Legal and Ethical Aspects of School Nursing Practice
The program provides candidates with an understanding of the local, state and federal
law and regulations applicable to the practice of school nursing. The program assists
candidates to understand the practice of school nursing within a public educational
system, including the structure and authority of school district administration, the
scope and practice of school nursing as regulated by the California Board of Registered
Nursing, applicable sections of the Education Code, and/or other relevant local, state,
and federal codes and regulations.
The program helps candidates understand how to apply decision making skills in an ethical manner within situations unique to the school setting. The program encourages candidates to continue to grow and develop as professionals within the area of school nursing.
Criterion 1: The program assists candidates in understanding the scope and practice of school nursing as regulated by the California Board of Registered Nursing, applicable sections of the Education Code, and other relevant local, state, and federal codes and regulations.
Before candidates can function competently as a school nurse, they must have a clear
understanding of laws and regulations governing school nursing practice. The program
enables candidates to identify, delineate, and clarify their role as a professional
school nurse though understanding the school nurse laws and regulations. Throughout
the 12 units of core school nurse coursework in the program, beginning with NURS 184,
Introduction to School Nursing Practice, candidates review legal guidelines of school
nursing practice and must provide appropriate legal references answering weekly questions,
other written assignments, and must follow those legal guidelines in their field experiences.
Candidates are registered nurses in the state of California, and as such are obligated to abide by the California Nurse Practice Act (Business and Professional Code, sections 2725-2742). Candidates read and apply the California Education Code, sections that relate to the role of the school nurse in California schools, state screening mandates, health promotion and health education guidelines, rights of students and confidentiality issues, medication at school, school safety, parent rights, required immunization for school entry, and other sections of the code that relate to health matters to class discussions and written work. Candidates research and report on other state codes that relate to school health, i.e. the California Code of Regulations, the Health and Safety Code, and laws, i.e., child abuse reporting. Candidates understand that the school nurse must adhere to their school district policies which are based on the California Education Code. Candidates research and describe each of the federal laws that affect schools and school nursing practice, for example, the No Child Left Behind Act of 2001; the Individuals with Disabilities Education Act (IDEA); the Family Educational Rights and Privacy Act (FERPA); and the Health Insurance Portability and Accountability Act (HIPAA) etc. Upon entering NURS 184, candidates are provided the rationale of membership in CSNO (California School Nurses Organization) and NASN (National Association of School Nurses) and the CSNO and NASN Position Statements established by each of these organizations that guide and strengthen school nursing practice. The National Association of School Nurses (2005) has published guidelines applicable to school nursing practice that candidates are responsible to include as a reference in answering weekly questions or presentation. The standards are called: Scope and Standards of Practice which includes the Standards of School Nursing Practice and Standards of Professional Performance, which are based on the American Nurses Association standards.
NURS 184, Introduction to School Nursing, the following weeks focus on legal aspects: Week 1, Nurse Practice Act and the role of the School Board of Education; week 2, coordinated school health programs, state and federal role and framework of school nurse practice; week 3, legal framework, liability issues, CSNO/NASN position statements; confidentiality, HIPAA/FERPA, duties of a health clerk. CA Ed. Code and district policies; week 4, week 5, state screening programs and Ed Codes that apply, BRN and delegation of administration of medications; week 6, Migrant Program, migratory children, legal record keeping; week 8, legal guidelines for communicable disease control; week 9, care of acute and chronic health conditions – school nurse legal role; week 10, health promotion and the Ed Code; week 11, individuals with disabilities (IDEA); week 12, Office of Civil Rights; week 13-14, legal basis for special education programs. An assignment in NURS 184 requires candidates to write a School Board Paper after attending a meeting. For the paper, students must research the election process for board member, to legal purpose of that body, and the role the board plays in approving district policies, including those developed for health services to pupils.
NURS 185 (School Nurse Seminar), the following weeks address legal aspects: Week 1, health framework; week 2, coordinated school health programs; week 3, standards of school nursing practice; week 4, health education and the Ed Code; week 5, Driver’s Ed, health insurance and codes; week 6, tobacco education and Ed Code; HIV/AIDS, sex education and Ed Code; week 8, programs for pregnant teens and Ed Code; week 9, attendance and district policy; week 10, sexual harassment; week 11, Crisis Management Response; week 12, politics 101; week 13, Healthy Start, grants; week 14, pursuing justice in the courts, minor consent, suspension/expulsion and sections of the Education Code that apply; week 15, Medi-Cal billing, reviewing the standards of practice. An assignment in NURS 185 requires student to write a Legislative Paper. To write this paper, candidates must research a bill, relevant to school health and/or school nursing, that is currently evolving though the legislative process, form an opinion of the bill based on the best interest of children’s health/families/nursing and contact (letter or office visit) a legislator/senator/governor and state their position on the bill and why. This assignment gives students excellent insight into the legislative process and importance of political involvement on the part of the school nurse.
NURS 186 and NURS 187 (elementary and secondary practicum courses respectively) – students review applicable sections of the Education Code that relate to their standards of school nursing practice, and the Nurse Practice Act. This is evidenced by providing services to children and families which is detailed in journals, developing curriculum/lesson plans, carrying out state mandated screening, sharing confidential information with others, training and supervising unlicensed assistive personnel. In completing a Cross-Cultural Special Ed Case Study in NURS 186, candidates must define steps involved in the process of evaluating a child or adolescent for considered placement in a special program which is a legal process (Individual Education Plan) and legal guidelines must be followed meticulously. In completing assignments in NURS 187, candidates must again consult the Education Code and district policy before creating new health curriculum at the secondary level (Health Education Curriculum Proposal) or before proceeding with facilitating a small group regarding health issues (Aggregate Teaching/Small Group Activity). Students must include the legal reasoning for each lesson they develop.
See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E33 and S34 for candidate competence in understanding of local, state and federal laws and regulations applicable to practice of school nursing.
Criterion 2: The program assists candidates to understand the practice of school nursing within a public educational system, including the structure and authority of school district administration:
In NURS 184, Introduction to school Nursing: Candidates learn that their position
in a school district is established through the California Education Code, in section
49426, which describes who shall practice school nursing in the state of California
and the role of the school nurse. Other facts candidates study are: The existence
of a State Nurse Consultant hired by the California Department of Education and is
available for consultation; school nursing is not mandated in California and school
districts may choose not to hire a school nurse); and there is no required school
nurse/student ratio. In NURS 184 candidates write a School Board Paper after attending
a school board meeting. In the assignment, Candidates describe the role and responsibility
of the Board of Education, how board members are elected, who is responsible to whom,
as well to describe the proceeding and events of the meeting. Candidates are also
required to review the organizational structure of the school district in which he/she
is employed and provide an example, so they understand the chain of authority. A weekly
question in NURS 184 (Wk 1) candidates describe the dynamics of the school community
and district organization in which the school nurse works. The chain of authority
is clearly defined, so school nurse knows who to report, i.e., a building principal,
superintendent, or director of health services who may be a psychologist. This subject
matter is also discussed during class time in practicum courses.
See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor checklists – E37 and S32 for candidate competence in understanding the public education system, including the structure and authority of school district administration.
Criterion 3: The program helps candidates understand how to apply decision making skills in an ethical manner within situations unique to the school setting:
In Nursing 184 (Introduction to School Nursing), in the beginning of semester, students
write their own Philosophy of School Nursing. The assignment involves researching
standards of nursing practice, theoretical concepts, moral/ethical responsibilities,
personal values and beliefs, and perception of the school nurse role. On completing
N185 (School Nurse Seminar), students are instructed to review their philosophy and
write how it has changed over the year. Further, in NURS 184, ethical and moral issues,
as well as ethical theories, are specifically addressed in Week 14, in the form of
weekly questions that candidates can choose to research and write up. These questions
relate to: Human and ethical values, ethical concepts, ethical quandary, problems
and examples. Questions also ask candidates to discuss different types of ethical
theories, and fundamental ethical principles that should guide all nursing practice.
In NURS 185, School Nurse Seminar (secondary), candidates are introduced to the many
health issues and health problems confronting adolescents which requires the candidate
to understand how to apply decision making skills in an ethical manner. In these cases
it is important for the candidate to have insight into sections of the California
Education Code with regard to legal and confidentiality issues, student rights, parent
In practicum courses, students are often faced with ethical, moral, legal issues that require consulting with the candidate’s school nurse preceptor, as well as looking within to evaluate own attitudes, values, and ethical and legal responsibilities toward the pupils, families, and the safety of community and others. In addition, students in both practicum courses, spend 12 hours each semester in online discussion with classmates sharing experiences, strategies, and responding to one another on issues related to decision making in clinical practice.
In NURS 186, School Nurse Practicum I (elementary), an ethical decision related to a DNAR (Do not attempt to resuscitate) order on a medically fragile child. Confidentiality issues, must be addressed when sharing medical information between parties. In Module IV, a specific journal question relates to ethical and moral decision-making. Students are required to address a current issue relative to Special Ed nursing and discuss legal/ethical ramifications and concerns related to a medically fragile child in their caseload. Students must reference school district policy, the Education Code, and the Nurse Practice Act in responding to the questions. In NURS 187, School Nurse Practicum II, candidates to address decision making related to adolescent health issues, especially confidential issues. A specific journal questions in Module II that relate to ethical decision-making and legal responsibility in which candidates must review and describe legal rights of teens and their parents regarding confidentiality in matters of birth control, pregnancy, abortion, as well as general counseling guidelines and reporting related to mental problems and potential suicide; and to discuss the school nurse’s ethical/legal responsibilities in these areas.
See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E31 and S31 for candidate competence in understanding how to apply decision making skills in an ethical manner within situations unique to the school setting.
See Sec. 3 (p. 407): NURS 186 and NURS 187 Preceptor Syllabus, Evaluation of Student Professional Dispositions: Disposition 3, “Candidate demonstrates the ability to make ethical judgments.”
Criterion 4: The program encourages candidates to continue to grow and develop as professionals within the area of school nursing:
National Association of School Nurses (2005) School Nursing: Scope & Standards of
Practice, Standard 8, sums up the aim of faculty for candidates in the program. Candidates
must participate in ongoing educational activities related to appropriate knowledge
bases and professional issues, other than program offering, while they are still in
the program. In practicum courses (NURS 186 and NURS 187) candidates spend 10-12 hours
attending local school nurse workshops, conferences, and meetings. During program
orientation day for candidates entering core school nurse courses, a representative
from CSNO (California School Nurses Organization) is invited to speak to candidates
about the advantages of membership in their school nurse organizations. Once a candidate
joins their professional organizations they are able to take advantage of networking,
educational offerings and excellent publications, such as the NASN (National Association
of School Nurses) Journal of School Nursing which includes research articles that
candidates can use in outcome based school nursing practice. It is also pointed out
to candidates that getting involved in their professional organizations, either as
board members or committee members, will keep them on the cutting edge of what is
happening in school nursing and increase their professional satisfaction through making
a difference for the profession and for the children they serve. In NURS 185, School
Nurse Seminar, candidates respond to a survey which requires self reflection and identifying
personal strengths and weaknesses with regard to levels of competence in various areas
of school nursing practice. Candidates in both seminar courses must base responses
to weekly questions on current research findings and sources of other evidence. As
a leadership activity in a practicum course, candidates may elect to spend clinical
hour to attend a CSNO section board meeting and to report back to classmates.
See Sec. 3 (p. 407): NURS 186 and NURS 187 Preceptor Syllabus, Evaluation of Student Professional Dispositions: Disposition 1, “Candidate demonstrates the ability to reflect.” Disposition 6, “Candidate demonstrates their enthusiasm for life-long learning.”