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Policy & AdvocacyPosition Papers and ReportsNASN Position Statements Full View    August 22, 2014
 
School-Sponsored Trips, Role of the School Nurse (Adopted June 2013)

School-Sponsored Trips, Role of the School Nurse


Position Statement

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SUMMARY
It is the position of the National Association of School Nurses, that the registered professional school nurse (hereinafter referred to as school nurse) is in a unique position to support students so that their individual healthcare needs are met both at school and on school-sponsored trips.  The school nurse has the nursing background to appropriately assess the proposed school-sponsored trip to determine the accommodations needed to allow all students to safely participate in activities.  All students, including students with special healthcare needs, have the right to participate in school‐sponsored trips (also referred to as field trips).  School nurses must serve a role in the planning and coordination for all school-sponsored trips, including those off-campus, so that all students with healthcare needs remain healthy and safe.  This planning process includes making accommodations for health care needs, determining required medications and treatments, and preparing for potential emergencies.

BACKGROUND

Schools offer school-sponsored trips to enhance the educational experience for students or to reward class accomplishments.  A trip may be as simple as a local excursion for just a few hours or as complicated as a trip for several days/nights to a different city, state or country.  While schools may invite parents/guardians of the student with healthcare needs to accompany the student on the trip, school officials cannot mandate that they attend.  

Three federal laws provide important protection to students with disabilities.  Section 504 of the Rehabilitation Act of 1973 and Title II of the American Disabilities Act of 1990 (ADA) are civil rights laws that prohibit discrimination against individuals with disabilities.  The Individuals with Disabilities Education Improvement Act (IDEIA), reauthorized in 2004, mandates a free and appropriate education in the least restrictive environment for those students who qualify for special education services (U.S. Department of Education, 2011).  All schools that receive federal monies are subject to follow Section 504 and the ADA Act (Gibbons, Lehr, & Selekman, 2013).  Many states have additional laws that provide supplementary protections for students.

Estimates indicate that in the United States, 26.6% of children have special healthcare needs (Van Cleave, Gortmaker, & Perrin, 2010).  Of these children, 86% receive prescribed medication, 52% require specialty medical care, 33% require vision care, 25% require mental health services, 23% require specialty therapies and 11% require the use of medical equipment (U.S. Department of Health and Human Services, 2008).

“The level of nursing or healthcare services required for a student in the classroom is, at a minimum, the same level of care that the student requires during school programs outside of the classroom” (Hootman, Schwab, Gelfman, Gregory, & Pohlman, 2005, p. 223).  As the number of students with specialized healthcare needs increases, it is critical that all school systems develop policies to address the provision of safe and competent health services for students while they are away from school buildings for school‐sponsored trips (Kentucky Department of Education, 2012).

RATIONALE

A system should be in place to engage the school nurse in all planning phases of the school-sponsored trip to ensure that all necessary accommodations are in place.  Currently, the costs associated with providing these accommodations are the responsibility of the school district and must be considered in the initial planning phases of a proposed school-sponsored trip (Foley, 2013).  The school nurse should perform an individual health assessment and develop the IHP at the beginning of the school year to appropriately plan safe care for students with medical needs throughout the school year, including the potential for off-campus school-sponsored trips.  The student’s healthcare needs on field trips are determined through a collaborative process coordinated by the school nurse, reviewed annually and include a nursing assessment, the healthcare provider orders and information provided by the family (Moses, Gilchrest, & Schwab, 2005).  The IHP outlines the plan for meeting the healthcare needs of the student at school and during school-sponsored trips, and is utilized to create emergency care plans (ECP).  Behrmann (2010) states “although children with food allergy have a serious medical condition, their allergy should not result in their exclusion from events, such as field trips” (p. 186).  This is true for all students with health needs.  

The school nurse’s knowledge about the individual needs of the students place him/her in a unique position to coordinate care that enables the student to fully participate in a safe and healthy school-sponsored trip experience.  Planning steps may include:

  • Assessing the transportation method, determining the food that will be served, the staff whom will be present, the layout of the planned visitation site, duration of the trip, and proximity to emergency medical care.
  • Addressing medication, medical treatments and procedures required during the trip, as well as the potential for health emergencies.

If allowed by state law, including applicable state nurse practice acts, and district policy/procedures, the school nurse may consider delegating some tasks to a non‐nurse, school staff member such as a teacher, utilizing the American Nurses Association’s Principles for Delegation by Registered Nurses to Unlicensed Assistive Personnel (UAP), which includes a nursing decision tree (ANA, 2012).  If the school nurse who is familiar with the student’s health condition and treatment determines that medical care cannot legally or safely be delegated,  a school nurse may need to accompany the student (Prenni, 2009), and an additional school nurse may need to cover the school health office.

If the school-sponsored trip takes place in a different state or country, plans must be in place to meet the nursing license and practice laws of that state or country.  The Nurse Licensure Compact (NLC) allows nurses to have one multistate license, with the ability to practice in both their home state and other party states.  A nurse who holds a license issued by a state that is not a member of the NLC has a single‐state license that is only valid in that state.  They must request and receive permission from the respective state’s board of nursing, to practice in another state (NCSBN, 2012).  Even if a trip is in a compact state, the nurse must still know the nursing laws/regulations of that state and practice accordingly, regardless of whether she/he is delegating tasks to a non‐nurse school staff member or actually attending the school-sponsored trips and performing the necessary health services (NCSBN, 2011).  If the nurse is traveling to another country, the nurse must consult with the consulate of the visiting country for permission to practice nursing (K. Erwin, personal communication, 3/14/13).

CONCLUSION

School-sponsored trips can be some of the most memorable experiences for students. Administrators, school staff, families and students must work closely with the school nurse to so that the healthcare needs and safety of all students are provided for during school-sponsored trips.  As more children with specialized healthcare needs enter the school system, the role of the school nurse becomes even more critical in assuring the rights, safety and educational experiences of all students.

REFERENCES

American Nurses Association.  (2012). Principles for delegation by registered nurses to unlicensed assistive personnel (UAP).  Silver Spring, MD: Author.

Behrmann, J. (2010).  Ethical principles as a guide in implementing policies for the management of food allergies in schools.  Journal of School Nursing, 26(3), 183-193.

Foley, M. (2013).  Health services management.  In J. Selekman (Ed.), School nursing: A comprehensive text (2nd ed., pp. 1190 – 1215).  Philadelphia, PA: FA Davis Company.

Gibbons, L., Lehr, K., & Selekman, J. (2013).  Federal laws protecting children and youth with disabilities in the schools.  In J. Selekman (Ed.), School nursing: A comprehensive text (2nd ed., pp.257-283).  Philadelphia, PA: FA Davis Company.

Hootman, J., Schwab, N. C., Gelfman, M.H.B., Gregory, E.K. & Pohlman, K.J. (2005).  School nursing practice: Clinical performance issues.  In M.H. Gelfman & N.C. Schwab (Eds.) Legal issues in school health services (pp.167-229). Lincoln, NE: Authors Choice Press.

Kentucky Department of Education.  (2012). Field trips and medication administration.  Retrieved from http://education.ky.gov/districts/shs/pages/field-trips-and-medication-administration.aspx

Moses, M., Gilchrest, C., & Schwab, N. (2005).  Section 504 of the Rehabilitation Act: Determining eligibility and implications for school districts.  Journal of School Nursing, 21(1), 48-58.

National Council of State Boards of Nursing (NCSBN).  (2011). Model nursing practice act and model nursing administrative rules.  Retrieved from https://www.ncsbn.org/Model_Nursing_Practice_Act_March2011.pdf

National Council of State Boards of Nursing (NCSBN).  (2012). Nursing license compact.  Retrieved from https://www.ncsbn.org/nlc.htm

Prenni, P. (2009).  Caring for the student with Wolff-Parkinson-White Syndrome.  Journal of School Nursing, 25(5), 327-332.

U.S. Department of Education.  (2011). Protecting students with disabilities: Frequently asked questions about Section 504 and the education of children with disabilities.  Retrieved from http://www2.ed.gov/about/offices/list/ocr/504faq.html

U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau.  (2008). The national survey of children with special healthcare needs chartbook 2005-2006. Rockville, MD: Author.

Van Cleave, J., Gortmaker, S., & Perrin, J. (2010).  Dynamics of obesity and chronic health conditions among children and youth.  JAMA, 303(7), 623-630.  doi: 10.1001/jama.2010.104

Acknowledgement of Authors:
Kathleen C. Rose, MHA, RN, NCSN
Christine M. Tuck, MS, BSN, RN, NCSN
Alicia L. Burrows-Mezu, MSN/Ed, BSN, BSc, RN

2012 Issue Brief Authors:
Lauren Mazzapica, BSN, RN
Janice Selekman, DNSc, RN, NC
Carmen Teskey, MA, RN, LSN

Adopted: June 2013

This Position Statement replaces the Issue Brief School Sponsored Trips, Role of the School Nurse (adopted June 2012).

All position statements from the National Association of School Nurses will automatically expire five years after publication unless reaffirmed, revised, or retired at or before that time.

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