Role of SN & Athletic Trainers

[PedsRN4Beach, ADN, LVN, RN]

Hi everyone!

I have been a Jr High nurse for 3 years now. I have about 1000 7th & 8th graders. I see 55-70 kids a day.

Prior to last year, we had no athletic trainer at the Jr High level. This past year we aquired a “part time” trainer, who was present during the first & last periods of the day only. (Athletic periods) This was great for easy, acute ortho injuries to be treated & sent back to class. However, it was hard when it came to injuries that were persistent, worrisome or longterm. Protocols were added, without discussion, that involved recurrent classroom accommodations. (i.e. concussions) When these protocols were initiated, it was stated by the trainers that it was my job to coordinate this.

As much as I respect and appreciate an AT’s knowledge...and majorly appreciate protocols, these students arent evaluated by a physician or midlevel until the END of the protocols. Thats days...maybe 2 weeks...after a head or ortho injury.

Again, I respect and appreciate AT’s, I’m just not sure where AT’s and RN’s boundaries are. If the AT was fulltime, like in high school, this would not be an issue. I have searched and searched, but I can not find any information on the AT & RN relationship within the BON or elsewhere period. Can an AT delegate to an RN? Are they considered a “midlevel” similar to an NP or PA? Of course, I want to save unnecessary expenses for the student...but if AT’s are not midlevels, I feel like this is also trusting another person with my license. Also, I feel like it’s easy to push protocols that you do not have to do the legwork on. Towards the end of the year, the AT would drop students off, state they would come back tomorrow for reevaluation, then be unavailable for days. These were AT diagnosed concussions, during state examinations at that.

Does anyone have any information that would help clarify this for me? I would really like to have a good understanding before the school year begins and we’re smackdab in the middle of football.

Thanks in advance!!!

[NurseInTheHall, ADN, RN]

I wouldn't think that an AT would be able to delegate to an RN but it may depend on your state and your school chain of command. Given the information you provided, it doesn't sound like this AT outranks you.

Research your state's laws regarding AT certification. In Oklahoma, that would be practicing medicine without a license - only a physician, NP or PA can make a medical diagnosis."As used in the Oklahoma Athletic Trainers Act: 1. "Athletic trainer" means a person with the qualifications specified in Section 530 of this title, whose major responsibility is the rendering of professional services for the prevention, emergency care, first aid and treatment of injuries incurred by an athlete by whatever methods are available, upon written protocol from the team physician or consulting physician to effect care, or rehabilitation;...".

I would interpret this to mean that the AT cannot write the protocol, but acts in accordance with a protocol established by a physician or whoever else has the authority to write the protocol in your state/school.