Name of Participant: ______________________ Years/months of experience as a School Nurse: ________

Date: ______________ Years of experience as a nurse: __________

School Nurse Mentor Program Checklist Rating Scale: 1 – Limited understanding; 2 – Some understanding & experience; 3 – Consciously incorporates into practice. Standard 1. Assessment – The school nurse collects comprehensive data pertinent to the client’s health or the situation.

Measurement Criteria: The school nurse is able to: Recognize normal and abnormal variations of clinical findings and childhood development when forming a nursing 1a. diagnosis. Involve the client, family, school staff, other healthcare providers, and/or school community, as appropriate, when 1b. gathering data. 1c. Prioritize data collection activities based on the client’s immediate condition. 1d. Utilizes recognized school nurse assessment techniques and instruments in collecting pertinent data. 1e. Document relevant data. Assess the school environment and program to determine modifications necessary to meet student health and safety 1f. needs. Standard 2. Diagnosis – The school nurse analyzes the assessment data to determine the diagnoses or issues.

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Measurement Criteria: The school nurse is able to: 2a. Derive the nursing diagnosis or issues based on assessment data. 2b. Validate the nursing diagnosis or issues with the client, family, school staff, school community, and other healthcare professionals when possible and appropriate. 2c. Document nursing diagnoses or issues in a manner that facilitates the determination of the expected outcomes and plan. Standard 3. Outcome Identification – The school nurse identifies expected outcomes for a plan individualized to the client or the situation. Insert Date Measurement Criteria: The school nurse is able to : 1 2 3 Involve the client, family, school staff, and other healthcare providers in formulating expected outcomes when possible 3a. and appropriate.

Rating Scale: 1 – Limited understanding; 2 – Some understanding & experience; 3 – Consciously incorporates into practice. Utilize culturally appropriate expected outcomes for the diagnoses. 3b. Know when to seek assistance from professionals with more experience when formulating expected outcomes. 3c. Include a time estimate for and documents expected outcomes. 3d. Modify expected outcomes based on changes in the status of the client or evaluation of the situation. 3e. Standard 4. Planning – The school nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. Insert Date Measurement Criteria: The school nurse is able to: 1 2 3 Develop individualized healthcare plans, using standard templates and other samples. 4a. Develop the plan in conjunction with the client, family, school community, and others, as appropriate. 4b. Utilize the plan to provide direction to educational staff. 4c. Consider the economic impact of the plan. 4d. Consider clinical, human and financial resources available when making decisions regarding health needs. 4e. Document delegation and supervision activities. 4f. Access a general knowledge base regarding and locate current statutes, rules, regulations, and standards when 4g. creating the plan, such as IDEIA and the delegatory clause of State Nurse Practice Act. Access a general knowledge base regarding the 504 process and creating individual healthcare plans as a component 4h. of the 504 process for students who qualify. Standard 5. Implementation – The school nurse implements the identified plan. Insert Date Measurement Criteria: The school nurse is able to: 1 2 3 Implement the plan in a safe and timely manner, usually within one week or less. 5a. Utilize district and community resources and systems to implement the plan. 5b. Collaborate with nursing colleagues and others to implement the plan. 5c. Foster organizational systems that support implementation of the plan. 5d. Standard 5A. Coordination of Care – The school nurse coordinates care delivery. Insert Date Measurement Criteria: The school nurse is able to: 5Aa. Coordinate creation and implementation of the individualized healthcare plan. 5Ab. Document the coordination of the care. Standard 5B. Health Teaching and Health Promotion – The school nurse provides health education and employs strategies to promote health and a safe environment. 2

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Measurement Criteria: The school nurse is able to: 5Ba. Provide general health education to the student body at large through direct classroom instruction or expert consultation. 5Bb. Use health promotion and health teaching methods appropriate to the situation and the client’s developmental level. 5Bc. Seek opportunities for feedback and evaluation of the effectiveness of the strategies used. 5Bd. Provide individual and group health teaching and counseling for and with clients. Act as a primary resource person to school staff (and others as appropriate) regarding health education and health 5Be. education materials. Standard 5C: Consultation – The school nurse provides consultation to influence the identified plan, enhance the abilities of others, and effect change. Insert Date Measurement Criteria: The school nurse is able to: 1 2 3 5Ca. Facilitates the effectiveness of a consultation by involving the stakeholders in the decision-making process. Standard 6: Evaluation – The school nurse evaluates progress towards attainment of outcomes. Insert Date Measurement Criteria: The school nurse: 1 2 3 Include the client and others involved in the care or situation in the evaluation process. 6a. Evaluate the effectiveness of the planned strategies in relation to client responses and the attainment of the expected outcomes. 6b. Document the results of the evaluation. 6c. Use ongoing assessment data to revise the diagnoses, the outcomes, the plan, and the implementation as needed. 6d. Standard 7. Quality of Practice – The school nurse systematically enhances the quality and effectiveness of nursing practice. Insert Date Measurement Criteria: The school nurse: 1 2 3 Demonstrate quality by documenting the application of the nursing process in a responsible, accountable, and ethical 7a. manner. Use creativity and innovation in school nursing practice to improve care delivery. 7b. Participate in quality improvement activities. Such activities may include: 7c. • Using state and/or district indicators to monitor quality and effectiveness of school nursing practice. 3

Rating Scale: 1 – Limited understanding; 2 – Some understanding & experience; 3 – Consciously incorporates into practice. • Collecting data to monitor quality and effectiveness of school nursing practice. • Analyzing factors related to safety, satisfaction, effectiveness, and cost-benefit options. • Analyzing organizational systems for barriers. Obtain provisional certification through Colorado Dept. of Education. 7d. Standard 8. Education – The school nurse attains knowledge and competency that reflects current school nursing practice.

Measurement criteria: The school nurse is able to: Participate in ongoing educational activities related to school nurse knowledge bases. Examples include infectious and nuisance diseases, chronic and acute pediatric health conditions, and mental health issues. Acquire knowledge and skills appropriate to school settings, including Universal Precautions and Child Abuse 8b. protection and reporting practices. Standard 9. Professional Practice Evaluation – The school nurse evaluates one’s own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations.

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8a.

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Measurement criteria: The school nurse is able to: The school nurse’s practice reflects the application of knowledge of current practice standards, guidelines, statutes, rules and regulations. Provide age appropriate care in a culturally and ethically sensitive manner. 9b. Engage in self-evaluation of practice on a regular basis, identifying areas of strength as well as areas in which 9c. professional development would be beneficial. Obtain informal and formal feedback regarding one’s own practice from clients, professional colleagues, mentor, 9d. administrator and others. Take action to achieve goals identified during the mentoring process. 9e. Understand and able to locate relevant guidelines, statutes, rules and regulations that govern school nurse practice. 9f. Standard 10. Collegiality – The school nurse interacts with, and contributes to the professional development of, peers and school personnel as colleagues. Insert Date Measurement criteria: The school nurse is able to: 1 2 3 10a. Share knowledge and skills with colleagues as evidenced by such activities as multidisciplinary student assistance conferences. 10b. Maintain compassionate and caring relationships with peers and colleagues. 9a.

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Rating Scale: 1 – Limited understanding; 2 – Some understanding & experience; 3 – Consciously incorporates into practice. 10c. Contribute to a supportive and healthy work environment by such activities as participation with disaster planning activities and/or becoming a member of crisis response team. 10d. Participate in appropriate professional organizations in a membership capacity. Standard 11. Collaboration – The school nurse collaborates with the client, the family, school staff, and others in the conduct of school nursing practice. Insert Date Measurement criteria: The school nurse is able to: 1 2 3 11a. Communicate with the client, the family, and healthcare providers regarding client care and the school nurse’s role in the delivery of that care. 11b. Partner with others for comprehensive health screening programs that effects change & generate positive outcomes. 11c. Document plans, communications, referrals, and collaborative discussions. Standard 12. Ethics – The school nurse integrates ethical provisions in all areas of practice. Insert Date Measurement criteria: The school nurse is able to: 1 2 3 12a. Maintain client confidentiality within legal and regulatory parameters of both health and education. 12b. Maintain a therapeutic and professional client-nurse relationship with appropriate professional boundaries. 12c. Demonstrate a commitment to practicing self-care, managing stress, and connecting with self and others. 12d. Seek available resources to formulate ethical decisions. Standard 13. Research – The school nurse integrates research findings into practice. Insert Date Measurement criteria: The school nurse is able to: 1 2 3 13a. Utilize the best available evidence, including research findings, to guide practice decisions. Actively participate in research activities at various levels appropriate to a new school nurse’s experience and position. 13b. Such activities may include: • Participating in data collection (surveys, pilot projects, and formal studies). • Sharing research findings with peers and others. • Critically analyzing and interpreting research for application to practice. Standard 14. Resource Utilization – The school nurse considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of school nursing services. Insert Date 5

Rating Scale: 1 – Limited understanding; 2 – Some understanding & experience; 3 – Consciously incorporates into practice. Measurement criteria: The school nurse is able to: 14a. Evaluate factors such as safety, effectiveness, availability, cost and benefits, efficiencies, and impact on practice, when choosing among practice options that would result in the same expected outcome. 14b. Assist the client and family in identifying and securing appropriate and available services to address health-related needs. 14c. Assign or delegates tasks, based on the needs and condition of the client, potential for harm, stability of the client’s condition, complexity of the task, and predictability of the outcome; as defined and permitted by Colorado State Nurse Practice Act; and according to the knowledge and skills of the designee. 14d. Develop evaluation methods to measure safety and effectiveness for interventions and outcomes. Standard 15. Leadership – The school nurse provides leadership in the professional practice setting and the profession.

Measurement criteria: The school nurse is able to: 15a. Demonstrate energy, excitement, and a passion for quality work. Willingly accept mistakes by self and others, thereby creating a culture in which risk-taking is not only safe, but also 15b. accepted. 15c. Inspire loyalty by valuing people as the most precious asset in the organization. 15d. Demonstrate knowledge of the philosophy and mission of the school district and the role of the school nurse in student achievement. 15e. Demonstrate knowledge of the roles of other school professionals and adjunct personnel. Standard 16. Program Management – The school nurse manages school health services.

Measurement criteria: The school nurse is able to:

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Implement state medication administration policies and procedures in collaboration with the school administration, the board of health, and the board of education. 16b. Understand school immunization requirements, including evaluation of records, and monitors for compliance. Communicates findings to administrators. 16c. Orient, train, document competency, supervise, and evaluate UAPs (unlicensed assistive personnel) in the school setting. Utilize delegation as defined in the delegatory clause of Nurse Practice Act. 16d. Adopt and use available technology appropriate to the work setting. Adapted for Colorado Mentoring Program November 2005 from American Nurses Association (2005). School Nursing: Scope and Standards or Practice. Nurses Book Organization, Silver Springs, MD 16a.

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Goals: (based on ratings from Program Checklist) 1.

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