The Balance Between Medication Administration Needs and District Staffing Concerns

District staffing needs undergo careful scrutiny as final budget adoption approaches.  In the case of school nurses, the School Code provides specific direction in Section 1402(a.1) that the number of students under the care of each school nurse shall not exceed 1,500.  However, with the increasing demands for Districts to dispense medication to students at designated times in multiple buildings, the issue of whether the administration of medication can only be performed by school nurses or whether the District has greater flexibility in having other designated school personnel administer medication in the school nurses’ absence must be answered.  Historically, school nurses have raised the argument that the Pennsylvania Professional Nursing Law only authorizes medication administration to students by a licensed registered nurse.  However, the regulations of Pennsylvania’s State Board of Nurse Examiners which are promulgated pursuant to the Nursing Law only indicate that “a licensed registered nurse may administer a drug ordered for a patient in the dosage and manner prescribed,” but it does not provide that the licensed registered nurse has the exclusive authority to administer medications, and of course, makes no reference to medication administration in the school environment.

The Nursing Law only controls the conduct and legal authority of licensed registered nurses.  It does not govern the actions of others, such as practical nurses, who are not licensed nurses.  In fact, the Practical Nurse Law, governs practical nurses, who may perform “selected nursing acts . . . which do not require the specialized skill, judgment and knowledge required in professional nursing.”  In addition, the Practical Nurse Law does not prohibit “auxiliary services” rendered by persons carrying out duties necessary for the support of nurses, including those duties which involve minor and very basic nursing services. As can be seen from the interplay of the various legislation, provision of care is not exclusive to licensed registered nurses unless that care is specifically contained in the law.  Administration of prescribed medication, where the dosage amount and the frequency of administration is established by the physician and the prescription has been filled by a pharmacist, is nowhere specifically identified in the Law as within the sole and exclusive authority of a registered nurse.  In fact, neither the law nor the regulations prohibit a school employee from dispensing medication to a student pursuant to the consent of the parents.  School Districts should require a written request and authorization from the student’s parents that the District administer the medication and authorize the School Administration to designate the school personnel who will administer the medication.  This will then give the School District the necessary flexibility to designate the appropriate personnel who will administer the medication.  Support for this position can be drawn from Section 1317 of the School Code which provides that every teacher, vice principal and principal has the right to exercise the same authority as to the conduct and behavior of students as the parents, guardians or persons in parental relation to such pupils may exercise over them.  In other words, the District stands in loco parentis to the student.  As such, the parent, guardian or anyone acting on their behalf or with their consent, is authorized to administer medication to the child pursuant to the directions contained on the prescription label.  Of course, to the maximum extent possible, the District should train the staff who will be administering the medication, especially regarding recording the type, dosage and time the medication was administered.

Further support for this position is found in regulations of the Department of Health with respect to child residential and day treatment facilities codified at 55 Pa. Code § 3800.187, 3800.188 and 3800.189.  These regulations specifically anticipate that, due to a parent’s incapacity or inability to provide appropriate parental control over their children, trained staff persons at the facilities, other than licensed registered nurses, may administer necessary medications.  In addition, the regulations of the Department of Public Welfare with respect to family child day care facilities codified at 55 Pa. Code § 3290.133 also authorize staff persons, other than nurses, to administer prescription medications according to the instructions on a prescription label.  Therefore, the only reasonable approach to dispensing medication in the school setting is that, in the absence of the school nurse, medication may be administered by another individual designated by the school after the school receives appropriate parental consent. 

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