Delegation Toolkit for School Nurses
Disclaimer: This toolkit is intended to provide resources for school nursing practice as it relates to delegation of nursing procedures in Oregon Schools. This is not legal, medical, nor nurse practice advice and is not prescriptive as it relates to individual students or individual nursing practice. These resources do not override individual assessment, and clinical judgment. Registered Nurses are responsible for their own assessments, practice, and obligation to the Oregon Nurse Practice Act (NPA).
Delegation
Nursing Delegation is defined as the ability of the registered nurse (RN) to consider the transfer of responsibility of a nursing procedure to an unregulated assistive person (UAP) while the RN continues to be accountable for the outcomes (American Nurses Association [ANA], 2007). The National Council of State Boards of Nursing and American Nurses Association have published National Guidelines on Nursing Delegation (2019) recognizing nursing delegation is an essential skill in nursing practice. The decision to delegate a nursing procedure is based upon:
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the judgment concerning the assessment of the student and supporting dynamics
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the competence of nursing
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the degree of supervision
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the procedure to be delegated
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the competency of the UAP (NCSBN/ANA, 2019)
The national guidelines on nursing delegation (NCBSN/ANA, 2019) have formulated a model (below) for delegation of nursing procedures that encompass the institutional responsibilities, the nurses responsibilities, and the UAP’s responsibilities.
(NCBSN/ANA, 2019)
Delegation in the School Setting
Delegation of nursing procedures in school settings is a necessity given the number and complexity of school nursing responsibilities, the increasing health needs of students, and the limited number of school nurses available to meet these needs (Resha, 2010).
Nursing delegation is the clinical decision by the RN (not a school administrator) to a competent UAP willing to perform a ttingselected nursing procedure in a selected situation for a selected individual. The school nurse completes the assessment of the student, the UAP training, the evaluation and validation of UAP competence, and provides ongoing supervision of the UAP as well as additional and ongoing evaluation of the student’s health outcomes (NASN, 2018).
Nursing delegation is only allowed in community-based care settings, including schools. Without the structure of a typical clinical setting, the nurse must ensure that this unique environment supports nursing delegation.
Evidence Based Practice
Basic Information
Legal Practice Standards
At the forefront of nurse case management for school nurses is the understanding of scope of practice as it relates to case management and delegation of nursing procedures in a community setting:
Public Access Practice Resources
Note: the following are national or regional resources that serve as a reference; they may or may not be consistent with Oregon law and do not supersede Oregon Nurse Practice Act (NPA).
American Nurses Association
National Association of School Nurses
National Council of State Boards of Nursing
Oregon Health Authority-Oregon Department of Education
Professional Development
Nurses must ensure that they have proficiency in areas of practice in which they delegate. The following include Free Continuing Education resources for Nursing related to delegation skills:
National Association of School Nurses
Oregon DHS
Online Home CEU
Tools
Nursing Delegation Resources
OSNA: Understanding Delegation
(Who/What/When/Where/Why/How Nursing Practice Document)
NASN
Templates
The following templates are modifiable for use by school nurses as it relates to their practice and should be used consistently with Oregon State Board of Nursing Delegation Laws, and local school policy.
Delegation Forms: (Documentation of the delegation process)
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Form 1: This form would be used to initiate the delegation process with student assessment and determination of whether or not to delegate.
- Form 2: This tool could be used to guide the nurse’s assessment of the UAP. It can be used for re-evaluation in addition to the Delegation Process Re-Evaluation Agreement
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Form 3: This form is used to document the initial agreement with the UAP to deliver care in the delegated procedure.
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Form 4: This form can be used for the re-evaluation of the UAP’s performance of the delegated procedure.
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Form 5: This form should be used when the nurse makes a determination to rescind the delegation.
Optional Documentation
Authors: Jan Olson, Lori Perkins, Wendy Niskanen
Peer Reviewers: Denise Cardinali, Tamara Bow, Corinna Brower, Kristiina Gagner, Tanya Martin, & Jamie Smith
Editorial Reviewer: Ann Occhi
References
American Nurses Association. (2007). Assuring safe, high quality health care in the pre-K through 12 educational settings. (Position Statement).
American Nurses Association. (2012). The principles of delegation. Silver Springs, MD: ANA.https://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principlesofdelegation.pdf
Barrow JM, Sharma S. Five Rights of Nursing Delegation. [Updated 2022 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519519/
Bifarin O., Stonehouse D.(2017) Clinical supervision: an important part of every nurse’s practice. Br. J. Nurs.;26(6):331–335. - PubMed
Blay N., Roche M. (2020). A systematic review of activities undertaken by the unregulated
National Council of State Boards of nursing (2016) National guidelines for nursing delegation. Journal of Nursing Regulation 7(1) 5-14
National Association of School Nurses. (2018). The role of the 21st century school nurse (Position Statement). Silver Spring, MD: Author.
National Association of School Nurses (2019). School-sponsored trips - The role of the school nurse (Position Statement). Silver Spring, MD: Author.
Nursing Assistant. J. Adv. Nurs;76:1538–1551. - PubMed
National Institutes of Health (2017). What are competencies? https://hr.nih.gov/about/faq/working-nih/competencies/what-are-competencies
Joint Position Paper from ANA and NCBSN on the National Guidelines for Nursing Delegation
https://www.ncsbn.org/public-files/NGND-PosPaper_06.pdf
Resha, C., (2010) Delegation in the School Setting: Is it a Safe Practice? OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 2, Manuscript 5.
Shore CB, Maben J, Mold F, Winkley K, Cook A, Stenner K. (2022). Delegation of medication administration from registered nurses to non-registered support workers in community care settings: A systematic review with critical interpretive synthesis. Int J Nurs Stud.;126:104121. doi: 10.1016/j.ijnurstu.2021.104121. Epub 2021 Oct 29. PMID: 34896760; PMCID: PMC8803545.
Stenner K, Shore CB, Maben J, Mold F, Winkley K, Cook A. Delegation of insulin administration to non-registered healthcare workers in community nursing teams: A qualitative study. J Adv Nurs. 2023 Apr 2. doi: 10.1111/jan.15662. Epub ahead of print. PMID: 37005976.
Zheng J, Tayag J, Cui Y, Chen J. Bloom's Classification of Educational Objectives Based on Deep Learning Theory Teaching Design of Nursing Specialty. Comput Intell Neurosci. 2022 Jul 21;2022:3324477. doi: 10.1155/2022/3324477. PMID: 35909830; PMCID: PMC9334097.