Perceived professional risk of school nurses associated with delegation of nursing care responsibilities to unlicensed personnel

Abstract

The increasing numbers of children who require health care services while attending school have prompted the delegation of nursing care responsibilities to unlicensed personnel. School nurses have expressed legal and professional concerns regarding delegation. The purpose of this study was to describe current delegation practices of school nurses to unlicensed personnel, examine legal and professional standards which impact delegation decisions, and explore the perceived professional risk of school nurses associated with delegation and risk to the health and safety of students. A professional and legal regulation of practice model provided the conceptual framework. A descriptive design was used to investigate the delegation practices of school nurses in Georgia. Eighty·- seven (N=l93) school nurses returned completed questionnaires. summary statistics were used to analyze the data. A Demographic Questionnaire provided information about sample characteristics. Analysis of data from the School Health Care Questionnaire determined the performance and delegation of nursing care responsibilities. Approximately 70% of the school nurses reported delegation to unlicensed personnel. Crosstabulation of performance and delegation revealed the most frequently delegated procedures as oral, inhalation, ophthalmiC/otic, and topical medication administration; seizure procedures; gastrostomy feedings; vision and hearing screenings; and urinary catheterizations. The investigator-developed Professional Risk Related to Delegation Scale determined the importance of standards used in delegation decisions and the risk associated with delegation practices. The majority of participants rated the legal and professional standards as considerable to extreme importance in delegation decisions. Findings supported that items consistent with appropriate delegation practices had lower risk scores; whereas, items consistent with inappropriate delegation had higher risk scores. overall, the school nurses reported moderate to very high professional risk and risk to the health and safety of students associated vlith delegation to unlicensed personnel. Findings show that school nurses in Georgia are concerned about professional risk associated with delegation to unlicensed personnel. These findings have implications for development of delegation practice models and refinement of legal and professional statutes and standards for the regulation of delegation.