The Role of Unlicensed Assistive Personnel in School Health Rooms
The School Health Room
Assistant
Understanding the Role of Unlicensed Assistive Personnel
in the School Health Room
Washington State School Nurse Corps 2016
Legal
Guidance
State, Federal and District Guidance
State: Washington Law Basics
Revised Code of Washington (RCWs)
Statues written by the Washington State Legislature
Once signed by the Governor, they becomes laws
Washington Administrative Codes (WACs)
Rules that are adopted by agencies to enact RCWs or Legislation
Family Education Rights and Privacy Act (FERPA)
Health Insurance Portability and Accountability Act
(HIPAA)
Section 504 of the Rehabilitation Act of 1973
Individuals with Disabilities Education Improvement
Act (IDEIA)
McKinney-Vento Act
Federal Laws
Related to School Health
District: Policies and Procedures
Know:
What they are
Where to find them
Why they are important
Professional Practice
Ethics, Confidentiality, Documentation
Ethics
Protect your students
Maintain privacy
Advocacy
Protect yourself
know your responsibilities
function within your job description
Documentation
Legal Considerations-
”If it wasn’t documented, it wasn’t done”
Communication tool for continuity of care
Health Records
Health Forms
Confidentiality
Washington State Medical Records
Health Care Information and Disclosure
RCW 70.02.005
Federal Privacy Rules
Family Education Rights and Privacy Act (FERPA)
Health Insurance Portability and Accountability Act (HIPAA)
Age of Consent
Providing Heath Care to Minors under Washington Law
Electronic Communication
Health Services Roles in the
School Setting
RN, LPN, Health Assistant, PDA
The RN protects and promotes student health,
facilitates normal development, and advances academic
success through provision of care coordination and
collaboration. The RN may delegate certain health care
tasks to un-credentialed school employees as allowed
by federal, state, district guidance and professional
practice.
Registered Nurse
The LPN carries out selected,
routine
aspects of nursing
care or assists the RN in performing
complex
nursing
care. The LPN does not delegate care/nursing tasks in
the school setting.
Licensed Practical Nurse
Parent Designated Adult (PDA)
A volunteer, who may be a school district employee,
who receives additional training from a health care
professional or expert in diabetic or seizure care
selected by the parents, and who provides care for the
child consistent with the care plan
Parent Designated Adult (PDA)
Role of the Health Room
Assistant
Professional Expectations
Communication
Professionalism (dress code, hygiene, proper
identification)
Provision of Care
Accept delegated tasks from RN such as
administration of medication or treatments
Participate in RN training for tasks expecting periodic
supervision and evaluation
Communicate concerns to RN per instruction
Document performance of every delegated task
RN Delegation – Your Role
Attend needed/required school trainings such as
blood borne pathogens, harassment, safety etc. per
district required systems
CPR, First Aid and AED training
Provide care and give medication as trained and
delegated by the RN
Work with the school nurse to identify trainings to
support health room work duties
Responsibilities – Training
Provision of Care
General Concepts, Triage, Critical Communication,
School Policy and Procedure
Job description
State standards for responding to illness and injury
Care Plans
Guidelines for Care
Prioritize student’s care needs
Enlist assistance from school staff as needed
Report emergent concerns or high case loads to RN
Triage
Health room visit
Initiation
Assessment
Interventions
Disposition
Health room visit
Initiation
Check-in each student in individual student paper log
or electronic documentation system
Document all health room visits and interactions with
students
Identify the student – known health conditions, care
plans, special considerations (autistic, nonverbal,
ELL…)
Identify the problem - reason for visit
Health room visit
Assessment
Listening skills
Calm approach
Identify the problem
Student report
Observations – body systems
Observations: skin color, discomfort, breathing, etc.…
Tools: thermometer, pain scale
Temperatures
Normal parameters
When to send a student home
Rechecking
Health room visit
Interventions
Comfort measures
Cold packs
Heat
Rest
Hydration
Crackers
Listening
Health room visit
Interventions (cont.)
Medications if ordered
Personal care and toileting
Special considerations
Age of consent
Confidentiality
Non-judgmental
Mandated reporting for minors
Behavioral Health
Encompasses mental health and substance abuse
Understanding trauma impact
Behavior management and accommodations
Providing services to minors
Behavioral Health
Specific Concerns
Panic attacks
Self-harm
Suicide threat
Aggressive behavior
Provision of Care
First Aid
Minor wound care
Clean
Bandage
Location of AEDs, first aid materials
Know when to call for help
Provision of Care
Common Health Conditions
Asthma
Anaphylaxis
Diabetes
Seizures
Cardiac
Other
Student Specific Plans
Know how to access quickly
Familiarize yourself with them
Care plan distribution
Provide feedback to the school nurse
Health Care Plan Implementation
Observation in health room
History of incident
Ice/cold packs for symptom management
Teacher notification if returning to class room
Parent notification
When to call 911
Head Injury
Care & Protocol
Documentation
Incident details if known
Signs and Symptoms
Interventions
Communication
Head injury reports
Incident reports
Head Injury
Care & Protocol
When to call the school nurse
When to call the parent
When to call school staff (administrators, counselors,
teachers etc.)
When to call 911
Critical Communication
Proper introduction
Listening skills
Personal affect
Managing conflict
Working with interpreters
Document communication
Communication with parents and
guardians
Determine if student may return to class, be released
to home, or referred
Confer with school nurse if indicated
Release student per school protocol
Document disposition and related communication
Complete necessary reports: Incident or accident
report, head injury forms, parent letters, teacher
notifications
Disposition
Regulations
Laws: Public and Private Schools – Administration of
Medication - Conditions
RCW 28A.210.260
District policy and procedure
Licensed Healthcare Provider Authorizations
Who can prescribe in WA. State
RN delegation, training, and
supervision
Receiving and handling medications
Administration
Medication Administration
Documentation
Medication errors
Back-up and disaster medication
Emergency drills and evacuations
End of year protocols: return and/or disposal of
medications
Medication Administration
Critical importance of handwashing
Handling of waste
Standard Precautions
Isolation of infectious students
Infection Control
Notify the School Nurse of any concerns related to
potential exposures or disease outbreaks
Follow the guidance of the School Nurse and Local
Health Jurisdiction
Refer to district policy and DOH and OSPI Infectious
Disease Control Guide for School Staff (2014)
Practice standard precautions and infection control
procedures.
Document observations and actions
Communicable Disease
Basic needs – food, shelter, clothing
School resources
Community resources
Insurance/access
Confer with the School Nurse or other staff
Referrals
Review responsibilities under law
RCW 26.44.020
;
RCW 28A.400.317
Review district procedure for reporting and
documentation
Mandated Reporting
Supporting Health services
Health Room Maintenance, Mandated Screenings, Clerical
Support
The Health Room
Infection Control
Health Room Supplies
Security
Safe Environments
Disaster Protocols
The Health Room
Keep health room organized, clean and uncluttered
Maintain routine schedule for washing of health room
blankets
Use one-time tissue covers for pillows and cots (Do
not use standard sheets or pillowcases)
Maintain clean refrigerator for ice packs, medications
or other health room supplies
Notify custodian as needed
Health Room Supplies
Inventory all supplies maintaining a master list
Order supplies as needed and prior to start of school
year per budget and in consultation with School
Nurse
Check expiration dates of all supplies and consumable
inventory
Maintain all equipment in clean working order
Notify the School Nurse of needs and concerns
Health Room Supplies
Safe keeping of individual student supplies (i.e.
diabetes, catheterization, etc..)
Assist with ordering 5th grade free puberty supplies
Assist with arrangements for calibration of screening
equipment
Work with building custodian for adequate supplies
of soap, paper towels and facial tissues
Safety and Security
Safekeeping of medications
Monitoring health room visitors and activities
Be aware of school safety procedures
Handling of Blood Borne Pathogens and Hazardous
Materials:
Chemicals- Safety Data Sheets (SDS)
Safe storage
Sharps
Spills
Guidelines for Implementation of School Employee Training
on HIV/AIDS and Other Bloodborne Pathogens
(2011)
WAC 296-823
Safe Environment
Disaster Protocols
Know location of exits and escape routes
Critical health supplies that need to be moved in a drill or
emergency
Emergency and disaster medications
Care plan book
First aid supplies
Location of AEDs
Incident command, know your role
Assist children in your immediate care
Documentation
Legal Guidance
Storage
Clerical
immunizations
Documentation – Rules and
Regulations
School district student health services policies and
procedures related to health records
FERPA and HIPAA federal laws
School health state laws (
RCW 28A.210
)
Medical Records—Health Care Information and
Disclosure state law (RCW 70.02)
Guidelines for Handling Health Care Information in
School Records
(2001)
Documentation – Storage
School Districts and Educational Services Districts
Records Retention Schedule
Archiving
Transferring
Destruction
Documentation – Clerical
Forms, managing and processing
Ensure confidentiality
Maintain student health file
Archive student health records
Assist in disseminating written communication to
families as directed
Immunization – Rules and
Regulations
School District Policies and Procedures
School and Child Care Immunization Website DOH
Immunization Manual for Schools, Preschools and
Childcare Centers
(DOH 2016)
DOH Immunization Information System (IIS)
Immunization
Compliance
Reporting
Records Management
Communication
Review student immunization information (CIS, COE)
for accuracy and compliance
Transfer immunization information into electronic
student data base
As indicated, inform families of community
immunization resources
Provide ongoing monitoring of students’
immunization status
Immunization
Compliance
Assist with completion and submission of the annual
Washington DOH Immunization Status Report for the
school
Notify school nurse of any student who is out of
compliance with immunizations
Immunization
Reporting
Immunization Records Management
Provide original CIS/COE document to graduating seniors
and/or students leaving district
Archive copies of CIS/COE with individual health records as
students leave or graduate from district
Maintain a current list or be able to print a list of students
who are exempt or out of compliance under the direction
of the School Nurse
In the event of a communicable disease outbreak, identify
and alert the School Nurse to students who may be at risk
(immune-compromised or have personal, religious or
medical exemptions)
Assist school nurse with immunization compliance
process (letters, phone calls etc.)
Assist school nurse in compiling information to be
included in an immunization exclusion packet
As directed by the school nurse assist in notifying the
parent/guardians of students whose immunizations
are out of compliance
Assist school nurse with distribution of
meningococcal, HPV and graduating senior letters
Immunizatoin
Communication
Mandated Screenings
As directed by school nurse:
Schedule vision and hearing screenings
Conduct, facilitate, assist with screening process
Record findings
Schedule re-screens
Inform teachers of students who did not pass
screenings so accommodations can be made
Process referrals
Identify barriers for follow up/treatment
Refer to the school nurse as needed
Document referrals and follow up
Mandated Screenings
Follow Up
Attendance matters to school and life success
Under the direction of the school nurse, monitor and
communicate attendance concerns
Identify concerns or trends and alert the school nurse
for follow-up
Monitor Attendance
Field trip planning
Obtain dates/locations of field trips
Evaluate field trip site for cell phone reception,
allergens, hazards
Obtain class roster of students who will be attending
Prepare first aid kits
Assist, as needed with field trip permission forms
Prepare health forms:
copies of IHPs/ECPs for appropriate staff
Medication orders
Medication preparation:
Assemble scheduled and as needed medications
Sign out to designated staff
Check in medications and forms upon return
Field trips
Reminders
Do Not:
Give medical advice or diagnose
Provide care beyond basic first aid
Administer medications/treatments prior to nurse
delegation
Perform tasks requiring sterile technique
Transport sick/injured students without authorization
Share protected health information
Reminders continued
Do:
Ask for help when needed
Practice self care
Have fun!
This document is provided by the Washington State School Nurse Corps (SNC) for school districts in Washington State. It is intended for use by school nurses and district administration to assist in understanding the functions and tasks of a health room assistant for the consideration of health services support and orientation and training purposes.
This is not an official Office of Superintendent of Public Instruction (OSPI) or Educational Service District (ESD) document nor does it contain any formal guidance by these agencies. It serves as a tool, not a legal interpretation or all inclusive list of required health room assistant functions or tasks. Districts are urged to review employee job descriptions, student health care needs, and policy and procedure associated with school health services to determine district specific UAP duties for orientation and training needs. It is also recommended they consult with their school nurse, district legal counsel or risk management staff for questions related to how specific RCW’s, WAC’s, or rules may impact the provision of care by unlicensed personnel in the school health room.
This comprehensive guide explores the role of unlicensed assistive personnel in school health rooms, covering state, federal, and district legal guidance, ethics, confidentiality, documentation, and the responsibilities of various health services roles in the school setting. It includes information on Washington state laws, federal laws related to school health, district policies and procedures, and key considerations such as ethics, documentation, and confidentiality in providing health care to students.
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Presentation Transcript
The School Health Room Assistant Understanding the Role of Unlicensed Assistive Personnel in the School Health Room Washington State School Nurse Corps 2016
State, Federal and District Guidance Legal Guidance
State: Washington Law Basics Revised Code of Washington (RCWs) Statues written by the Washington State Legislature Once signed by the Governor, they becomes laws Washington Administrative Codes (WACs) Rules that are adopted by agencies to enact RCWs or Legislation
Federal Laws Related to School Health Family Education Rights and Privacy Act (FERPA) Health Insurance Portability and Accountability Act (HIPAA) Section 504 of the Rehabilitation Act of 1973 Individuals with Disabilities Education Improvement Act (IDEIA) McKinney-Vento Act
District: Policies and Procedures Know: What they are Where to find them Why they are important
Ethics, Confidentiality, Documentation Professional Practice
Ethics Protect your students Maintain privacy Advocacy Protect yourself know your responsibilities function within your job description
Documentation Legal Considerations- If it wasn t documented, it wasn t done Communication tool for continuity of care Health Records Health Forms
Confidentiality Washington State Medical Records Health Care Information and Disclosure RCW 70.02.005 Federal Privacy Rules Family Education Rights and Privacy Act (FERPA) Health Insurance Portability and Accountability Act (HIPAA) Age of Consent Providing Heath Care to Minors under Washington Law Electronic Communication
RN, LPN, Health Assistant, PDA Health Services Roles in the School Setting
Registered Nurse The RN protects and promotes student health, facilitates normal development, and advances academic success through provision of care coordination and collaboration. The RN may delegate certain health care tasks to un-credentialed school employees as allowed by federal, state, district guidance and professional practice.
Licensed Practical Nurse The LPN carries out selected, routine aspects of nursing care or assists the RN in performing complex nursing care. The LPN does not delegate care/nursing tasks in the school setting.
Parent Designated Adult (PDA) Parent Designated Adult (PDA) A volunteer, who may be a school district employee, who receives additional training from a health care professional or expert in diabetic or seizure care selected by the parents, and who provides care for the child consistent with the care plan
Role of the Health Room Assistant
Professional Expectations Communication Professionalism (dress code, hygiene, proper identification) Provision of Care
RN Delegation Your Role Accept delegated tasks from RN such as administration of medication or treatments Participate in RN training for tasks expecting periodic supervision and evaluation Communicate concerns to RN per instruction Document performance of every delegated task
Responsibilities Training Attend needed/required school trainings such as blood borne pathogens, harassment, safety etc. per district required systems CPR, First Aid and AED training Provide care and give medication as trained and delegated by the RN Work with the school nurse to identify trainings to support health room work duties
General Concepts, Triage, Critical Communication, Provision of Care
Guidelines for Care School Policy and Procedure Job description State standards for responding to illness and injury Care Plans
Triage Prioritize student s care needs Enlist assistance from school staff as needed Report emergent concerns or high case loads to RN
Health room visit Initiation Assessment Interventions Disposition
Health room visit Initiation Check-in each student in individual student paper log or electronic documentation system Document all health room visits and interactions with students Identify the student known health conditions, care plans, special considerations (autistic, nonverbal, ELL ) Identify the problem - reason for visit
Health room visit Assessment Listening skills Calm approach Identify the problem Student report Observations body systems Observations: skin color, discomfort, breathing, etc. Tools: thermometer, pain scale Temperatures Normal parameters When to send a student home Rechecking
Health room visit Interventions Comfort measures Cold packs Heat Rest Hydration Crackers Listening
Health room visit Interventions (cont.) Medications if ordered Personal care and toileting Special considerations Age of consent Confidentiality Non-judgmental Mandated reporting for minors
Behavioral Health Encompasses mental health and substance abuse Understanding trauma impact Behavior management and accommodations Providing services to minors
Behavioral Health Specific Concerns Panic attacks Self-harm Suicide threat Aggressive behavior
Provision of Care First Aid Minor wound care Clean Bandage Location of AEDs, first aid materials Know when to call for help
Provision of Care Common Health Conditions Asthma Anaphylaxis Diabetes Seizures Cardiac Other
Health Care Plan Implementation Student Specific Plans Know how to access quickly Familiarize yourself with them Care plan distribution Provide feedback to the school nurse
Head Injury Care & Protocol Observation in health room History of incident Ice/cold packs for symptom management Teacher notification if returning to class room Parent notification When to call 911
Head Injury Care & Protocol Documentation Incident details if known Signs and Symptoms Interventions Communication Head injury reports Incident reports
Critical Communication When to call the school nurse When to call the parent When to call school staff (administrators, counselors, teachers etc.) When to call 911
Communication with parents and guardians Proper introduction Listening skills Personal affect Managing conflict Working with interpreters Document communication
Disposition Determine if student may return to class, be released to home, or referred Confer with school nurse if indicated Release student per school protocol Document disposition and related communication Complete necessary reports: Incident or accident report, head injury forms, parent letters, teacher notifications
Medication Administration Regulations Laws: Public and Private Schools Administration of Medication - Conditions RCW 28A.210.260 District policy and procedure Licensed Healthcare Provider Authorizations Who can prescribe in WA. State RN delegation, training, and supervision Receiving and handling medications Administration
Medication Administration Documentation Medication errors Back-up and disaster medication Emergency drills and evacuations End of year protocols: return and/or disposal of medications
Infection Control Critical importance of handwashing Handling of waste Standard Precautions Isolation of infectious students
Communicable Disease Notify the School Nurse of any concerns related to potential exposures or disease outbreaks Follow the guidance of the School Nurse and Local Health Jurisdiction Refer to district policy and DOH and OSPI Infectious Disease Control Guide for School Staff (2014) Practice standard precautions and infection control procedures. Document observations and actions
Referrals Basic needs food, shelter, clothing School resources Community resources Insurance/access Confer with the School Nurse or other staff
Mandated Reporting Review responsibilities under law RCW 26.44.020 ; RCW 28A.400.317 Review district procedure for reporting and documentation
Health Room Maintenance, Mandated Screenings, Clerical Support Supporting Health services
The Health Room Infection Control Health Room Supplies Security Safe Environments Disaster Protocols
The Health Room Keep health room organized, clean and uncluttered Maintain routine schedule for washing of health room blankets Use one-time tissue covers for pillows and cots (Do not use standard sheets or pillowcases) Maintain clean refrigerator for ice packs, medications or other health room supplies Notify custodian as needed
Health Room Supplies Inventory all supplies maintaining a master list Order supplies as needed and prior to start of school year per budget and in consultation with School Nurse Check expiration dates of all supplies and consumable inventory Maintain all equipment in clean working order Notify the School Nurse of needs and concerns
Health Room Supplies Safe keeping of individual student supplies (i.e. diabetes, catheterization, etc..) Assist with ordering 5th grade free puberty supplies Assist with arrangements for calibration of screening equipment Work with building custodian for adequate supplies of soap, paper towels and facial tissues
Safety and Security Safekeeping of medications Monitoring health room visitors and activities Be aware of school safety procedures
Safe Environment Handling of Blood Borne Pathogens and Hazardous Materials: Chemicals- Safety Data Sheets (SDS) Safe storage Sharps Spills Guidelines for Implementation of School Employee Training on HIV/AIDS and Other Bloodborne Pathogens (2011) WAC 296-823
Disaster Protocols Know location of exits and escape routes Critical health supplies that need to be moved in a drill or emergency Emergency and disaster medications Care plan book First aid supplies Location of AEDs Incident command, know your role Assist children in your immediate care
Documentation Legal Guidance Storage Clerical immunizations
