School Nursing Practice FAQs
SCOPE OF PRACTICE
We are often asked questions about the Scope of Practice within the nursing professions in New York. The following is from the Office of Professions website.
What are the three distinct licenses within nursing in New York State and how are they defined?
A Registered Professional Nurse (RN) may:
diagnose and treat a patient’s unique responses to diagnosed health problems;
- perform health assessments to identify new symptoms of possibly undiagnosed conditions or complications
- teach and counsel patients about maintenance of health and prevention of illness or complications;
- execute medical regimens as prescribed by licensed physicians, dentists, nurse practitioners, physician assistants, and podiatrists, and,
- contribute as members of an interdisciplinary health care team and as consultants on health related committees to plan and implement the health care needs of consumers.
A Licensed Practical Nurse (LPN) provides skilled nursing care tasks and procedures under the direction of an RN, physician, or other authorized health care provider.
A Nurse Practitioner (NP) is an RN who has earned a separate license as an NP through additional education and experience in a distinct specialty area of practice. Nurse practitioners may diagnose, treat, and prescribe for a patient’s condition that falls within their specialty area of practice. This is done in collaboration with a licensed physician qualified in the specialty involved and in accordance with an approved written practice agreement and protocols. Nurse Practitioners are autonomous and do not practice under the supervision of the collaborating physician.
How do I know what falls within my legal scope of practice?
If the concern is related to school nursing, you can begin by calling our Center. If you need additional assistance, you can contact the NYS Board for Nursing by mail at: NY State Education Department, 89 Washington Ave.-Education Building, State Board for Nursing, Second Floor, West Wing, Albany NY 12234 or by email at firstname.lastname@example.org, or by telephone at 518-474-3817 ext. 120.
Can a licensed practical nurse (LPN) practice independently?
No. New York State Education Law § 6902 requires LPNs to practice under the direction of an RN, clinical nurse specialist, NP, physician, dentist, PA, specialist assistant, podiatrist, or midwife (“directing practitioner”). The directing practitioner must provide an appropriate degree of direction to the LPN, which is determined by the care needs of the patients and the skill and ability of the LPN. In most cases, the directing practitioner must be on premises when LPNs provide nursing care. The directing practitioner does not necessarily have to be on premises to direct an LPN where: (1) the LPN has demonstrated competence to meet the nursing care needs of the LPN’s patients; (2) the LPN’s patients are highly unlikely to require personal intervention by the directing practitioner; and (3) the directing practitioner is available to direct the LPN by telephone and can personally intervene within 15 minutes to ensure timely and appropriate care. The directing practitioner remains ultimately responsible for providing appropriate direction by phone or in person to ensure patient or client safety. LPNs must practice under the direction of a directing practitioner even if the LPN has been issued an "Independent Medicaid Provider Number" by the New York State Department of Health. The "Independent Medicaid Provider Number" merely allows the LPN to be paid for Medicaid services provided by the LPN; it doesn’t authorize the LPN to practice independently.(Updated FAQ-NYSED)
Can a RN be supervised by an unlicensed person?
No, Only a licensed physician, nurse practitioner, midwife, podiatrist, dentist, clinical nurse specialist or an RN may supervise the nursing practice of an RN. All other licensed professionals (including licensed practical nurses) are not legally allowed to supervise the professional nursing practice of an RN. They could, however, supervise non-clinical matters such as attendance, dress code, etc.
Can a licensed practical nurse (LPN) be supervised by an unlicensed person?
No, Only a licensed physician, nurse practitioner, midwife, podiatrist, dentist, physician assistant, specialist assistant, clinical nurse specialist or registered professional nurse may direct the nursing practice of an LPN. Although no other licensed professionals or individuals are legally authorized to supervise the professional nursing practice of an LPN, they could supervise non-clinical matters such as attendance, dress code, use of paid and unpaid leave.
Who is permitted to perform the required screenings in school?
Education Law Section 905 states that: The director of school health services of each school district in this state that is required to provide school health services, or the health department or agency otherwise responsible to provide such services, shall conduct screening examinations of vision, hearing, and scoliosis of all students at such times and as defined in the regulations of the commissioner, and at any time deemed necessary. However Education Law Section 902 states that schools may employ an RN and other health professionals to assist the medical director: Any such board or trustees may employ one or more school nurses, who shall be registered professional nurses, as well as other health professionals, as may be required. Such registered professional nurses and other health professionals shall aid the director of school health services of the district and shall perform such duties, including health instruction for the benefit of the public schools as may be prescribed by such board or trustees, in compliance with each such health professional's practice act. Therefore schools may employ RN’s or other health professionals to perform the required screenings in schools. Schools are encouraged to consult with their legal counsel if they have additional questions.
- Education Law Article 19 Section 902 defines a health professional: "health professionals" means persons duly licensed or otherwise authorized to practice a health profession pursuant to applicable law, including, but not limited to, physicians, registered professional nurses, nurse practitioners, physicians assistants, optometrists, dentists, dental hygienists, dietitians and nutritionists, and audiologists. LPNs under the direction of a physician or RN may also conduct screenings.
What is the role of the school nurse in preparing for school emergencies?
The Registered Professional Nurse has a vital role in each aspect of emergency planning and management:
- School nurses should assess potential emergency risks and assess the effectiveness of preparation through emergency trainings and practice activities.
- School nurses have unique knowledge of children with special health care needs, which are of utmost importance in the planning and responding phases of emergency management.
- The position of school nurses places them in a strategic position to assist in the short-term and long-term recovery phase following an emergency.
- School nurses must review and evaluate a school’s response to an emergency in concert with the school’s emergency team.
Is the school nurse responsible for the care of school district employees?
if the care of staff members is included in their responsibilities. Some districts include this in their nurses’ duties and some do not. If it is not in your job description, this becomes an issue for your district’s Human Resources Department unless the staff member experiences an emergency medical concern. If you are an occupational health nurse, your responsibilities may be expanded. In the event of an emergency, a school nurse should provide care as any RN would.
Can LPNs be expected to carry out the professional duties of a school nurse?
No.The scope of practice of the RN and LPN are not interchangeable. The RN is the professional nurse in school settings who may independently, within the scope of practice of the Registered Professional Nurse, triage, assess students, interpret clinical data, develop nursing care plans, and make decisions regarding nursing care. This can be found on our Laws and Guidelines page under the heading “School Nursing” in a documents titled, “Use of Licensed Practical Nurses and the Term “School Nurse” in School Settings.
If an LPN works outside of their scope of practice, would that action affect the RN's license?
Ultimately, the LPNs are licensed individuals who are held to be responsible for knowing their own scope of practice. Their actions would not affect the RN’s license unless the RN delegated a task to the LPN which was outside of their scope of practice.
In a school setting, could an unlicensed person perform tracheostomy suctioning on a student?
No, a registered professional nurse, licensed practical nurse or parent, may only perform tracheostomy suctioning in the school setting.
Resource: The Provision of Nursing Tasks and Health-Related Activities in the School Setting for Students with Special Health Care Needs. March 1995. NYSED. (posted 10-16-01)
Do school nurses need to wear an identification badge when providing nursing services in the school setting?
Yes. All nurses must wear an identification badge indicating their name and professional title when practicing in a school.
Can an Emergency Medical Technician (EMT) function as a school nurse?
No. An EMT cannot function as a school nurse. An EMT works under a cooperative agreement with emergency medical services and they provide the guidance for care to the EMT. An EMT, unless providing direct care as an official emergency responder at the moment that they are administering care, should present themselves to the school nurse and function as an unlicensed person would – as an “extra pair of knowledgeable hands” – but take direction from the school nurse. The school nurse should be careful not to delegate anything to the EMT beyond what an unlicensed person should do.
Is there any penalty for unlicensed school personnel practicing nursing? (i.e. administering medications outside of the guidelines, etc.)
Education Law states that the unauthorized practice of nursing is a Class E felony. For more information please see page 8 of theProvision of Nursing Tasks document (the document name is linked to the reference).
Is there a state guideline stating how many students a school nurse should be responsible for in New York?
No state guideline is available being that school nurses are not mandated in New York State. Information is available in the form of a position statement from the National Association of School Nurses (www.nasn.org) on caseload assignments
What should a school district do when they are unable to provide a substitute on a day when the school nurse is ill and unable to provide nursing coverage?
There is a universal shortage of substitute school nurses, so it is a good idea to develop a policy for coverage in the event that a school building does not have a nurse for a day. On the legal front- school nurses are not mandated, so it's not a legal issue that a building does not have a nurse.
Things to consider when developing a policy:
The school administrator should be notified as soon as possible that the nurse is out for the day and that there isn't coverage for the school's Health Office.
- The district should consider determining which nurses would act as coverage for which buildings in the event of an emergency or if consultation is needed. Medication administration guidelines must still be adhered to: an unlicensed person may assist a self directed student in taking their dose of medicine, but a nurse must administer medications to all non self-directed students.
- Have the policy identify which staff members are trained and willing to administer epinephrine and glucagon. Be sure that they know to access the medication and are notified that the nurse is not in the building.
- Have a school policy set up for calling 911 for emergencies.
Guidelines must still be followed and a non licensed person cannot practice nursing for the day. It's actually a Class E Felony to practice nursing without a license, so school staff and administration need to be careful not to cross the line in the care they can give.
Are schools required to have a nurse for summer school?
NYS does not mandate school nurses, however they do need to provide the accommodations needed (including health related support) to allow students to have full access to their educational programs. There are several models that schools can use to deliver school health services for their summer school programs. These include:
- School Nurse in each building - A school nurse is available in each building that houses students in a summer program.
- School Nurse for the district - A school nurse is housed in one district building with the resources and ability to respond to a health issue at all buildings housing students in the summer program.
- School Nurse consultation - A school nurse is available to consult on health issues as they arise.
- LPN may provide nursing services under the direction of a registered professional nurse who is consistently and immediately available for ongoing consultation and can respond on site within 15 minutes as needed An LPN may not use the title "School Nurse".
- No licensed professional - A nurse is not available for the summer program. Nursing treatments may not be delivered in these programs, including medication administration to nurse dependent students. Non patient specific epinephrine would not be available for summer school students.