Recommended School Health Services Staff Roles

Health

and

Human

Services

Texas

Department

State

Health

Services

TEXAS

Recommended School Health Services Staff Roles

Last Updated: April 2018

Background

Like school health services in the rest of the United States, school health in

Texas has evolved from a simple system of visiting nurses to a complex

network of multifaceted school health programs and full-service school-

based health centers.

Texas school nurses have provided many services to local school children in

supporting the complex physical and mental health issues that are now

being addressed in the school setting. School nurses provided essential

information to the Department of State Health Services (DSHS) in detecting

varicella outbreaks in children that had previously been immunized. In

addition, school nurses play a vital role in providing information about flu

and other infectious diseases and reporting outbreaks to DSHS.

With more children entering school with complex medical issues, schools are

challenged to match the available resources and the needs of the students in

the development of school health services. The Texas Education Code (TEC)

§38.012 outlines requirements that school boards are to follow in

implementing or expanding school health services. Although there are

different models implemented throughout the state, the following guidelines

will help in developing a local model that is both reflective of state laws,

professional licensing, and best practices in school health service delivery.

The different levels of the model are described below.

Medical Advisor/Director

A physician currently licensed by the Texas Board of Medical Examiners that

provides contracted or consultative services to the school district through

the health services coordinator and/or administrative personnel in matters

that impact the areas of the Whole School, Whole Community, Whole Child

model.

Suggested responsibilities include but are not limited to:

• Participates in the establishment of goals and priorities for the school

health program.

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Recommended School Health Services Staff Roles

• Serves as a member of the district’s school health advisory committee,

exposure control committee and other health and safety related

committees.

• Serves as a subject matter expert to administration regarding policies

and administrative regulations on student and employee health,

including but not limited to: management of serious physical and

mental health problems, communicable disease control, health

screenings, environmental hazards, first aid, automated external

defibrillator protocols, epinephrine auto-injectors, accident prevention

and emergency care;

• Advocates for the school health program and promotes discussion and

collaboration with community agencies and organizations, such as

medical, dental and other professional health associations, health

departments and consumer groups;

• Serves as a consultant to coordinate health services with other district

departments such as special education, athletics, physical education,

nutrition services and health education;

• Participates in professional growth planning for school nurses and

other school personnel as needed;

• Promotes communication between the school district and primary care

physicians, medical specialists and health care facilities regarding

treatment plans for students;

• Upon request, provides review for outside proposals for health-related

activities within the district such as education research and service

activities; and

• Develops, reviews, revises and oversees implementation of standing

orders required for AEDs, epinephrine auto-injectors, and other health

service needs related to district policies and administrative regulations.

School Health Services Coordinator

A licensed healthcare professional (Registered Nurse (RN) or Advanced

Practice RN) at the district level that is responsible for the management and

coordination of all school health service policies, administrative regulations,

activities and resources, including program administration, implementation

and evaluation. The healthcare professional should have experience in school

health, community health, pediatric/adolescent health care, and/or nursing

administration.

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Recommended School Health Services Staff Roles

Suggested responsibilities include:

• Coordinates implementation of state mandates related to school health

services including, but not limited to: CPR/AED, screenings,

immunizations, Type 2 Diabetes Screening (if applicable) and other

state laws, rules and regulations;

• Identifies, analyzes and applies current nursing and medical research

findings to plan and provide health care delivery for all students;

• Determines the goals and priorities of the health services program in

conjunction with nursing and other staff, within the goals and strategic

plan established by the district;

• Establishes the organization and determines the priority for allocation

of resources to achieve the school health services program goals;

• Develops programs and recommends policies and administrative

regulations related to health and safety and provides expert advice to

district administration and other departments regarding policies,

administrative regulations, nursing and healthcare standards on

matters impacting students, staff and the community;

• Collaborates with district level administrators to integrate and

implement health policies, and practices with the priorities of the

district;

• Coordinates departmental and district staff development, orientation,

training, and certification as related to the health needs of students;

• Is a permanent member of the district’s school health advisory council;

• Communicates with parents and community in areas concerning

student health and safety, acting as the district liaison to parents in

health matters;

• Serves as a member of the local school health advisory council, and

other district committees related to health and safety issues of

students and staff, such as crisis intervention planning teams, staff

wellness programs, and exposure control committees;

• Prepares and monitors department budgets to include projected needs

and secures funding for special projects to accomplish the goals of the

health services program in a cost-effective manner;

• Assists with hiring appropriate district and campus-level staff through

establishing criteria for education and experience, as well as

departmental and campus staffing needs;

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Recommended School Health Services Staff Roles

• Networks with internal and external stakeholders, and represents the

district in discussion and collaborative programs relates to student and

staff health issues;

• Conducts performance appraisals of school health staff, especially

clinical performance;

• Assesses, improves, and evaluates school health priorities and

practices for the district; and

• Serves as the district’s media spokesperson on health-related issues.

School Nurse (RN)

A registered nurse (RN) licensed by the Texas Board of Nursing, at the

campus level that provides nursing and health services that meet the needs

of the students (and staff) on a school campus(es); and/or supervises and

trains other staff to provide health services. The school nurse is responsible

for implementing the district school health services program in a way that is

best suited to the population of the campus (es). According to the National

Association of School Nurses, the school nurse facilitates positive student

responses to normal development; promotes health and safety; intervenes

with actual and potential health problems; provides case management; and

actively collaborates with others to build student and family capacity for

adaptation, self-management, self-advocacy and learning. (NASN, 2011).

Suggested responsibilities include:

• Collaborates closely with the campus principal, school counselor,

teachers, parents, food service staff, and other staff to provide

leadership and ensure a healthy school environment. Assists in

meeting the health needs of the general school population and those

students identified with specific health conditions;

• Provides direct care utilizing professional assessment skills, the

nursing process, individualized healthcare plans and established school

health policies, procedures and protocols;

• Initiates and maintains accurate student health records, immunization

records, medication administration records, individual student

treatment plans, and individualized healthcare plan utilizing

confidential methods;

• Establishes effective procedures for carrying out mandatory screening

programs and submitting required reports;

• Communicates with parents regarding individual students and serves

as a liaison between school personnel, the family, health care

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Recommended School Health Services Staff Roles

professionals, and the community, to ensure appropriate referral and

follow up for student health needs;

• Contributes to the campus communications to parents and the local

community regarding health issues;

• Attends Admission, Review and Dismissal (ARD) meetings of students

with identified health needs, and develops the IHP;

• Develops and implements IHPs and evaluates outcomes of skilled and

direct nursing care and procedures for medically fragile students, thus

integrating the medically fragile student safely into the school

environment;

• Collaborates with district personnel, including school

psychologist/special education diagnostician regarding implementation

of health-related Individualized Education Program (IEP) goals and

services;

• Educates faculty and staff as needed on health-related topics;

• Develops and recommends campus policies and procedures to promote

the health and wellness of students and staff;

• Provides consultation to campus administration in crisis/emergency

situations;

• Participates in staff development as outlined in the Texas Nurse

Practice Act to maintain professional nursing skills and knowledge

including but not limited to: Basic Life Support for Healthcare providers

(CPR/AED), certification in mandated screenings and continuing

education as required by the Texas Board of Nursing; and

• Supervises, trains and evaluates LVNs, unlicensed diabetes care

assistants, other unlicensed assistive personnel, or other school health

personnel as designated by the campus principal to have responsibility

for assisting students with health needs.

Definition of a school nurse based on Texas Administrative Code Education

Commissioner’s Rules – Texas Administrative Code, Section 153, §153.CC.

(D) A school nurse is an educator employed to provide full-time

nursing and health care services and who meets the requirements to

practice as a registered nurse (RN) pursuant to the Nursing Practice

Act and the rules and regulations relating to professional nurse

education, licensure, and practice and has been issued a license to

practice professional nursing in Texas.

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Recommended School Health Services Staff Roles

Vocational Nurse (LVN)

A vocation nurse, licensed by the Texas Board of Nursing, who provides

direct services to meet the needs of students (and staff) on a school campus

or campuses. The school vocational nurse is responsible for implementing

the district health program under the direct clinical supervision of the School

Health Coordinator (RN or higher level practitioner) or school nurse/RN, in a

way that is best suited to the population of the campus (es). Clinical

supervision by an RN, MD, and Advanced Practice-RN, Physician’s Assistant,

dentist or podiatrist is a required by the Nurse Practice Act.

Suggested responsibilities include:

• Maintains current certifications in CPR, use of the AED, and state

mandated screenings;

• Collaborates with the campus principal, school counselor, teachers,

parents, nutrition services and other staff under the direction of the

supervising RN regarding the health needs of the general population

and those students with identified health conditions;

• Provides direct care utilizing school health procedures and protocols

and IHPs established by the RN supervisor, and/or medical advisory;

• Maintains accurate and confidential student health records, including

immunization records, medication administration records, and

individual student treatment records;

• Contributes to and implements the IHPs as established by the RN;

• Carries out mandatory screenings, collects data and submits required

reports as directed;

• Communicates with parents regarding individual students as directed

by the RN;

• Attends ARD meetings (if RN unable) of students with identified health

needs, collaboration with appropriate campus staff and RN regarding

implementation of health related IEP items;

• Educates faculty or staff as needed on health-related topics as planned

and directed by the RN;

• Communicates regularly with the School Health Coordinator or School

Nurse/RN regarding communicable diseases, specific student health

needs/concerns, campus and department issues, health and safety

hazards and all non-routine matters; and

• When directed by the RN, the LVN provides guidance to unlicensed

assistive personnel on health-related tasks.

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Recommended School Health Services Staff Roles

Unlicensed Assistive Personnel (UAP)

An unlicensed school staff member who is typically referred to as a Health

Aide, Clinic Aide, Instructional Aide or Special Education Aide who carries out

limited health-related tasks. This person may have previous experience in

health care, be certified by the state as a Certified Nurse Assistant (CNA), or

Certified Medical Assistant (CMA), have received formal first aids training

through the Red Cross or similar program, or may have gone through a

campus or district orientation and training related to school health services

such as medication administration, or specific health condition training such

as diabetes care training. In schools without designated school health staff,

the non-licensed staff often fill this role. Emergency Medical Technicians

(EMTs) are considered unlicensed assistive personnel when practicing in a

school setting since they are only authorized to practice under a Texas

licensed physician.

Suggested responsibilities include;

• Provides basic first aid and care for minor injuries and illness and

chronic health conditions according to district policy and

regulations/protocols established by the School Nurse/RN or the

district medical advisor;

• Administer students’ medications under the assignment of the school

administrator or delegation of the RN, following district policies and

procedures;

• Takes vital signs (temperature, pulse, respiration rate, and blood

pressure) and accurately documents, only if trained to do this;

• Communicates findings and student complaints to supervising school

health staff for direction;

• Contacts parents of students who need to be picked up from school

according to established school health services protocols or as directed

by the School Nurse/RN;

• Contacts EMS according to established school health services protocols

or as directed by the School Nurse (RN);

• Maintains confidential health records (sorting, filing, reviewing for

completeness);

• Assists with the screening programs;

• Sends out routine notices to parents;

• Maintains an efficient and safe clinic including infection control

procedures, under the direction of the School Nurse/RN;

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Recommended School Health Services Staff Roles

• Communicates regularly with the School Health Coordinator or School

Nurse/RN regarding communicable diseases, specific student health

needs/concerns, campus and department issues, health and safety

hazards and all non-routine matters;

• Orders and maintains health office supplies; and

• Can serve as an unlicensed diabetes care assistant after receiving

appropriate training. (See diabetes Care Guidelines) at Texas

Diabetes Care Guide.)

References

1) Texas Education Code, Section 38.012.

2) Texas Medical Board.

3) Texas Board of Nursing.

4) National Association of School Nurses, Definition of school nursing.

2017.

5) Texas Administrative Code, Title 9, Chapter 153, Section 153.CC.

Texas Administrative Code-Definition of School Nurse

This document was developed by the TSHAC. For additional information

about the committee, go to TSHAC Home Page. External links to other sites

appearing here are intended to be informational and do not represent an

endorsement by DSHS. These sites may not be accessible to people with

disabilities. For information about any of the resources listed, contact the

sponsoring organization directly. For comments or questions about this

publication, contact the School Health Program at (512) 776-7279 or by

email at schoolhealt[email protected]. Copyright free. Permission granted

to forward or make copies in its entirety as needed.

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