Frequently Asked Questions

1. What is the citation in the law that indicates who can perform nursing tasks and/or administer medications to students?
2. Can an LPN provide school health services including diabetic care as long as supervision is provided?
3. How should school districts handle the issue of medications when students go on field trips or participate in after-school activities?
4. How should school districts handle the need for nursing procedures when students go on field trips or participate in after-school activities?
5. Must all children with special health care needs have an individualized health care plan (IHCP)?
6. Are school districts authorized to employ Emergency Medical Technicians (EMTs) to provided health care to children with special health care needs in the absence of the school nurse?
7. If a non-licensed individual takes a course that certifies him/her to give medications in the home, can that person give medications in the school setting?
8. Can a non-licensed person who receives appropriate training administer medications?
9. Can the school nurse provide training to non-licensed persons to administer injectable medications in anticipation of an emergency?
10. What procedures should be followed when a nurse working in a school building is employed by another agency (i.e. private duty nurse for a child with special health care needs)?
11. Where can districts get training information and resources on school health issues?

1. What is the citation in the law that indicates who can perform nursing tasks and/or administer medications to students?

Section 20-87a of Chapter 378 of the Connecticut general statutes (The Nurse Practice Act) states that only registered nurses may execute medical regimens. Section 20-87c indicates that licensed practical nurses may perform selected tasks and share responsibility under the direction of a registered nurse or advanced practice registered nurse.

Section 10-212a of Chapter 169 of the Connecticut general statues allows a school nurse or any other nurse licensed pursuant to the provisions of chapter 378 to administer medications to students in schools. In addition § 10-212a allows, in the absence of a school nurse, the principal, any teacher, licensed athletic trainer, licensed physical or occupational therapist employed by a school district, or coach of intramural and interscholastic athletics of a school may administer, subject to the provisions of subdivision (2) of this subsection, medicinal preparations, including such controlled drugs as the Commissioner of Consumer Protection may, by regulation, designate, to any student at such school pursuant to the written order of a physician licensed to practice medicine, or a dentist licensed to practice dental medicine in this or another state, or an optometrist licensed to practice optometry in this state under chapter 380, or an advanced practice registered nurse licensed to prescribe in accordance with § 20-94a, or a physician assistant licensed to prescribe in accordance with § 20-12d, and the written authorization of a parent or guardian of such child. The administration of medicinal preparations by a nurse licensed pursuant to the provisions of chapter 378, a principal, teacher, licensed athletic trainer, licensed physical or occupational therapist employed by a school district, or coach shall be under the general supervision of a school nurse. § 10-212a further allows school paraprofessionals to administer medication to a specific student with a medically diagnosed allergic condition that may require prompt treatment in order to protect the student against serious harm or death. 

The Regulations of Connecticut State Agencies Section 10-212a-1 through 10-212a-10 Administration of Medications by School Personnel and Administration of Medication During Before- and After-School Programs and School Readiness Programs. These regulations provide the procedural aspects of medication administration in the school setting. The regulations include definitions within the regulations; the components of a district policy on medication administration; the training of school personnel; self-administration of medications; handling, storage and disposal of medications; supervision of medication administration; administration of medications by coaches and licensed athletic trainers during intramural and interscholastic events; administration of medications by paraprofessionals and administration of medication in school readiness programs and before- and after-school programs. 

Public Act No. 12-198 (HB 5348) An Act Concerning the Administration of Medicine to Students with Diabetes, the Duties of School Medical Advisors, the Availability of CPR and AED Training Materials for Boards of Education and Physical Exercise During the School Day. This Act allows a qualified school employee selected by the school nurse or principal to administer an emergency glucagon injection to a student with diabetes, under certain conditions and with a written authorization from the student's parents and a written order from the student's Connecticut-licensed physician. The Act also bars a school district from restricting the time or place on school grounds where a student with diabetes may test his or her blood-glucose levels, if the student has written permission from his parents or guardian and a written order from a physician. 

The Act extends required educational guidelines for school districts in how to manage students with life-threatening allergies to cover students with glycogen storage disease. It requires the State Department of Education and the Department of Public Health to issue the new guidelines by July 1, 2012, and school districts to develop individualized health care and glycogen storage disease action plans for their students with the disease by August 15, 2012. The plans must allow parents or guardians of students with the disease, or those they designate, to administer food or dietary supplements to their children with the disease on school grounds during the school day. The Act bars claims against towns, school districts, and school employees for damages resulting from these actions. 

 

2. Can an LPN provide school health services including diabetic care as long as supervision is provided?

Yes. LPNs may be hired to perform nursing tasks permitted in the LPN scope of practice under the direction of a school nurse. The tasks must be part of an individual nursing care plan that is developed, maintained and evaluated by a school nurse.

 

3. How should school districts handle the issue of medications when students go on field trips or participate in after-school activities?

Connecticut state law allows a number of trained school employees to administer oral, topical and inhalant medications to students who cannot self-administer medications. Non-licensed personnel may administer injectable medication to students who have a medically diagnosed allergic condition.  In addition, with the written authorization of a student's parent or guardian, and pursuant to a written order of the student's physician licensed under chapter 370, a school nurse or a school principal shall select, and a school nurse shall provide general supervision to, a qualified school employee to administer medication with injectable equipment used to administer glucagon to a student with diabetes that may require prompt treatment in order to protect the student against serious harm or death. 

For other students who need other injectable medications and cannot self-administer, a number of options are available: 

• the parent or guardian may attend the activity and administer the medication; or 
• the student’s health care provider can be consulted and may order the medication time to be adjusted or the dose eliminated; or 
• the school may send a school nurse, substitute school nurse or LPN on the field trip to administer the medication.

A child may not be prevented from participating in an educational activity, such as a field trip, solely on the basis of a special health need. Even if no medication is needed during the field trip, the school must have trained personnel who can respond to an emergency.

 

4. How should school districts handle the need for nursing procedures when students go on field trips or participate in after-school activities?

When a student is unable to perform a necessary health-related task independently and the task is a nursing procedure, the school nurse has to participate or the school nurse may delegate the task to an appropriate, trained unlicensed person. To delegate this task, the nurse must decide that the specific task is appropriate to delegate:

• For a particular student; and 
• to a particular staff member(s).

The identified staff member must also be willing to assume the task and the task cannot require nursing judgment.

 

5. Must all children with special health care needs have an individualized health care plan (IHCP)?

An IHCP, a plan of care for a child with health needs, is not required by law, but is customarily used in nursing practice and is recommended for all students with special health care needs who require care for their health care needs. The IHCP may be a stand-alone plan developed by the nurse in consultation with a team that includes a parent or guardian, the health care provider, teachers and others responsible for the student, or it may be a part of an Individualized Education Plan or 504 Plan.

 

6. Are school districts authorized to employ Emergency Medical Technicians (EMTs) to provided health care to children with special health care needs in the absence of the school nurse?

No. The definition of services that may be provided by EMTs allows these individuals to function as EMTs only when they are working as members of the emergency medical system. An EMT may not be hired to provide nursing procedures, including medication administration, to children with special health care needs. An EMT who has been hired as a health aide must work within the scope of the health aide job description and be trained as a health aide.

 

7. If a non-licensed individual takes a course that certifies him/her to give medications in the home, can that person give medications in the school setting?

No. Medication administration in schools is governed by Section10-212a of the Connecticut general statutes.

 

8. Can a non-licensed person who receives appropriate training administer medications?

Yes. A full time school employee who meets the criteria of section 10-212a and has been appropriately trained by the school nurse for the specific student and medication may administer oral, topical and inhalant medications. 

 

9. Can the school nurse provide training to non-licensed persons to administer injectable medications in anticipation of an emergency?

According to §10-212a-2(e) Non-licensed persons may administer injectable medications only to students who have been medically diagnosed with an allergic condition, which may require prompt treatment to protect the student against serious harm or death. In addition, Public Act No. 12-198 amends Section 10-212a of the general statutes and allows “qualified school employee” to administer medication with an injectable equipment used to administer glucagon to a student with diabetes that may require prompt treatment in order to protect the student against serious harm or death.

 

10. What procedures should be followed when a nurse working in a school building is employed by another agency (i.e. private duty nurse for a child with special health care needs)?

Procedures that govern health care for students, including care provided by nurses from outside agencies, should be established by school district policy. Procedures should address situations where: 1) there is a school nurse in the building, 2) there is no school nurse in the building.

• If the nurse is hired by the school district there should be a contract with the agency in place. The agency is responsible for assuring that the nurse has a valid license and the expertise to perform the functions required. 
• The school district should have all the required orders and authorizations in place.

The agency nurse and school nurse should work together to develop a plan to assure that the student’s health needs will be met (i.e., an emergency). However the school nurse should never be expected to substitute for the agency nurse in providing constant care of the student or to supervise a nurse who is not employed by the district. Agency nurses should be expected to abide by the health and administrative policies of the district (i.e., notification to the school nurse or administrator when in the building, evacuation and emergency procedures, etc.). Procedures should be established for the school nurse to follow if the school nurse determines that an agency nurse is performing a procedure in an unsafe way. Agency nurses assigned to care for a specific student should not be expected to substitute for the school nurse.

 

11. Where can districts get training information and resources on school health issues?

Many hospitals in the state provide training, information and resources. Connecticut Children’s Medical Center, Hospital for Special Care, University of Connecticut John Dempsey Medical Center and Yale University and Hospital may be able to guide school districts in the right direction. The State Department of Education is an additional resource. Regional Education Service Centers (RESCs) can be helpful in providing consultation, technical support and training. Some colleges offer continuing education related to school health.