Delegation in School Nursing
Delegation is the process of authorizing another individual to perform a nursing task outside their usual role. It applies to both licensed nurses and unlicensed assistive personnel (UAP). The nursing process — assessment, diagnosis, planning, implementation, and evaluation — cannot be delegated. The Delegation Model supports safe and efficient task sharing while clearly defining responsibilities to protect the public. Nurses should always consider the Five Rights of Delegation and exercise professional judgment in determining delegation.
Five Rights of Delegation
The activity or task falls within the job description and is included as part of the established written policies and procedures of the practice setting.
The health condition of the patient is stable and predictable.
The unlicensed assistive personnel have the training, capability, and continued demonstrated skills and knowledge to perform the delegated activities or tasks.
The delegating nurse must communicate specific instructions for the delegated activities or tasks and ascertain that the unlicensed assistive personnel understand what is expected and agree to the delegation.
The delegating nurse must be readily available to the unlicensed assistive personnel performing the delegated nursing activity or task, either in-person, by telephone, or through another form of telecommunication in compliance with 02-380 C.M.R. ch. 11, "Joint Rule Regarding Standards of Telehealth Practice."
School nurses determine the appropriate delegation of health-related tasks by considering safety, stability of the student's condition, nature of the task, training requirements, and capability of the staff. The final decision as to what can be safely delegated in any specific situation is within the scope of the delegating nurse's judgment. Although other personnel may be employed to assist the licensed registered professional nurse in the performance of these functions, such personnel cannot be used as a substitute for the responsibility of the licensed registered professional nurse. The delegating nurse can determine at any time that nursing activities or tasks can no longer be delegated based on a change in the health status of the patient, the unlicensed assistive personnel's performance of the activities or tasks, or other circumstance that may jeopardize patient health or safety.
Roles & Responsibilities
Licensed Practical Nurses can be a valuable addition to a school health services team. Meeting the healthcare needs of children with special healthcare needs in the school system is critical and a team consisting of both registered nurses and LPNs can ensure a safe and healthy educational experience. LPNs do not meet the professional requirements for licensure as a registered professional nurse (RN) and requirements for certification by the Maine Department of Education as a certified school nurse.
- May assist the certified school nurse with specified health tasks
- May assume health-related responsibilities only when those responsibilities do not require independent, specialized nursing knowledge, skill, or judgment including assessment and evaluation of student health outcomes, and only when those responsibilities have standardized protocols and procedures leading to a predictable outcome (32 M.R.S.A. § 2102(2)(C))
- Must work under the direction of a registered nurse
- Must function within their scope of practice including medication administration
Unlicensed Assistive Personnel are individuals acting on behalf of the school who do not have a professional license that allows them to practice nursing. They complete tasks as trained, directed, and overseen by a registered professional nurse.
- May complete specific tasks as delegated
- May administer medications as trained and delegated
- May provide first aid assistance if trained
Resources
- Navigating Delegation in the School Setting — A comprehensive course on EnGiNE outlining the factors school nurses should consider when deciding whether or not to delegate, with case studies to engage learners.
- School Health Associates — Training resources including short videos, sample procedures, and competency checklists for common nursing tasks
- National Association of School Nurses — Collection of resources on delegation in the school setting