One School Nurse, Three Buildings, and a Second-Grader With Type 1 Diabetes: Delegation and Accountability Beyond the Hospital
[Student Name]
University of Phoenix
NSG/397: Professional Nursing Role
Week 4 Assignment
[Instructor Name]
[Date]
The school district, staff and student are a composite written for a model paper. No real child is described.
A composite school nurse is responsible for three elementary schools with a combined enrollment of about 1,400 students. She spends roughly one day a week in each building and the rest of her time moving between them and managing health plans. This fall, a 7-year-old girl newly diagnosed with type 1 diabetes enrolled at one school. She needs blood glucose checks before lunch and when she has symptoms, insulin doses by pen based on carbohydrate counts, snacks on a schedule and emergency treatment if her blood glucose falls too low. The nurse cannot be in the building every day, yet the child needs safe diabetes care every hour she is at school, so the question is not whether to delegate but how to delegate safely. This paper applies delegation guidelines and interprofessional principles to her situation.
The Team
The student's care depends on an interprofessional team. Her pediatric endocrinologist writes the diabetes medical management plan. Her parents know her daily routine. At school, the team includes the school nurse, the principal, the teacher, a health aide who staffs the health office, the cafeteria manager who provides carbohydrate information and a physical education teacher. The American Diabetes Association position statement on diabetes care in schools states that students with diabetes need trained school personnel available to provide routine and emergency care throughout the school day and at school-sponsored activities, and that the school nurse coordinates that care and trains staff (Jackson et al., 2015).
Interprofessional collaboration requires clear roles and communication among people with very different backgrounds (Interprofessional Education Collaborative [IPEC], 2023). A teacher or health aide does not share the nurse's training, so the nurse's role includes translating medical orders into procedures the team can follow.
The Delegation Guidelines
The national delegation guidelines from the nursing regulators' council describe delegation as a shared process with three parties, the employer, the delegating nurse and the delegatee, each carrying distinct duties (National Council of State Boards of Nursing [NCSBN], 2016). The employer sets policy and provides adequate staff; the nurse assesses the patient, decides what can safely be handed off, gives clear instructions, supervises and evaluates; and the delegatee accepts only work he or she has been trained to do and does it as instructed. The guidelines organize the nurse's decision around five rights, which ask whether the task, the circumstances, the person, the instructions and the follow-up are all appropriate.
Delegation must be permitted by state law. In the composite state, the nurse practice act and the board's school health rules allow a registered nurse to delegate blood glucose monitoring, glucagon administration and insulin administration by pen to trained unlicensed school staff, provided the nurse assesses the student, trains and documents competence of each staff member and provides ongoing supervision.
Applying the Five Rights
Right task. Blood glucose checks with a meter, treating mild low blood glucose with fast-acting sugar and giving glucagon in an emergency are routine, have predictable outcomes and follow clear procedures, so they are appropriate to delegate. Giving insulin by pen according to a written dose chart is delegable under state rules. Calculating a correction dose that requires judgment beyond the chart, deciding how to respond to an unusual pattern of readings and communicating with the endocrinologist about plan changes are not delegable; they require nursing assessment and judgment.
Right circumstances. The student is newly diagnosed, and her plan will change as her insulin needs settle. For the first weeks, the nurse arranged to be at the student's school at lunch three days a week and available by phone on the other days, and asked the endocrinology team to send dose changes through her rather than directly to school staff.
Right person. The nurse selected the health aide and two teachers who volunteered, based on their willingness, availability and reliability, and did not require the classroom teacher to take on insulin if she was uncomfortable.
Right directions and communication. The nurse wrote an individualized health plan and an emergency action plan with pictures, translated the endocrinologist's dose chart into a simple table and taught each staff member using demonstration and return demonstration.
Right supervision and evaluation. She observed each trained staff member perform the tasks with the student before they did so independently, reviewed the blood glucose log daily by phone or electronic record in the first month and then weekly, and scheduled refresher training each semester.
Training and Documenting Competence
Shannon and Kubelka (2013), writing about delegation risks in school nursing, emphasized that school nurses reduce risk by assessing the student's stability, choosing delegatees carefully, providing thorough training, documenting competence and supervising regularly, and that inadequate training and supervision are common sources of error. The nurse used a competency checklist for each task, signed by the staff member and herself, and kept copies in the student's file and the district health office.
Where Accountability Remains
Delegation transfers the performance of a task but not the nurse's accountability for the decision to delegate, the quality of training and supervision or the overall plan of care (NCSBN, 2016). If a trained staff member gives the wrong insulin dose because the dose chart was unclear, the nurse is accountable for the chart. If a staff member skips a glucose check because no one covered the health office during a field trip, the principal and the nurse share accountability for a gap in the plan. The nurse therefore worked with the principal to ensure that a trained staff member is always present during the school day and on field trips.
Conclusion
Keeping a young child with type 1 diabetes safe in a school with a nurse present one day a week depends on delegation done well. Applying the national delegation guidelines, state rules and the diabetes care position statement, the school nurse delegated routine, predictable tasks to trained staff, kept tasks requiring judgment for herself, communicated clearly across a team of non-clinicians, supervised closely at first and documented competence. Delegation extended her reach without transferring her accountability, which remains with the nurse for every decision she makes about who does what.
References
Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3. https://www.ipecollaborative.org/ipec-core-competencies
Jackson, C. C., Albanese-O'Neill, A., Butler, K. L., Chiang, J. L., Deeb, L. C., Hathaway, K., Kraus, E., Weissberg-Benchell, J., Yatvin, A. L., & Siminerio, L. M. (2015). Diabetes care in the school setting: A position statement of the American Diabetes Association. Diabetes Care, 38(10), 1958-1963. https://doi.org/10.2337/dc15-1418
National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14. https://doi.org/10.1016/S2155-8256(16)31035-3
Shannon, R. A., & Kubelka, S. (2013). Reducing the risks of delegation. NASN School Nurse, 28(4), 178-181. https://doi.org/10.1177/1942602X13489886
How this NSG 397 Week 4 example is structured
The NSG/397 shelf page describes Week 4 as widening to interprofessional work, delegation and the accountability that comes with it. The paper uses a school setting because delegation there is unavoidable and the delegatees are not health care workers, which makes each delegation principle visible. It sets out the team, applies the delegation guidelines to specific tasks, addresses training and supervision and ends with what accountability means when the nurse is not in the building. Students search this week as NSG 397 Week 4, NSG397 Wk 4 or NSG/397 Wk 4; all three are the same assignment.
NSG/397 Week 4 questions, answered
What does NSG/397 Week 4 usually ask for?
The course shelf describes Week 4 as widening to interprofessional work, delegation and accountability. Many sections ask for a paper analyzing delegation decisions and team roles in a practice setting, using delegation guidelines and your state's rules. Your instructions decide the format.
Can a school nurse delegate insulin administration?
It depends on state law and the board of nursing's rules. Many states allow a school nurse to train and delegate some diabetes tasks, such as glucagon administration and in some states insulin, to unlicensed school staff under specific conditions. The nurse must check her state's rules before delegating.
Does delegating a task transfer accountability?
No. The delegatee is accountable for performing the task correctly, but the nurse remains accountable for the decision to delegate, for training and supervision and for the overall nursing care of the student.
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