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How can I find out what guidelines and standards of practice apply to nurses in specific situations?

Wednesday September 12, 2012
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Dear Nancy,

I am an RN being asked to train only, and not supervise a "task" (i.e. tube feeding, oral suctioning, etc.) in a school setting. I was told that the physician is delegating directly to unlicensed assistive personnel in the school, although I am providing the training and determining competency. I am aware that once the training is completed, there is no mechanism in place for the task to be supervised.

Because I am taking on the training of the task, do I become the respondent superior and own the delegation? Or can I do only the training while the ordering physician retains the delegation of the task?

I am being told I am not a school nurse (I wasn’t hired by the school) and therefore "school nurse" guidelines and standards of practice do not apply to me. Is this true? Or do I become a "school nurse" because I am the only RN providing nursing services in the school?


Nancy Brent replies:

Dear Diana,

Your question raises many legal issues that cannot be responded to in depth in this column. Some general responses will be made, but it would be essential for you to consult with a nurse attorney or attorney in your state who works with nurses and understands your state's school code and the school nurse's role in the school setting.

First, be clear that your role as a school nurse is governed by your state nurse practice act and rules. Therefore, delegation of any nursing responsibility or task must adhere to the state's practice act. Also, know that when one delegates something to another person, the delegatee retains responsibility for the decision to delegate and to whom. A good review for you about delegation is the American Nurses Association's” “Principles for Delegation” (available on the ANA website at www.nursingworld.org) and the National Council of State Boards of Nursing's “Five Rights of Delegation.” (www.ncsbn.org).

The National Association of School Nurses (NASN) has published several documents on delegation in the school setting. They can be accessed at www.nasn.org.

It is unclear what your legal role is if you are not employed by the school. Are you an "independent contractor" contracting with the school to provide the services you do? Is this school a private or public school? Generally speaking, if you are a nurse providing school nurse services in the school, then you are, in reality, the school nurse and should abide by those guidelines and standards of practice.

Most likely, the school board does not want to pay you as a school nurse, or you may not have the required educational preparation for a school nurse required by the state's school code, so the result is to treat you as an RN. Remember, though, the nurse practice act always applies to you, regardless of your role and/or your title.

When a nurse, including a school nurse, delegates to another, no respondent superior relationship exists. The employer, in this case, the school, is governed by this doctrine. It comes into play when, as an example, a nurse or other employee injures a person or patient, and the injured party sues not only the nurse or employee but his or her employer under this doctrine of vicarious liability.

Last, there is an interesting case about delegation, training and supervision of UAPs you might want to review in preparation for your meeting with your attorney. The case, Carol Mitts v. Hillsboro Union High School District No. 3, et al, is a 1990 Oregon case. You can read a brief summary of the case by going to http://www.sde.ct.gov/sde/cwp/view.asp?a=2663&q=334202 . Scroll down the article on the page to PRACTICE BY UNLICENSED PERSONS where the discussion of the Mitts case begins.


Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.