Delegation

The safety and wellbeing of the student is the center focus of all decisions regarding the delegation of nursing tasks. Delegation is used in many professional arenas of employment, to include education and healthcare. 

Nursing delegation in schools is the process of a registered nurse transferring the authority to perform selected nursing tasks or health service delivery in selected situations to a qualified and consenting delegatee.

Steps

1. The school nurse assesses their understanding of the task prior to completing or delegating the task. 
   Children come to school with all kinds of ongoing health service needs. A registered nurse who has not performed a task in a long time, practices within their role to maintain accountability and safety. The school nurse protects the student by seeking updated knowledge from other licensed personnel in the specific expertise or healthcare field to ensure the task is proficiently performed correctly in a safe and skilful manner. 

2. The school nurse assesses the learner. 
   The school nurse collects data from various sources, to include but not limited to: nursing assessment of the student, the stability of the their health condition, the complexity of the nursing task or activity, the predictability of the outcome from completing the nursing task or activity, Information communicated in collaboration with the family or healthcare provider information if shared by the family, and other resources available to adequately monitor, evaluate and supervise delegated tasks. 

3. The school nurse assesses the nursing task or activity to be delegated. 
   The school nurse ensures  the nursing task or activity: is not complex, is part of the student’s routine healthcare,  follows a sequence of steps, does not require assessment if the delegatee is unlicensed, does not require judgement by the unlicensed delegatee,  does not require interpretation by the unlicensed delegatee, does not require modification, has a predictable outcome, is not beyond the ascribed level of practice of the delegatee. 

4. The school nurse ensures delegation is within the right circumstance. 
   The school nurse reflects on the communication between the parents, student (if applicable), school nurse and school personnel. The school nurse and parent relationship focuses on the student's access to their education program with a balance of continuity of care within licensed standards of practice.  School nurses respect parents' choices and understand that families may not be aware that nursing tasks performed in the home setting take on a more complex dimension in the school business setting. School nurses and licensed educators are held to the higher regulatory standards when making health service delivery decisions versus a parent or guardian making health service delivery decisions at home to their child.

5. The school nurse identifies the delegatee in the school setting. 
   Primary consideration with assignment and delegation is given to the recommendation of the school nurse and consent from the delegatee. The school nurse is required to retain accountability and assess the delegatee’s attributes prior to being compelled to make a decision for delegation. These attributes include, but are not limited to the delegatee’s credentials, education, previous healthcare experience, existing job duties or responsibilities, willingness, ability to follow school guidelines, school policies, school procedures, and capability to follow the communication structure. 

6. The school nurse creates an Individualized Health Plan (IHP) and plans the direction for the nursing task or activity.
   The school nurse develops an IHP for ongoing nursing and delegated health service delivery. The school nurse documents the provision of training to the delegatee that includes the delegatee’s consent, the steps of the delegated task, attestation that a skills check was completed annually and evaluation/supervision of the delegate task.

7. The school nurse collaborates and plans a two-way process of communication with the delegatee that includes documentation.
   The two-way communication process promotes trust, initiative, appreciation, and willingness to help with ongoing health service delivery to students. Communication also includes timely documentation that is accurate to collaborate with others and provide a record that the task or activity was complete.
   
   Communication from the school nurse to the delegatee includes student specific characteristics, unexpected observations to report, concerns requiring immediate communication. 
   
   Communication from the delegatee to the school nurse includes asking questions about delegated nursing tasks, seeking clarification prior to performing health services, asking for additional training, additional supervision and complete documentation of care provided.

8. The school nurse determines frequency of supervision, monitoring, and evaluation of the delegatee performing the delegated nursing tasks or health service delivery.  
   The school nurse reviews if the delegation was performed correctly and documentation was completed by the delegatee. The school nurse provides feedback and addresses any challenges related to delegation and provides feedback to the delegatee.

9. The school nurse retains accountability to determine frequency of onsite supervision and assessment. 

Unacceptable delegation, revocation of delegation or declination of assignment

An assignment is the provision of nursing care requested from a school district or school administrator to a school nurse that is within the authorized scope of practice for the nurse. 

Delegation is the act of transferring to the delegatee the performance of specific nursing tasks or health service delivery that is beyond the delegatee’s role in the school setting that requires additional training and a hands on skills check.

The school nurse cannot delegate: 

• nursing assessment to an unlicensed delegatee
• formulating nursing diagnoses
• family or patient education
• planning
• supervision, monitoring or evaluation
• nursing judgement
• any nursing activities or functions which are beyond the scope of practice of the licensed practical nurse to an unlicensed delegatee 

The school nurse declines an assignment when the nurse:

• does not have the authority to intervene or take correct action if necessary
• has never performed the health task that is to be supervised, monitored and evaluated
• does not have the opportunity and/or proximity to provide effective monitoring, evaluation, or onsite supervision
• would not be able to intervene if there was a problem

The school nurse may determine not to delegate or revoke delegation with reasons such as: 

• regulatory issues
• failure of the delegatee to demonstrate competency in the nursing task after completion of training
• incomplete demonstration of competency in performing the nursing task by the delegatee when providing health services
• issues with safely provide onsite supervision, monitoring, or evaluation the delegated nursing tasks
• student health status change
• assessment data