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Role & CareerCode of Ethics    December 3, 2016
 

Code of Ethics

  

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National Association of School Nurses

CODE OF ETHICS

Preamble

Acknowledging the diversity of the laws and conditions under which school nurses practice, the National Association of School Nurses (NASN) believes in a commonality of moral and ethical conduct. As such, NASN adopts the American Nurses Association’s (ANA) Code of Ethics for Nurses with Interpretive Statements (2015), which establishes an ethical foundation for all nurses. Furthermore, this foundation is supported by the School Nursing: Scope and Standards of Practice, 2nd Edition (ANA & NASN, 2011) and ethical guidelines provided by state boards of nursing. School nursing practice, built upon these ethical foundations, is grounded in the NASN core values of child well-being, diversity, excellence, innovation, integrity, leadership, and scholarship (NASN, 2015).  It is the responsibility of both the individual nurse and nursing organizations to function within these ethical provisions.  For the purpose of this document the term student also refers to families and school communities.

Organizational Ethics

NASN, a 501(c)(3) non-profit organization established to support student health through the advancement of school nursing practice, has ethical responsibilities to its members and the communities those members serve (NASN, 2015). These organizational responsibilities include:

  • Promotion of ethical work environments that support student and community health;

  • Development of “…a research agenda that will lead to a culture of ethical practice in diverse settings that is evidence-based and measurable in terms of outcomes…” (Johns Hopkins School of Nursing & Johns Hopkins Berman Institute of Bioethics, 2014, p. 5);

  • Development of relationships with organizations whose principles and actions are in harmony with NASN’s mission and values and the termination of relationships with organizations whose known actions violate NASN’s business and ethical principles; and

  • Support of the role of the school nurse through advocacy, integrity, and participation in public policy development and social justice.

School Nurse Ethics

School nurses straddle two statutory and regulatory frameworks, health and education. Because school nurses practice nursing in an educationally focused system, they face unique legal, policy, funding and supervisory issues that may also have ethical dimensions. These issues may include:

  • Unsafe school nurse to student ratios,

  • Accountability for care delegated to Unlicensed Assistive Personnel (UAP),

  • School administrator request to amend documentation,

  • School administrator assignment of nursing tasks to UAP without the input of the school nurse, and

  • Parent/guardian request for medical treatment for his/her student, which is inconsistent with school nurse scope of practice (Brent, 2013).

As such, school nurses must have not only the skills to communicate within both the healthcare and education arenas, but also the requisite knowledge and skills to interpret applicable laws, regulations and professional standards, as well as apply ethical theories and principles (ANA & NASN, 2011).

Child Well-being

  • School nurses support and promote student abilities to achieve the highest quality of life as understood by each individual and family.

  • School nurses integrate “caring, kindness, and respect into nursing practice” (ANA & NASN, 2011, p. 51).  

  • School nurses serve a unique role in transition planning to address student health needs within the school environment.

  • School nurses maintain protection of, and confidentiality with, student health records according to the Health Insurance Portability and Accountability Act (HIPAA), Family Education Rights Protection Act (FERPA), other applicable federal laws, state laws and regulations, and professional standards of practice to safeguard privacy.

  • School nurses utilize interventions designed to mitigate the effects of adverse childhood experiences and other social determinants of health.

  • School nurses refer students to other health professionals and community health agencies as needed to promote health and well-being.

Diversity

  • School nurses deliver care in a manner that promotes and preserves student autonomy, dignity and rights so that all are treated equally regardless of race, gender, socio-economic status, culture, age, sexual orientation, gender identity, disability or religion.

  • School nurses deliver care in an inclusive, collaborative manner that embraces diversity in the school community.

  • School nurses actively promote student health, safety, and self worth.

  • School nurses intervene to eliminate discrimination and bullying.

Excellence

  • School nurses must have knowledge relevant to meet the needs of the student and maintain the highest level of competency by enhancing professional knowledge and skills and by collaborating with peers, other health professionals and community agencies.

  • School nurses incorporate information from supervisory clinical evaluation to improve their nursing practice.

  • School nurses evaluate their own nursing practice in relation to professional standards of practice and applicable laws, regulations and policies.

Innovation

  • School nurses utilize available research in developing health programs, individual plans of care, and interventions.

  • School nurse workplace environments impact the quality of health care; therefore, school nurses collaborate to improve these environments.

  • School nurses are aware of social determinants of health in the school community, provide health care to all students, support school staff, and partner with families and other community members to reduce health disparities.

Integrity

  • School nurses maintain confidentiality within the legal, regulatory and ethical parameters of health and education.

  • School nurses understand, follow and inform others about student health record protection according to HIPAA, FERPA, other applicable federal laws, and state laws and regulations.

  • School nurses take “appropriate action regarding instances of illegal, unethical, or inappropriate behavior that can endanger or jeopardize the best interest of the healthcare consumer or situation” (ANA & NASN, 2011, p. 50).

Leadership

  • School nurses are student advocates.

  • School nurses support student rights in navigating the educational environment.

  • Delegation or assignment of nursing tasks, including accountability for delegated tasks, may be the responsibility of the school nurse. School nurse assignments and delegations must be consistent with state nurse practice guidelines and established best practice.

  • School nurses work within educational institutions to define and implement professional standards of practice and school health policy development.

Scholarship

  • School nurses are life long learners in pursuit of knowledge, training and experiences that enhance the quality of their nursing practice.

  • School nurses participate in and promote research activities as a means of advancing student health and school health services.

  • School nurses conduct research as appropriate to the nurse's education, position and practice environment.

  • School nurses adhere to the ethics that govern research, specifically:

  • Rights to privacy and confidentiality;

  • Voluntary and informed consent; and

  • Awareness of and participation in the mechanisms available to ensure the rights of human subjects, particularly vulnerable populations (e.g. minors, disabled).

Conclusion:  

In the course of day-to-day practice and based upon the applicable state nurse practice act and professional scope and standards of practice, school nurses may find themselves in situations that present ethical dilemmas.  School nurses and school nurse organizations have a responsibility to practice in accordance with the NASN core values, NASN Code of Ethics and professional standards of practice. School nurse decision-making is guided by these principles that promote improved student health, academic success and excellence in school health services. NASN believes the practice of school nursing demands a vigilant focus on ethics.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursebooks.org.

American Nurses Association & National Association of School Nurses. (2011). School nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD:  Nursebooks.org.

Brent, N. (2013, July 15). The state nurse practice act, nursing ethics and school nursing practice. [Blog post]. Retrieved from http://www.cphins.com/blog/post/the-state-nurse-practice-act-nursing-ethics-and-school-nursing-practice

Johns Hopkins School of Nursing & Johns Hopkins Berman Institute of Bioethics. (2014, November). A blueprint for 21st century nursing ethics: Report of the national nursing summit - executive summary.  Retrieved from http://www.bioethicsinstitute.org/wp-content/uploads/2014/09/Executive_summary.pdf

National Association of School Nurses. (2015, June). About NASN. Retrieved from https://www.nasn.org/AboutNASN

Last revised 06/28/2016

 
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