School-sponsored Trips - The Role of the School Nurse
It is the position of the National Association of School Nurses (NASN), that the registered professional school nurse (hereinafter referred to as school nurse) is the expert healthcare provider in the school setting who can support and guide students and staff in meeting the healthcare needs of students both at school and on school-sponsored trips such as extracurricular activities, field trips, intramural athletic events, and interscholastic athletic events (NASN 2016; Connecticut State Department of Education, 2014). All students, including students with special needs, have the right to participate in school-sponsored trips (U. S. Department of Education [USDE]/ Office of Civil Rights [OCR], 2016). The school nurse's role is critical in planning, coordinating, and educating staff, families, and students to assure appropriate care for all students every day at school and during school-sponsored trips (NASN, 2016; Yonkaitus & Shannon 2017).
School-sponsored trips are offered to complement and enhance the educational experience for students. 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 the parents/guardians of a student with special healthcare needs to accompany the student on the trip, school officials cannot require that a parent/guardian of a child with special healthcare needs attend if parents of students without special healthcare needs are not required to accompany their children (USDE/OCR, 2016).
Beginning in the 1960’s, the United States began enacting laws to support students with special needs (Galemore & Sheetz, 2015). The rights of students with disabilities are protected through the Individuals with Disabilities Education Improvement Act (IDEIA) (2004) and Section 504 of the Rehabilitation Act of 1973 (Yonkaitis & Shannon, 2017). All schools that receive federal funds are subject to Section 504 and the American with Disabilities Act (ADA) of 1990 (USDE/OCR, 2017). Under Section 504 regulations, equal access includes serving students with disabilities in the academic and non-academic settings, including school-sponsored trips. To guarantee that students with disabilities have equal access to school programs, Section 504 requires that schools provide modifications and/or accommodations. If a student with a disability needs an accommodation or related aids or services to participate in the field trip, those services must be provided (USDE/OCR, 2016). Local school districts are responsible for providing the needed accommodations to students with disabilities to safely participate alongside their classmates on school-sponsored trips.
In 2015, the Every Student Succeeds Act (ESSA) identified the school nurse as the healthcare expert to manage students with chronic healthcare needs, including those with disabilities (ESSA, 2015). In 2011-2012 approximately 25% of children aged 6 to 17 years were reported to have a special health care need (Child Health USA, 2014). School nurses are responsible for informing educational communities about the medical needs of students so that they may safely participate in school-sponsored trips. For example, a student with a life-threatening allergy could qualify for a 504 plan that would include modifications so that the student may participate safely on a field trip (Galemore & Sheetz, 2015).
A system should be present which engages the school nurse in all planning phases of the school‐sponsored trip to ensure that a comprehensive plan for student care and safety is in place. According to federal mandates, schools must provide equal opportunities to access participation in all activities, both academic and extracurricular, including access to health services (Erwin, Clark, & Mercer, 2014). To promote proper access to health services, the school nurse should perform individual health assessments and develop or update individual health plans (IHPs) annually. These timely plans will enable appropriate, safe care for students with special healthcare needs throughout the school year, including for potential school-sponsored trips. The student’s healthcare needs on school-sponsored (field) trips are determined through a collaborative process coordinated by the school nurse, reviewed at least annually, and as needed throughout the school year (NASN, 2016). 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 or ECPs (Erwin et al., 2014).
The school nurse’s knowledge of the individual needs of students places the school nurse in a unique position to coordinate care that enables the student to fully participate in a safe and healthy school‐sponsored trip experience (NASN, 2016).
Planning steps may include
- assessing trip plans, including transportation methods, student’s dietary issues and needs; accompanying staff; layout/structure of the planned visitation site(s); duration of the trip; and proximity/access to emergency medical care;
- addressing medical issues such as medication, medical treatments, and procedures required during the trip, as well as the potential for health emergencies; and
- determining the cost of accommodations. Currently, the costs associated with providing accommodations are the responsibility of the school district and must be considered in the initial planning phases of a proposed school‐sponsored trip (USDE/OCR, 2016).
For in-state school-sponsored trips, depending on state regulations, the school nurse may be able to consider delegating some tasks required during the trip to a non‐nurse staff member, such as a teacher (Bobo, 2014). The school nurse will utilize appropriate principles of nursing delegation as described in the national guidelines written by The National Council of State Boards of Nursing (NCSBN, 2017), the state Nurse Practice Act, and other state school nurse delegation guidelines. If the school nurse determines that medical care cannot be legally or safely delegated, the school nurse will need to determine and coordinate the nursing staff required to accompany the student. The school nurse will need to arrange for proper staffing in the school health office if it is determined the school nurse should accompany the child on the trip (Erwin et al., 2014).
If the school-sponsored trip takes place in a different state or country and requires the presence of the school nurse, there will be licensing laws that need to be considered, so that the school nurse can legally provide nursing services in 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 compact states (NCBSN, 2017). Some states do not have a compact law. The school nurse must act accordingly, relating to all facets of practice. For trips occurring out of the United States, the nurse or a school representative should contact the U.S. State Department, which will direct the inquiry to the appropriate international contact (Erwin et al., 2014).
School-sponsored trips may be common occurrences in the educational lives of students and can be some of their most enjoyable. School districts that receive federal funding are legally bound to assure that all students have access to these opportunities (USDE/OCR, 2016), regardless of disability or healthcare needs. It is the position of NASN that the school nurse’s role is critical in the planning, coordination, and education of staff, families, and students. Providing appropriate care and protecting the needs and rights of ALL students allows for a safe, enjoyable educational experience for each person participating in these trips.
Americans with Disabilities Act of 1990 (ADA) (2000), 42 U.S.C. §§ 12101-12213.
Bobo, N. (2014). Principles for practice: Nursing delegation to unlicensed assistive personnel in the school setting. Silver Spring, MD: National Association of School Nurses.
Connecticut State Department of Education. (2014). Field trips-guidance for school nurses. Retrieved from http://www.sde.ct.gov/sde/lib/sde/pdf/publications/field_trips/fieldtrips.pdf
Erwin, K., Clark, S., & Mercer, S.E. (2014). Providing health services for children with special health care needs on out-of-state field trips. NASN School Nurse, 29(2), 85-88. doi: 10.1177/1942602X13517005
Every Student Succeeds Act (ESSA). (2015). Public Law No: 114-95 (12/10/2015). Library of Congress, Washington D.C. Retrieved from https://www.congress.gov/bill/114th-congress/senate-bill/1177/text
Galemore, C.A., & Sheetz, A.H. (2015). IEP, IHP, and Section 504 primer for school nurses. NASN School Nurse, 30(2), 85-88. doi: 10.1177/1942602X14565462
Individuals with Disability Education Improvement Act, 20 U.S.C. 1400 et seq. (2004).
National Association of School Nurses. (2016). Framework for 21st century school nursing practice. NASN School Nurse, 31(1), 45‐53. doi: 10.1177/1942602X15618644
National Council of State Boards of Nursing. (2017). Nursing licensure compacts. Retrieved from https://www.ncsbn.org/compacts.htm
Rehabilitation Act of 1973, 29 U.S.C. 504. (2000).
U. S. Department of Education, Office for Civil Rights. (2016). Parent and educator resource guide to Section 504 in public elementary and secondary schools. Retrieved from https://www.ed.gov/news/press-releases/us-department-education-releases- guidance-civil-rights-students-disabilities
U. S. Department of Education, Office for Civil Rights. (2017). Sub-part D of the Section 504, preschool, elementary, and secondary education. 104.31 application of this subpart. Retrieved from https://www2.ed.gov/policy/rights/reg/ocr/edlite-34cfr104.html
U.S. Department of Health and Human Services, Health Resources, and Services Administration, Maternal and Child Health Bureau. (2014). Child health USA 2014. Rockville, Maryland: U.S. Department of Health and Human Services. Retrieved from https://mchb.hrsa.gov/chusa14/
Yonkaitis, C. F., & Shannon, R. A. (2017). The role of the school nurse in the special education process: Part 1: Student identification and evaluation. NASN School Nurse, 32(3), 178-184. doi: 10.1177/1942602X17700677
Acknowledgment of Authors:
Alicen Hardy, ADN, RN
Cameron Traut, MS, BSN, RN, NCSN
Cindy Begley, BSN, RN
Adopted: June 2013
Revised: January 2018
Suggested citation: National Association of School Nurses. (2018). School-sponsored trips -The role of the school nurse (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.