Understanding the Role of Unlicensed Assistive Personnel in School Health Rooms

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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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  1. The School Health Room Assistant Understanding the Role of Unlicensed Assistive Personnel in the School Health Room Washington State School Nurse Corps 2016

  2. State, Federal and District Guidance Legal Guidance

  3. 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

  4. 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

  5. District: Policies and Procedures Know: What they are Where to find them Why they are important

  6. Ethics, Confidentiality, Documentation Professional Practice

  7. Ethics Protect your students Maintain privacy Advocacy Protect yourself know your responsibilities function within your job description

  8. Documentation Legal Considerations- If it wasn t documented, it wasn t done Communication tool for continuity of care Health Records Health Forms

  9. 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

  10. RN, LPN, Health Assistant, PDA Health Services Roles in the School Setting

  11. 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.

  12. 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.

  13. 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

  14. Role of the Health Room Assistant

  15. Professional Expectations Communication Professionalism (dress code, hygiene, proper identification) Provision of Care

  16. 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

  17. 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

  18. General Concepts, Triage, Critical Communication, Provision of Care

  19. Guidelines for Care School Policy and Procedure Job description State standards for responding to illness and injury Care Plans

  20. Triage Prioritize student s care needs Enlist assistance from school staff as needed Report emergent concerns or high case loads to RN

  21. Health room visit Initiation Assessment Interventions Disposition

  22. 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

  23. 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

  24. Health room visit Interventions Comfort measures Cold packs Heat Rest Hydration Crackers Listening

  25. Health room visit Interventions (cont.) Medications if ordered Personal care and toileting Special considerations Age of consent Confidentiality Non-judgmental Mandated reporting for minors

  26. Behavioral Health Encompasses mental health and substance abuse Understanding trauma impact Behavior management and accommodations Providing services to minors

  27. Behavioral Health Specific Concerns Panic attacks Self-harm Suicide threat Aggressive behavior

  28. Provision of Care First Aid Minor wound care Clean Bandage Location of AEDs, first aid materials Know when to call for help

  29. Provision of Care Common Health Conditions Asthma Anaphylaxis Diabetes Seizures Cardiac Other

  30. 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

  31. 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

  32. Head Injury Care & Protocol Documentation Incident details if known Signs and Symptoms Interventions Communication Head injury reports Incident reports

  33. 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

  34. Communication with parents and guardians Proper introduction Listening skills Personal affect Managing conflict Working with interpreters Document communication

  35. 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

  36. 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

  37. Medication Administration Documentation Medication errors Back-up and disaster medication Emergency drills and evacuations End of year protocols: return and/or disposal of medications

  38. Infection Control Critical importance of handwashing Handling of waste Standard Precautions Isolation of infectious students

  39. 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

  40. Referrals Basic needs food, shelter, clothing School resources Community resources Insurance/access Confer with the School Nurse or other staff

  41. Mandated Reporting Review responsibilities under law RCW 26.44.020 ; RCW 28A.400.317 Review district procedure for reporting and documentation

  42. Health Room Maintenance, Mandated Screenings, Clerical Support Supporting Health services

  43. The Health Room Infection Control Health Room Supplies Security Safe Environments Disaster Protocols

  44. 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

  45. 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

  46. 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

  47. Safety and Security Safekeeping of medications Monitoring health room visitors and activities Be aware of school safety procedures

  48. 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

  49. 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

  50. Documentation Legal Guidance Storage Clerical immunizations

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