Abstract
School nurses have an important role in planning for the health needs of students on field trips. Students with special health care needs require additional considerations and planning. This article discusses areas to consider and ways to overcome obstacles for students with special health care needs participating in field trips.
Keywords
Background
A school field trip is any trip that the school sponsors as part of the educational process or is staffed by school employees. Students with special health needs cannot be excluded from participation in field trips, despite the unique challenges posed for school staff. Two federal laws, enforced by the Office for Civil Rights, prohibit discrimination based on disability. Section 504 of the Rehabilitation Act of 1973 prohibits discrimination in any program or activity that receives federal funds. Title II of the Americans with Disabilities Act of 1990 (ADA) prohibits public entities from disability discrimination regardless of whether they receive federal financial assistance (U.S. Department of Education, 2022).
The NASN in their 2024 position statement, School-sponsored trips—Equitably addressing student health needs, provides guidance for school staff. Students with special health needs require school nurse oversight and expertise to arrange equitable, inclusive, and appropriate care for all students to be able to attend school-sponsored trips. School nurse collaboration should begin during the initial planning, to be most effective. The school nurse should be informed of the field trip at least 2 to 3 weeks prior to allow time to make appropriate arrangements. Each school’s administration should have a system for notifying the nurse of upcoming trips. Advance planning can allow ample time to train staff in states that permit delegation of nursing tasks, and time to secure a licensed nurse for those tasks that cannot be safely delegated.
For any student who is eligible for accommodations, either through a 504 accommodation plan or an individual education program, teams must discuss and include guidance for field trips in the student’s written plan. This allows parents or guardians the opportunity to voice any concerns prior to a scheduled event. Parents may volunteer to chaperone the trip or decline permission for their student to attend. Parent attendance cannot be mandated or used as a reason to exclude any student from participation. Ultimately, it is the school staff that must determine the required accommodations and implement the team’s plan while complying with federal and state legal requirements.
Planning and Considerations
There are multiple factors the school nurse must consider when planning a field trip for students with special health care needs (Box 1). Assessment of the planned destination is the first step. This can be done through contacting the site for more information. As needed, investigate if the site is handicap accessible, has wheelchair accessible restrooms, and has a private location for diapering or performing necessary procedures. For outdoor trips, determine if the pathways are paved or are safe for students using wheelchairs, and students with mobility or balance issues. If necessary, plan a modified route for students with these issues.
Factors to Consider When Planning a Field Trip for Students With Special Needs
Source: Compiled from the Colorado Department of Education Field Trip School Nurse Checklist (2024), the Massachusetts Field Trip Tool Kit (2015), and the Wisconsin Department of Education Field Trip Guide (2019).
The Environment
Assess the site for potential environmental hazards. Will the air temperature be safe for students with health concerns? If there are concerns about a student’s ability to tolerate environmental conditions, these should be discussed with the parent and medical provider to determine if it is safe for the student to attend.
Will there be air quality issues or allergens that could trigger student’s asthma or allergies? Will there be strobe or other flashing lights that could trigger a seizure? If yes, additional planning is needed to help students avoid these aspects of the field trip (Colorado Department of Education, 2024).
Collaborate with the designated teacher(s) to determine if there are students with activity or endurance limitations and arrange accommodations for these students. For students with temporary health concerns, such as a concussion or fracture, discuss with the parent and medical provider whether it is safe for the student to attend based on your nursing assessment of the site and planned activities (Massachusetts Department of Public Health, 2015). Consider what accommodations these students may require should they attend.
Transportation
Transportation between the school and the site is determined by student’s needs. Students using wheelchairs and those who cannot safely climb the steps onto a bus may need transportation accommodations. If car seats or safety harnesses are needed, they must be requested in advance. If oxygen will be transported on the bus, proper clamps are required to secure the oxygen tank (Kentucky Department of Transportation, 2022). Who in your district handles these requests? Does your school contract bussing services from a private provider, and what are their requirements? Your building principal or transportation director might be the best place to start for guidance.
Health and Dietary Needs
Next, the school nurse must assess the health and dietary needs of students attending the trip. Will the trip duration necessitate meals, medications, or treatments? If there will be food served, as part of the trip, plans must be made to accommodate special diets and food allergies. It may be that all students bring a sack lunch to school for the trip. Then, students with food allergies will require their lunches to be stored separately. If food will be provided at the trip site, food for special diets may need to be sent from home or school. Determine if any of the medication, food, or formula need to be refrigerated. If yes, arrange for a cooler with ice to take on the trip. Teachers and chaperones must be educated on all food restrictions and allergies.
If the trip occurs during medication or treatment administration times, plans must be made to ensure these are administered. For short trips, it may be possible to adjust times to be given just before leaving school or immediately upon returning. It is difficult to give medications or perform procedures during a play or concert. Arrange for these to be done immediately prior or after the performance or at intermission to prevent missed medication doses or treatments and to decrease interruptions for the student. For districts that allow it, determine if any student(s) are able to safely self-administer their medications. Self-administration should be observed and documented by a chaperone or a teacher. Most districts do not allow students to carry prescription medication, however, so staff will still need to store the medication until time for administration. Parents may attend the trip or send a relative who can administer the medications or perform treatments, but this cannot be required. Check with administration to determine if special forms or background checks are required for a parent to attend a trip.
The school nurse must know district-related policies and the delegation rules for the state. Where allowed, medication administration and treatments may be delegated to staff with proper training and documentation (McClanahan et al., 2019). If it is required for a nurse to administer medication or a treatment, the school must provide this service. Often the district will send a substitute nurse on the trip. Sometimes an agency nurse is hired for the trip. When the trip is in the same city, it may be possible for a school nurse to travel to the field trip site just to administer the medication or the treatment.
Arrangements must be made for safe handling and transportation of all required medication and supplies. Remember, district medication policies still apply on field trips. Only FDA-approved medications may be administered on a field trip. Medications should be sent in an original pharmacy container labeled with the student’s name, medication, dose, and prescriber. Packaging medications into individual envelopes for field trips is a common practice, but should be discouraged because it violates most school district medication policies (Krol & Penny, 2024).
Request that the parent or guardian provide a second pharmacy labeled bottle at the beginning of the school year to ensure a field trip dose of medication can be properly stored. Pharmacies will usually provide the extra bottle to the parent without charge. If a nurse is not attending, medications and treatment supplies should be sent with the classroom teacher for safe handling during the trip. Medications with potential for abuse must be stored in a locked box. Teachers should be reminded to never leave any medication unattended (McClanahan et al., 2019).
The school nurse must determine what equipment or supplies are required to provide routine health and emergency care for designated students during the trip. What will be needed for students with chronic conditions such as diabetes, asthma, seizures, or allergies? What about specialized equipment for tube feeding, tracheostomy replacement or suctioning, catheterization, ostomy care, or other types of procedures? Will cups and water be needed for medication administration? Will there be electricity to plug in equipment, or is battery-operated equipment necessary? It is helpful to bring a disposable pad to use as a clean surface for procedures or diapering. For students using oxygen, determine how long their supply will last to ensure an adequate supply for the entire trip.
Send a basic first aid kit with the teacher. Many teachers prefer fanny pack type kits that are easy to carry. Encourage sunscreen use for staff and students attending outdoor trips. Students prone to toileting accidents should bring a change of clothes. Diapers or briefs and wipes will be needed for those with incontinence.
Emergency Planning
School nurses should inform teachers of students’ health concerns at the beginning of the school year. If necessary, review these with the teacher. Send copies of health care plans and emergency action plans (EAPs) with the teacher, along with any required medications or supplies such as portable suction. Review EAPs with the teacher, as needed prior to the trip, and advise them to keep emergency supplies near the student throughout the trip (Massachusetts Department of Public Health, 2015).
Most teachers carry cell phones that can be used to call 911 in an emergency. For remote locations, consider whether cell service will be accessible. Determine how long it would take Emergency Medical Services (EMS) to reach the field trip location. If there would be extended time before EMS could arrive, teachers must be trained on how to respond to a health emergency (Colorado Department of Education, 2024; Massachusetts Department of Public Health, 2015).
Additional Considerations
If delegating care to unlicensed assistive personnel (UAPs) during the trip, your state’s rules for delegation of care must be followed. The UAP’s must be properly trained. Document the training and competency assessments (Krol & Penny, 2024).
Overnight trips require additional planning and coordination with parents and primary caregivers. Notice of the field trip must be increased to a month or more to ensure safe care. Additional problems such as sleepwalking, nocturnal enuresis, sleep apnea, or night terrors require a staff plan to address these issues. Determine if the students will need prescription or over-the-counter medications that are not given during school hours. Medication orders from the health care provider and written permission to administer from the parent are required for these and must be obtained according to school medication policies.
Out-of-state trips require even more planning. Any nurse crossing state lines must follow state law (e.g., state nurse practice act) in the destination state and be aware whether there is any nursing license reciprocity agreement (Krol & Penny, 2024). Additional discussion regarding out-of-state field trips is beyond the scope of this article.
Post Field Trip Actions
Upon return, the school nurse should check with assigned staff to ensure medications and treatments were administered and documented. Inquire if there were any injuries, illnesses, or medical concerns that occurred during the trip. Advise staff to document any they report, facilitating adequate follow-up, as needed. Parents must be informed of any injuries, missed medication doses, or health problems that arose for their student during the trip.
School nurses should retrieve the first aid kit, medications, and equipment from designated staff the same day as the field trip to prevent items from being lost. Review any emergency plan that was implemented with the staff person assigned. Determine whether the EAP requires any revisions. If issues occurred on the trip, the school nurse (SN) should work with the teacher and administration to resolve and develop a plan to prevent similar issues in the future.
Conclusion
Students with disabilities have the right to participate in field trips with peers (U. S. Department of Education, 2022). Inclusion of school nurse expertise in all phases of planning is critical for students with special health needs to ensure safe student participation (NASN, 2024). This is true even for students with a 1:1 assigned nurse. Accommodations and modifications must be customized to individual student needs, the constraints of travel, and the destination site. This level of critical thinking is exclusive to a registered school nurse, and it requires school nurse advocacy to gain access to the educational teams making these decisions.
Footnotes
Linda Kimel from Rockford, IL, USA is retired. Most of her 35 year school nursing career focused on students with special health care needs. She is co-chair of the NASN Special Needs School Nurses Special Interest Group.
MaryAnn is founder and consultant for Special Education Nurse LLC in Johnston, IA, USA. She is a former member of the NASN School Nurse Editoral Board, NASN Director from Iowa, Special Needs SIG Co-chair, and JOSN Editorial Board.