Nursing Update Joan Keith, MEd, RN, LSN, NCSN School Nurse

Nursing Update Joan Keith, MEd, RN, LSN, NCSN School Nurse Consultant May 6, 2022 Ohio Association of Pupil Services Administrators

Provide update Objective regarding School Nurses and health services in the school setting.

If you’ve seen a nurse, you have seen one nurse . we are all different! Be aware of the differences in licensure, education, training, and experiences. Each nurse has unique background of experiences. Be aware of the differences in scope of practice (i.e., RN vs LPN). Pay attention to the nurse’s credentials. In Ohio, a nurse must clearly display name and type of nursing license. Ex: Joan Keith, RN Only a person who holds the Ohio Board of Nursing license as a nurse may call herself or himself a nurse. Only a RN can evaluate another nurse’s clinical practice. When determining compensation, consider compensation based on all of the years of nursing experience.

School Nurse Credentialling Ohio Department of Education provides credentials for nurses working in the school setting. Options include: School Nurse License. o Temporary. o 5 Year. School Nurse Registration. All require background checks. https://education.ohio.gov/Topics/Teaching/Licensure/Apply-for-Certificate-License /Pupil-Services-Licenses

Must have a Registered Nurse (RN) license from the Ohio Board of Nursing. School Nurse License: Temporary Must submit official transcripts from an accredited college or university verifying a minimum of a bachelor’s degree with their initial license applications. Annual renewal requires ( 40): Six (6) additional semester hours of coursework in an approved school nurse licensure program. Must submit official university transcripts reflecting the completed coursework with their renewal application. Only issued at the request of an employing Ohio school or district.

School Nurse License: Five Year Must have a Registered Nurse (RN) license from the Ohio Board of Nursing. Must complete an Ohio Department of Higher Education approved school nurse licensure program. Minimum of a Bachelor’s Degree is required. Renewal every five years ( 200). https://education.ohio. gov/getattachment/To pics/Teaching/Licensur e/Apply-for-CertificateLicense/Pupil-ServicesLicenses/Licensure-Co nsiderations-for-Health -Care-Professionals-1. pdf.aspx?lang en-US

Must have a Registered Nurse (RN) license from the Ohio Board of Nursing. School Nurse Registratio n-New! Minimum of a Bachelor’s Degree is required. The registration is a NEW option for pupil services providers. It is not required for providers to hold both the registration and the pupil services license. Renewal every five years ( 150). Does not require additional coursework regarding working in the school setting as required for School Nurse Licensure.

Substitute School Nurse License No longer available on the ODE website.

Ohio Board of Nursing “Actively Safeguarding the Health of the Public Since 1915.” Regulates over 300,000 licenses and certificates for registered nurses (RNs), licensed practical nurses (LPNs), advanced practice registered nurses (APRNs), dialysis technicians (DTs), community health workers (CHWs) and medication aides (MA-Cs). Licensure requirements are specified in the Nurse Practice Act, Chapter 4723., and the Ohio Administrative Code Chapters 47231 through 4723-27. https://nursing.ohio.gov/licensing-certification-ce/

Registered Nurse (RN) Must complete a Board approved RN education program and pass minimum competency National Council Licensure Examination (NCLEX). Curriculum minimum of two years full time study regarding the art and science of nursing care across the lifespan, including lab and clinical experiences.

Licensed Practical Nurse (LPN) Must complete a Board approved LPN education program and pass minimum competency National Council Licensure Examination (NCLEX). Curriculum shall consist of content that spans a minimum length of thirty weeks of full-time study, including examination time. A practical nursing education program that is offered to students at the secondary or high school level may be commenced no earlier than the beginning of a student's junior year. Not eligible for an ODE school nurse license or registration.

RN and LPN Scope of Practice Licensed Practical Nurse (LPN) Registered Nurse (RN) Independent authority to “Dependent" practice, engage in all aspects of meaning authorized to practice. practice only when directed by an RN. Determines data needed for Collects data for nursing nursing assessment. assessment. Determines the nursing plan Implements nursing plan of of care-directs an LPN to implement or delegates to care as directed by RN. May others. delegate to others if directed *The LPN is accountable to identify the RN or other authorized health care provider by RN. who is directing the LPN’s practice. Otherwise, the LPN may be engaging in practice beyond the LPN authorized scope.*

RN and LPN Scope of Practice RN and LPN Scopes of Practice: https://nursing.ohio.gov/wp-content/uploads/2020/02/RN-LP N-Scope-of-Practice-2019.pdf . RN and LPN Decision Making Model: https://nursing.ohio.gov/wp-content/uploads/2019/10/decisio n-making-model20191007 14055357.pdf . RN and LPN Practice FAQs: https://nursing.ohio.gov/wp-content/uploads/2019/10/10.8.1 9-RN-LPN-FAQs-2019.pdf .

Immunization Requirements Contained in the Director’s Journal and updated as necessary. Immunization summary created annually and shared with school nurses to assist in immunization record review. ODH Immunization program collects information from schools each year (due October 15). ODH Immunization program surveys random sample of schools to validate reporting. https://odh.ohio.gov/know-our-programs/Immunization/Immunization

Immunization Requirements https://odh.ohio.gov/wps/wcm/co nnect/gov/9683ace0-573f-4ed3b9d4-08d714d1fb85/Ohio%2BIm munization%2BSummary%2B324-2022.pdf?MOD AJPERES&CO NVERT TO url&CACHEID ROOT WORKSPACE.Z18 M1HGGIK0N0J O00QO9DDDDM3000-9683ace0573f-4ed3-b9d4-08d714d1fb85n.lvOYg

Additional Annual Deadlines Vision and hearing screening reporting: Kindergarten and new-to-the-district student reporting is due November 1. https://odh.ohio.gov/k now-our-programs/chil dren-s-hearing-visionprogram/screening-rep orts

Medicaid Schools Program (MSP) Includes federal Medicaid matching funding for medically necessary therapy services, certain administrative activities, and specialized transportation associated with accessing therapy services. Nursing services eligible for MSP reimbursement must be provided: By a licensed nurse (cannot be delegated care). To students who are: Medicaid eligible. Have an Individualized Education Program (IEP).

Role of the School Nurse Great overview of role of Related Service Providers may be found on the ODE website at https://education.ohio.gov/Topics/Special-Education/Related-Servi ces Includes information about education and professional practice of: Educational Audiologist and Speech-Language Pathologist. Occupational and Physical Therapists. School Psychologist. School Nurse.

Role of the School Nurse Summary includes 14 bullets of what they can do. Includes: Development of individualized healthcare plans (IHPs) and emergency action plans (EAPs) for students, nursing delegation, and training of staff regarding these plans. Provide care provision or coordination and contribute to Individual Assessment Team (IAT), 504 plan and individualized education program (IEP) processes. Considering the additional workload of the pandemic, there are many more activities done by the school nurse to support the school community. https://education.ohio.gov/Topics/Special-Education/Related-Services/School-Nurs e

Nursing delegation is subject to the Ohio Nurse Practice Act. Role of the School Nurse Only a Registered Nurse can determine if a nursing task can be delegated to an unlicensed person (such as secretary, teacher, or principal). Delegating nurse must: Be available by telecommunication when the task is being done. Train the delegee on how to do the nursing task. Periodically observe the task being done in case there is a need to retrain the delegee or retract delegation.

Role of the School Nurse Nursing delegation is subject to the Ohio Nurse Practice Act-nurses cannot delegate medication administration. In the school setting, school administration designates which school employee will administer medication. Administration must ensure the designated employee is trained to administer medication by a licensed health professional. Ohio law (ORC 3313.713) does not address if or how often medication administration training must be repeated. School nurses can provide this training. There are resources on the ODH website to help them do that: https://odh.ohio.gov/know-our-programs/school-nursing-progra m/conferences-trainings .

Employment of the School Nurse School nurses are not mandated in Ohio law. Therefore, all employment decisions about school nurses are made at the local level. School nurses may be: Board hired. Provided by the local health department. Provided by a hospital. Provided by a staffing agency. Funding also varies by district.

Employme nt of the School Nurse An individual school may have a combination of board hired and contracted nurses. If contracting with an entity, ensure that lines of authority and communication are outlined in the agreement. To whom does the nurse report? Their employer? The school? Who can direct and evaluate their practice? Their employer? The school? Who is responsible for finding a sub if they are unable to work? Their employer? The school? This also includes “Private Duty” nurses.

Summary Registered nurse has an independent scope of practice. A licensed practical nurse must have a RN directing the care provided. A licensed practical nurse has a dependent scope of practice. In general, most school nurses possess years, even decades, of nursing experiences.

Questions? Thank you for your time and attention.

Contact Information Joan Keith, MEd, BSN, RN, NCSN Ohio Licensed School Nurse State School Nurse Consultant Ohio Department of Health [email protected] 614-728-2953