Licensed Practical Nurse (LPN)
Associate Degree Nurse (AD RN)
Diploma Nurse (RN)
Baccalaureate Degree Nurse (BSN RN)
Masters Degree Nurse (MSN RN)
Advanced Registered Nurse Practitioner (ARNP )
Administrators of school health programs should be familiar with the different levels of educational preparation in order to select the nurse most appropriate for implementation of their programs. The degree of the nurse's academic achievement and the extent of the nurse's educational and experiential preparation will influence, if not directly determine, the comprehensiveness of the School Health Services program.
The Licensed Practical Nurse (LPN)
The Licensed Practical Nurse (LPN) attended a 10-12 month program preparing for practice in a structured setting where individuals with common needs and predictable outcomes are served. The LPN must practice under the supervision of a registered nurse (RN), licensed physician, dentist, osteopath, or podiatrist (NRS 71-1, 132-55).
NOTE: Nebraska Board of Nursing has defined supervision. This definition is to be used as a guide for the Registered Nurse. Supervision is defined as personally observing a function or activity, providing leadership in the assessment, planning, implementation and evaluation of nursing care; delegating functions or activities while retaining accountability; and determining the nursing care being provided is adequate and delivered appropriately. Accountability of the supervising licensed practitioner means being obligated to answer for one's acts, including the act of supervision. Supervision does not mean the supervising licensed practitioner must be physically present. Depending upon the environment, number of clients and acuity of care, the supervision licensed nurse may provide supervision by telephone, policies, and protocols. The supervising licensed nurse must provide written parameters distinguishing situations which are acceptable from those situations which must be reported to the supervising licensed nurse before any needed further intervention can be started. Policies and defined parameters should be spelled out in writing and are of prime importance in dealing with emergencies and administering first aid. |
The Associate Degree Nurse (AD RN)
The Associate Degree Nurse (AD RN) attended 2 (two) academic years, plus l (one)summer, preparing for technical nursing practice in medical, surgical, pediatric, and obstetrical areas.
The AD RN is prepared to function in acute and chronic care facilities serving clients with well defined needs. Settings must be controlled by organized nursing services and staff structures, professional nursing standards, policies, procedures and protocols.
This level of nurse should function only within a school health program which is under the direction of a school nurse administrator.
The Diploma Nurse (RN)
The Diploma Nurse (RN) attended 3 (three) academic years, plus 3 (three) summers, to become prepared not only with technical skills but also at the professional level with management and leadership skills.
This RN is prepared to function in acute, chronic, and psychiatric facilities and to care for clients with predictable as well as unpredictable outcomes.
The nurse educated at this RN professional level -- who consistently pursues continuing education developed for the school nurse specialty, who is supported by school nursing standards, policies, procedures and protocols, and who is under the supervision of a school nurse administrator -- is capable of implementing the school health program.
The Baccalaureate Degree Nurse (BSN RN)
The Bachelor of Science Degree Nurse (BSN RN) attended 4 (four) academic years which added theory, statistics, social groups, and community nursing experience to preparation at the professional level. This RN's focus of care is in acute, chronic, and community settings.
This nurse is prepared to develop school nursing standards, policies, procedures and protocols for full implementation and direction of the school health program.
The Masters Degree Nurse (MSN RN)
The Masters of Science Degree Nurse (MSN RN) attended 1-2 academic years, after obtaining the BSN degree, to specialize in a selected program of concentrated studies, for example, maternal and child health, nursing administration, nursing education, psychiatric and mental health, or public health.
This nurse specialist is prepared to serve individuals, groups, and communities through education, consultation, administration, direct clinical care and by implementing research. This nurse is prepared to function autonomously and should provide maximum leadership in the development of school health programs.
The Advanced Registered Nurse Practitioner (ARNP)
The Advanced Registered Nurse Practitioner (ARNP) refers to a nurse (RN) prepared by virtue of additional knowledge and skills gained through an organized post-basic program of nursing in a specialty area. These licensed nurses must also achieve national professional certification in their specialty, for example, psychiatric and mental health clinical nurse specialist, school nurse practitioner, family nurse practitioner, and pediatric nurse practitioner.
The Focus of Clinical Nursing Practice
While there are many levels of educational preparation for nursing, there is only one focus of clinical nursing practice.
The essence of this clinical nursing practice is the diagnosis and treatment of human responses to health and to illness.
The core of clinical nursing practice is dynamic and evolves as
... patterns of human responses amenable to nursing intervention are identified,
... nursing diagnoses are formulated, nursing interventions are made explicit, and
... responses (client outcomes) are evaluated.
The depth and breadth to which the individual nurse engages in the total scope of the clinical practice of nursing are defined by knowledge base, role, client population and practice environment.
The School Nurse's Clients: STUDENTS ... STUDENTS' FAMILIES ... and the SCHOOL STAFF
In the School Health Services Program, nurses' clients include not only the students, but the students' families and the school staff as well.
A conceptual framework for nursing which nicely illustrates school nursing practice is I. M. King's Dynamic Interacting Open Systems Theory (1981). This model accurately portrays the relationship between the School Nurse and the individual student as a unique unit within the school setting.
Intra -personal LevelAt this intra- personal intervention level the School Nurse assesses each learner-at-risk -- physically, developmentally, emotionally, socially, culturally, economically, geographically, and academically.
Inter -personal Level
The School Nurse then becomes part of an inter- personal system when interacting with other individuals -- students, parents, teachers, counselors, psychologists. These interactions may take the form of a dyad (teacher-nurse conference), triad (parent-child-nurse conference), or group (special education team).
At this inter-personal system level, the School Nurse may assume many roles: direct health care provider, health educator, health counselor, child advocate, case manager, and evaluator. The School Nurse may acquire these roles working with the comprehensive school health education team as well as with the early intervention and special education multidisciplinary team.
Inter -systems Level
Larger groups with common interests and goals create another level of system which King calls the inter-systems level. The systems with which School Nurses and students routinely interact are the health care system (medical, dental and mental health) and the social services systems. The school nurse must, therefore, be very knowledgeable about these and other community and regional resources currently available to serve students, parents, and staff.
The School Nurse must apply the nursing process -- assessment, nursing diagnosis, outcome identification, plan, implementation, evaluatio n -- in all three dimensions of King's open system.
It is the interaction of the phenomena of interest to the school nursing specialty -- society (education, school-community environment), client (student, family and staff), school nursing (clinical nursing practice), and health (promotion, prevention, maintenance, rehabilitation) -- which generates the multiplicity of roles the school nurse must assume in order to facilitate the educational process for students.
Each individual nurse is responsible for knowing and practicing within the scope of practice for which their nursing education and clinical experience have prepared them.
All registered nurses, irrespective of specialty, are held to the Standards of Clinical Nursing Practice (American Nurse Association, 1991).
All School Nurses are held to their specialty guidelines as promulgated in School Nursing Practice: Roles & Standards (National Association of School Nurses, 1993).
Every School Nurse should be knowledgeable about the content of these two ANA and NASN documents which create their current practice parameters.
STANDARDS of CLINICAL NURSING PRACTICE
A synopsis of the American Nurses Association Standards of Clinical Nursing Practice (ANA, 1991) follows. But the complete, necessary measurement criteria are found in the full ANA document -- which every School Nurse should have . for ready reference.
Standards in nursing practice are authoritative statements enunciated and promulgated by the nursing profession by which the quality of practice, service, or education can be judged.
The role of these standards of nursing practice is:
-- to describe the responsibilities for which nurses are accountable
-- to provide direction for professional nursing practice
-- to define the profession's accountability to the public
-- to define the client outcomes for which nurses are responsible
The Standards of Clinical Nursing Practice (ANA, 1991) includes both Standards of Nursing Care and Standards of Nursing Professional Performance.
6 Standards of Nursing Care