School Health Services

When to keep your child at home: 

• Fever -- Temperature greater than 100.4 degrees. Your student may return when  their temp. has been below 100 degrees for 24hrs without fever reducing medication. 
• Chills
• Shortness of breath or difficulty breathing.
• New loss of taste or smell.
• Vomiting -- May return when there has been no episodes of vomiting without the use of medication for 48 hours.
• Diarrhea -- 3 or more watery stools in 24 hours or sudden onset. May return when resolved for 48 hours.
• Sore Throat -  May return when resolved for 24 hours.
• Rash -- Any new onset of rash if accompanied by fever. May return after rash resolves or if clearance given by health care providers. 
• Cough -- Persistent cough with or without fever, serious sustained coughing, shortness of breath or difficulty breathing 
• Symptoms or complaints that prevent the student from participating in his/her usual school activities including severe fatigue and muscle or body aches.
• Stiff neck or headache with accompanying fever -- May return after resolution of symptoms or diagnosis made and clearance given. 
• Jaundice (yellowing of eyes or skin) -- May return after diagnosis from physician and clearance given.

Certified School Nurses. Oregon law defines “school nurse” as a RN who is certified by the Teacher Standards and Practices Commission (TSPC) as qualified to conduct and coordinate the health service programs of a school (ORS 342.455; ORS 342.475). 

Registered Nurses. Oregon law allows school districts to hire RNs licensed in the state of Oregon to provide school nursing services (ORS 336.201). However, schools may not designate these individuals as “school nurse” unless they hold a TSPC Professional School Nurse certificate (ORS 342.455; ORS 342.475). Per Oregon licensure laws, RN scope of practice includes providing direct care; clinical direction and supervision of others including licensed practical nurses (LPNs) and unlicensed personnel; and health education and health policy development within the RN’s areas of competence. (OAR 851, division 45). 

Licensed Practical Nurses. Oregon law permits schools to hire LPNs to provide certain nursing care to students (ORS 336.201). Per Oregon licensure laws, LPNs must practice under the clinical supervision of a RN or Licensed Independent Practitioner (ORS 336.201 and OAR 851, Division 45).

Delegation: Nursing care tasks must be performed or overseen by a Registered Nurse. When the nurse is not directly providing services, the Nurse Practice Act provides them the authority to delegate tasks to non health professionals. The nurse may only delegate care in this manner after determining that the student's condition is stable and predictable, and the person taking on the delegation is both willing and competent to perform the task. By law, the decision to delegate nursing care, or not, lies specifically with the Registered Nurse.

Medically Complex Students: Oregon law defines “medically complex students” as those students who may have an unstable health condition and who may require daily professional nursing services. Students in this category have health conditions which require a licensed nurse to do an assessment, write a health care plan, and teach and oversee tasks of care to non-nurse school staff who are working directly with the student. The nurse has intermittent direct contact with the student (e.g., to write a health care plan, nursing services, address emergent problems, monitor school staff performance of tasks, access new medical orders, and similar tasks). 

Medically Fragile Students: “Medically fragile students” are those students who may have a life-threatening health condition and who may require immediate professional nursing services. Students in this category have a health condition which requires frequent, one-on-one intervention by a Registered Nurse. 

Nursing Dependent Students: “Nursing-dependent students” are those students who have an unstable or life- threatening health condition and who require daily, direct, and continuous professional nursing services. Nursingdependent students require one-on-one services by a licensed nurse so that they are medically safe in the school setting. 

Health Management Plan: School nurses are licensed to develop individualized care plans, which are important for students with identified health needs. A Health Management Plan provides guidance regarding how a specific student’s condition is to be managed during the school day and at school-sponsored events. A Health Management Plan is often an attachment to the Individualized Education Plan (IEP) or 504 plan.  To develop a Health Management Plan, the nurse follows the nursing process to assess the student and situation, identify a nursing diagnosis, plan and implement appropriate nursing interventions, and evaluate whether the interventions are meeting student needs. The nurse conducts this process in collaboration with the student, family, school staff, and community providers.