Nursing titles and health care plans.

Nurse Harry just finished teaching the trip leader how to bandage a blister. He's administering one camper's medication while a group of campers hike up to the health center for a screening before their canoe trip. Another camper is lying down in the back with an upset stomach.

Camp nurses assume a variety of roles including educator, program manager, direct care provider, health counselor, and consultant.

With so many roles and expectations, nurses as well as camp directors, campers, staff, and parents can sometimes forget who is qualified to do what and the standards under which procedures can be performed.

When can the title "nurse" be used?

One of the common misconceptions at camp is that every health center manager can be referred to as the "camp nurse." The title "nurse" is protected. Each state defines the limits and boundaries under which nursing practice is valid. The limits vary for different types of nurses; roles also vary by state.

Camp directors must understand the distinction between various nursing titles. (See Figure 1.) To use the title nurse when the person does not meet the qualifications identified by state law establishes an expectation in everyone's mind that a particular level of care will be provided. Camp directors must use a title for their health care provider that is consistent with the provider's credentials and appropriately communicates that person's role to others.

An appropriate way to determine if the person being considered for the camp nurse position qualifies to use the title nurse is to contact the Board of Nursing of the state in which the camp is located and verify if the person is, in fact, licensed as a nurse in that state. (Don't have the number or address for the Board of Nursing? Call the personnel office of a clinic or hospital in the camp's state for assistance.)

International considerations

The same conditions apply to a person who is a nurse in another country; the individual must hold a license to practice nursing from the state in which the camp is located. Reciprocity between countries does not apply to nursing.

Many Boards of Nursing take six months or more to review the credentials of non-United States nurses. The board may also require the person to take the state's nursing exam. This extensive review process makes it impractical for most camps to consider hiring people from other countries for the camp nurse position.

It is possible, however, to consider international applicants as health care assistants if they have necessary state credentials and an appropriate person supervises.

Student and graduate nurses

Similarly, student and graduate nurses (GN) may be strong assistants, but are not licensed to practice nursing. If a GN applies for a camp health care position, determine if the person expects to be credentialed in the camp's state prior to the start of camp. Make the staff agreement contingent upon those credentials. Some states no longer issue provisional nursing licenses to GNs.

Developing a health care plan

While it is inappropriate to call a first aider a nurse, there are several health care providers, other than nurses, who may be appropriate for various roles in your health care plan. When choosing providers, consider:

* the health needs of the camp population, both campers and staff

* the camp program

* the scope of the risk management plan

* the camp's location in relation to health care support systems.

There must be a good match between the camp's needs and the provider's credentials.

The American Camping Association health care standards require the existence and annual review of a written health care plan that provides guidelines in the following areas:

[TABULAR DATA FOR FIGURE 1 OMITTED]

* responsibilities and authority of the camp health manager and other staff providing health care (including first aid)

* routines for camp health care, sanitation, and record keeping

* provision of supplies and equipment

* relationships and agreements with medical personnel, hospitals, and providers of emergency care

* requirements for signed health histories for all campers and staff; signed permission to obtain emergency medical treatment

* for resident camps, health screening of all campers and staff; a health examination for campers and staff up to 24 months prior to camp

* a list of activities or locations where first aid and/or CPR certified personnel are required to be present

* availability of emergency transportation for medical emergencies

* requirement of camp staff training and written procedures on responsibility in health care, use of supplies and equipment, and managing medical waste and body fluids

* requirements for storage of medications under lock and administration under prescription or signed instructions of parent or physician

* availability of health care shelter and continual supervision of campers in the health center. Other items to include as resources allow:

* health program goals

* communicable disease and injury control programs

* health promotion programs

* health program evaluation process

The nurse and camp administrator share the responsibility of incorporating state and federal Occupational Safety and Health Administration (OSHA) requirements into the health program.

Health care providers, staff, and in some cases parents, should review your health care policies and procedures to ensure they include the following:

* a system for informing everyone of revisions

* the date the policy was developed and when it went (goes) into effect

* answers to the questions:

What should be done? Why should it be done? Who is responsible? How should it be carried out?

"Healthier camping for all" is a realistic goal. Choose the appropriate health care provider for your camp (and refer to that person by the title his or her credentials warrant). Develop a health care plan suited to your population, program and location.

References

Lishner, K.M. & Bruya, M.A. (1994). Creating a Healthy Camp Community. Martinsville, IN: American Camping Association, Inc.

American Camping Association, Inc. (1993). Standards for Day and Resident Camps. Martinsville, IN: Author.

Linda Erceg is president of the Association of Camp Nurses. She is also the health and safety coordinator at Concordia Language Villages in Bemidji, Minn.