School-sponsored Before, After, and Extended School Year/Out of School Time Programs
It is the position of the National Association of School Nurses (NASN) that all students, including those with disabilities or special healthcare needs, must have equal opportunity to safely take part in school-sponsored before, after, and extended school year programs and activities, also known as Out of School Time (OST). The registered professional school nurse (hereinafter referred to as school nurse) has the knowledge, skills, and expertise required for assessing, planning, coordinating, implementing, and evaluating student healthcare needs so that all students may fully participate in OST programming and activities.
BACKGROUND AND RATIONALE
For many students, time at school extends beyond regular school hours. Students may participate in a range of school-sponsored OST activities such as intramural sports, interscholastic athletics, special interest groups, clubs, performing arts, overnight field trips, summer or extended year programs, holiday or vacation programs, before and after school care, or transportation. School-sponsored programs and activities are typically considered to be those that are authorized, conducted, or supported by the local educational agency (LEA) or a public school within the school district (Clark, 2017). Any school that receives federal funds must assure that every student has equal opportunities to participate in all school-sponsored activities, both academic and extracurricular, including access to health services if needed (U.S. Department of Education [USDE]/Office for Civil Rights [OCR], 2022). If a student with a healthcare condition or disability needs healthcare accommodations or related services to participate safely in an OST activity, LEAs are responsible for providing the needed services (USDE/OCR, 2022).
Naturally, students’ health needs during the school day travel with them through OST activities (U.S. Department of Health and Human Services, Centers for Disease Control and Prevention [CDC], 2021). To appropriately determine and address the health and safety needs of participating students, school-sponsored OST programs should, at a minimum, engage the school nurse to consult, advise, facilitate, and collaborate with others (Afterschool Alliance, n.d.; NASN, 2022; Venrick et al., 2020; NASN, 2019). School nurses understand the health needs of individual students and the student population, have knowledge about local and state school health and nursing regulations, and are uniquely qualified to provide the necessary healthcare and care coordination for students involved in OST activities.
School nurse-led care coordination is a key principle of the Framework for 21st Century School Nursing Practice™ (NASN, 2016; NASN, 2020). In providing OST care coordination, school nurses work with a team of administrators and educators while providing “oversight and alignment of multiple evidence-based components and interventions that support the health and well-being of students” (NASN 2019, p. 24). Nursing aspects of care coordination for OST activities or programs may include sharing health information as appropriate or delegating tasks such as medication administration (CDC, 2021). The school nurse may also provide training and support that is necessary for preparing OST personnel to respond to student health needs or health emergencies (Clark, 2017). The school nurse is the professional responsible for delegating nursing care, in accordance with state regulations and students’ individualized healthcare plans, emergency action plans, or specific health needs. It is the school nurse who determines whether the provision of care, health accommodations, or medication administration can be legally and safely delegated to non-medical personnel (Resha, 2017). However, the school nurse “cannot delegate any activity that requires clinical reasoning, nursing judgment or critical decision making” (National Council of State Boards of Nursing & American Nurses Association, 2019, p. 7).
To conduct quality OST programs, “skilled personnel and dedicated funding (with)… dedicated resources and staff are important to effective implementation” (Education Development Center, 2022, p. 49). School nurses should be sufficiently financially compensated by local educational agencies (LEA) for providing training, consultation, or direct services above and beyond the regular workload, beyond regular school hours, or beyond the regular school year calendar contract. Compensation should be at least comparable to that provided to other specialized professional-level leaders whose employment includes work for OST program planning or activities (Clark, 2017).
School nurse expertise is crucial for planning, coordinating, and determining safe, supportive OST healthcare services and staffing. The provision of school nursing services protects student healthcare rights and enables every student to experience full and equitable participation in school-sponsored OST experiences (Clark, 2017; NASN, 2016; NASN & Alliance for a Healthier Generation, n.d.).
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Clark, E. (2017). School-sponsored before, after, and extended school year programs. In C. Resha & V. Taliaferro (Eds.), Legal resources for school health services, (pp. 597-601). SchoolNurse.com.
Education Development Center. (2022). Supporting quality in summer learning: How districts plan, develop, and implement programs. https://www.edc.org/sites/default/files/uploads/supporting-quality-summer-learning.pdf
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National Association of School Nurses & Alliance for a Healthier Generation. (n.d.). Healthy out of school time road map. https://higherlogicdownload.s3.amazonaws.com/NASN/3870c72d-fff9-4ed7-833f-215de278d256/UploadedImages/PDFs/Practice Topic Resources/Healthy_Out-of-School_Time_Roadmap_Healthier_Generation_and_National_Association_of_School_Nurses.pdf
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Resha, C. A. (2017). Process for delegation in the school setting. In C. Resha & V. Taliaferro (Eds.), Legal resources for school health service, (pp. 35-48). SchoolNurse.com
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2021). Supporting students with chronic health conditions in school-based out of school time programs. https://www.cdc.gov/healthyschools/323508-A_FS_SupportingStudentsWithChronicHC.pdf
U.S. Department of Education, Office for Civil Rights. (2022). Protecting students with disabilities. https://www2.ed.gov/about/offices/list/ocr/504faq.html#skipnav2
Venrick, H., McClure, N., & Hande, K. (2020). Leveraging school nurse expertise to meet children's health and nutrition needs in afterschool programs. NASN School Nurse, 35(1), 15-17. doi: 10.1177/1942602X19874490
Acknowledgment of Author(s)
Wendy A. Doremus, DNP, RN, FNP-BC (retired), PHNA-BC (retired)
Sarah Portle, MEd., BSN, RN, NCSN
Erica Harp, BSN, RN, NCSN
Adopted: January 2014
Revised: June 2018, June 2023
Suggested citation: National Association of School Nurses. (2023). School-sponsored before, after, and extended school year/out of school time programs (Position Statement). Author.
All position statements from the National Association of School Nurses will automatically expire five years after publication unless reaffirmed, revised, or retired at or before that time.