5920.E

AN ACT Relating to delegating nursing care in schools; amending RCW 18.79.260; adding new sections to chapter 28A.210 RCW; adding a new section to chapter 18.79 RCW; creating new sections; and providing an effective date.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. The legislature recognizes that many students in the K-12 setting need appropriate nursing service support to actively and fully participate in their educational program. It is not the intent of the legislature to replace the role of school nurses, but to increase their ability to delegate specific tasks safely to school employees for students needing routine health care services. The opportunity to delegate to registered and certified nursing assistants could enhance the viability and quality of care and learning in the common schools of this state. It is not the intent of the legislature to require school employees to be certified nursing assistants. Only those employees who carry out delegated nursing tasks as delineated pursuant to sections 1, 2, and 4 through 7 of this act are required to be registered or certified nurse assistants.

(1) Registered nurses shall have the option to delegate to certified and registered nursing assistants the following tasks: Oral and topical medications and ointments; nose, ear, and eye drops and ointments; catheterization using only clean technique as provided by RCW 18.79.290; suppositories; and gastrostomy feedings in established, wound-healed gastrostomies.

(2) The following procedures shall not be delegated: Sterile procedures; crossing the barrier of the skin; and management, manipulation, or care for intravenous devices, intravenous lines, infusion of intravenous substances, enemas, colostomy care, or dressing changes.

(3) Delegation shall only occur for students with a "stable and predictable" condition as defined by the Washington state nursing care quality assurance commission. In addition to this section and sections 4 through 7 of this act, nurse delegation in common schools is subject to applicable provisions of law.

(4) In order to protect the public health and safety, at the beginning of the school year public school districts and private schools that provide for delegation of nursing tasks under this section shall designate as delegatees one certificated employee or one classified employee and one alternate at each school. Any delegatee shall:

(a) Show proof of training in infection control, developed and provided by the school district;

(b) Register with the department of health and be subject to the uniform disciplinary act, chapter 18.130 RCW, for purposes of tasks performed as a delegatee; and

(c) Meet all training requirements provided by the delegating nurse in accordance with protocols set by the nursing care quality assurance commission.

(5) Sections 1, 2, and 4 through 7 of this act do not apply to emergency first aid situations.

NEW SECTION. Sec. 2. Unless the context clearly requires otherwise, the definitions in this section apply throughout sections 1 and 4 through 7 of this act.

(1) "Registered nurse" means school district nursing personnel who are licensed pursuant to chapter 18.79 RCW and may in addition hold state board of education certification as a school nurse.

(2) "Delegating nurse" means a registered nurse as defined in this section.

(3) "Delegatee" means a certified or registered nursing assistant.

Sec. 3. RCW 18.79.260 and 1994 sp.s. c 9 s 426 are each amended to read as follows:

A registered nurse under his or her license may perform for compensation nursing care, as that term is usually understood, of the ill, injured, or infirm, and in the course thereof, she or he may do the following things that shall not be done by a person not so licensed, except as provided in RCW 18.79.270:

(1) At or under the general direction of a licensed physician and surgeon, dentist, osteopathic physician and surgeon, podiatric physician and surgeon, physician assistant, osteopathic physician assistant, or advanced registered nurse practitioner acting within the scope of his or her license, administer medications, treatments, tests, and inoculations, whether or not the severing or penetrating of tissues is involved and whether or not a degree of independent judgment and skill is required except as provided in sections 4 through 7 of this act;

(2) Delegate to other persons engaged in nursing, the functions outlined in subsection (1) of this section;

(3) Delegate to certified and registered nursing assistants credentialed under chapter 18.130 RCW the functions outlined in sections 1 and 4 through 7 of this act;

(4) Instruct nurses in technical subjects pertaining to nursing;

((~~(4)~~)) (5) Hold herself or himself out to the public or designate herself or himself as a registered nurse.

NEW SECTION. Sec. 4. (1) The Washington state nursing care quality assurance commission, as provided by chapter 18.79 RCW, shall:

(a) Define "stable and predictable" conditions as used in section 1 of this act;

(b) Develop a clear and readable model informed consent form that substantially complies with chapter 7.70 RCW for nurses to use to provide consumers, delegatees, and the delegating nurse information regarding the delegation process, the rights of refusal by the delegatee and the consumer and/or the parents or guardian, and agreement by all parties of the delegation of the nursing task; and

(c) Develop delegation protocols that shall be available to schools by June 1, 1996, that include the following requirements:

(i) Thorough student assessment by the registered nurse before consideration of delegation;

(ii) The registered nurse obtaining written consent signed by the student and/or parent or guardian and the delegatee agreeing to the provision of delegated nursing tasks;

(iii) The registered nurse analyzing the complexity of the nursing task that is considered for delegation;

(iv) The registered nurse evaluating the ability of the delegatee to perform the delegated nursing task in the absence of direct nurse supervision;

(v) The registered nurse training the delegatee the specific delegated nursing task for each student. The training requirements may vary depending upon the degree of complexity of the delegated task;

(vi) The registered nurse informing the delegatee that the delegated nursing task is specific to a student and is not transferable;

(vii) The registered nurse initially observing the delegatee performing the delegated task;

(viii) The registered nurse providing written instructions to the delegatee on delegated nursing tasks;

(ix) The registered nurse informing the delegatee to be alert to any changes observed in student status that could require reassessment by the registered nurse;

(x) The registered nurse providing documentation of compliance or barriers to compliance in carrying out nurse delegation tasks and a written plan for nursing supervision and reevaluation of nursing tasks; and

(xi) The registered nurse having proof that the delegatee has received infection control training from the school district.

NEW SECTION. Sec. 5. No one may coerce a registered nurse into compromising student safety by requiring the registered nurse to delegate if the registered nurse determines it is inappropriate to do so. The registered nurse shall have total discretion and final decision making in determining the appropriateness of delegation.

(1) The registered nurse, delegatee, and student and/or student's parent or guardian must sign an informed consent form regarding the delegation process, rights of refusal, and agreement to delegation of nursing tasks.

(2) Registered nurses shall not be subject to any employer reprisal or commission disciplinary action for refusing to delegate tasks or refusing to provide the required training for delegation if the registered nurse determines delegation may compromise student safety.

(3) The delegatee shall have the right to refuse the assignment of a delegated task and the student and/or the parent or guardian shall have the right to refuse the delegation of nursing tasks.

(4) Delegatees shall not be subject to any employer reprisal or commission disciplinary action for refusing to accept delegation of a nursing task.

NEW SECTION. Sec. 6. (1) The delegating nurse and delegatee shall be held accountable for their own actions in the delegation process.

(2) Registered nurses acting within the protocols of their delegation authority are immune from suit in any action, civil or criminal, performed in the course of their delegation duties.

(3) Delegatees are immune from suit in any civil or criminal action, when following written delegation instructions from registered nurses, and performed in the course of their duties.

NEW SECTION. Sec. 7. Public and private schools are subject to nurse delegation protocols under RCW 18.79.260 and 18.79.290 and sections 5 through 7 of this act, excluding those tasks under RCW 28A.210.260 and 28A.210.270.

NEW SECTION. Sec. 8. A new section is added to chapter 18.79 RCW to read as follows:

Nurse delegation in public and private schools is governed by sections 1, 2, and 4 through 7 of this act.

NEW SECTION. Sec. 9. By June 1, 1996, the nursing care quality assurance commission shall adopt rules incorporating the requirements of sections 1, 2, and 4 through 7 of this act for the delegation of clean catheterization by registered nurses to delegatees in schools.

NEW SECTION. Sec. 10. The department of health in consultation with the nursing care quality assurance commission, office of the superintendent of public instruction, and other interested parties shall submit a report on nurse delegation in public schools to the legislative health committees by December 1997. The office of the superintendent of public instruction shall also implement communication strategies to assure that students, parents and/or guardians, the delegating nurse, and the delegatee have a complete understanding of the delegation process and the implications of current or revised statutes and rules. The commission shall provide data on incidence of harm to the public due to the delegation of nursing tasks, reports of registered nurses being coerced to delegate, coercion of delegatees to accept delegated nursing tasks, the number of students who received delegation, and the accumulated time involved in the delegation of nursing tasks. The report should include relevant information on serving health care needs to students before and after nurse delegation.

NEW SECTION. Sec. 11. The legislative budget committee shall study possible funding sources for adding more registered nurses to public and private schools in Washington state. The committee shall use data on the number of school nurses in each district and the number of children needing nursing care in schools during the school year 1995-96, as compiled by the superintendent of public instruction. The committee shall report to appropriate committees of the legislature by December 1996.

NEW SECTION. Sec. 12. Sections 1, 2, and 4 through 7 of this act are each added to chapter 28A.210 RCW.

NEW SECTION. Sec. 13. Sections 1 through 3 and 5 through 7 of this act shall take effect September 1, 1996.