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NASN CODE OF ETHICS
Acknowledging the diversity of the laws and conditions under which school nurses practice, the National Association of School Nurses (NASN) believes in a commonality of moral and ethical conduct. As such, NASN adopts the American Nurses Association’s (ANA) Code of Ethics for Nurses with Interpretive Statements (2015), which establishes an ethical foundation for all nurses. Furthermore, this foundation is supported by the School Nursing: Scope and Standards of Practice, 3rd Edition (ANA & NASN, 2017) and ethical guidelines provided by state boards of nursing. School nursing practice, built upon these ethical foundations, is grounded in the NASN core values of child well-being; diversity, equity, and inclusion; excellence; innovation; integrity; leadership; and scholarship (NASN, 2020). The school nurse is responsible for complying with applicable federal, state, and local laws, regulations, ordinances, executive orders, policies, and any other applicable sources of authority, including any applicable standards of practice (NASN, 2016b).
SCHOOL NURSE ETHICS
“School nurses straddle two statutory and regulatory frameworks, health and education. Because school nurses practice nursing in an educationally focused system, they face unique legal, policy, funding, and supervisory issues that may also have ethical dimensions” (ANA & NASN, 2017, p. 37). Examples of challenges to school nurses’ ethical foundation include:
- Unsafe school nurse to student workloads,
- Accountability for care delegated to Unlicensed Assistive Personnel (UAP),
- Documentation expectations that do not align with the standards of nursing practice,
- Assignment of nursing tasks to UAP without the input of the school nurse, and
- Attempts by non-licensed school administrators to direct practice.
As such, school nurses must have not only the skills to communicate within both the healthcare and education arenas, but also the requisite knowledge and skills to interpret applicable laws, regulations, and professional standards, as well as apply ethical theories and principles common across all nursing specialties (ANA & NASN, 2011).
The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person (ANA, 2015, p.1).
School nurses deliver care in a manner that promotes and preserves student autonomy, dignity, and rights, delivering care in an inclusive, collaborative manner to embrace diversity in the school community. School nurses promote equitable treatment of all students, regardless of health, race, gender, socio-economic status, culture, age, sexual orientation, Adopted by NASN Board of Directors June 2021 Board Standing Rule 1.08 2 gender identity, ability, or religion. The school nurse supports and promotes each student’s unique abilities to achieve the highest quality of life. School nurses develop long-term trusting relationships and recognize the necessity to maintain clear boundaries that support student and family inclusion in decisions surrounding care (ANA & NASN, 2017). In the same light, school nurses recognize the value of input from and collaboration with their educational colleagues to facilitate student health planning with the classroom in mind. Respect, collegiality, and civility serve clear communication and improved student health outcomes.
The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population (ANA, 2015, p.5).
School nurses provide primary, secondary, and tertiary interventions to support individual students, groups of students, and entire school populations at a micro and macro level. As public health practitioners, school nurses are aware of social needs, social determinants of health, and partner with families and other community members to reduce health disparities. School nurses work within educational institutions to define and implement professional nursing standards of practice and development of school health policy to meet the needs of the school community.
The nurse promotes, advocates for, and protects the rights, health, and safety of the patient (ANA, 2015, p. 9).
School nurses are student advocates and support student rights in navigating the educational environment. Regardless of the setting or the situation, the school nurse endorses and understands that the primary commitment is to the student. School nurses support transition planning as students navigate multiple transitions during a PK-12 education - from classroom to classroom, school-to-school, and PK-12 education to college or adult life. School nurses actively promote student health, safety, and self-worth. In order to safeguard student privacy, school nurses maintain confidentiality within the legal, regulatory, and ethical parameters of health and education, and inform others about student health record protection in accordance with the Family Educational Rights and Protection Act (Family Educational Rights and Privacy Act, 1974), Health Insurance Portability and Accountability Act (Health Insurance Portability and Accountability Act, 1996), and other applicable federal and state laws and regulations.
The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and provide optimal patient care (ANA, 2015, p. 15).
School nurse workplace environments impact the quality of health care; therefore, school nurses collaborate to improve these environments. Working within educational institutions, and in collaboration with education partners, school nurses inform, define, and implement professional standards of practice and school health policy. School nurses must have knowledge relevant to meet the needs of students and maintain the highest level of competency by enhancing professional knowledge and skills. Self-evaluation as well as evaluation by administrators with healthcare experience, based on applicable laws, regulations, and policies; professional standards of practice; and the Framework for 21st Century School Nursing PracticeTM assists the school nurse in identifying areas to grow competence and expand practice (NASN, Adopted by NASN Board of Directors June 2021 Board Standing Rule 1.08 3 2016a). As allowed by state nurse practice acts, and in accordance with established best practice, school nurses assume responsibility and accountability for the delegation or assignment of tasks. School nurses take appropriate action when encountering illegal, unethical, or inappropriate behavior that places student health and safety at risk.
The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth (ANA, 2015, p. 19).
As lifelong learners, school nurses must have knowledge relevant to meet the needs of the individual students and entire student populations. Maintenance of high levels of competency is enhanced through collaboration with peers, other health professionals, and community agencies. National school nurse certification recognizes school nurse competence and expertise (ANA & NASN, 2017). School nurses recognize that wholeness of character extends to students, families, school staff, school leaders, and all others with whom they engage. Personal and professional integrity are maintained via careful attention to verbal, non-verbal, and written communication that is culturally informed, unbiased, truthful, accurate, and wellplanned. Supervisory evaluation by an experienced school nurse informs continuous improvement of each school nurse’s practice. The potential tension between administrators and school nurses can result in ethical dilemmas resulting in moral distress for the nurse (ANA & NASN, 2017, p. 37; Savage, 2017). It is incumbent upon the school nurse to advocate for evidence-based practice decisions that are based on respect of self and others.
The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care (ANA, 2015, p. 23).
School nurses exert a positive impact on the quality of healthcare via collaborative decision making within the educational setting to establish work environments are supportive of student health, safety, and learning. School nurses work within educational institutions to define and implement professional standards of nursing practice as well as school health policy development, implementation, and evaluation.
The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy (ANA, 2015, p. 27).
School nurses are life-long learners in pursuit of knowledge, training and experiences that enhance the quality of their nursing practice. They work within PK-12 education institutions to define and implement professional standards of nursing practice and school health policy development. School nurses utilize available evidence in developing health programs, individual plans of care, and interventions. School nurses engage in quality improvement projects in pursuit of better health outcomes for students. With school district approval, school nurses may collaborate with researchers in research activities that will advance student health and school health services.
The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities (ANA, 2015, p. 31).
School nurses are aware of social determinants of health impacting the school community, provide healthcare to all students, support school staff, and partner with families and other community members to reduce health disparities. They utilize evidence-based interventions designed to mitigate the effects of adverse childhood experiences and other social determinants of health. School nurses refer students to other health professionals and community health agencies as needed to promote health and well-being. Lastly, school nurses are advocates for policy change to protect and promote health rights to reduce health disparities.
The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy (ANA, 2015, p. 35).
Engagement with professional associations, such as the National Association of School Nurses, and state affiliate organizations allows the school nurse to work collaboratively to ensure evidence-based professional practice aligned with nursing values focused on student education, health equity, and social justice. School nurses work within educational institutions to define and implement professional standards of practice and school health policy. To ensure equitable access to school health services and in accordance with state nurse practice acts, school nurses delegate or assign nursing tasks, while retaining accountability for these tasks.
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursebooks.org.
American Nurses Association & National Association of School Nurses. (2011). School nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Nursebooks.org.
American Nurses Association & National Association of School Nurses. (2017). School nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Nursebooks.org.
Family Educational Rights and Privacy Act, 20 U.S.C. § 1232g; 34 CFR part 99 (1974).
Health Insurance Portability and Accountability Act, P.L. No 104-191, 110 Stat. 1938 (1996).
National Association of School Nurses. (2020). About NASN. Retrieved from https://www.nasn.org/AboutNASN
National Association of School Nurses (2016a). Framework for 21st century school nursing practice: National Association of School Nurses. NASN School Nurse, 31(1), 45-53. https://doi.org/10.1177/1942602X15618644
National Association of School Nurses. (2016b). NASN Code of Ethics. https://higherlogicdownload.s3.amazonaws. com/NASN/8575d1b7-94ad-45ab-808e-d45019cc5c08/UploadedImages/PDFs/Professional Topic Resources/2016_Code_of_Ethics.pdf
Savage, T.A., (2017) “Ethical Issues in School Nursing” OJIN: The Online Journal of Issues in Nursing Vol. 22, No. 3, Manuscript 4. doi:10.3912/OJIN.Vol22No03Man04
Adopted by NASN Board of Directors
June 2021 Board Standing Rule 1.08