School Nurse Medication Delegation Instructions

1. The school nurse maintains accountability in nursing judgment to delegate nursing tasks or functions.
2. The school nurse is required to develop an individualized health plan (IHP) if the student receives ongoing individualized health services at school, such as:
   1. routine or emergency medication administration,
   2. any other health service requiring intervention or interpretation,
   3. use of a health device to compensate for the reduction or loss of a body function,
   4. administration of health procedures,
   5. student requires an emergency action plan (EAP), requires an emergency evacuation plan (EEP), or
   6. administration of healthcare.
3. The school nurse obtains consent from the school personnel agreeing to complete the delegated task or medication administration.
4. The school nurse has the school personnel take the on-line medication administration course every five years if this is the task delegated.
5. The school nurse has the school personnel take the on-line medication administration course every five years if this is the task delegated.
6. The school nurse has the school personnel take the on-line medication administration course every five years if this is the task delegated.
7. If the delegation is for a population of students, the signed certificate and delegation consent forms are stored as directed by district or accredited nonpublic school policy.
8. If the delegation is for an individual student, the form(s) are stored in the student's health record.

Parents are required to provide consent to include, but not limited to:

• administration of any prescription or nonprescription (FDA approved) medication administration
• administration of a school’s voluntary supply of nonprescription medication or voluntary supply of emergency medication•ongoing health service delivery at school for their child

Parents may provide additional documentation to include, but not limited to:

• the necessary health information at registration to inform the school of their child’s unique health needs.
• the necessary documentation to ensure the school nurse can make safe delegation decisions related to health services carried out in a manner that supports the continuity of care between the healthcare provider, home and the licensed school health personnel
• consent to communicate with their child's health care provider (excluding emergencies or clarification between provider and provider as outlined in the FERPA Joint Guidance, 2019)

The school nurse utilizes standards of practice, professional judgment and maintains accountability in decisions to delegate practice and health service delivery in schools. Both the licensed educator and the licensed school nurse are held to higher regulatory standards than parents are at home, therefore the district or school must abide by policy and license requirements in the provision of health service delivery. 

Competency Documentation: The school nurse is required to document health instruction competency of the school personnel to perform a specific delegated activity, skill, or procedure that is beyond the school personnel’s traditional role. The school nurse is required to obtain consent from unlicensed personnel to perform any special health service or intrusive nonemergency medical service to meet the requirement in Iowa Code 280.23. 

School Nursing Documentation: The school district or accredited nonpublic school is required to have a policy that includes maintaining a record of all special health service delivery. The school nurse working under the auspices of the school is required to document the nursing process in development of an IHP, professional nursing practice delivery, technical assistance, instruction, competence, hands on skills checks, supervision, and evaluation of authorized qualified personnel. The school nurse must also document delegation revocation and comply with all documentation requirements in policy and IAC 655.6. 

Health Service Delivery Documentation: The documentation required by the school nurse or the qualified school personnel for health services must include the student’s name, the health service, date of birth, the prescriber or the person authorizing or delegating the task, date, time, outcome or student's response, signature of the person providing the service and any unusual circumstances in the provision of the service. 

Medication Administration Documentation: The medication administration record required or documentation must include the date, student’s name, date of birth, prescriber or person authorizing administration, medication name and purpose, medication dosage, administration time, administration method, signature and title of the person administering medication, and any unusual circumstances, actions or omissions.