Policy Brief: Supervision of School Nurses

Janet Palmer
Western Washington University
NURS 412 Health Policy and Leadership
Dr. Bill Lonneman
March 4, 2017
 Summary

The health of children in our state should be a priority. School nurses fill a vital role in

healthcare by bridging the gap between home and school. 16% to 18% of school aged children

have chronic health problems with 8% of school aged children having an allergy (Lineberry &

Ickes, 2015). School nurses create health plans to help ensure the success of these children in

academics (McDowell, Buswell, Mattern, Westendorf, & Clark, 2015). All nurses in Washington

state are governed by the Nurse Practice Act (chapter 18.79 RCW) and the uniform disciplinary

act (chapter 18.130 RCW). This bill, HB1346, clarifies the supervision of nurses within the role

of school nurse. Currently, non-nurses, such as school administrators and principals, supervise

the role of RN and make decisions about healthcare without the training of a nurse.

Background

School nurses in Washington state are currently in a grey area of the law. While their

practice is governed by the nurse practice act, the nurses themselves are overseen by school

administrators and principals as employees of the school districts. The result of this is that school

nurses are having their nursing judgement and practice under the review of individuals who do

not share their expertise and education. School nurses are having disciplinary action against them

for calling emergency services for a child when their nursing judgement called for further

evaluation by healthcare professional because parents became angry at the ambulance fees

associated with the decision. Other cases have had the principal making health decisions that

deviate from the health plan of a child in the absence of the school nurse.
 As defined by the nurse practice act of Washington state (WAC 246-840-705), The

registered nurse functions in an independent role when utilizing the nursing process as defined in

WAC 246-840-700(2) to meet the complex needs of the client. When appropriate it is her duty

to report changes in patient condition to other providers (WAC 246-840-700). This status means

that her role as a health care provider should not be overseen by someone who does not hold the

educational requirements and specialization of a nurse. The National Association of School

Nurses (2016) states that the minimum education requirement to be a school nurse is to have a

baccalaureate degree in nursing and hold a valid license in the state the nurse practices in.

Recommendations

The health and safety of our children needs to be a priority. It is my recommendation that

this bill is supported as it clarifies the role of the RN within the education system and allows the

RN to practice according to the standards already established within the Washington state nurse

practice act.
 References

Beshears, V., Clark, E., Lambert, P., Sheets, J., Teskey, C., & Yow, B. (2016, June). Education,

Licensure, and Certification of School Nurses. Retrieved from National Association of

School Nurses:

https://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStateme

ntsFullView/tabid/462/ArticleId/26/Education-Licensure-and-Certification-of-School-

Nurses-Revised-June-2016

Lineberry, M. J., & Ickes, M. J. (2015). The Role and Impact of Nurses in American Elementary

Schools: A Systematic Review of the Research. The Journal of School Nursing, 31(1),

2233. https://doi.org/10.1177/1059840514540940

McDowell, B. M., Buswell, S. A., Mattern, C., Westendorf, G., & Clark, S. (2015).

Individualized Healthcare Plans: The Role of the School Nurse. Position Statement.

Revised. National Association of School Nurses (NASN). Retrieved from

http://eric.ed.gov/?id=ED558476

WAC 246-840-700: Standards of nursing conduct or practice. (n.d.). Retrieved March 4, 2017,

from http://app.leg.wa.gov/wac/default.aspx?cite=246-840-700

WAC 246-840-705: Functions of a registered nurse and a licensed practical nurse. (n.d.).

Retrieved March 4, 2017, from http://app.leg.wa.gov/wac/default.aspx?cite=246-840-705