Section 2: Health Service Delivery Roles

Parent/Guardian

The parent/guardian's role in health service delivery is crucial as they act as the primary support system for their child's health by:

• promoting healthy habits at home.
• modeling safe management of their child’s ongoing health needs.
• collaborating with school nurses and the health service delivery team at school to ensure the school has adequate information to meet their child’s needs.
• actively participating in communication.
• working in partnership to promote positive student health outcomes to support their child's overall well-being. 

Parents/Guardians must provide:

• their choice of an approved record option to satisfy Iowa HHS screening requirements for enrollment
• consent for any ongoing health service delivery for their child(ren) outside of emergency and school personnel’s licensure requirements to act.
• consent for any medication administration by qualified, authorized and consenting delegatee’s or delivered within the school nurse’s scope and standards of practice.
• any other required documentation for the school or school sponsored program.

Parents/Guardians may provide:

• health information at registration.
• communication throughout the school year regarding their child’s health needs.
• medical information and records that are protected by the Family Education Privacy Rights Act if maintained by a school or school sponsored program
• consent for release or exchange information between the school or program and the child’s providers.
• consent for schools to seek health insurance reimbursement for health service delivery.
• consent for evaluation under the Individuals with Disabilities Education Act or Section 504.

Parents/Guardians may seek resolution:

Parents/guardians may seek resolution at any time through grievance procedures through local communication with:

• their child’s school (public, accredited nonpublic, independent accredited nonpublic or charter)  and/or school board or authorities in charge,
• state entities, and/or
• federal entities. 

Parents/guardians may also revoke consent at any time. It is always best to resolve disputes at the earliest stages by those parties who are most involved in a child's education or program (namely the child's parents, school staff and area education agency (AEA) staff). When Parents/guardians, school and program staff work together, usually problems can be worked out and an agreement can be reached that is in the best interest of the child.

Administration 

School and program leaders collaborate with school nurses in the nurse’s selection of willing and appropriate paraprofessionals or licensed personnel to carry out delegated health service delivery or  nursing tasks prior to their employment beginning or prior to assigned responsibility changes. School and program administration understands that:

1. consenting paraprofessionals or licensed personnel must feel comfortable to complete the health service delivery or tasks within the scope of their  employment.
2. school nurses must feel comfortable with the skill level of the delegatee to follow a sequence of steps, communicate, document, and have a method to supervise, monitor and evaluate the delegatee.
3. school nurses are the professional who is delegating health service delivery or nursing tasks within licensure safely in the absence of the licensed school nurse in accordance with their scope of practice. 

School Nurse

The school nurse oversees health service delivery in the school or school sponsored program for the entire school population and may delegate tasks in accordance with practice by following a delegation process outlined by the licensing board and standards of practice. Other licensed health personnel’s interdisciplinary services are coordinated and dependent on an individual's overall health needs. The school nurse collaborates to lead the school health services team in the identification of and intervention for health-related barriers to improve student learning and is part of the education team. 

Delegation by a school nurse to authorized or qualified personnel means that the nurse retains accountability to ensure that delivery of care is implemented safely and effectively to produce positive health outcomes. The school nurse independently utilizes the nursing process and professional nursing judgment with decisions to delegate. 

The school nurse retains accountability in the delegation for:  

• Holding current licensure to practice nursing with their state regulatory licensing board and maintaining knowledge of the current scope and standards of practice
• Understanding the Iowa Nurse Practice Act provides the practicing nurse with safe parameters providing the student and family, as the consumer, rights of protection when needing nursing care and
• Completing training with the delegatee before a nursing task or activity is carried out.
• Ensuring proficient completion of the return skills demonstration for the delegated health task from the delegatee to the school nurse for the person to become qualified or authorized to perform health service delivery
• Maintaining documentation of the unlicensed assistive personnel’s consent, competency, completion of education, and evaluation of delegated nursing tasks or activities.
• Following the steps in delegation with the primary focus on student or child safety to include the right task, the right circumstance, the right person (UAP), the right direction/communication, and the right supervision, monitoring, and evaluation.

Signing Consent & Delegation Form as a School Nurse

The school nurse provides written consent attesting on the Consent and Delegation Form that they:

• have utilized the delegation process identified in the Nurse Practice Act,
• the signed qualified personnel signed has successfully completed an annual return skills demonstration of all selected or listed delegated health service(s)/task(s),
• has documented the annual skills demonstration,
• has communicated the frequency of supervision, monitoring and evaluation of the delegated special health service(s) /nursing task(s) to the qualified personnel or delegatee,
• has communicated directions and expectations for completion of the delegated activity and has received confirmation of understanding of the communication from the qualified personnel by signature using the steps outlined in the Iowa Department of Education School Nurse (SN) Toolkit or the Consent and Delegation Form

Qualified or Authorized School Personnel (Paraprofessional)

Students attend schools and school sponsored programs with individualized complex health needs. This need makes it necessary to offer a broad and varied experience to the student that lends to group or one-on-one delivery of special health services to provide a least restrictive educational environment. Paraprofessionals and program personnel have a professional identity and maintain positive, supportive, cooperative, and professional relationships with their licensed colleagues. The value of paraprofessionals, program personnel, and the complexity of their roles is recognized and essential to the success of safe school and school sponsored program health service delivery in collaboration with licensed health personnel. 

The primary consideration with assignment and delegation by the recommendation of the licensed health personnel working under the auspices of the school or school sponsored program include many factors such as the personnel or paraprofessional’s:

• education,
• credentials, previous healthcare experience,
• existing job duties or responsibilities,
• willingness,
• ability to follow guidelines, policies, and procedures,
• ability to maintain confidentiality of information,
• ability to work with children,
• ability to understand and follow the process of communication in an emergency
• your consent agreeing to perform delegated nursing tasks or activities 

Signing Consent & Delegation Form as a Qualified or Authorized School Personnel (Paraprofessional)

The paraprofessional provides written consent attesting on the “Consent and Delegation Form” that they:

• understands directions,
• understand their expectations for completion,
• understand their responsibility,
• understand their accountability in the provision of the selected health service(s)/task(s) as instructed and after demonstrating competency by completing an annual hands-on skill check with the school nurse to meet the nurse’s licensure requirement, policy, and rule requirements,
• agrees to communicate concerns or incidents promptly,
• agrees to ask questions, and
• agrees to document all health services/delegated task(s) provided in accordance with the special health services policy.

Licensed Nurses Providing 1:1 or Group Care

Students attend schools and school sponsored programs with individualized complex health needs. This need makes it necessary to offer a broad and varied experience to the student that lends to group or one-on-one delivery of special health services to provide a least restrictive educational environment. Licensed nursing personnel have a professional identity and maintain positive, supportive, cooperative, and professional relationships with their licensed colleagues. The value of licensed nursing personnel and the complexity of their roles is recognized and essential to the success of safe school and school sponsored program health service delivery in collaboration with the licensed school nurse.

Signing Consent & Delegation Form as a Licensed Nurse Providing 1:1 or Group Care

The licensed nurse providing 1:1 or group care provides written consent attesting on the “Consent and Delegation Form” that they:

• understands directions,
• understand their expectations for completion,
• understand their responsibility,
• understand their accountability in the provision of the selected health service(s)/task(s) as instructed and after demonstrating competency by completing an annual hands-on skill check with the school nurse to meet the nurse’s licensure requirement, policy, and rule requirements,
• agrees to communicate concerns or incidents promptly,
• agrees to ask questions,
• agrees to follow all practice requirements, and
• agrees to document all health services/delegated task(s) provided in accordance with the special health services policy.

Accountability of Licensed Professionals

The licensed school nurse retains accountability in delegation for: 

• holding current licensure to practice nursing with their state regulatory licensing board
• being knowledgeable of their scope and standards of practice
• understanding the Iowa Nurse Practice Act that is written to provide the consumer rights of protection when needing nursing care and provide the practicing nurse with safe parameters within which to work (IAC 655 Chapter 6)
• the completion of training with the delegatee prior to a nursing task or health service delivery activity being performed
• ensuring proficient completion of the return skills demonstration for the delegated task or activity from the delegatee to the school nurse prior to a nursing task or activity being performed
• supervision, monitoring and evaluation of the delegated
• maintaining documentation while employed under the auspices of the school or organization to include the delegatee’s consent, competency and completion of education in the delegated task(s) or activities, documentation of the evaluation
• the nursing process and evaluation of the student’s health outcomes
• following the steps in delegation with the primary focus on student safety

The licensed education practitioner retains accountability for:  

• not delegating educational tasks to unqualified personnel
• not performing beyond their licensed scope of practice
• maintaining conditions that are not harmful to student learning
• not aiding, assisting, or abetting an unlicensed individual in the completion of acts for which licensure is required

The Iowa Board of Nursing and Board of Educational Examiners has provided guidance if any licensed person violates one of the provisions of Iowa Administrative Code (IAC) 655-6 or IAC 282-25(3), a complaint could be filed and disciplinary action taken. Together, licensed education practitioners and licensed school nurses follow regulatory standards and guidance in the delegation of their professional practices to protect the health and safety of Iowa students.