Outline for Substitute Manual - New York State Center for ...



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

▪ 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

▪ 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

▪ Treatments

← Treatment Area - Location

← Treatments - Daily Schedule

← Treatments - PRN

← Treatment Supplies

Illness

▪ Procedure for Recording Student Visits

▪ Protocols for Illnesses

▪ Plans for Communicable Diseases

▪ Students with Immunization Exemptions

Injuries

▪ 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 |Location |Notes |

|Substitute Manual | | |

|School Health Services Manual | | |

|Exposure Control Manual | | |

| | | |

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:

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. Uses the nursing process to assess the health needs of students and staff.

2. Administers medications and treatments as ordered.

3. Provides care for student and staff illness and accidents.

4. Develops individual health care plans and modifications for students with special health care needs.

5. Serves as liaison between the home, medical community, and the school regarding student health concerns.

6. Manages mandated school screening programs and school/sports physicals and follow-up.

7. Monitors the school environment and recommends changes to promote health and safety.

8. Coordinates school health services by managing the health office and supervising paraprofessionals.

9. Prepares and maintains accurate cumulative health records including immunizations.

10. Serves as resource person to home school, the school district, and community regarding health issues.

11. Serves as a member of the building Child Support Team, as needed.

12. Reviews and evaluates own job performance and maintains professional development.

13. Reviews and evaluates school health services.

14. 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: |Treatments |Medications |Student Visits |

|7:30 AM |( |( Yes / ( No |Ongoing |

|8:00 AM |( |( Yes / ( No | |

|8:30 AM |( |( Yes / ( No | |

|9:00 AM |( |( Yes / ( No | |

|9:30 AM |( |( Yes / ( No | |

|10:00 AM |( |( Yes / ( No | |

|10:30 AM |( |( Yes / ( No | |

|11:00 AM |( |( Yes / ( No | |

|11:30 AM |( |( Yes / ( No | |

|12:00 PM |( |( Yes / ( No | |

|12:30 PM |( |( Yes / ( No | |

|1:00 PM |( |( Yes / ( No | |

|1:30 PM |( |( Yes / ( No | |

|2:00 PM |( |( Yes / ( No | |

|2:30 PM |( |( Yes / ( No | |

|3:00 PM |( |( Yes / ( No | |

|3:30 PM |( |( Yes / ( No | |

OR

|Schedule |Time(s) |Notes |

|Medications | | |

|Blood Glucose Testing | | |

|Nebulizer Treatment(s) | | |

| | | |

| | | |

| | | |

| | | |

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 |Location/Procedure |

|Student Visit Log | |

|Duplicate Health Office Visit Forms | |

|Parent Phone Calls | |

|Attendance Phone Calls | |

|Notes to Parent | |

|Notes to Teacher | |

|Procedure for Dismissal | |

| | |

| | |

| | |

| | |

| | |

| | |

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: |

| |The parent requests that the child be allowed to not participate (this|

| |may be done for one day) |

| |The physician sends in a note (should contain the end date for the |

| |excuse and the reason) |

| |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 |Location |

|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): | |

| | |

| | |

| | |

| | |

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 | |

| | |

| | |

|[pic]Buddy Pass[pic] |[pic]Buddy Pass[pic] |

| | |

|Student Name: ___________________ |Student Name: ___________________ |

|Date begin: _________ Date end: _________ |Date begin: _________ Date end: _________ |

|Please allow this student to leave class early to assist ____________ |Please allow this student to leave class early to assist ____________ |

|(Student Name) due to the use of crutches or wheelchair. |(Student Name) due to the use of crutches or wheelchair. |

|School Nurse: ____________________ |School Nurse: ____________________ |

[pic]

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:



Medication Information:

Medications are to be locked at all times other than when administering medications.

|Medication |Notes |

|Medication location: | |

| Daily medications | |

| PRN medications | |

| Emergency medications | |

| Inhalers | |

| Nebulizer | |

| | |

| | |

| | |

|Controlled medication procedure | |

|Medication book | |

|Additional medication permission forms | |

| | |

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 & |Time(s) |

| |equipment) | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

PRN Treatments:

|Student |Treatment (include location of supplies & |Time(s) |

| |equipment) | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

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 facial injury

o permanent scarring

o threatened loss of limb

o brain injury

o dental injury

o 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: Time Called: Time Arrived:

Called by:

Reason Called:

DATA UPON AMBULANCE ARRIVAL

Date: Time Student Arrived:

Name:

Parent/Guardian Name:

Address:

Telephone Number:

Work: Cell:

Age: 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 |Contact Information: |

| |Phone and/or extension |

|Principal | |

|Assistant Principal | |

|Main Office | |

|Secretary | |

|Social Worker | |

|Guidance Counselor | |

|School Psychologist | |

|Maintenance | |

| | |

| | |

| | |

| | |

| | |

| | |

Contact List of Teachers

[Insert your school’s information here]

District Nurse and School Medical Director Contact Information

|School Name |Nurse Name |Work Number |Fax Number |

|High School: | | | |

| | | | |

|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:

▪ 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.

-----------------------

Name________________ ext.

Back up nurse for your building

Medical Director

Name___________________________________

How to contact:__________________________

________________________________________

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