Medical conditions shared

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So I went to a training last Friday where the principal handed out paperwork to all the teachers, yard duty aides, paraprofessionals, cafeteria aides, listing the names of all the children in her school with medical conditions and what they were. She looked at me as I raised my hand in concern about privacy issues and said she knew I would have concerns but she cleared it with administration. So, I encouraged everyone to not take the paperwork outside their school rooms and put it in a personal file of some sort and don't show it to anyone.

It is very frustrating to say the least. What do you all think?

http://www.education.nh.gov/instruction/school_health/faq_records.htm

Can a list of students' health issues be distributed to teachers or other staff?

A school-wide health concerns distribution list violates FERPA and is not best practice. If individual staff or faculty members need to be informed of a student's condition, that student requires an ECP (emergency care plan) listing symptoms to be alert for and the required response to those symptoms. It is recommended that parents, as a part of the IHP (individual health plan), participate in deciding who on staff and faculty requires identifiable health information for the child's safety. Staff and faculty who are trusted with personally identifiable health information should receive training regarding their responsibility to safeguard that information.

Nurses can ensure that confidentiality is respected by revealing only necessary health concerns and only to those individuals whose knowledge may affect the student's health. For example, individuals who have no contact with a particular student have no need to know that student's medical or mental health issues. Using functional implications is not only more discrete but has the additional benefit of delivering more practical information to school employees that generally have limited medical knowledge.

The best approach to handling this potential problem is to work with your school administration to draft medical information policies that are consistent with the requirements of both FERPA and the state Board of Nursing.

Specializes in School Nursing, Public Health Nurse.

I think that's horrible and it's illegal! I would ask her if Administration cleared it with the State or the Feds! Ridiculous! There was a lot of flack when I started at my District this year and I refused to do a Health Concern List and distribute it to all staff like the previous Nurses. I got the, "The other Nurses did it" or "We've always done that" or "We've never gotten in trouble" or "The county said we can" blah, blah, blah. I said no and when I email teachers health plans include the Vice Principal's in the email's because they are in charge of security and are 1st Responders if I'm not around or there first. I also include a message stating that this information is confidential and to share only with subs or interns and they can make their own personal student health concern list, but that cannot be shared otherwise it is a violation of FERPA.

What is the fine or repercussion of violating FERPA? I would find out and take that plus the law to Administration and see how they feel about it. Also, mention that parents today are very sue-happy, especially ones who are very protective of their child's health information and wouldn't be happy to know their child's name is on a list floating through the school with no information on how to help that child in case of an emergency.

Specializes in Complex pedi to LTC/SA & now a manager.

Not a school nurse but I had to sign a consent for the school nurse to release any medical info that wasn't included in his IEP to teachers. Specifically any precautions & potential side effects of his medication regime. Basically to release an emergency action plan to his teachers. If I were a parent in your school I would be filing a formal FERPA complaint. Parents inevitably find out that the info was released as someone always has a big mouth.

I seriously doubt based on what you posted admin secured parental permission.

No they didn't get parental permission. Thanks - I've been gathering info to take to the Administration.

Another nurse in the district that helped train me stated they put the permission sentence in the health plans for the parents to sign. One of the school secretaries mentioned putting that on the registration forms all parents fill out at the beginning of school but I think each health plan would be better.

Thanks for the input.

Specializes in School nursing.

I have two permission statements on the health form I send home to parents every year. One is permission to share their child's health with staff on a need-to-know basis and the other is permission to talk with their child's health care provider if necessary. 95% of parents check yes and sign to both of these things. I make a list of the parents that check no and keep it on my computer in a password protected file to cross-check when I have a health concern that might need to be shared with a few teachers.

That being said, I do have available in electronic form, password protected, an allergy list for students that is available. We do not have a cafeteria, so students eat in classrooms and any teacher or staff member might be covering a lunch shift. We are a peanut/nut free school to avoid several reactions, but it is a new policy this year that several children (well, mostly their parent to be honest) are resisting. Luckily, the parents of all my children with allergies have checked off permission to share their child's allergy.

Either way, your principle is way of her scope, so to speak. Sorry this has been such a tough year for you, OP...

Either way, your principle is way of her scope, so to speak. Sorry this has been such a tough year for you, OP...

Your last comment took me by surprise . . .then I looked at stuff I've written about and I realize I've vented quite a bit here.

I'm truly not happy working with the adults (most of them) in this job but the kids are great. I was told in the very beginning that this would be the case - a medical person in this environment. I think I've mentioned somewhere in all these posts that I've decided not to get my credential and stay past the 5 years. (In my state you must have a BSN and promise to get a credential in 5 years - you are given a temporary one by the state).

I've contacted my state rep of NASN about this and waiting to see if maybe I can get a FERPA expert to just come do a presentation. The principal and I have gone head-to-head over things and I don't think she'd like me to tell her how she was wrong and I was right. . . I've gone to many a training on FERPA and HIPAA so I'm sure even in my school district, there must be one. ;)

(There are a couple of employees who share my concerns about zero tolerance and other things but we are definitely outnumbered).

I handed out a list "first name only" of the students in my center who were under seizure precaution and those who had allergies, to every staff member.The list must stay in their classroom or office, and out of sight. Everything else is private.

Specializes in School Nursing, Public Health Nurse.
I handed out a list "first name only" of the students in my center who were under seizure precaution and those who had allergies, to every staff member.The list must stay in their classroom or office, and out of sight. Everything else is private.

Even under those circumstances that list is still inappropriate and violates FERPA.

A school-wide health concerns distribution list violates FERPA and is not best practice. If individual staff or faculty members need to be informed of a student's condition, that student requires an ECP (emergency care plan) listing symptoms to be alert for and the required response to those symptoms. It is recommended that parents, as a part of the IHP (individual health plan), participate in deciding who on staff and faculty requires identifiable health information for the child's safety. Staff and faculty who are trusted with personally identifiable health information should receive training regarding their responsibility to safeguard that information.

The whole idea is to avoid making lists, unless it's for your own personal use, and provide information on how to help the child in the case of an emergency. A list of names means nothing, but knowing these students are Diabetic and this is what I do in case of hypo/hyperglycemia...is more effective and protects the student.

In response to previous post...

This is a small center. Everyone is in contact with the children and needs to be aware. The list contains first name and what food they are allergic too. Letting the staff who are in contact with the children know the first name of children who are prone to seizures is good safe practice also. Every other information is private or given at discretion to individual staff members. Safety first is my concern.

Specializes in School Nursing, Public Health Nurse.
In response to previous post...

This is a small center. Everyone is in contact with the children and needs to be aware. The list contains first name and what food they are allergic too. Letting the staff who are in contact with the children know the first name of children who are prone to seizures is good safe practice also. Every other information is private or given at discretion to individual staff members. Safety first is my concern.

Yes safety is the concern, but the point is giving a list of names is still a violation. Since you have a small center I would suggest a binder with a health plan for each child instead of a list of names. If you tell staff the s/sx of their allergies for each kid or what type of seizures the child is prone too this will provide a safer environment. For example, if I provide a list of seizure students to my staff they know to look out if any of the students are having a seizure (generally speaking most lay person associate seizures with tonic-clonic seizures). What if a student is having an absence seizure and the staff doesn't realize it because all I gave them was a list of students with no specific information about that student's condition. Even with allergies, symptoms are produced differently in each child from anaphylaxis to hives or even swelling in odd areas. The information you need to give to your staff needs to be unique to that child, even if you use a generic care plan. But each care plan should be tailored to that child's specific health circumstances. That is the purpose of the law. To not just inform about a child's condition, but to inform staff on what to react to and how to assist that child in case of an emergency.

Specializes in School nursing.

Adding to my thoughts above, I will state that at my school, we have general action plans for allergic reaction, asthma, and seizures. Simple, straight forward instructions on one sheet of paper are posted everywhere in the school, and a copy also resides on our computer server. I've given Epi-pen training. All of this is not specific to what student has these conditions, just that they might exist - we are a small school, all staff could encounter a student/situation and knowing how to handle it is key.

I agree that even when parent's have given permission to release health info to need-to-know staff, that training of what to do if that health emergency occurs is 100% necessary.

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