Download Sample Substitute School Nurse Manual

The information in this sample Substitute Nurse Manual is for informational purposes only.
The New York Statewide School Health Services Center has made every attempt to ensure that
the information and resources contained in this document reflect best practice in the field of
school nursing.
This document is intended for guidance to be used by the school district and school nurse in
providing for safe, quality student care in the absence of the building nurse. It does not
constitute a mandate nor imply liability, should the district choose other options for use. While
this resource contains recommendations that represent best practice, the professional school
nurse must be the practitioner to determine the appropriateness of care delivered to each
individual student in the unique situation in which they practice and must revise this as needed
to reflect their local school district policies and procedures.
Health Office
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Welcome letter
School Nurse Information
 School Nurse Overview
 Job description
 Daily schedule
Location of Equipment, Work Hours and Office Information
Web and Computer Access
Written Documentation
 Procedure for Dismissal
Medical and Absence Notes
 Physical Education excuses
 Parent/health care provider notes
References:
 School Health Manual
 Standing Protocols or Guidelines
 Exposure Control Manual
 Reference books
Confidential Health Concerns
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Confidentiality statement
 Highlight medically fragile students
Nurse’s Confidential Health List
Care Plans
 Emergency Care Plans (ECP)
 Individualized Healthcare Plans (IHP)
Crutches/Wheelchair Procedure
 Elevator
 Travel time
 Buddy Pass
Medications & Treatments
 Medications
 Medication Administration Procedures & Guidelines
 Medications Location
 Prescription
 OTC
 Emergency Medications
 Inhalers
 Nebulizers
 Medication Book and Procedures
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Treatments
 Treatment Area - Location
 Treatments - Daily Schedule
 Treatments - PRN
 Treatment Supplies
Illness
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Procedure for Recording Student Visits
Protocols for Illnesses
Plans for Communicable Diseases
Students with Immunization Exemptions
Injuries
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Evaluation & Treatment of Injuries
Exposure & Accident Reports
Exposure Control Manual
Transportation Guidelines
Emergencies
 Emergency Considerations
 School Policies Related to Health and Emergency Protocols
 Ambulance Call
 Administration Involvement
 911 Call
General School Information
 Schedules/Class Lists/Rosters
 School Daily Schedule
 Student Lunch Periods
 Start & End of Day Routines
School Staff Information
 School Staff Contact Information
 Contact List of Teachers
 District Nurses and School Medical Director Contact Information
Appendix
 Map of Building (Insert Map of Building)
 Highlight locations of AEDs – use red heart stickers, fire
extinguishers, gymnasiums, elevators, cafeterias/teacher lounge
 Exit to take for Fire Drills/Evacuations
 Crisis Management
 Insert school crisis plan
 Field Trips
 Guidelines – Procedures
 First Aid Kits – location
 Does a nurse need to accompany any students on the field trip Procedure
 Sports Certification
 Sports Exams
 Sports clearance procedures
 Procedure for Bus Accidents
 Forms
Welcome to the
School District!
This Substitute School Nurse Manual has been developed to assist substitutes with the various
office procedures and district policies to ensure continuity of care and support when a
substitute School Nurse comes to a health office in the district. We hope to provide substitutes
with the resources needed to feel comfortable in the office as well as provide the quality health
care that our students experience on a daily basis.
The __________Central School District encourages substitute School Nurses to arrange for a
visit to the schools that he/she will work in. Please call the building School Nurse (SN) to
arrange for a convenient time to come in.
The first time that a substitute will be at a building, it is advisable to arrive 15 minutes early to
review this manual and the individual office information. Whenever possible, please review
information with the building SN prior to the day of her absence.
Please help the district keep an accurate Substitute School Nurse list by informing us of any
changes in your contact information or employment status.
Thank you, in advance, for your presence today and we hope that you have a wonderful
experience. We are committed to providing the district’s children with a quality school health
services program and appreciate your partnership in accomplishing that goal.
Every school has information that is specific to the operation of that school and/or health office.
Please call the school’s main office with any specific questions.
School Nurse Overview
School Nurses (SNs) manage the school health office and administer mandated health
screenings. Our professional practice is bound by the Nurse Practice Act of New York State
Education Law, State School Health Services Guidelines, and district policies and procedures.
There are school nurses in the following schools:
School Name
Nurse’s Name
Nurse Phone Number
While most activities are standardized between the various health offices in the district, each
office has some individual differences in daily operations.
The ____________ Central School District maintains a School Health Services Manual that is a
comprehensive guide to our school nursing practice. Most questions that arise in relation to
School Health Services will be covered in this manual that is found in each office.
Additional SN responsibilities will be elaborated upon in this manual
It is the responsibility of the Substitute School Nurse to locate the Substitute Manual, School
Health Services Manual and the Exposure Control Manual and become familiar with the
operational procedures particular to each building. In this school, they are located:
Resource
Substitute Manual
School Health Services Manual
Exposure Control Manual
Location
Notes
District Health Services Contact Information is in School Staff Information section.
Please note the back-up nurse for the building in which you are substituting. When faced with
questions or concerns, please follow these guidelines regarding the appropriate person to
contact:
Back up nurse for your building
Name________________ ext.
Medical Director
Name___________________________________
How to contact:__________________________
________________________________________
Sample RN Job Description
REGISTERED PROFESSIONAL NURSE
QUALIFICATIONS:
a. Hold current New York State license as a Registered Professional Nurse.
b. Current certification in CPR.
DESIRABLE QUALIFICATIONS:
a. Baccalaureate degree in nursing or related field.
b. Experience in pediatric and/or community or public health nursing.
c. Prior experience in school nursing.
REPORTS TO: Building principal, immediate supervisor, Pupil Personnel Services Director.
JOB GOAL: To provide primary health and emergency care to students, promote wellness and
serve as a resource for health concerns in the school setting.
RESPONSIBILITIES:
To be performed in a manner consistent with professional standards, the New York State Nurse
Practice Act, state regulations and district policies.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Uses the nursing process to assess the health needs of students and staff.
Administers medications and treatments as ordered.
Provides care for student and staff illness and accidents.
Develops individual health care plans and modifications for students with special health
care needs.
Serves as liaison between the home, medical community, and the school regarding
student health concerns.
Manages mandated school screening programs and school/sports physicals and followup.
Monitors the school environment and recommends changes to promote health and
safety.
Coordinates school health services by managing the health office and supervising
paraprofessionals.
Prepares and maintains accurate cumulative health records including immunizations.
Serves as resource person to home school, the school district, and community regarding
health issues.
Serves as a member of the building Child Support Team, as needed.
Reviews and evaluates own job performance and maintains professional development.
Reviews and evaluates school health services.
Reports suspected physical and sexual abuse and neglect, follows communicable disease
control procedures and informs administration and/or parents regarding school
exclusion and readmission.
School Nurse’s Daily Schedule
[Insert timeline of typical day in your office] or use:
Time:
7:30 AM
8:00 AM
8:30 AM
9:00 AM
9:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
1:00 PM
1:30 PM
2:00 PM
2:30 PM
3:00 PM
3:30 PM
Treatments
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

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Medications
 Yes /  No
 Yes /  No
 Yes /  No
 Yes /  No
 Yes /  No
 Yes /  No
 Yes /  No
 Yes /  No
 Yes /  No
 Yes /  No
 Yes /  No
 Yes /  No
 Yes /  No
 Yes /  No
 Yes /  No
 Yes /  No
 Yes /  No
Student Visits
Ongoing
OR
Schedule
Medications
Blood Glucose Testing
Nebulizer Treatment(s)
Time(s)
Notes
Location of Equipment, Work Hours and Office Information
Keys
Location
Office Door Keys
Medication Storage Keys
Desk Keys
Other Keys:
At end of the day the keys should be returned to the following location:
Building Schedule
Hours
School Hours:
School Nurse’s Hours:
Health Aide Hours:
Main Office Hours:
The best time to go to lunch: (include location of cafeteria and faculty dining)
Voicemail instructions:
Parking information:
(Permit required:  Yes  No)
Become familiar with the office - walk around, open drawers & closets
Equipment
Location
Emergency bag:
Evacuation bag (for supplies & medications):
Stethoscope
Blood pressure cuff
Oxygen (if available)
Medications
Dailies
PRNs
Inhalers
Emergency Meds
Medication Book
Confidential Health Information for Nurse
Additional bandages, etc.
Building Map located in Appendix – note location of the Automated External Defibrillator
Web and Computer Access
[Insert your school’s directions for Web and Computer access here]
Written Documentation
The health office is a very busy place on a daily basis. The SN cares for injuries, illnesses and
assorted other student needs. The school nurse’s role is to observe, assess and monitor a
student, taking all vital signs (including respiration) as indicated.
Most students come for illnesses and injuries, but a child in distress often is unable to continue
to be in a classroom setting. Please be sensitive to the fact that while some students may not be
physically ill, they have needs that the SN often addresses in order to help meet their basic
needs so they can return to the classroom. Many visits to the health office are for conditions that
respond to tender loving care and nurturing, while some may be symptomatic of more complex
problems in the students.
It is vitally important that records are kept regarding student visits and healthcare delivery. All
visits should be recorded on the student visit log indicating the summary of action taken. Minor
injuries do not require recording on the child’s permanent health record, but may be done if the
nurse has the opportunity. Computer documentation is also acceptable.
In this building, the procedure includes:
Documentation
Student Visit Log
Duplicate Health Office Visit Forms
Parent Phone Calls
Attendance Phone Calls
Notes to Parent
Notes to Teacher
Procedure for Dismissal
Location/Procedure
Procedure for Dismissal
[Insert your school’s procedure]
Refer district guidelines regarding dismissal of ill children.
If a parent is unable to come to school to pick up a child who is ill, it is appropriate to
consult with administration to discuss options for student dismissal. With
administrative permission, it may be possible to contact the district transportation
department to make special arrangements for special bus transportation home in
extreme circumstances.
Medical and Absence Notes
Type of Note
Location/Procedure
Absence Notes
Healthcare Provider Notes
Parent Notes
Physical Education Notes
Students can be excused from physical
education class in the event of illness or
injury under the following conditions:
o The parent requests that the child be
allowed to not participate (this may be
done for one day)
o The physician sends in a note (should
contain the end date for the excuse
and the reason)
o The SN, in her nursing judgment,
deems it unsafe for a student to
participate in physical education class
or sports
This is communicated in this school in this
manner:
References
Reference
School Health Services Manual
Medication Orders and Records
Health Records
Confidential Health List (for nursing
personnel)
District Policies
Standing Policies and Protocols
Exposure Control Manual
Crisis Intervention Plan
Reference Books (list):
Location
Confidentiality Statement
The registered professional nurse is bound by confidentiality in all practice settings, and is
encouraged to pursue best practice in this area at school. The school setting presents some
unique challenges in the number of individuals present at any given time, the lack of private
phone locations, and the level of activity in the building. When sharing appropriate health or
student information, refrain from conversations in the hallway or public areas. Take a moment
to relocate to a quieter location that will provide the necessary privacy needed to discuss
appropriate concerns with other school professionals.
Nurse’s Confidential Health List
[Insert your school’s confidential health list for nursing personnel here]
Care Plans
Location of Emergency Care Plans:
Students with Emergency Care Plans:
Name of Student
Medical Diagnosis/Reason for Plan
Location of Individualized Healthcare Plans:
Students with Individualized Healthcare Plans:
Name of Student
Medical Diagnosis/Reason for Plan
Crutches / Wheelchair Procedure
Information
Details
School Policy
Location of elevator (if applicable)
Procedure for allowing additional passing
time
Crutch or Buddy Passes
Buddy Pass
Buddy Pass
Student Name: ___________________
Date begin: _________ Date end: _________
Please allow this student to leave class early to
assist ____________ (Student Name) due to the
use of crutches or wheelchair.
School Nurse: ____________________
Student Name: ___________________
Date begin: _________ Date end: _________
Please allow this student to leave class early to
assist ____________ (Student Name) due to the
use of crutches or wheelchair.
School Nurse: ____________________
School Name
HALL PASS
Date: _________________________
Name: ___________________________________
PLEASE:
 Allow extra time to & from classes
 Allow use of elevator as needed
 Allow for an extra book in classroom
 Allow for visit to health office
 Assist the student in the event of an emergency evacuation
Medication Administration Procedures and Guidelines
Only those medications which are necessary to maintain the student in school and which must
be given during school hours should be administered. Any student who is required to take
medication during the regular school day or while participating in school-sponsored activities
(e.g., field trips, athletics) should comply with all procedures. In addition to the required
licensed prescriber’s order written parental permission is also required.
Guidelines for Administration of Medications can be found at:
http://www.schoolhealthservicesny.com/uploads/AdminMed.pdf
Medication Information:
Medications are to be locked at all times other than when administering medications.
Medication
Medication location:
Daily medications
PRN medications
Emergency medications
Inhalers
Nebulizer
Controlled medication procedure
Medication book
Additional medication permission forms
Notes
Medication Book and Procedures
[Insert location and any pertinent information about medication charting here]
[Include the following:
o Health Provider Orders and Parent Permission Forms
o Sign off form used for charting medications
o List of students with daily medications
o List of students with PRN medications
o How to deal with “No Shows”
o Additional medication forms]
Treatment Area
[Insert location here]
Please check student’s order and/or Standing Protocols from Medical Director
Daily Treatments:
Student
Treatment (include location of
supplies & equipment)
Time(s)
Treatment (include location of
supplies & equipment)
Time(s)
PRN Treatments:
Student
Treatment Equipment and Supplies
Equipment
Location
Procedure for Recording Student Visits
[Insert sample of Student Visit Records]
Protocols for Illnesses
[Attach Standing Protocols from your Medical Director]
Plans for Communicable Diseases
[Attach school guidelines for Communicable Diseases]
Students with Immunization Exemptions
Medical Exemptions:
Student
Notes
Religious Exemptions:
Student
Notes
Evaluation and Treatment of Injuries
All student visits should be recorded – please see Health Office Management for a
description of the procedure for the building in which you are substituting.
Accidents and illnesses are addressed on pages ____ of the School Health Manual.
Accident reports should be completed when a school accident requires additional
medical intervention. Special attention should be given to situations that include:
o
o
o
o
o
o
facial injury
permanent scarring
threatened loss of limb
brain injury
dental injury
alleged negligence
Nursing judgment should always be used in the decision to complete an accident
report. The substitute SN should complete the paper forms included with this section,
and the building SN will complete the procedure upon his/her return to school.
Exposure & Accident Reports
[Insert location of forms here]
Exposure Control Manual
[Insert location of manual here]
Transportation Guidelines
[Insert location of guidelines here]
Emergency Considerations
Good nursing practice dictates that each health office be supplied with a readily
accessible, easily carried, and recognizable emergency pack that includes supplies for
basic first aid, including supplies for infection control, a stock Epipen with non-patient
specific orders and a glucose source, such as glucose gel or honey sticks.
A plan for communicating with the principal should be established.
A list of all students with significant medical conditions and medical orders for
prescription medication, including emergency contact numbers, should be kept in the
emergency pack.
School Policies Related to Health and Emergency Protocols
[Insert location of protocols here]
Ambulance Call
Administration Involvement & 911 Call
In the event that an emergent student health situation arises and an ambulance is needed,
confer with administration before calling the ambulance if at all possible (if a situation is
progressing towards that point, involve administration as early in the process as possible).
Call 911, notify the main office that an ambulance has been called so they can assist the
emergency personnel in getting to the affected student or staff as soon as possible.
When the ambulance has left and the situation is resolved, complete the ambulance call form
below and send to ____________________________________
AMBULANCE CALL
_____________________SCHOOL DISTRICT
To:
From:
Date:
Re:
Ambulance Call
Ambulance Company Responding:
Name of Patient:
Date Called:
Called by:
Reason Called:
Time Called:
Time Arrived:
DATA UPON AMBULANCE ARRIVAL
Date:
Time Student Arrived:
Name:
Parent/Guardian Name:
Address:
Telephone Number:
Work:
Age:
Cell:
Date of Birth:
Allergies to Medicine:
Current Medication:
Tetanus Date:
Past Medical History:
Documentation of Current Injury/Illness:
Medication Given:
Vital Signs: Blood Pressure #1
#2
Pulse
Respiration
Time Ambulance Called:
Time Ambulance Arrived:
Schedules/Class Lists/Rosters
[Either insert here or give location]
School Daily Schedule
[Insert your school’s Daily Schedule here]
Student Lunch Periods
Hours
Student Lunch Periods:
(1st Lunch)
(2nd Lunch)
(3rd Lunch)
Start & End of Day Routine
[Insert schedule here]
School Staff Contact Information
Name
Principal
Assistant Principal
Main Office
Secretary
Social Worker
Guidance Counselor
School Psychologist
Maintenance
Contact Information:
Phone and/or extension
Contact List of Teachers
[Insert your school’s information here]
District Nurse and School Medical Director Contact Information
School Name
High School:
Nurse Name
Work Number
Fax Number
Middle School:
Elementary
School(s):
School Medical
Director:
Please do not give out telephone numbers, fax numbers, e-mail or any personal information
to parents or staff without individual permission from the nurse or medical director.
Map of Building
[Insert Building Map Here]
Place red heart sticker on location of AED in building
Mark Exit to take for Fire Drills/Evacuations
Highlight location of fire extinguishers, gymnasiums, elevators, cafeteria/ lounge
Crisis Management
Students may, at times, face a crisis at school. This can take many different forms and
create unique situations. Each building should also have a safety manual. You may
refer to that manual as needed.
General Guidelines for intervening with a student without escalating a situation:
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Present a calm appearance
Speak softly
Speak in a non-provocative and nonjudgmental manner
Speak in a neutral, concrete manner
Put space between you and the other individual
Show respect for the individual
Avoid intense direct eye contact
Balance your control versus an authoritarian stance
Facilitate the other individual’s talking
Listen to the other individual
Do not interpret meaning
Do not make promises that you cannot keep
Do not block the other’s route of exit/escape
From Assessment & Management of Violent Patients,
Kenneth Tardiff, MD, M.P.H., APA Press, 1989
In a crisis situation, collaboration with other school professionals is a key to a successful
outcome. Calmly access help as needed from other SN’s, the mental health staff, and
school administration.
Review confidentiality guidelines as needed. However, student concerns regarding
sexuality issues must, by law, remain confidential. The student must clearly
understand that if the safety of the student or another person is in jeopardy, the
information the student reveals may need to be shared.
Field Trips
[Insert Field Trip Care and Medication Policy here]
Does a nurse need to accompany any students on a field trip due to medical needs?
If the student is self-directed with a self carry and self administer order, the nurse does
not need to go.
If the student is not self directed and requires medicaiton, then the parent, person in
parental relationship or a nurse must go on the field trip.
Sports Certification
[Insert your district’s form]
Timing of sports physical exams:
1. An exam is considered valid if it occurred within 12 months prior to the
start of the sports season. Example: A complete physical exam which is
signed by a licensed practitioner and dated on or after August 1, 2008 is
required in order for HS athletes to both try out and participate in the 2009
fall sports season.
2. The exam is considered valid for the entire sport season even if the date
expires during the season.
Sports Clearance procedure
1. Review the information on the interval history form, noting
a. parent phone data
b. sport
c. date of last tetanus (should be less than 10 years old)
d. parent signatures (watch for forgeries. . . )
e. special notes/considerations: contact lenses, allergies, protective
gear, injuries, etc.
2. Compare card to student health record, including information on the back
of record re: any injury or illness since the last physical exam dates. Any
student who has been excluded from physical education since last cleared
requires a specific doctor’s note returning him/her to sports.
3. Correct missing or incorrect information such as tetanus date, protective
equipment, etc. with the most current information. Fill in date of physical
exam, check visual acuity PRN.
4. Boldly note any restrictions or considerations on coach’s card.
5. Complete procedure following your district’s protocol.
Our School Medical Director (_________) has the final authority to determine the
physical capability of a student to play a sport .
If you think a student has an injury or illness that should keep them out of practice,
alert the coach and/or athletic office.
Procedure for Bus Accidents
[Insert your school district policy here]
(This guidance comes from the book, Legal Issues in School Health Services and does not reflect
state policy)
School districts need to plan in advance how they are going to handle bus accidents,
whether on or off school property. In the event of an accident, the driver or a school
official available by beeper should have information about students with high-risk
health conditions, such as bleeding disorders. Consultation with the school nurse
should occur as rapidly as possible. Students may be too traumatized or embarrassed
to self-identify significant health histories but any require special attention in injury
assessment.
At times, school nurses have been directed to eave their assigned school (s) to provided
urgent care to students off-campus (e.g., at the site of a bus accident en route to school).
Rarely is this advisable since EMS is better prepared to handle a true emergency, with
necessary equipment and an ambulance, and the school nurse may be needed to care
for other students in the school building. Once the students arrive at school, however,
the school nurse should triage, assess, and intervene, as appropriate, to address student
health needs. When districts or principals do expect school nurses to travel off campus
to the site of accidents or to attend ill persons on adjacent property, it is wise to first
obtain consultation about this expectation from the school nurse supervisor, the school
district’s attorney, and the state board of nursing. School district or campus planning
should address who will do what and when. Crisis drills help to eliminate spontaneous
but ill-conceived reactions.
Forms
Insert forms used in your Health Office with instructions for use
Examples might include:
Passes
Accident/Injury Forms
Physical Education Excuses
Athletic Permission Slip and Medical Recertification Form
Parent and Prescriber’s Authorization for Administration of Medication in
School
Head Injury Sheets
Health Appraisal Forms
Individual Student Log Sheet
Working Papers
Early Dismissal Pass for Illness
ADDITIONAL DOCUMENTS
The following section may contain additional documentation that is specific to the building that
you are currently substituting in.