Before School, After School, and Extracurricular Activities
Each school district will have to determine who, what, when and how they will meet the health care needs of students outside of the “regular” school day which may include before/after school care, athletics, and transportation to/from school and events. This may look different if the student is covered through special education, 504 plan, or an Emergency Care Plan (ECP).
The role of the school nurse will vary pending job description or job contract with the school for days/hours/weeks of employment. However, the school may look to the RN/LSN as the healthcare expert to help plan and address the needs of students.
As described in Nursing Delegation for the School Setting, if the RN/LSN is not actively employed it is very unlikely that the RN/LSN can provide student specific nursing delegation. Student specific nursing delegation requires that the RN/LSN develop the plan, provide training and on-going supervision, and monitor the delegated nursing activity.
The school nurse may, as outlined in the job description, provide some consultation to help these programs determine how they will meet the health needs of those enrolled.
When nursing delegation is not possible, the professional nurse can provide consultation. Consultation is a professional (RN) activity of collaborating and coordinating with others in the management of care across systems. This is not “student specific” like delegation, but population based, and can include general health information to others regarding a health condition, safe medication administration procedures, and emergency response such as for activities occurring outside of the regular school day or students going on an out-of-state or out-of-country field trips.
Role of the School Nurse:
- Provide consultation on safe planning and preparation processes including considerations for identifying students with health and medical needs.
- Provide program leaders with a framework for decision making including, but not limited to:
- Administration and storage of participant medications.
- Allowance for participants to self-administer medication when appropriate.
- Considerations for individualized health needs or emergency care plans.
- Allowance for parent/guardian to train school staff (lay-person to lay-person) on their child’s medication or health needs during the trip.
- Provide time and opportunity for school staff for training on first aid, medication administration, understanding and following emergency care plans.
- Determine how, when and who may need access to the health office for medication administration or copies of emergency care plans.
District/School Responsibility:
- Overall promote and maintain health and safety for all participants during these activity periods.
- Establish procedures to meet the health needs of students including medication administration, identify staff to care for students and ensure they have the appropriate training.
- Understanding applicable laws for before and after school daycare programs that are licensed child care centers.
- Creating a registration process that allows parents/guardians to identify their child’s specific medical or health needs.
- Communicating with students and parent/guardians the plan for training and delivery of health services occurring outside of the “regular” school day to meet the students’ needs.
- Provide time and opportunity for school staff for training on first aid, medication administration, understanding and following emergency care plans, and working with parent/guardian to understand individual student needs.