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Update Advisory regarding Delegation of Rescue Medications to Unlicensed Personnel

Amended June 14, 2013 Update Advisory regarding Delegation of Rescue Medications to Unlicensed Personnel

A meeting was held to discuss rescue medication delegation to unlicensed personnel with representatives from the Department of Education, Special Medical Services, Bureau of Developmental Services, the NH School Association , the NH Board of Nursing and a representative working with policies related to disabilities.

The discussion around the opinion provided by the Board of Nursing on April 18, 2013 that delegation of rescue medications does not fit under the Nur 404 delegation rules and also focused on clarification of the term "stability" in relation to children and adults with chronic health conditions that display predictable or expected symptoms of which interventions are identified in a medical plan of care. A client who experiences frequent clinical emergencies requiring ongoing nursing assessment and 911 calls will not be considered candidates for nursing delegation to unlicensed personnel. The nurse representatives expressed agreement with following the delegation rules and have requested that the board reverse the original opine about emergency medications not considered under the auspices of the delegation rules. Nurse representatives voiced unanimously that nurses in the school setting are key in assessing the appropriateness of delegation.

The representatives from the School Nurse Association and Special Medical Services expressed concern, however, over the current wording of the term "stable" as written in Nur 101.20.

The Board of Nursing has reviewed the definition in relation to delegation and proposed the following wording in order to clarify "stable" in relation to client's health status: The definition of term "stable" means "a client whose overall health status,as assessed by a nurse, is at the expected baseline, or with predictable or expected responses that can occur with known chronic or long term conditions."

In determining the act of delegating, the nurse would consider the following:

  • Is the plan for monitoring known chronic medical conditions unchanged for this client?
  • Are medications identified in the medical plan of care unchanged?
  • Has the client been without recent need for the emergency room, surgeries or hospitalizations relating to the chronic medical conditions?
  • Is the client free from other medical conditions that may have an impact on their baseline or their expected responses to known chronic/long term medical conditions?

Delegation to unlicensed personnel, under Nur 404, requires that unlicensed personnel are competent to perform a clearly identified task for a client who is at baseline or displaying predictable or expected responses to their medical condition.

The discussion also addressed many issues to role of the school nurse. Some of the issues discussed relate to education/training needs, minimal requirements for educational preparation of the school nurse, the need to explore specialty certification, implementation of a standardized orientation for new school nurses, and having a readily available expert consultant for school nurse inquiries regarding practice. Many of these suggestions will be further collaboratively explored in the near future by the departments represented at this meeting.

The board expresses many thanks to the participants that were part of this discussion. Their input and suggestions have been helpful to clarify this issue.


New Hampshire Board of Nursing
121 South Fruit Street   |  Concord, NH 03301
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