Use of Licensed Practical Nurses and the Term “School Nurse” in School Settings
Date: October 27, 2004
To: District Superintendents
Superintendents of Public Schools
Superintendents of State-Operated and State-Supported Schools
Nonpublic School Administrators and Educators
New York City Board of Education
Principals of Public and Nonpublic Schools
Directors of Pupil Personnel Services
New York State Association of School Nurses
New York State Nurses Association
Nurse Practitioners/School Nurse-Teachers/ Registered Nurses and Licensed Practical Nurses
employed in Public and Nonpublic Schools
James A. Kadamus, Deputy Commissioner
Office of Elementary, Middle, Secondary and Continuing Education
Johanna Duncan-Poitier, Deputy Commissioner
Office of the Professions and Office of Higher Education
Use of Licensed Practical Nurses and the Term “School Nurse” in School SettingsIt has come to our attention that some schools/districts may have hired Licensed Practical Nurses for duties within the school setting that are beyond their scope of practice as established in Article 139, the Nurse Practice Act. This memo seeks to differentiate the practice of Registered Nurses (RNs) from that of Licensed Practical Nurses (LPNs). This information is provided in order to ensure students’ health and safety as well as prevent professional misconduct charges against LPNs who practice beyond the scope of their practice.
Section 6902 of Article 139 of the Education Law distinguishes between the legal definitions of RNs and LPNs as follows:The practice of the profession of nursing as a registered professional nurse is defined as diagnosing and treating human responses to actual or potential health problems through such services as casefinding, health teaching, health counseling, and provision of care supportive to or restorative of life and well-being, and executing medical regimens prescribed by a licensed physician, dentist or other licensed health care provider legally authorized under this title and in accordance with the commissioner's regulations. A nursing regimen shall be consistent with and shall not vary any existing medical regimen.
The practice of nursing as a licensed practical nurse is defined as performing tasks and responsibilities within the framework of casefinding, health teaching, health counseling, and provision of supportive and restorative care under the direction of a registered professional nurse or licensed physician, dentist or other licensed health care provider legally authorized under this title and in accordance with the commissioner's regulations. These definitions authorize Registered Nurses to function independently while also executing medical orders from select authorized health care providers. RNs have a critical role in nursing diagnosis, which is interpreted by the Department as including assessment. Developing student health plans, assessing and discriminating between physical and psychosocial signs and symptoms of students, and representing the nursing needs of students at IEP conferences are functions clearly congruent with the definition of registered professional nursing practice as presented above.Licensed Practical Nurses in New York State function by law in a dependent role at the direction of the RN or other select authorized health care providers. LPNs may administer medications, assist in preparing students for physical exams, and gather student measurements, signs, and symptoms that can be used by the RN in making decisions about the nursing care of specific students. The LPN may also be hired by parents to accompany their students to school in order to carry out certain health care procedures as ordered by an authorized provider. In this instance, the LPN is subject to the direction of the authorized provider who has ordered the specific health care procedures, and the school RN. LPNs may not function independent of direction; they do not have assessment privileges; they may not interpret clinical patient data or act independently on such data; they may not triage; they may not develop a nursing care plan. In addition, the role of LPNs does not include nursing diagnosis. Some schools currently employ LPNs who are expected to carry out the professional duties of RNs. LPNs in this situation are practicing outside of their legal scope and could face professional misconduct charges. The scopes of practice of RNs and LPNs are not interchangeable and such practices expose schools to potential litigation. The RN is the professional nurse in school settings who may independently, within the scope of Registered Professional Nursing, triage, assess students, interpret clinical student data, develop nursing care plans, and make decisions regarding student nursing care. We hope this information is helpful. If you have questions or need additional information, please contact the New York State Board for Nursing by phone, at 518-474-3817 ext. 120 or e-mail firstname.lastname@example.org. Additional information is also available through the New York Statewide School Health Services Center at www.schoolhealthservicesny.com or by telephone at 585-349-7632.