Guidelines for Medication Administration in Schools
Guideline #4: Delegation of Medication Administration by the LSN/RN
4.1 Definition of Delegation by the Licensed School Nurse/Registered
This section is specific to schools with RNs on staff or contract.
According to the National Council of State Boards of Nursing (1997), delegation is the “transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation.” The dictionary meanings of delegation––direction and prescription––each contain the same elements: a giver, a recipient, and a degree of authority. The concept includes authoritative instruction and the acts of empowering one person to act for another.
The Nurse Practice Act (Minnesota Statutes sections 148.171 to 148.285 and Minnesota Rules, chapters 6301 to 6330) says that both professional (LSN/RN) and practical nursing (LPN) include, but are not limited to the performance of acts or functions that are delegated to the nurse by another health care professional. However, only the LSN/RN has the direct statutory authority to delegate to others (see also National Association of School Nurses, 1994/2002), and the UAP may carry out only those nursing acts or functions that have been delegated by an LSN/RN.
4.2 The Responsibilities of Nursing Delegation
In Minnesota, LSNs/RNs can delegate medication administration as a delegated medical function as authorized by state regulation and within their legal scope of practice. The LSN/RN uses professional judgment to decide what is delegated and to whom. The LSN/RN may choose to not delegate some medication administration activities. It is the judgment of the LSN/RN whether the delegated functions can be properly and safely performed by the person without jeopardizing the student’s welfare. Some activities that require specialized nursing knowledge and skill may be delegated to LPNs, but not to UAPs. Some activities that do not require specialized nursing knowledge may be delegated to UAPs by LSNs/RNs. It is the responsibility of the LPN and/or UAP to perform the delegated activities correctly. The LSN/RN is accountable to verify that the delegatee can perform the activity and do so safely. Delegation to UAPs is determined on a case-by-case basis and is most appropriate when they are caring for students with routine, repetitive, ongoing medication administration. When medication administration is not routine and the student’s response to medication is less predictable, nursing delegation should be carefully considered.
When LSNs/RNs have responsibility for medication administration, they are the only ones who can make delegatory decisions.
When delegating medication administration to UAPs, the LSN/RN shall assess the situation and consider the following nursing delegation principles:
- Principle 1: The delegating LSN/RN must assess student needs prior to delegating.
- Principle 2: The LSN/RN must provide adequate oversight of the medication administration activities.
- Principle 3: The LSN/RN must keep written documentation of the UAP’s initial and ongoing competency.
- Principle 4: The medication administration function must be one in which:
- The nursing care needs of the student are stable.
- Performance of the function does not pose potential harm to the student.
- The function involves little or no modification.
- The function has a predictable outcome.
- The function does not inherently involve ongoing assessment, interpretation, or decision making.
- The UAP has appropriate skills and competency levels.
- Supervision is available.
If medication administration is delegated, those accepting delegation cannot re-delegate those nursing functions to anyone else without the involvement of and supervision by an LSN/RN. As an essential component of delegation, appropriate training must be conducted. See Guideline #2: Roles of the Minnesota Guidelines for further information about delegation of medication administration by the registered nurse.
4.3 The Medication Administration Decision-Making Tree
The decision-making tree is a tool developed to assist LSNs/RNs in making delegation decisions. It offers a series of questions for the delegator to ask with a specific student, caregiver, and nursing activity in mind. If any questions are answered with a “yes,” the medication administration is delegatable.