I need your advise please

Nurses HIPAA

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Hello Everybody

I am an LPN working for a home health care company.

I'm taking care of a special needs child. I go to school with him.

My problem is the school nurse. She demands me to chart for the school or give a copy from my charting and MAR.

I feel that it would violate the HIPPA and could jeopardize my license because of the double charting.

My employer stated that it is ok to do it and it would be done for billing purposes.

The school nurse is not involved in direct patient care and I don't work for the school either.

I expressed my concern to my employer and I did not received any reliable response i.e. legal reference etc. other then saying it is ok.

I am hesitating to escalate this issue to the corporate compliance team fearing that my boss would just take me off this case.

We all work on PRN base and it is hard to get 40 hours as I have now with this case. Also they could just not giving me anything because of my "defiance"

So my question is that would you chart for a company who you don't work for or would you give a copy of your documentation including MAR out of your hand to the school?

Thank you for reading this long thread....

Specializes in Maternal - Child Health.

I'd like to offer some information from the perspective of a school nurse.

First and foremost, everyone's goal is to enable this child to safely attend school and participate as fully as possible.

I believe the tension arises from lack of clarity regarding your and the school nurse's responsibilities in reaching that goal. It would be helpful to know the organizational structure of the school and how you fit into that. It is ultimately the principal's duty to provide (or enable others to provide) for the safety and well-being of every child and adult present in the building. Where health matters are concerned, the school nurse is the person to whom the principal delegates this responsibility. She is well within her bounds to ask and have a good understanding of what the child's condition and needs are, what the plan of care is, how it is being carried out, and whether it is effective or not. She is also responsible for ensuring that safety, infection control and hygiene practices are being followed, especially since these impact not only your 1:1 student, but also every other person in the building.

For example, Diastat is a controlled substance. Most State Boards of Nursing/Pharmacy or Departments of Public Health issue strict guidelines on how this medication may be held and administered in the school setting, not only to ensure that it is safely given to your 1:1 student, but also to ensure that it does not fall into the hands of a child or adult who may be sickened by it. This is just one of many considerations that don't necessarily apply when you care for this child in the home setting, but become an issue when you accompany the child to school, where you must comply with state and school district policies and procedures. While you may have the right to essentially act as this child's substitute parent in the school setting, you are not excused from following school district rules, or state laws.

To an extent, your actions may be determined by who hired and pays you. If you are paid by the school or district, then they can and should require you to document according to their instructions. If you are paid by the family, you may keep your notes confidential, but the school is within reason to ask you to document pertinent information in the school record to demonstrate that the child received appropriate care and supervision in school, which is everyone's goal.

Please request a meeting with your agency, the child's parents and school officials so these concerns can be worked out in a professional manner. Failure to do so will foster even greater tension, which will only harm your student in the long run.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
I'd like to offer some information from the perspective of a school nurse.

First and foremost, everyone's goal is to enable this child to safely attend school and participate as fully as possible.

I believe the tension arises from lack of clarity regarding your and the school nurse's responsibilities in reaching that goal. It would be helpful to know the organizational structure of the school and how you fit into that. It is ultimately the principal's duty to provide (or enable others to provide) for the safety and well-being of every child and adult present in the building. Where health matters are concerned, the school nurse is the person to whom the principal delegates this responsibility. She is well within her bounds to ask and have a good understanding of what the child's condition and needs are, what the plan of care is, how it is being carried out, and whether it is effective or not. She is also responsible for ensuring that safety, infection control and hygiene practices are being followed, especially since these impact not only your 1:1 student, but also every other person in the building.

For example, Diastat is a controlled substance. Most State Boards of Nursing/Pharmacy or Departments of Public Health issue strict guidelines on how this medication may be held and administered in the school setting, not only to ensure that it is safely given to your 1:1 student, but also to ensure that it does not fall into the hands of a child or adult who may be sickened by it. This is just one of many considerations that don't necessarily apply when you care for this child in the home setting, but become an issue when you accompany the child to school, where you must comply with state and school district policies and procedures. While you may have the right to essentially act as this child's substitute parent in the school setting, you are not excused from following school district rules, or state laws.

To an extent, your actions may be determined by who hired and pays you. If you are paid by the school or district, then they can and should require you to document according to their instructions. If you are paid by the family, you may keep your notes confidential, but the school is within reason to ask you to document pertinent information in the school record to demonstrate that the child received appropriate care and supervision in school, which is everyone's goal.

Please request a meeting with your agency, the child's parents and school officials so these concerns can be worked out in a professional manner. Failure to do so will foster even greater tension, which will only harm your student in the long run.

Yes, I think these are excellent points raised. Rather than get into what you think is a turf war, try to find out how much responsibility the school board bears for every child's well-being. There must be a legal way to keep each other informed for the benefit of the child. You may also want to seek guidance from your State Board of Nursing on this issue. This can't be the first time anyone has encountered this situation.

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Specializes in HH, Peds, Rehab, Clinical.

HIPAA! For the love of Mike, it's HIPAA!

It really seems like you are determined to engage in a power struggle with the school nurse. Knock it off. There is a special needs child attending the school, she DOES potentially have to care for this child, it would be in everyone's best interest if she were in the loop regarding her medications, needs, cares, etc.

You say the agencies guidelines say you can share information if they give written permission. Just get it already and move on. I can certainly see why you've gotten a label with your agency and they'd be reluctant to assign other cases to you. Sorry for the bluntness, but by your own words I can see why they'd think that.

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Why not call your malpractice carrier, pass this by them for some direction?

Or ask your boss for a written letter stating that you are allowed to give copies to the school nurse?

Sounds to me like there's a reason that this seems to be the only 40 hour position available......

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Specializes in Pedi.

Public schools in the United States of America are obligated to provide for all eligible children in their district to attend school. If this means paying for a 1:1 nurse for a vent dependent child, they must do it. The school is probably paying for this child's nursing services and the services are probably outlined in either his IEP or 504 plan. Even though you are present with this child, the school nurse is the healthcare professional employed by the school who has ultimate responsibility for the health and safety of all children in the school. Given that the school is likely paying for this child's service and HIPAA comes into play with health insurance, it may not apply at all. FERPA would apply.

I don't see the issue with the school nurse knowing where the Diastat is. What if the child has a severe seizure in which he needs to be bagged? While you're doing that, she can grab and administer the Diastat. Sometimes you need 2 people when a child is seizing.

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Specializes in SICU, trauma, neuro.
I'd like to offer some information from the perspective of a school nurse.

I was hoping a school nurse would chime in on this. I read this the other day, didn't respond at the time, but was thinking that it's reasonable that the school nurse would need to know what's going on treatment-wise with this child. Not want to know, need to know. She's the school nurse, this medically fragile child is a student in the school that employs her, thus she bears responsibility for this child...and it's her license, too.

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Since your employer does not provide definitive guidance that countermands the school nurse's instructions, do what you are told and document accordingly. Or, make arrangements for another job. My employer emphasized to me that I was subordinate to the school nurse.

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Specializes in HH, Peds, Rehab, Clinical.

Op? Coming back?

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As a private duty nurse who attends school with patients regularly, I agree that the nurses, the agency and the school (and the parents) need to come together and communicate. Yes, the home nurse is on schools grounds, and the regulations, etc are different When at school, but it sounds like this is definitely something that needs to be discussed with all involved.

If I am carrying Diastat as an emergency drug for the patient, it would be kept in a certain place in the travel/emergency bag. In case of some emergency where the home nurse is 'incapacitated' or, more realistically, dealing with an emergency with her medically fragile patient, and has her hands full, then yes, the school nurse may need to know where this med is kept. But I would NEVER hand over narcotics that I am responsible for to another nurse. What if she 'lost' the package or refused to give it back? It is your responsibility. i am not trying to be negative toward school nurses. I have just never met one like the OP describes, and have usually felt like we were working together and could discuss things rationally and reasonably. Since, of course we have the same goal: the patients well being and getting the most out of the school day safely.

I have been in a situation where I had to perform an emergency procedure at the school' and thankfully, everything went fine. The school nurse was there, and we worked together, but I directed her in what needed to be done because I am the primary nurse. I don't know what kind of training she has in regards to this specific patient, his equipment, ventilator, etc. but if I was concerned I would most definitely bring this up with my agency, the principal, whoever I had to. As a nurse you have to protect your patients and your license. And get your own , PLEASE.

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