Discretionary medication administration in schools

This memorandum is in response to queries from the field regarding PRN or discretionary medication administration in schools.

Registered nurses working as school nurses are in a unique place. Although they are school employees working under the rules and regulations of the local school board and State of Maine Department of Education, they are also licensed by the Department of Professional and Financial Regulation, Board of Nursing and therefore must follow the Nurse Practice Act and its rules. The registered nurse coordinates and oversees unlicensed personnel within a school to assign specific health tasks to be done and provides the training. Any unlicensed school staff who will administer medication must be trained by a registered nurse or physician before carrying out this task. It is the position of the Board of Nursing, that any task that requires a nursing assessment or judgment cannot be assigned to unlicensed personnel. When medication is not routine, such as with over-the-counter ibuprofen, for example, and the student’s response to the medication is less predictable, nursing oversight should be carefully considered. When evaluating if medication can be administered by an unlicensed staff, the school nurse should assess the situation and consider the following:

  • The task should not inherently involve ongoing assessment, interpretation, or nursing judgment and decision making
  • The school nurse should have the ability to provide adequate oversight of the unlicensed staff member’s medication administration tasks

It is recommended that schools take time to review their medication policies and procedures to ensure requirements from both the Board of Nursing and the Department of Education are being met. The following are resources that may assist your school in doing this:

Maine Board of Nursing Position Statement for School Nursing http://www.maine.gov/boardofnursing/practice/position-statements/school-nursing.html

Maine State Board of Nursing, Chapter 6 Regulations relating to coordination and oversight of patient care services by unlicensed health care assistive personnel. http://www.maine.gov/boardofnursing/docs/Chapter%206.pdf

Maine Department of Education, Chapter 40 Rule for Medication Administration in Maine schools. http://www.maine.gov/sos/cec/rules/05/chaps05.htm

Maine Department of Education, Decision Tree for Nurse Coordination and Oversight. http://www.maine.gov/doe/schoolhealth/manual/documents/nurse_decision_tree.pdf

Maine Department of Education, School Health Manual. Medication Administration in Schools Introduction http://www.maine.gov/doe/schoolhealth/manual/documents/intro_medication_administration_in_schools.pdf

For further information contact Emily Poland, School Nurse Consultant, Maine Department of Education at emily.poland@maine.gov.