School Nurse Incident in Orlando. What Would You Have Done? - page 2

I'm not a nurse yet, so I only know how I feel about this. What should this nurse have done? What would you have done? Nurse refuses student inhaler during asthma attack School says medical release form lacked parent's... Read More

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    Perhaps a mod can merge this thread with the one in the School Nursing forum, where a number of experienced school nurses have already weighed in.

    As a school nurse myself, my B.S. detector is going off...We don't have anything close to the whole story. If the child was truly unconscious and in severe respiratory distress, how did he get fixed without ACLS intervention?
    Purple_Scrubs, lindarn, kids, and 6 others like this.

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  2. 0
    My apologies. I didn't know there was a school nurse forum, or that this was already being discussed.
  3. 10
    I'm not going to attempt to justify or berate the nurse's actions, since we don't really know what happened. But for those unfamiliar with school procedures, I'll explain the normal routine for meds at school:

    Requirements vary by state law and district policy, but for the most part, for a student to receive medication at school, the medication must be necessary for school attendance and must be required during normal school hours. (For example, if a routine medication can be given at home outside of school hours, it will not be accepted at school.)

    For school personnel to administer meds at school, there must be a written physician order AND signed parental consent. One or the other doesn't cut it. The medication must be provided to the school in it's original container, with the original label clearly displaying the student's name. Bringing in pills in a baggie, a prescription vial with someone else's name, or an unlabeled inhaler is unacceptable. Just as nurses don't administer unprescribed medication in a hospital or clinic, neither can nurses in a school setting.

    Most states have laws allowing for the self-carrying and self-administration of emergency medications (usually inhalers or epi-pens) by students who are documented to have the knowledge and awareness of safety to do so. This requires physician documentation, parental consent and the agreement of the nurse that the student meets the criteria. This is usually appropriate for older grade school students (4 or 5th grade and up) and teenagers. If a student violates the safety rules attached to self-carrying a medication, such as allowing other students to play with the medication, it is removed from the child's posession and goes under lock and key.

    Some kids carry inhalers without consent and without the school's knowledge because their parents don't want to be bothered with filling out the necessary paerwork. We all know this, and do our best to get these kids into compliance by implementing self-carry paperwork. I don't confiscate inhalers, period, but will raise holy he** when I find them being used without authorization. These are the parents that refuse to be bothered by providing us with the necessary information we need to assist their children safely in school, but they will also be the first to sue when their child suffers because s/he hid in the locker room and ineffectively self-administered an empty, expired inhaler.

    Lastly, some states and districts have emergency protocols, signed by physicians that allow school personnel to administer asthma and allergy drugs while awaiting 911 in the event of a severe, presumed asthma attack or anaphylactic reaction. This is the best of all worlds, because it allows school nurses and personnel to do what is right, even if the parents haven't bothered to.

    http://www.education.ne.gov/legal/we...RULE592006.pdf

    Scroll to page 10
    Purple_Scrubs, kids, sharpeimom, and 7 others like this.
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    I apologize in advance if this posting is too long. I live in the county next to the one this occured in. I am also an elementary school nurse. The FL State Dept. of Health works with the schools in creating a clear protocol for medication administration. Students are not allowed to carry inhalers, period, unless the parent has signed an authorization for the school to administer it, and the MD has authorized it. Otherwise, the inhaler is brought to the clinic by the parent in the original box the Rx is on, and they sign a consent. The Rx is considered a doctor's order. If there is no Rx label on the box, there is no way for the nurse to know if he is truly supposed to have the med, or did he take it off Uncle Fred's dresser. And yes, that has happened. It addition, there is no route, no time, no dose, etc that every MD order must have.

    Therefore the nurse can't give it
    . That is the law! This is made clear in the student handbooks signed by both the parent and student at the beginning of each school year. It is also clearly spelled out in each individual school's web sites. It is also explained to parents if they bother to call and ask. Students have been known, in the past, to carry inhalers, not tell anyone, but then play around with it and let their friends try it out with unintended consequences. Believe me, it has happened in my district!

    I watched the news story several times. I saw it and was astonished. First, as I understand it, there were no, repeat no signs of any respiratory distress. There was none observed by the nurse, nor was it observed by any other witness in the school that was there at the time. He was sitting in the administrator's office waiting until his mother came. Does anyone seriously think that a nurse, administrator, and anyone else in the office who even thought they something wrong would not have called 911 if it was needed? Second, the school found the inhaler in his backpack during a security check. He wasn't trying to get it out and use it. It was found. The school did not know he had it. There is no order on file for it. The school called the parent, and they were on the way.

    The nurse followed the protocol, the law, and the Nurse Practice Act. Is it not drilled into our heads since Day 1 in nursing school that you do not give medications to anyone without a doctor's order? And yet, the nurses name and schools name have been dragged through the mud. Now the parents plan to sue the nurse, and the school district. Of course. And their attorneys comment? "even if it was the law, the law needs to be changed". And changing the law starts at the expense of this girl's livelihood, and the school's reputation? I do not know the circumstances of what lead up to the student supposedly being locked out of the clinic. I'm sure I'll hear it and whether it's the truth or not, we'll never know.

    I'll just end this by saying I am sick, sick, sick to death of parents like these. All school nurses know exactly what I mean when I say every school has them. The ones that couldn't be bothered to spend 5 minutes filling out paperwork. The ones who have no clue about what really happened, but go shooting their mouths off without knowing the facts. And the lawyers who latch on to the nuts in the name of "justice" but it's really just lining their pockets that matters. I've had kindergarteners bring in needles from Dad's supply. I've had kids bring in liquids and pills, ear drops, eye drops and insulin/syringes that their parents told them to give me. Does anybody think about what could happen if the inhaler, or pill, or syringe gets into the wrong hands? And these parents have brains?

    All I can think is, this could have been me. It's just blowing my mind. This could have been me.

    mc3
    Last edit by TheCommuter on May 26, '12 : Reason: reformatting
    MelEpiRN, Purple_Scrubs, kids, and 18 others like this.
  5. 0
    We really don't need any more info than was provided. The child complained of SOA (whether he was faking it or not is no matter), he had a prescribed inhaler but according to school policy the school nurse was not allowed to administer it or give it to him to admin to himself so 911 should have been called immediately. This covers the school, the nurse and above all, the complaint of the child/student. When the nurse did her PA, if there were no s/s of SOA the nurse should have tried to get a hold of the mother, but if she was not immediately available then 911 should have still been called.

    Of course the student became irrate...I suffer from asthma myself and so does one of my children...it must have been horrible to feel like you are suffocating and have the people who are supposed to keep you safe do nothing, and we can all agree that nothing was done as the inhaler was not administered and 911 was not called.
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    I am witholding judgment until more information is available. So far, we do not have the nurse's side of the story.
  7. 0
    What info is needed from the nurse? The kid complained of SOA, he had to be treated. If she could not give him his inhaler, then she should have called 911.
  8. 0
    Wow, My son has asthma and I had to get the form signed but they still didn't let him carry his inhaler with him. My son can be a "drama king" but I would rather error on the side of caution and just give it to him than not give him something he needs.
  9. 6
    Quote from PetsToPeople
    We really don't need any more info than was provided. The child complained of SOA (whether he was faking it or not is no matter), he had a prescribed inhaler but according to school policy the school nurse was not allowed to administer it or give it to him to admin to himself so 911 should have been called immediately. This covers the school, the nurse and above all, the complaint of the child/student. When the nurse did her PA, if there were no s/s of SOA the nurse should have tried to get a hold of the mother, but if she was not immediately available then 911 should have still been called.

    Of course the student became irate...I suffer from asthma myself and so does one of my children...it must have been horrible to feel like you are suffocating and have the people who are supposed to keep you safe do nothing, and we can all agree that nothing was done as the inhaler was not administered and 911 was not called.
    I agree that if someone is in distress, yes call 911. But this is also a school full of teenagers who love drama and to disrupt things.

    The other thread has a link to an aired news story. It gives a different point of view. Parents Of Student Denied Inhaler Get Attorney - Orlando News Story - WESH Orlando

    At 17 y/o aggression is not the solution when you are short of breath. Inhalers are abused for the "hyped" up feelings that are produces when abused. I am skeptical that the young man had blue fingers and lain on the floor. The other news story was a little more credible.

    It sounds like the school has had issues with this family/young man in the past and he was in no danger. It seems the young man was never given medical attention even after his mother was called and she went to the school finding him "blue". The mothers attorney is the attorney for Casey Anthony's parents.......a bit of a media monger.

    I am skeptical........http://allnurses.com/school-nursing/...es-714434.html.
  10. 3
    I am sure that as the truth comes out we will find out that the young man was not knocking on deaths door. I have horrible asthma. When I have a "severe attack" like was described a puff from an inhaler doesn't cut it. I hope this nurse gets herself a good lawyer. I see drama all the time from parents, and I'm guessing this is more hype than anything else.
    Not_A_Hat_Person, Tina, RN, and wooh like this.


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