuse and neglect.
  7. Perform nursing care for children with special health care needs per physician orders.
  8. Perform other health-related tasks as deemed necessary.

Note: By state law, Chapter 335, LPNs must practice under the supervision of a registered professional nurse or a licensed physician. LPNs are allowed to provide nursing care without direct physical oversight but must be under the supervision of a registered professional nurse or a licensed physician.

Educational Preparation

Graduate of an accredited, licensed practical nursing program.

Terms of Employment

The school will specify the number of days worked in a school year and the number of hours per day.

Paraprofessionals/Unlicensed Assistive Personnel (UAP)

Qualifications
  1. Current in basic first aid and CPR training.
  2. Adequate office management skills (i.e., typing, filing, and computer skills).
  3. Training in issues of confidentiality and infection control.
General Responsibilities
  1. Provide basic first aid for illness and injury according to written school policy and procedures.
  2. Maintain health records and perform clerical duties as assigned.
  3. If trained appropriately, may perform initial screening procedures for vision, hearing, and growth, etc.
  4. Maintain health office and equipment.
Education and Preparation

The UAP should have a high school diploma or equivalency certificate.

Reporting

The UAP reports to the registered nurse supervisor and building principal.

Terms of Employment

The UAP is often employed on an hourly basis and only on days that school is in session.

Use of Unlicensed Assistive Personnel in the School Setting

The area of school nursing is known for the under-utilization of skills and expertise at all levels of personnel, from the school nurse to the health clerk. For a school nurse to perform clerical tasks and other non-nursing functions is not a cost-effective use of professional expertise. An alternative is to use appropriately prepared unlicensed assistive personnel (paraprofessionals) in the school setting when they are available, whether it is a paid health clerk/aide, a parent volunteer, or a student clerk. These paraprofessionals can make an effective contribution to the school health program, making it possible for the nurse to focus on professional nursing tasks.

The use of unlicensed assistive personnel requires a management approach to school nursing programs. Management has been defined as accomplishing organizational goals through the collaborative efforts of others. Having paraprofessionals available extends the school nurse's ability to serve more students more effectively. The school nurse must be able to assess the program needs and develop and implement a plan through delegation to individuals with the skills to perform these tasks.

Community Health Nurses in Schools

Community health nurses are resources to school nurses and school districts. School health programs and community health programs often have similar goals. Local public health agencies have a responsibility for population-based services, and school nurses are positioned to collaborate with the local public health agency to meet that mandate. When school districts do not have school nurses, they might consider contracting with the local public health agency for the desired services. Such services might include training school personnel in medication administration, assessing students with special health care concerns to determine the level of services needed, and consultation on special health and safety issues.

Guidelines for the New School Nurse

It is both exciting and overwhelming to be a new school nurse. Once hired, the new school nurse should meet with the school or district administrator and review the following:

  1. The school district’s philosophy for the school health program, including the use of the secretary and/or unlicensed assistive personnel (UAP).
  2. The written job description for the school nurse.
  3. The written school health policies and procedures, school health manual, and guidelines.
  4. Orientation to the buildings and grounds and introduction to key personnel in the district.
  5. The school calendar, building schedules, and individual class rosters.

The new school nurse should continue programs in operation according to accepted policies and procedures until he/she has an opportunity to assess the program and work with the SHAC and administration to identify desired changes. If there are no current written procedures, the nurse should identify those with top priority and draft them for the superintendent’s review and approval. (See Laws, Rules and Regulations Relating to School)

It is crucial to understand that states/jurisdictions have different laws and rules/regulations about delegation, and it is the responsibility of all licensed nurses to know what their state Nurse Practice Act (NPA), rules/regulations, and policies (NCSBN & ANA, 2019) permit.

When possible, the nurse should accomplish the following activities before school begins:

TaskQuestions to considerResources
  • Meet with the building principal(s), district or lead nurse or supporting physician and office staff to determine communication patterns for the exchange of information (mailbox, emails, phone calls, referrals to nurse, notification of teachers, staff meeting schedule, etc.).
  
  • Locate the school health office(s).
  • What clinic space and supplies are available?
  • What is needed?
  • How are supplies obtained?
  • See Appendix 2D for a list of recommended school health facilities and supplies
  • Locate the health records.
  • What type of information has been collected?
  • Who records the information?
  • How current are the records?
  • What students have health problems and how has that information been shared?
  • Are records computerized?
  • Are records stored in a locked file separate from the educational records?
  • See Laws, Rules and Regulations Relating to School
  • Develop a school nurse schedule to meet the identified needs based on the number of buildings, the number and types of students, the number of grades per school, the days of special education staffing, and individual building schedules. Get the schedule approved by the building administrator.
 
  • See Appendix 2E for Suggested School Nursing Calendar
  • Meet the faculty and describe the nurse’s role and procedure for referrals. Discuss medication administration, including the use of over-the-counter medications. Provide faculty with a copy of the nurse’s schedule.
  
  • Meet the special education coordinator in each building. Find out when building-level conferences are held.
  • What is the procedure for service referral and how is the nurse notified of students who need evaluation?
  • Who obtains permission for assessment and who sets the dates for team conferences?
 
  • Meet with the food service manager and workers, bus drivers’ supervisor and custodian.
  
  • Develop or update a community resource file.
  • Is there a school health advisory council?
  • What emergency services are available?
  • What resources does the local public health department have?
  • What mental health services are available for students in crisis?
  • What community service organizations exist and what are their areas of interest?
  • Who are health care providers and how are services accessed?
  • Who are the contacts at the social services agencies?
 
  • Identify the data collected to document the school nursing activity for accountability and quality assurance.
  • Are new data sources needed?
 
  • Become familiar with the school district policies and procedures, laws, rules, and regulations relating to the school health program.
  
  • Identify resources for professional support, i.e., in-service and consultation available through the local, district, and state departments of health and education.
  
  • Contact the DHSS state school nurse consultant for information on school nurse orientation, program guidelines, training for screening programs, school nurse continuing education opportunities, contacts with district, state and national professional organizations, etc.
 
  • See Resources for School Health Programs for contact information
  • Request an opportunity to visit a school nurse in a neighboring district. It is an inexpensive continuing education and an opportunity to begin networking with colleagues.
 
  • See list of resources for school health program
  • Learn what printed materials, such as journals and manuals are available.
 
  • See list of resources for school health program

“The guidelines within the state nurse practice act and the state nursing regulations provide the framework for safe, competent nursing practice. All nurses have a duty to understand their nurse practice act and regulations and to keep up with ongoing changes as this dynamic document evolves and the scope of practice expands.”

(Russell, 2017, p. 22)

Delegation

There are five rights to delegation, according to the National Council of State Boards of Nursing:

  1. Right task—does the task fall within the job description of the delegated party? Is there a written procedure/policy to follow?
  2. Right circumstance—is the patient stable and is there a predictable outcome?
  3. Right person—does the delegated party have the necessary skills/knowledge to perform the task?
  4. Right directions and communication—has the licensed nurse instructed the delegated party on the task? Is the delegated party able to identify changes in the student’s condition and to communicate changes with the licensed nurse so that the licensed nurse can reassess the student? Has the delegated party accepted the delegation?
  5. Right supervision and evaluation—is the licensed nurse able to monitor the delegated activity and follow up with the delegated party after the activity to evaluate patient outcomes? (NCSBN & ANA, 2019).

It takes time and practice to become seasoned at delegation. Asking questions, reviewing policies and procedures, reviewing job descriptions, and reviewing state laws and the state’s Nurse Practice Act are all part of the big picture of delegation. The following information will help the school nurse go step by step in asking themselves whether a nursing procedure could be delegated, but it is always the school nurse’s final decision on whether it is safe to do so.

Delegation Decision Making Tree
Image: Decision Tree for Delegation by Nurses

The Delegation Decision-Making Tree, a tool developed by the ANA and modified by other organizations, assists nurses in making delegation decisions. Licensed nurses have ultimate accountability for the management and provision of nursing care, including all delegation decisions.

To use the Delegation Decision-Making Tree, start with a specific client (student), caregiver (UAP) and nursing activity. Beginning at the top of the tree, ask each question as presented in the box. If you answer “no” to the question, follow the instructions listed to the right of the box and arrow. If you answer “yes,” proceed to the next box. If you answer “yes” for any question, the task is delegable.

Recordkeeping

The Missouri Secretary of State’s Office is responsible for updating any changes to the law in the recordkeeping for school districts. The school nurse will need to identify the staff person in charge of the school district’s records and seek instruction from them on the district’s current system. Some districts keep all records electronically in a student information system while other districts still use paper copies. Whatever system the district uses, they must maintain health records according to state and federal laws and keep records available only to those with a need to know.

The Family Educational Rights and Privacy Act (FERPA) pertains to student records developed by a school district, while Health Insurance Portability and Accountability Act (HIPAA) records normally pertain to a clinic or hospital. The Family Educational Rights and Privacy Act (20 U.S.C. § 1232g; 34 CFR Part 99) is a federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education. The Health Insurance Portability and Accountability Act of 1996 is a federal law that requires the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. (For more information on these two acts, please see Laws, Rules and Regulations Relating to School.)

Use the following chart to understand the retention of school health records according to Missouri law.

Table 4. Local Records Retention Schedules

Local Records Retention Schedules

Record TypeRecordFunction of the RecordRetention Requirements
Individual Student Records

Cumulative Health Record

May include:

  • School health clinic record
  • Physician orders for medications, treatments, procedures
  • Treatment records and drug distribution, and other services received through school nurse's office (flow charts for asthma peak flow readings, seizure logs, blood glucose, catheterizations, tube feedings, etc.)
  • Parent(s)/guardian(s) consent for medication, treatments, procedures
  • Behavioral assessments (assessment of drug or alcohol use, observations for medication effects (ADD/ADHD)
  • Injury reports from health care provider (i.e., care and activity restrictions, physician releases, or exclusion from sports/school), hospital records
  • Child abuse and neglect documentation–notes, graphics
  • Screening reports from medical professionals
  • Head injury notes
  • Immunization records
Record specific to a student with health history, immunization records, including immunization exemptions, screening results, etc.10 years or age 23
Special Education RecordsRecords needed for student’s Individualized Education Program (IEP)

Destruction of Information (34 CFR 300.624): The public agency shall inform parents when personally identifiable information collected, maintained, or used under this part is no longer needed to provide educational services to his/her child.

The information must be destroyed at the request of the parent subject to the federal requirement that districts retain records for a minimum of three (3) years from the date the child no longer receives special education and related services.

Various Health RecordsEmergency Cards (renewed annually)

May contain:

  • Student name
  • Address
  • Parent information
  • Doctor’s name
  • Hospital preference
  • Medical history
1 year
Health Care PlansSummary of nursing plan of care for students with special health needs1 year
Immunization “in progress” formsDocuments staff is verifying student is current until next scheduled immunization is dueUntil next immunization is complete (Revised 8/09)
Incident ReportsIncident reports–record of internal concerns, medication errors Stored separately from student records

(Missouri Secretary of State, 2023; RSMo 167.027)

Resources

Table 5. Resources for School Health Programs

Resources for School Health Programs

Missouri Department of Health and Senior Services (DHSS) [NEEDS LINK]

The Department employs a state school nurse consultant to provide consultation to school nurses, school administrators, agencies, and organizations interested in school health, and the public on issues pertaining to health services in schools. Contact the state consultant via phone at 573-522-2822 or e-mail at SHS@health.mo.gov. 

DHSS has many school health-related materials available on the school health website, free of chare. Schools may copy or adapt for use without permission, any DHSS material.

Missouri Department of Elementary and Secondary Education (DESE)

The following resources are available from DESE’s website:

Missouri Department of Social Services (DSS)

Guide for Mandated Reporters of Child Abuse and Neglect (2020)

Missouri Department of Mental Health

Find information on the location and types of DMH funded programs available including children’s services

Missouri State Board of Nursing

Find information related to RN/LPN practice on the Boards website under the “Practice” tab. Also find on this site:

Missouri Secretary of State

Local Records Retention Schedules

Missouri Association of School Nurses

The association provides leadership and promotes professional growth to advance the practice of school nursing.

National Association of School Nurses

  • Publications on a variety of issues such as screening programs, education programs, evaluation of programs and practices, etc.
  • Journals, newsletters, publications, manuals, and videos for professional development of nurses; and
  • Position statements on issues related to school nursing, including delegation issues.
PediaLink: American Academy of Pediatrics Education — Where Knowledge Thrives
The National Association of Councils on Developmental Disabilities
Resha, C., & Taliaferro, V. (2024). Legal Resource for School Health Services. School Nurse.com: Virginia

Table 6. Resources for Professional Development for School Nurses

Resources for Professional Development for School Nurses
Using the Standards of School Nursing Practice as a guide, school nurses may identify a need for continuing education (CE) in an area but have difficulty accessing a program due to geography, cost, or time. Online courses are readily available on many topics. School nurses may provide a copy of CE certificates to the school administration, which will be placed in their personnel file. It is evidence that the school nurse is a life-long learner and that the nurse is keeping their knowledge and skills up to date.
The Public Health Foundation’s TRAIN.org is a nationwide network of universities focusing on workforce development for individuals working in public health settings, including schools. The St. Louis University School of Public Health Learning Management System (LMS) is part of this network, as is the Centers for Disease Control and Prevention (CDC) and the Federal Emergency Management Agency (FEMA). School nurses can access courses in principles of public health, epidemiology, disease prevention, HIPAA, emergency preparedness and response, etc. Most courses are free, and learners can complete them in segments, take mastery testing and download completion certificates. TRAIN and LMS will track courses completed and provide transcripts.
The Department of Mental Health encourages all individuals who might respond to an emergency or disaster to access the National Child Trauma Safety Network course on psychological first aid. This 12-hour interactive course is free of charge, and participants can download a certificate when they complete it.
Members of the National Association of School Nurses (NASN) have access to many continuing education opportunities, free of charge. Courses currently available through NASN include education on immunizations, leadership, collaboration, standards of practice, quality improvement, and many others. NASN also has an annual conference at which school nurses can earn CE’s.

The Centers for Disease Control and Prevention website offers information on health-related topics, including:

Nurse.com provides many short courses on all aspects of nursing.
Show Me School Health provides school nurses free videos, information, and procedures to help educate school nurses and other staff.
School Health Associates, LLC has many videos, procedures, and modules that school nurses can review.
The Missouri Association of School Nurses has opportunities for continuing education at their conferences for both members and nonmembers.

Chapter 2 References

Appendix 2A: Sample List of Responsibilities for Registered Nurse Supervising LPNs

The nurse supervisor will:

  1. Health Office Management
    1. Be available to LPN for consultation by telephone or in person.
    2. Provide guidelines/protocols for care of illness and injury.
    3. Review health room logs routinely (frequency determined by RN).
    4. Review medication and treatment logs on a routine basis and maintain a record of review.
    5. Consult with LPN concerning students with health and absentee problems.
    6. Develop or maintain a community resource file for access to care and referrals.
  2. Special Health Care Needs
    1. Assess students with special health care needs to determine the level of care needed.
    2. Identify students needing health care plans (Emergency Action Plans, Individual Health Care Plans, Individualized Health Care Action Plans, Section 504 Accommodation Plans, etc.) and prepare as needed. Provide staff education regarding chronic health conditions as needed.
    3. Participate in observation of students with ADD/ADHD when requested.
    4. Develop individualized health care plans (IHP) for students with chronic illness or disability in collaboration with LPN.
    5. Provide support for/assist the LPN in the implementation activities of IHP or other caregivers, as appropriate.
  3. Screening Programs
    1. Determine the frequency of screenings by program and grade after consultation with school administration.
    2. Assist LPN with initial screening programs, including students with special needs, if needed.
    3. Rescreen all students identified with possible defects, review health history and consult with parent(s)/guardian(s) as needed in making referral decisions.
    4. Monitor referral completion rates and assist as needed with parental contact.
    5. Prepare health information from screenings for IEP staffing as requested.
  4. Education
    1. Provides support for/assists LPN to provide in-service to designated school personnel on medication administration.
    2. Provide classroom instruction on health topics when appropriate and as requested.
    3. Provide student-specific information to teachers regarding students with special health care concerns.
    4. Assist teachers in finding health instruction resources.
    5. Provide input regarding health instruction/curriculum needs.
  5. Other Duties
    1. Assess the school environment on a routine basis, including playground equipment, restrooms, etc.
    2. Support/assist LPNs during illness outbreaks (e.g., data collection and management of health concerns).
  6. Evaluation
    1. Meet with LPN to monitor school health nursing activities, including triage of illness and injury, medications and treatments, absenteeism, etc. (frequency determined by RN, suggested minimum is four hours per week).
    2. Determine and educate the LPN new to school nursing and evaluate competencies on a regular basis.
    3. Review the results of screening programs to determine a plan for the subsequent school year.
    4. Meet on a routine basis with the LPN and school administrator to review the program.
    5. Collaborate with school administrator in performance evaluation of LPN.

Appendix 2B: Sample List of Responsibilities for Licensed Practical Nurse

Under the Supervision of a Registered Nurse

  1. Health Room Management and Triage
    1. Maintain cumulative health records.
    2. Maintain a daily log of all students seen in the health room.
    3. Follow established policies and procedures for the care of ill and injured students.
    4. Follow up with students with excessive absences for health reasons and consult RN.
    5. Send out referral letters for health problems and screening failures after rescreening by RN and making referral decisions, if applicable.
    6. Follow up on referrals and track referral status.
    7. Implement a fluoride rinse program and maintain the required record of the program if the district is participating in the fluoride rinse program.
    8. Maintain health room supplies and equipment.
    9. Prepare weekly reports of nursing activity for school administration.
    10. Identify possible abuse and neglect and follow the district reporting procedures.
  2. Special Health Care Needs
    1. Participate in developing emergency action plans for students needing emergency provisions.
    2. Implement individual health care plans, including special care procedures, as approved by RN or physician.
    3. Provide vision and hearing assessment for students being evaluated for special education placement and report findings to RN and Special Education team, if applicable.
    4. Provide health information to students and families as needed.
  3. Screening Programs
    1. Screen all new students for height/weight, vision, hearing, and dental problems within one week of enrollment.
    2. Do initial screening for vision and hearing problems per district policy/protocol.
  4. Education Activities
    1. Provide health instruction to students, teachers, parent(s)/guardian(s), and community as needed.
    2. Assist teachers in finding resources for health education.
    3. Participate in community outreach programs.
    4. Assist school food service personnel in promoting healthy food choices.
    5. Assist school personnel with health needs, as indicated.
  5. Evaluation
    1. Meet weekly with the nurse supervisor to monitor school health nursing activities, including triage of illness and injury, medications and treatments, absenteeism, etc., and with the school administrator at least monthly regarding the school health program.
    2. Review medications and treatments at least weekly with the nurse supervisor, if applicable and necessary.

Appendix 2C: Sample Agreement for Supervision

By state law, Chapter 335, LPNs must practice under the supervision of a registered professional nurse or a licensed physician. LPNs can provide nursing care without direct physical oversight but must be supervised by a registered professional nurse or a licensed physician. School Districts may modify this template to include protocols and procedures specific to the individual school district.

 

Sample Agreement for Supervision

Appendix 2D: School Health Facilities and Supplies

The school’s health facilities should accommodate all school health activities, such as emergency care of illness and injury, health appraisals, routine screenings, conferences, private interviews, etc. Lavatory and toilet facilities are essential for infection control. The preferred location is adjoining the administrative offices to facilitate communication and provide for supervision of the health room when the nurse is not present. The facility should be located on the ground floor, near an entrance, to expedite transportation of the sick and injured.

The number of students served and the components of the health services program will determine the number of individual areas in the health facility. There should be space for isolation of students, as well as a resting area. It is also helpful to have a large enough area to conduct routine screenings. A private office and a separate waiting room are desirable.

School health facilities should also allow for storage of health records in locked file cabinets in the health room, which should also be locked when not in use. Staff must also keep medications in locked cabinets. Controlled substances should be kept in locked boxes in a locked cabinet or room. The nurse and administrator should control access to keys. A refrigerator is needed in which to store medication that needs to be refrigerated, and a freezing compartment is helpful for storing readily accessible ice packs.

Table 7. Suggested equipment and supplies for the health room

LocationRecommended Supplies
Reception Area and Office
  • Clock with second hand
  • Desks and chairs
  • Lockable filing cabinet(s)
  • Telephone with access to an outside line
  • Copies of program guidelines
  • Disease-specific manuals and nursing texts
  • Pediatric reference books
  • Computer
  • Printer
  • Wi-Fi Access
Assessment Area
  • Thermometers
  • Stethoscope
  • Flashlight
  • Sphygmomanometer with assorted cuff sizes
  • Scale
  • Gooseneck lamp
  • Sharps container
  • Vision screening equipment
  • Puretone audiometer
  • Non-latex disposable gloves
  • Masks
  • Emergency medications including:
    • Albuterol, if standing order
    • Epinephrine, if standing order
    • Naloxone, per school board policy and protocol
  • Copies of standing orders, self-carry policies
  • Some schools may be equipped with special care equipment including:
    • Peak flow monitoring devices
    • Nebulizer
    • Source of glucose
    • Suction equipment
    • Automatic external defibrillator (AED)
    • Nasal oxygen, if ordered
    • C-spine immobilizer
    • Tympanometer
    • Stop the Bleed packs, if trained
Infirmary Area
  • Antiseptic soap
  • Ace bandages
  • Activated charcoal
  • Bandages with nonstick pads, assorted sizes
  • Basin for soaking
  • Biohazard bags
  • Bleach
  • Box/cabinet with lock for medications
  • Cots (low, flat, with washable surfaces)
  • Cotton balls in a container
  • Elastic wrap
  • Emergency blankets
  • Emergency medications
  • Emesis basin
  • Flashlight
  • Folding screen for privacy (or curtains)
  • Forceps
  • Gauze pads in assorted sizes
  • Hot water bottle
  • Ice packs
  • Masks
  • Nebulizer
  • Non-latex disposable gloves
  • Paper cups and dispenser
  • Paper towels
  • Refrigerator
  • Resealable plastic bags
  • Safety pins
  • Sanitary napkins (individually wrapped)
  • Scissors (bandage, cuticle, and all-purpose)
  • Splints

“Emergency Go Bag”

Some schools have
developed
“Emergency Go
Bags” containing
materials and
supplies that are
readily accessible
and portable in the
event of an
emergency,
requiring an
alternative location
to provide
emergency care
until emergency
personnel arrive.

  • Folder of Emergency Action Plans
  • File of emergency information and contact for students and staff, including allergies.
  • Forms for documentation of care provided in emergency for EMS or hospital personnel.
  • First aid supplies including gauze, tape, absorbent pads, and splints.
  • Stop the Bleed supplies including a tourniquet and trauma shears
  • Masks, gloves
  • Pens, pencils, and markers
  • Safety pins, clips, or tape for attaching emergency information to the student
  • Materials for triage designation
  • Hand sanitizer
  • Paper towels
  • Resuscitation masks
  • Supplies provided for emergency needs of children with special health care concerns, including medications, bottled water

Appendix 2E: Suggested School Nursing Activity Calendar

Note: A program this extensive is not appropriate for a new school nurse to implement but may provide ideas for organizing activities.

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