Role of the Licensed Practical Nurse/Licensed Vocational Nurse in the School Setting

Role of the Licensed Practical Nurse/Licensed Vocational Nurse in the School Setting

 

Position Statement

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SUMMARY

It is the position of the National Association of School Nurses (NASN) that the Licensed Practical Nurse or Licensed Vocational Nurse (LPN/LVN) can be a valuable member of the school health team led by the registered professional school nurse (hereinafter referred to as school nurse). The LPN/LVN performs nursing functions and shared nursing responsibilities, according to the scope of practice outlined by the nurse practice act of the state in which the LPN/LVN is licensed, and under the supervision of the school nurse (Schwab, Hootman, Gelfman, Gregory, & Pohlman, 2005).

BACKGROUND

LPNs/LVNs are nurses who complete a 12-month program offered through vocational high schools or community colleges followed by passing the state licensure exam. Their practice is guided by state nurse practice acts that outline the scope of their practice and include working under the supervision of a registered nurse (RN). Each state’s nurse practice act regulates the scope and practice of both the RN and the LPN/LVN (Laubin, Schwab, & Doyle, 2013). Registered nurses complete two to four years of pre-service preparation at a community college or university followed by passing the state licensure exam.

The demand for health services in schools has increased over the last few decades partly because of an increased number of students with special healthcare needs and disabilities. In the school setting, there are increasing numbers of students with disabilities and chronic conditions (i.e. intellectual disability, hearing impairment, speech or language impairment, visual impairment, emotional disturbance, orthopedic impairment, autism, traumatic brain injury, other health impairment, learning disability, asthma, diabetes, seizures and life-threatening food allergies) requiring nursing services. The needs of the students may include medication administration, care coordination for students with chronic disease, intermittent catheterization, tracheostomy care and suctioning, gastrostomy care and feedings, skin assessment, positioning, or equipment monitoring (Caldart-Olson & Thronson, 2013).

Federal regulations define the right of students with special health needs to receive the services they need to attend public school, including school health services. The laws guarantee access to education and support services for special education and regular education students with disabilities and with special healthcare needs (Gibbons, Lehr, & Selekman, 2013). Individuals with Disability Education Improvement Act (IDEIA) (2004), Rehabilitation Act of 1973 (§504) (2000), and the Americans With Disabilities Act of 1990 (ADA) (2000) are three federal laws that stipulate that students with special healthcare needs have the right to be educated with their peers in the least restrictive environment (Gibbons et al., 2013). These students also have the right to receive support and accommodations for conditions that adversely affect their capacity for learning (Schwab et al., 2005).

RATIONALE

Sharing some nursing tasks provides the school nurse an opportunity to fully implement the school nurse role including development of Individualized Healthcare Plans and carrying out the health education and case management tasks (Fleming, 2011). In order to safely create an effective school health team and determine the appropriate use of nursing resources, the school nurse should consider the following action steps:

  1. Complete nursing assessments for students with disabilities and chronic conditions in the school, and determine the individual healthcare needs.

  2. Examine the unique parameters of the state’s nurse practice act – the definitions of scope of practice. These state-specific statutes will determine what nursing tasks the LPN/LVN can carry out in that state (American Nurses Association [ANA], 2012).

  3. Review if the LPN/ LVN can work independently. Some nurse practice acts preclude an LPN/ LVN from functioning independently because in these states an LVN/ LPN can only work under the direct supervision of a registered nurse. In states such as these, LPNs/ LVNs may only be assigned to positions where they have onsite supervision by a registered nurse such as one-on-one nursing services or a second nurse in large high schools.

  4. Determine which nursing tasks and actions can be appropriately assigned or delegated in accordance with state nurse practice acts to the LPN/ LVN. Some examples include medication administration, delegated student-specific tasks, and assisting in managing the minor injuries and illness complaints that make up a large portion of health room visits.

  5. Plan for the process of RN supervision based on the number of students served and the acuity of the needs of the students served. The state’s nurse practice act will outline requirements for RN supervision. Consider whether onsite supervision is required or if one RN may supervise more than one school (National Association of State School Nurse Consultants & NASN, 2012).

CONCLUSION

LPNs/LVNs can be a valuable part of school health teams that provide nursing services to meet the increasing number and acuity of student healthcare needs. The RN leads the school health team, performs the nursing assessment and develops the Individualized Healthcare Plan (IHP). The RN is the professional accountable for assessing the individual student healthcare needs and determining who has the capability and competence to provide appropriate care for the student (Resha, 2010). The scope of practice of LPNs/LVNs may include implementing the IHP and administering medications under RN supervision according to state nurse practice acts. LPNs/LVNs must work closely with the school nurse so that the healthcare needs and safety of all students are provided for during the school day. As more children with special healthcare needs enter the school system, the roles of the school nurse and the LPN/LVN become even more critical in assuring the rights, safety, and educational experiences of all students.

REFERENCES

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

Americans with Disabilities Act of 1990 (ADA) (2000), 42 U.S.C. §§ 12101-12213. 

Caldart-Olson, L., & Thronson, G. (2013). Legislation affecting school nurses. In J. Selekman (Ed.), School nursing: A comprehensive text (2nd ed.) (pp. 225-256). Philadelphia, PA:  F.A. Davis Company.

Fleming, R. (2011). Imperative issues affecting school nurse practice: Implications for the future of school nursing and child health in Washington state. Washington State Nurses Association. Retrieved from http://www.wsna.org/practice/publications/documents/school%20nurse%20white%20paper%20-%20r2.pdf 

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

Individuals with Disability Education Improvement Act (2004), 20 U.S.C. 1400 et seq.  

Laubin, M., Schwab, N. C., & Doyle, J. (2013). Understanding the legal landscape. In C. Costante (Ed.), School nurse administrators: Leadership and management, (pp.459 - 519). Silver Spring, MD: National Association of School Nurses.

National Association of State School Nurse Consultants and the National Association of School Nurses. (2012). Joint consensus statement: Safe school nurse staffing for quality school health services in schools. Retrieved from https://www.nasn.org/Portals/0/statements/consensus_safe_sn_staffing.pdf

Rehabilitation Act of 1973, 29 U.S.C.794 § 504. 

Resha, C. (2010).  Delegation in the school setting: Is it a safe practice? OJIN: The Online Journal of Issues in Nursing, 15(2). doi: 10.3912/OJIN.Vol15No02Man05

Schwab, N. C., Hootman, J., Gelfman, M.H., Gregory, E. K., & Pohlman, K. J. (2005). School nursing practice: Professional performance issues. In N.C. Schwab and M.H. Gelfman (Eds.), Legal issues in school health services: A resource for school administrators, school attorneys, and school nurses, (p.p. 123- 165). Lincoln, NE: Author’s Choice Press.

Related NASN Position Statements:

Role of the School Nurse (2011) http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullView/tabid/462/Arti
cleId/87/Role‐of‐the‐School‐Nurse‐Revised‐2011

Education, Licensure, and Certification of School Nurses (2012) http://www.nasn.org/portals/0/positions/2012pseducation.pdf  

Acknowledgment of Authors:
Jessica Porter, BSN, RN, NCSN
Anne Coyle, BSN, RN, NCSN
Cheryl-Ann Resha, EdD, MSN, RN, FNASN
Joan Cagginello, MS, BSN, RN

Adopted: June 2015

Suggested citation: National Association of School Nurses. (2015). Role of the licensed practical nurse/licensed vocational nurse in the school setting (Position Statement). Silver Spring, MD: Author.

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.