Trip Nurse Policy for Students Requiring Nursing Services

OFFICE OF SCHOOL HEALTH

June 2021

TO: Office of School Health Nursing Staff

FROM: Gail Adman, RN

Director of Nursing

Office of School Health

SUBJECT: Trip Nurse Policy for Students Requiring Nursing Services

This memo provides updated guidance to address the needs of students who require medication,

treatment, or other nursing services while on school trips. It outlines how and by whom student services can

be administered, and on when nurses must attend such trips, based on a Medication Administration Form

(MAF) or Diabetes Medication Administration Form (DMAF) or non-medication procedure form

(Medically Prescribed Treatment Form), signed by the provider and parent.

The New York State Education Department (NYSED) has three functional categories of students for

medication administration: 1) Nurse Dependent Students (formerly known as non-self-directed): 2)

Supervised Students (formerly known as self-directed and 3) Independent Students (formerly known as

students who may self-administer).

• Nurse Dependent Students may not self-carry or self-administer medication.

• Supervised Students may not self-carry but may self-administer medication in a supervised

setting.

• Independent Students may self-carry and self-administer medication if the school receives a

written order from the provider indicating such and written parent consent.

The student’s healthcare provider will determine the student’s functional category (skill set) for

medication administration and non-medication nursing services/procedures, and the nurse will verify the

student’s ability. An Office of School Health (OSH) school nurse will determine the need for a nurse to

accompany a student on a class trip based on whether the student is Nurse Dependent, Supervised, or

Independent during the school day. (D)MAFs/Medically Prescribed Treatment Form (non-medication) are

submitted for students who need medications or services during school hours. However, for school

sponsored trips/school sponsored activities which occur outside of regular school hours, the student must

provide an amended order which addresses the need for nursing services beyond the school day.

NYSED Guidelines for Medication Management in Schools, pp. 8-10,

http://www.p12.nysed.gov/sss/documents/MedicationManagement-DEC2017.pdf (NYSED Guidelines).

OFFICE OF SCHOOL HEALTH

The standard best practice to administer medications is within one hour before and one hour after

the prescribed time for administration (this may not include types of insulin due to onset and duration of the

medication’s effects).

Depending on the individual student’s needs and the length of the field trip, this may

allow a student to attend the trip by taking their medications before or after the field trip, thereby eliminating

the need for a trip nurse.

If the medication or nursing services/procedure needs cannot be met in accordance with the

guidelines in this document and in accordance with DOE policy and applicable law, the principal must

postpone the trip whenever possible, or as a last resort cancel the trip, until care can be arranged.

Nurses assigned to accompany students on a school trip are expected to respond to all student

medical emergencies. Principals should ensure the trip nurse accompanying the student(s) travel on the same

DOE authorized vehicle as the student(s) requiring nursing services, and ensure that the nurse is assigned

to a central location at the trip destination.

THE FOLLOWING CRITERIA SHALL APPLY IN DETERMINING THE NEED

FOR NURSING COVERAGE ON A TRIP

• Independent Students: Are students who self-carry and self-administer medications. If the

parent previously provided consent that the student may self-carry and self-administer as

attested to by the provider as part of the approved Medication Administration Form (MAF)

provided to the school, additional consent is not needed. A nurse is not needed on a class trip if

all students are Independent students. However, for Independent students with diabetes with a

504 Plan, the school principal, 504 Coordinator, or designee must confirm that at least one

unlicensed voluntary school staff member trained in diabetes emergency care and glucagon

administration (such staff are listed on the student’s Diabetes 504 Plan under “Trained Non-

Licensed Personnel”, Section 2.1 or 2.4) is attending the trip.

• The provider attestation must confirm the student has demonstrated they can self-

administer their medications effectively. Pursuant to Education Law Article 19

Students who provide the documentation for the following medications must be

permitted to self-carry and self-administer:

• Inhaled rescue medications for respiratory symptoms (Education Law Article 19

§916); or Epinephrine auto-injector to treat allergies (Education Law Article 19

§916-a); or Insulin, glucagon, and other diabetes supplies to manage their diabetes

(Education Law Article 19 §916-b)

• If a student is self-carrying and self-administering their medication, the medication

administration is not documented by the school, and the parent/guardian assumes

responsibility for ensuring their child is taking the medication as ordered.

See NYSED Guidelines, p 26.

OFFICE OF SCHOOL HEALTH

• Supervised Students: Are students that are self-directed but do not self-carry their

medications. Students are determined to be a Supervised Student by the student’s provider and

verified by the school nurse. (See Appendix A: Nursing Assessment for Determination of

Supervised Student.)

• The determination is based on a student’s cognitive and emotional development,

not simply based on age or grade. In more complex cases, the nurse will review the

case with their nursing supervisor and/or supervising physician. A nurse may not

need to accompany a Supervised Student.

• A Supervised Student may be assisted by trained unlicensed voluntary school staff

to self-administer their own medications. The assistance from unlicensed

personnel is limited to assistance with tasks only at the direction of the student. If

the time of the medication cannot be adjusted within the acceptable window to

eliminate the need for the medication on the trip, a staff member may volunteer to

carry the medication and assist the student in taking their own medication. The

volunteer staff member will be instructed on how to assist the student by the school

nurse. Alternately, parents/guardians may accompany their child on the field trip.

However, parents/guardians cannot be required or pressured to attend a field trip. A

parent/guardian may also choose to appoint a parent designee who is a friend or

family member to act in their place at a single school event or field trip.

In the

event a trained unlicensed voluntary school staff member is not available to attend

the trip to meet the needs of the students, a nurse will be identified to attend and

provide necessary medical care. In the event a trained unlicensed voluntary school

staff member, nor a nurse, is available to attend the trip to meet the needs of the

student(s), and the parent/guardian or their designee does not attend, then the

principal must postpone the trip whenever possible, or as a last resort cancel the

trip, until care can be arranged.

Nurse Dependent Students: Are students who cannot self-carry or self-administer their own medication,

even with supervision. The procedure for obtaining a nurse for a school trip is described in further detail

below. In addition, in place of a nurse, parents/guardians may choose to accompany their child on the trip to

administer their child’s medication and or nursing services/procedure. A parent/guardian may choose to

appoint a parent designee who is a friend or family member to act in their place and administer medication to

their child at a single school event or field trip.

The person chosen as the designee by the parent or guardian must be in accordance with Education

Law §6908: a family member, household member or friend, or person employed primarily in a

domestic capacity who does not hold himself or herself out or accept employment as a person

licensed to practice nursing.

In the event a nurse is not available to attend the trip to meet the needs of the student or students, and

the parents/guardians choose not to attend or appoint a designee, then the principal must postpone the

trip whenever possible, or as a last resort cancel the trip, until care can be arranged.

See NYSED Guidelines, pp. 44-45; N.Y. Educ. Law § 6908.

OFFICE OF SCHOOL HEALTH

II.

PLANNING FOR ALL SCHOOL TRIPS

The school nurse will:

• At the start of each school year, meet with designated school personnel to emphasize the need

for early identification of all school trips including extended day/overnight trips to ensure

nursing coverage is available.

• Send/notify parents/guardians an Asthma ALERT letter if student the uses stock albuterol

while in school. The student must bring a personal metered dose inhaler (MDI) to have

medication available on the trip as the stock albuterol does not leave the school building.

(Appendix D)

• Receive a list of school trips from school administration each month, review which students

will be participating in the trip and plan which medications must be administered on trips and

which can be time-adjusted. (The student’s teacher must notify the parent/guardian,

principal, and school nurse of any upcoming field trips with at least 2 weeks’ advance notice

so that a trip nurse request can be submitted.)

• Review which students are Independent, Supervised, or Nurse Dependent.

For Supervised Students, the school nurse will:

• Complete the Supervised Student Listing for Field Trips by Class. (Appendix E) for

each class and place the form in the Trip section of the medication binder.

• Given the one-hour window for medication administration, determine whether the student

will need to take medication on the trip or whether the student may take the medication

before leaving for the trip or upon return from the trip.

• If medication is required, the principal will identify a trained unlicensed staff volunteer who will

carry the student’s medication and supervise the student’s self-administration of the medication.

If the parent or their designee attend the field trip, no staff person shall be required. When the

parent identifies a designee to attend the trip, it is best practice for the parent to provide the

medication to the designee. If the parent does not provide the medication, the student’s school

supply of medication provided to the school by the parent will be made available to the designee.

The student’s school supply of medication should be given to a designated staff member at the

conclusion of the trip and returned to the school nurse. School nurses must document school

supplies given on the receipt of medication form and count sheet.

OFFICE OF SCHOOL HEALTH

• Meet with the staff volunteer prior to the trip to review medication instructions

incorporating the 5 rights of medication delivery along with emergency care plans and

provide them the medication and Field Trip Medication Account Form (Appendix G) on

the day of the trip.

• Instruct the trained volunteer staff that medication must remain in a properly labeled pharmacy

container, or original over the counter container with the student’s name written on the package,

and in the possession of a supervising adult until it is handed to the student to self-administer

on the trip.

• Verify medication counts upon return and collect the administration form from the volunteer staff

member.

For Nurse Dependent Students, the school nurse will:

• Given the one-hour window for medication administration, consider whether the student

will need to take medication on the trip or whether the student may take the medication

before leaving for the trip or upon return from the trip.

• Provide the student with their required medication during the trip. Parents may discuss medication services

for trips with the nurse as needed.

• If the parent or their designee attends the field trip, no nurse shall be required to attend the trip.

It is best practice for the parent to provide the medication to the designee. If parent/guardian does

not provide the medication, the student’s school supply of medication provided to the school by

the parent should be made available to this designee. Nurses must document school supplies

given on the receipt of medication form and count sheet.

• Complete the Request for Trip Coverage Form to request trip nurses for Nurse Dependent

students who require medication during the school trip in the event that a

parent/guardian/parent designee cannot attend the trip. (Appendix F).

• Provide Trip Plan and Service Record to the Contracted RN (Trip Nurse) and collect upon

return from trip (Appendix C).

• The OSH nurses should meet with the Contracted RN or Staff Nurse assigned for trip

services (Trip Nurse) nurse at least 15 minutes before leaving the school to review the

medication or treatment orders

• One sheet per student is completed and submitted to the OSH RN upon return from the trip.

The OSH RN will place the trip plan and service record sheet in student’s section in MAF

binder.

• If the OSH RN is not on site at the time the class returns, please leave the “Trip Plan and Service

Record” in a sealed envelope in the medical room mailbox to maintain confidentiality.

OFFICE OF SCHOOL HEALTH

For all Supervised and Nurse Dependent students, the school nurse will:

• Request that parents provide an extra properly labeled pharmacy container which is properly

labeled with the correct medication name, dose, and time, to be used on school trips. The

nurse should transfer the amount of medication needed on the trip to the empty properly labeled

pharmacy container provided by the parent. This is even more important when a student has a

controlled substance to be taken on a school trip. If the parent is unable to provide an extra

pharmacy container, the pharmacy container supplied to school must be given to the designated

adult accompanying the child on the trip.

III.

ADDITIONAL PROCEDURES FOR EXTENDED DAY OR OVERNIGHT TRIPS

The procedures and guidelines below apply when a school trip extends beyond the school day or is

an overnight trip. In addition, a determination must be made whether students have medication

administration or other nursing needs that are not normally provided during the regular school day.

Planning for the trip:

There should be at least thirty (30) days advance notice in order to allow ample time to receive

all pertinent documentation necessary to provide nursing service coverage for extended

day trips and overnight trips.

Many students take daily and as needed (PRN) medications at home that the school or school

nurse is not aware of, for which a nurse may be required on the trip. The Principal / principal

designee will notify parents of the process and the availability of forms to request nursing

coverage if necessary.

The school nurse must review all the documentation provided by parents/guardians related to

medications administered at home and determine whether students requiring medication are

Independent, Supervised, or Nurse Dependent for purposes of the trip (see descriptions above).

Obtaining Nursing Coverage:

Where it is determined that a nurse’s presence is required on the trip for a Nurse Dependent

student, the principal or designee must give a written request to the school nurse for a nurse

to be assigned to an extended day or overnight trip.

The school nurse must complete the Request for Trip Coverage Form and forward it and the

trip itinerary to the nursing supervisor. The form must:

Contain a list of the names of students, together with New York City Identification

(NYCID) Number or OSIS Number of who must take medication during the trip and

whether the student is Independent, Supervised, or Nurse Dependent.

OFFICE OF SCHOOL HEALTH

Diabetes pumps. CGMs, or other external devices such as colostomy appliances, etc. where applicable

must be identified on the sheet.

Include the applicable orders on MAF/DMAF which cover all home and daytime

medications. (24 hours)

Note: Home medication and additional daily orders must be approved by the Supervising

Medical Doctor before the student can attend the trip.

The nursing supervisor will:

Review the list of students who have been identified as Independent, Supervised, or

Nurse Dependent and confirm the need for nursing coverage on the trip.

Forward the Trip Coverage Form, trip itinerary, student MAF/DMAF orders to the OSH

contract liaison.

Advise school administration that the school is responsible for the nurse’s transportation,

lodging, and admittance fees to events. OSH or the trip coverage nurse is not responsible

for fees related to the trip itinerary.

If overnight or extended day trip nurse coverage is approved, the nursing supervisor may give

the school nurse the option to cover the trip. An agency nurse should be requested for school

coverage.

Nurses attending Overnight Trips shall be compensated as follows:

• On the day/evening the nurse remains overnight the compensation shall be for 18 hours.

• On the day the nurse is returning to school site and not remaining overnight the

compensation will be up to twelve (12) hours.

• Same agreement applies to Agency Nurses.

• Compensation is paid through OSH budget.

The Nurse Practice Act covers New York State (NYS) Registered Nurses (RNs) who accompany

students on field trips to other states as long as they do not hold themselves out to be “RNs” to anyone

in the host state. The school nurse should contact the State Board of Nursing of the state to which they

are traveling. The contact information for each state is located: https://www.ncsbn.org/contactbon.htm.

When asking questions about professional nursing, inquiries should also include the ability of

unlicensed persons to provide care.

If traveling out of the country the U.S. Embassy can provide direction for the appropriate contact for

that country. For information on Canadian field trips, visit: https://www.cna-aiic.ca/en/about-cna/our-

members/provincial-and-territorial-members and www.cno.org/PracticeSupport.

OFFICE OF SCHOOL HEALTH

IV.

MEDICATION AND SUPPLIES FOR ALL EXTENDED DAY OR OVERNIGHT

SCHOOL TRIPS

Parent/Guardians of students attending a school trip must supply all medications and/or

supplies that will be needed during the trip for their child. School “stock” medication

and/or equipment cannot be taken for school trips.

• Medications must be provided in a pharmacy labeled bottle.

• Over the counter (OTC) medications must be in the sealed original package and labeled with the student’s

name.

• All medical equipment/supplies need to be labeled with the student’s name.

• Back up supplies need to be provided and labeled with the student’s name i.e. extra

diabetes supplies/equipment, batteries, etc.

Parent/Guardians must supply working emergency contact phone numbers for both the parent/guardian and the

prescribing doctor. It is helpful to indicate whether the number is a home/work or cell phone number.

Special accommodations for medication or equipment need to be addressed by the parent/guardian,

school, and school nurse. Medications should be stored as directed by the product manufacturer,

Special accommodations may include, i.e. refrigerator in room for insulin, an insulated bag for

medication, or portable nebulizer. The school should work with the location of the trip for any

location-based accommodations, e.g., refrigerator. The parent/guardian must provide all medication

and supplies.

The school nurse should coordinate with the parent/guardian, parent’s designee, and/or the

school’s volunteer staff to collect orders and supplies for the trip before departure.

OFFICE OF SCHOOL HEALTH

References: NYSED Guidelines for Medication Management in Schools 2017

Appendix A: Nursing Assessment for Determination of Supervised Students

Appendix B: Parent/Guardian Permission to Designate Another Adult to Administer Medication or

Treatment

Appendix C: Trip Plan and Service Record

Appendix D: Asthma Alert for Students Using Stock Albuterol At School

Appendix E: Supervised Student Listing for Field Trips by Class.

Appendix F: Request for Trip Coverage

Appendix G: Field Trip Medication Account form for Volunteer Staff

Appendix H: Checklist for Training Unlicensed Assistive Personnel To Assist Self-Directed/Supervised Students

in Taking Their Own Medication

OFFICE OF SCHOOL HEALTH

Appendix A

Nursing Assessment for Determination of Supervised Student for a School

Field Trip/School Sponsored Event

New York State Guidelines for Medication Management in Schools 2017 allows students who have been

determined to need supervision either by the school nurse or the student’s provider to be assisted by

trained unlicensed personnel to self-administer their own medication. The supervised student can

complete the tasks below to take their own medication under supervision. Any assistance must be at

the student’s direction, which includes but is not limited to: request assistance for opening or pouring

from bottles, assembling nebulizer tubing, and verifying the student’s math calculations and the

number entered into an insulin pump as needed.

Name: ___________________________ Medication: _______________________ Grade: ____________

Teacher/HR: _____________________________ DOB: ______________________ Date: _____________

This student can independently complete the following:

Administer the medication to themself via the correct route

Comments:

YES

☐

Recognize this medication (e.g., color, shape, size)

Comments:

YES

☐

Determine the correct dosage which is needed (e.g., one tablet, 2 puffs, 3 units, etc.)

Comments:

YES

☐

Identify the time this medication is needed during the school day (e.g., lunch time,

before/after lunch, before PE class)

Comments:

YES

☐

Describe how to take this medication from original labeled pharmacy container or

original OTC container and administer it to themselves (or can direct staff member to

assist) by the correct route (e.g., oral, nasal, inhaled, topical)

Comments:

YES

☐

Describe why (purpose) this medication is taken and under what circumstances it is

appropriate to do so (e.g., to improve attention, blood glucose or vital sign ranges that

are acceptable to take medication, taken only for headache, shortness of breath, etc.)

Comments:

YES

☐

OFFICE OF SCHOOL HEALTH

Nursing Assessment for Determination of Supervised Student

Student describes what happens when this medication is not taken (e.g., unable to

complete school work, blood glucose will elevate, etc.)

Comments:

YES

☐

Student describes when to refuse to take this medicine when appropriate (wrong

color, shape, amount, duplicate dose)

Comments:

YES

☐

❑

This student meets the criteria of being self-directed.

❑

This student does not meet the criteria of being self-directed.

Plan to assist student in becoming self-directed and date of reassessment:

School Nurse: __________________________________ Email: _________________________________

School: ______________________________________________________________________________

Phone: ______________________________________ Fax: ____________________________________

Parent/Guardian Signature: ___________________________________________

Print Parent/Guardian: ___________________________________________

Date copy of document shared with parent: _______________

OFFICE OF SCHOOL HEALTH

Appendix B

Parent/Guardian Permission to Designate Another Adult to Administer

Medication

To be completed by Parent/Guardian:

I authorize ,

(Name of designee - family member, friend, household member or other relationship

appropriate, in accordance with Education Law §6908)

to administer the following medication(s):

to my child

(Student name)

at the following school sponsored event:

Name of Event:

Date: Location:

I acknowledge that District

(Name of school district)

will not be liable for any problems that may arise as a result of the administration of such medication by

the designee.

Parent/Guardian Printed Name:

Parent/Guardian Signature: Date: ___________________

OFFICE OF SCHOOL HEALTH

Appendix C Trip Plan and Service Record

• Contracted RN or Staff Nurse assigned for trip services (Trip Nurse) should meet the OSH nurse at least 15 minutes before

leaving the school to review orders

• One sheet per student is completed and submitted to OSH RN upon return from the trip OSH RN will place sheet in student’s

section in MAF binder.

• If OSH RN is not on site at the time, please leave this “Trip Plan and Service Record” in a sealed envelope in the medical room

mailbox to maintain confidentiality.

School ______________________________________________ Borough___________________ Trip Date ___________________

Student’s Name ________________ OSIS # if in a Public School Class

Medical Room Phone Number General Office Number

OSH Nurse

Circle copy of orders given

Medication /Equipment/ supplies given to trip RN

OSH RN initials

Trip RN initials

MAF

DMAF

Trip Nurse

Time

Given

Medication Name

Dose Given

Mg/tabs/cc

Route

Comments

Trip RN

initials

Time

Treatment given (E.g. catheterization, GT feed, O2)

Route

Comments

Trip RN

initials

DMAF will indicate whether to use the student’s correction factor or carb coverage ratio or both

Time

Blood

Glucose

Treatment

for low BG

(Carb amt

and food)

Ketones

(Negative,

Small,

Moderate,

Large)

(A)

Correction factor

Insulin sensitivity

factor

Insulin dose to

correct a high blood

glucose

(B)

Carb

Coverage

Insulin

dose

to cover

snack or

lunch

Total

Insulin

Dose

Sliding

Scale only

if ordered

Injection

site

☐ Insulin Pump

☐Insulin pen Insulin

☐Insulin syringe

Trip RN’s

initials

Units

Check DMAF for amount of hours

between insulin doses

Units

Trip Nurse’s signature Name of Contract Agency

OFFICE OF SCHOOL HEALTH

Appendix C Page 2 if needed

Time

Blood

Glucose

Treatment

for low BG

Ketone test if ordered

(Negative, Small,

Moderate, Large)

Insulin Type

and Amount given

Injection site

☐ Insulin Pump

☐Insulin pen Insulin

☐Insulin syringe

Trip RN’s

initials

OFFICE OF SCHOOL HEALTH

Appendix D

Asthma Alert for Students Using Stock Albuterol At School

School Year

Dear Parent /Guardian:

Your child may be scheduled for a school trip this school year. As you know we have a medication

order from your child’s provider to use stock Albuterol while your child is in school.

This is a reminder that you must send your child’s Personal Metered Dose Inhaler (MDI) with your

child in order that they have it available on the school trip. The stock Albuterol is only for use while your

child is in the school building.

Thank you.

School Nurse/Advisor

Date___________________________________________________

OFFICE OF SCHOOL HEALTH

Appendix E

Supervised Student Listing for Field Trips by Class

Class

Last name

First name

OSIS #

Medication

Comments

OFFICE OF SCHOOL HEALTH

Appendix F

OFFICE OF SCHOOL HEALTH

NYC DEPARTMENT OF EDUCATION

REQUEST FOR TRIP COVERAGE

Please Print Clearly

TODAY’S DATE:

SCHOOL: or @

DISTRICT: REGION:

PERSON REQUESTING TRIP: PHONE & FAX:

(Staff Nurse must fill out form or Regional supervisor depending on site)

Student

Date of Trip

Medical Needs

Destination

Timeframe of Trip

Please fax completed form to:

DO NOT CALL TO CONFIRM FAX RECEIPT, YOU CAN EMAIL

OFFICE OF SCHOOL HEALTH

Appendix G

Field Trip Medication Account for Volunteer Staff

This form is to be used by a staff volunteer who is carrying medication on a Field Trip for a student who is

determined to be a Supervised Student. Form must be returned to school nurse after trip.

Date of the Trip: School:

Name of Student: Age: Grade:

Staff Volunteer:

Medication: mg/Unit: Dosage to be given

Time: Frequency:

School nurse has reviewed the name, dosage, and frequency of times student may self-

administer medication.

Amount /count of medication given to take on trip:

Staff Volunteer signature: Nurse Signature:

Date and time medication administered by student:

Date

Time

Initials

Amount of medication returned:

Person returning the medication:

Nurse (signature) Date

OFFICE OF SCHOOL HEALTH

Appendix H

Checklist for Training Unlicensed Assistive Personnel

To Assist Self-Directed/Supervised Students in Taking Their Own Medication

The individual below has been observed or verbalized their ability to

be able to successfully complete the following skills:

Initial Training

Date/Initials

Review

Date/Initials

1. Ask the student their name

2. Locates provider & parent authorization to administer medication

and verify student identity by name or photo (if available)

3. At student’s direction, locates the medication and assists the

student if requested to open, remove, pour or assist with math

verification or numbers entered into a BG meter

4. Asks student name of medication, what it is for, how it helps them

and what happens if they do not take it

5. Matches medication label to order for correct name, medication,

and dose

6. Verbalizes that student will either open container, take out correct

dose and place in cup or direct the trained staff member to take

out correct dose and place in cup (if unable to do so themself)

7. Observes student taking medication as prescribed

8. Returns medication bottle to medication cabinet or school nurse

(after a field trip) and secures medication per district policy

9. Provides documentation to nurse that medication has been taken

by the student as prescribed, or if not taken reason for omission

RN Initials

Print Name

RN Signature

Title

Name of Unlicensed Staff Member Trained: _________________________________________

Signature of Unlicensed Staff Member Trained: _______________________________________