Frequently Asked Questions

Can a school district require a parent/guardian to come to school to administer a medication or procedure due to a staffing shortage? 

No, unless you do not have a provider order and/or parent authorization. You should include nursing services necessary for a student to receive free appropriate public education (FAPE) in the student’s education and/or health plan. Additionally, shifting the responsibility for providing those services to the parent/guardian should not occur. If there is a question about how to provide FAPE due to staffing shortages, districts should consult with their board attorney. 

What is the difference between medical orders and school nursing procedures? 

Nearly every nursing procedure performed in a school setting has accompanying medical orders that provide the necessary information regarding the prescribed intervention. For example, medical orders for a student who requires a gastrostomy tube feeding should include: 

• the type and amount of formula, 

• infusion type and rate, 

• frequency and timing of administration, 

• amount of water used to flush the tube, and 

• how to manage a blocked tube. 

The medical orders do not include instructions on how gastrostomy tube feeding is performed, such as how to prime the tubing or set the pump to the prescribed rate. Typically, a district will develop school nursing procedures that should contain this information. 

Is parent/guardian permission required for a procedure to occur in the school setting? 

Yes. In accordance with Tenn. Code Ann. § 49-50-1602, the student's parent or guardian must give permission in writing for appropriately licensed health care professionals to perform health care procedures and administer medications. 

Who should perform healthcare procedures during the school day or at related events? 

Licensed health care professionals shall perform healthcare procedures including administration of medications to students during the school day or at related events in accordance with applicable guidelines of their respective regulatory boards and in conformity with policies and rules of local boards of education or governing boards of nonpublic schools. 

What should a school/school nurse do if a student arrives at school with no doctor's orders and the parent/guardian requests services? 

Under Tennessee law, medical treatments and/or medical procedures are to be administered as prescribed by a licensed physician, dentist, podiatrist, or nurse authorized to prescribe pursuant to Tenn. Code Ann. § 63-7-123. State Board rule 0520-01-13-.03 requires a physician’s orders and parental authorization are required for any health care procedures performed by a licensed health care professional in the school setting. When the requested service involved requires one of these, the school/school nurse should not begin the services until the requirement is met. 

How does a school nurse determine if a procedure can be delegated to unlicensed assistive personnel? 

School nurses should review Tennessee law, Tennessee Board of Nursing rules and regulations, and school district policy and procedure to determine if a procedure can be delegated. Additional information on delegation is in the Guidelines for Healthcare in a School Setting and the Tennessee Board of Nursing position statements. 

Where can I find the requirements for procedure competencies? 

Districts and school nurses should review Tennessee law and Tennessee Board of Nursing rules and regulations. The Chronic Health Conditions Toolkit contains a list of required trainings and competency requirements but is not guaranteed to be up-to-date.