Unlicensed Assistive Personnel (UAP) Training Support Materials 

Planning for Delegation

Prior to delegating nursing tasks to UAPs, the school nurse must familiarize themselves with the state laws and guidelines related to their roles and responsibilities within the school nurses’ scope of practice. Key resources to review include the Nurse Practice Act, Board of Registration of Nursing (BORN) regulations and delegation (5 rights) guidelines, and 105 CMR 210: The Administration of Prescription Medications in Public and Private Schools. Trainings and resources can be found on SHIELD’s website as follows:  

• Medication Administration and Delegation Resources 
  • A comprehensive collection of regulations, guidance, and training materials, including links to BORN’s Five Rights website, and UAP training resources
• Medication Administration in a School Setting: School Nursing Practice in Massachusetts (audit or credit version) - EDIT
  • An introductory self-paced course that reviews laws, guidelines, and medication practices, including delegation
• Medication Administration in a School Setting (eBook) - LINK  
  • A key resource outlining medication administration in schools that includes in-depth information on delegation.  

MA BORN’s Five Rights of Delegation “clarify the critical components of the delegation decision-making process. The Five Rights delineate professional and legal accountability for nurses at all levels, from nursing service administrators to staff nurses.”  

School nurses are advised to apply the Five Rights as they make delegation determinations and to document their decision-making process for each delegation.  

UAP Training Process

UAPs must be trained and demonstrate to the nurse they are able to successfully complete each delegated task. To assist this process, SHIELD has developed a free, self-paced training: Medication Administration for Unlicensed Personnel (LINK TO THE COURSE).  

Upon completion of this course, UAPs will be able to  

• Apply the 5 rights of medication administration  
• Identify at least two examples of a medication error 
• Provide at least three examples of when to consult with the school nurse 
• Be prepared to demonstrate the safe administration and documentation of medication using the nine steps of medication administration 

This course includes a post-test (pass at 80%), a certificate to document training, and a job aid the UAP can refer to as needed. The nurse can review these materials with the UAP prior to training them in each delegated task. To become familiar with the materials provided, SHIELD recommends that school nurses take this course prior to instructing UAPs to do so.  

School Nurse Delegation Checklist

Note: Use the checkbox next to each step to mark it as completed or print this page to check the box manually. 

  1. Decide who can be trained as a UAP for each particular student. It is the right of the school nurse to refuse someone if there is concern about their ability to safely fulfill the role of the UAP. Proceed to step 2 if you feel they are appropriate for training. (Reference resources: 105 CMR 210.004, BORN Five Rights, Medication eBook).  

  2. Instruct the UAP to take the SHIELD training: Medication Administration for Unlicensed Administration Personnel (ADD THE URL) and ask them to return to you a copy of the post-training quiz and certificate of completion.

  3. Review the post-test with the UAP and answer questions they may have about the training. Also, review any questions they may have gotten wrong on the post-training quiz. Note: A passing grade for the quiz is set at 80% (two attempts are allowed for passing). If the UAP cannot pass after two attempts, question if this is the right UAP to safely delegate medication administration. Keep a copy of the quiz and certificate for your records.

  4. Review the job aid with the UAP to ensure they understand the scope and responsibility of their role, most importantly, the five rights of administration, the nine steps of safely administering medication, and what to do if there is a medication error or concern. 

  5. Once you feel confident that the UAP understands the process of medication administration, assess their skills: 

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  6. Document the completion of the skills training with the UAP. The school or school system must retain this documentation and be able to provide it to caregivers or school nurse delegators upon request. 

Key Points:

• If for any reason, the school nurse has concerns about the UAP’s ability to safely administer medication, they need to make their concerns known to the nursing supervisor or other appropriate school administrators. The school nurse is held accountable for all aspects of the delegation decision-making process, its implementation, supervision, and evaluation. 
• Remember that the school nurse must be available to the UAP at all times should they have any questions or concerns.   
• The school nurse must have separate skills training for each prescription medication that has been provided for every student.  In other words, the school nurse can’t just show the UAP what to do with one student and assume they are trained for all students. 
• If the school nurse is not completely aware of the specifics, they should take the SHIELD UAP training to become familiar with the process as well as review the Medication Administration Handbook, Medication Delegation content.