504 - The school nurse is an integral multidisciplinary team member in assisting schools to close the gap of early identification of child find for students who may need additional accommodations or specialized instruction. School nurses are encouraged to notify the special education director and 504 coordinator upon the development of the Individual Student Health Plan (IHP), annually thereafter, or whenever a substantial change in student health occurs requiring the IHP to be amended. The Americans with Disabilities Act Amendments Act, effective January 1, 2009, impacted school nursing. In 2015, the Iowa Department of Education sent out a Memorandum: Intersection of 504 and IHPs letter reminding schools of this correlation.
Bloodborne Pathogens Employee Requirements - Schools are required to provide Bloodborne Pathogen training and school nurses often request information regarding the Hepatitis B vaccination series requirements. The de minimus classification for not offering the pre-exposure Hepatitis B vaccination series to school personnel does not apply to healthcare personnel expected to render first aid in the course of their work. The following resources are available:
Note: The de minimus classification for not offering the pre-exposure Hepatitis B vaccination series to school personnel does not apply to healthcare personnel expected to render first aid in the course of their work.
- Iowa Schools Bloodborne Pathogen Guidance - Includes OSHA-Occupational Exposure to Bloodborne Pathogens Regulations and Standards
- Bloodborne Pathogens Exposure: Fact Sheet
Clinical Laboratory Improvement Amendment - School nurses perform tests in the daily course of their work for students and school employees (e.g. blood glucose tests, ketone urine checks, strep throat swabs, Department of Transportation and Federal Motor Carrier Safety Association required school transportation drivers drug and alcohol testing). Schools that perform less than 15 types of tests in the course of business fall under the Department's statewide waiver to meet the requirement for all schools with the State of Iowa Hygienic Laboratory.
Delegation and the Iowa School Nurse - Iowa school nurse delegation, decision making, and documentation. This resource assists school nurses and leadership teams to understand delegation of health services. Scope of Practice and Regulation of School Nurses - A 4-12-21 memorandum from the Iowa Board of Nursing addresses the scope of practice allowed for the Licensed Practical Nurse (LPN), Registered Nurse (RN), and Advanced Registered Nurse Practitioner (ARNP) in Iowa schools.
Voluntary Stock Emergency Medication Supply - School boards and school authorities may adopt a policy to voluntarily stock epinephrine auto-injectors, opioid antagonists, bronchodilators, or bronchodilators and canisters. The school nurse delegates medication administration. Qualified personnel administering medications, to include stock emergency medications, must complete the medication administration course provided by the department, complete an annual skills check with the school nurse and complete an annual awareness training for the use of stock emergency medications. The awareness training covers when stock medications should be administered to individuals or students who have not received a formal diagnosis or prescription from a licensed healthcare provider. These trainings are part of the general medication administration course that is a requirement to administer any medication in schools.
Annual Awareness Trainings:
- Stock Bronchodilator Video (December 2022) - Iowa American Lung Association
- Stock Epinephrine Auto-Injector Video (August 2023) - Iowa School Nurse Organization
- Stock Opioid Antagonist Video (2022) - Iowa Health and Human Services
School districts and schools utilize the reporting for when voluntary stock emergency medications are administered:
- Stock Epinephrine Auto-Injector Administration Report
- Stock Bronchodilator or Bronchodilator and Canister Use Report
Evaluation for the School Nurse - School nurses develop professional portfolios for evaluation purposes with school leadership. Resources for evaluation of clinical and professional standards of the school nurse.
Iowa Physicians Order for Scope of Treatment (IPOST) - On September 5, 2019, the Director issued a supervisory order regarding school compliance with physician’s order for scope of treatment. This supervisory order explains to schools that school nurses and other health care providers employed by schools and AEA must comply with physician orders for scope of treatment under Iowa Code chapter 144D ("IPOST"), including when an IPOST contains orders regarding life-sustaining procedures (e.g., an order to not perform CPR or call 911). This order also notes that other school personnel may comply with IPOST forms. This order makes clear that the prior attorney general opinion on do-not-resuscitate orders and other life-sustaining procedures declarations interpret a different statute.
Iowa School Health Legal Reference Summary - The summary is a compilation of links to federal regulations, state regulations, Iowa administrative codes, and resources that are summarized and are not a substitute for actual law.
Iowa School Medical Cannabidiol Guidance - A guidance document for schools regarding the use of medicinal marijuana and management of hazardous and medication waste. In 2017, the Iowa legislature enacted a law that created the “Medical Cannabidiol Program” (Iowa Code 124E; Iowa Administrative Code 641.154). The guidance covers school district employee use of medical cannabidiol, student use of medical cannabidiol, Individuals with Disabilities Education Act, School Nurse’s administration of medical cannabidiol, and school employees asked to become “care providers” for students under the Iowa Medical Cannabidiol Act.
Individual Health Plans (IHP) and Emergency Action Planning - The school nurse develops the IHP as a working document for delivery of health services provided at school in collaboration with the parent or guardian, individual’s health care provider or education team. The following template and resource is available for the school nurse. Families and their child's healthcare provider or contracted nursing agency may provide schools with treatment records, action plans, contracted agency health plans and medical management plans that address the child’s chronic health condition or health services in a different environment. These documents do not replace an IHP, but may be incorporated. The IHP addresses the whole child and the delivery of health services in the school environment to promote access to education programming using the nursing process.
- Iowa Individual Health Plan Template
- Emergency School Health Planning (Special Health Services) - On the linked webpage, scroll down to the Emergency Plans/Action Plans subheading under the Individual Health Plans section.
Mandatory Abuse Reporting
Licensed school employees and additional school staff are required to report suspected child or dependent adult abuse to the department of human services within 24 hours followed by a written report within 48 hours (Iowa Code 232.68 to 232.70).
- Child Abuse: A Guide for Mandatory Reporters
- Report of Suspected Child Abuse Form
- Sample Policy on Identifying and Reporting Child Abuse (Chapter 102 Level 1 Investigation Manual)
Medicaid Presumptive Eligibility - Medicaid Qualified Entity (QE) for presumptive eligibility. The school nurse, in a Medicaid approved provider school, can become a QE to make the presumptive determination about a child's Medicaid eligibility based on the family's income self declaration statement for the child to receive immediate medical care.
Medication Administration and Management - School nurses delegate the task of medication administration to unlicensed personnel. The following resources assist the school nurse in this delegation.
- Medication Administration Course - School districts and accredited and nonpublic schools are required to use the course provided by the Iowa Department of Education (Iowa Administrative Code 281-12.1). A blank certificate will be generated when an individual obtains 100% completion and passing scores on all 17 modules/quizzes. The certificate is only valid after a hands on skills check to demonstrate competency in medication administration is completed and documented by the school nurse. To access the course, go to https://training.aealearningonline.org/index_login.php and fill in all required fields. If you do not know your district password, contact your school administrator or email to support@aeapdonline.org.
- Student Medication Administration Record Sample
- Medication Error Report Sample Form
- Medication Administration Toolkit (2023)
- Medication Administration Manual (2023)
School Hazardous Waste and Medication Management Guidance
Scope of Practice and Regulation of School Nurses - A 4-12-21 memorandum from the Iowa Board of Nursing addresses the scope of practice allowed for the Licensed Practical Nurse (LPN), Registered Nurse (RN), and Advanced Registered Nurse Practitioner (ARNP) in Iowa schools.