June 27, 2002

Dr. Michael J. Vetere
Superintendent
Monongalia County Schools
13 South High Street
Morgantown, West Virginia 26501-7546

Dear Dr. Vetere:

The West Virginia Department of Education is in receipt of your request for a Superintendent Interpretation dated April 30, 2002 regarding School Nurses.

In particular, you asked the following:

Question #1:

Regulations on prescription medication administration are addressed in the Basic and Specialized Health Care Procedure Manual for West Virginia Public Schools, page II-37, (Attachment 3). The manual gives the authority for school nurses to delegate the administration of prescription medications to trained school employees. The WV BOE delegation model on page 17 of the booklet entitled "Criteria for Determining Scope of Practice for Licensed Nurses and Guidelines for Determining Acts That May be Delegated or Assigned by Licensed Nurses" (Attachment 4), does not allow nurses to delegate the administration of any medication to unlicensed personnel, unless working in a facility; however, the definition of facility does not include schools. The WV State Code, page 117, section 18-5-22a, (Attachment 5), directs individual counties to develop their own policy regarding medication administration. Can the licensure board suspend or revoke licenses if the school nurses are following county policy?

Answer #1 -

Article 50, Appendix C, in the "Criteria of Determining Scope of Practice for Licensed Nurses and Guidelines for Determining Acts that may be Delegated or Assigned by

Dr. Michael J. Vetere
June 27, 2002
Page 2

Licensed Nurses" only refers to delegation within a facility under the authority of the Department of Health and Human Resources.

W.Va. Code 30-7-1 defines the practice of registered professional nursing in part as follows "performance for compensation of any service requiring substantial specialized judgment and skill based on knowledge and application of principles of nursing . . . or in the supervision and teaching of other persons with respect to such principles of nursing . . ." (Emphasis added)

When a school nurse delegates the administration of medication to non-licensed personnel he or she must make that decision based on her specialized skill, judgment, and knowledge regarding the condition of the student and based on WV Board of Education Policy 2422.7, Sections 3.9, 3.11, 3.14, 4.1, 5.1 and 6.3.

The WV Board of Examiners can suspend or revoke licenses if an RN is negligent in delegating authority to unlicensed personnel.

Question #2:

The administration of over-the-counter medication is not addressed in the Basic and Specialized Health Care Procedure Manual for West Virginia Public Schools. Again, the WV BOE does not allow school nurses to delegate the administration of any medication to unlicensed personnel. Also, the WV State Code directs individual counties to develop their own policy regarding medication administration (Attachment 6 is Monongalia County's current policy).

Answer #2 -

Over the counter medications can be administered by the school nurse with parent permission, if the county policy specifies this. However, if specialized skill and judgment are needed in determining whether or not to administer an over the counter medication, this procedure can not be safely delegated by the school nurse.

Question #3:

Does the doctrine of "in loco parentis," as outlined in WV Code 18A-5-1, (Attachment 7), pertain to medication administration? In other words, would the legal

Dr. Michael J. Vetere
June 27, 2002
Page 3

interpretation of "in loco parentis" allow unlicensed personnel to administer over-the- counter medication if a parent sends a written request to do so along with medication in its original container?

Answer #3 -

No. See answer to question 2.

Question #4:

Does state law supersede regulations by licensure boards? For example, WV Code 18-5-22 was revised by the 2002 Legislature to allow secretaries to dispense medication. The WV BOE advises against this practice. Please clarify the position nurses can safely assume.

Question #4 -

Yes, W.Va. Code supersedes regulations. WV Board of Education Policy 2422.7 has been amended to reflect the 2002 legislative changes to W.Va. Code 18-5-22. In providing for safe administration of medications delegated to any unlicensed personnel, consideration must be given to the environment, potential distractions, correct identification of the student, and all other guidelines for safe medication administration.

If you have any further questions or concerns relative to this issue, please feel free to contact Lenore Zedosky, Executive Director, Office of Heathy Schools at (304) 558- 8830.

Hoping that I have been of service, I am

Sincerely,

/s/