No 504? Legalities?

  1. It is still the beginning of the school year & parents are still returning medical exam forms & immunization updates. In NY, parents of kids needing medications or special treatments must turn in a 504 form. Once it is signed by their doctor, it goes to the Health Dept & Board of Education for approval. As you can imagine, this process can take 3-4 weeks. In the meantime, you may have a child in need of care that you are not legally able to provide.

    For instance, a parent drops off an epi-pen for a student with severe peanut allergies & an inhaler for her "very rare" asthma attacks. If this child suffers an acute allergic reaction & her 504 paperwork is somewhere in the beaurocratic machine, what is the nurse to do? Of course I would call 911. If I also administer her epi-pen & asthma inhaler what are the consequences? I know I can be fired, but is this also grounds for loosing my nursing license?
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  2. 6 Comments

  3. by   Huganurse
    Have a nice day!!!
    Last edit by Huganurse on Jun 30, '02
  4. by   stephi57
    Hi~~just a few thoughts. I have been a school nurse in VT for 15 yrs and also work in a hospital setting. First, check both your school job description and your state nursing regulations. As an RN, you are practicing on your own license and responsible for decisions you make. I have run into a few situations where the school view of wht should be done did not match the medically correct best practice. Use professional literature for standards based practice and have protocols & procedures established--this can be done through a local MD, the state nurse association, etc, depending on your state's structure. I have a copy of the School Health Alert clinical guidelines for school nurse's which has been immensely helpful. If your district "pushes" you toward unsafe practice, document the incidents or policies and send a letter to the Health Dept, local, state & national legislators, local health care providers. Don't be afraid to stand on your clinical judgment and education--you know nursing, they do not. Anyhow, this is kind of long, but I wish you good luck and a healthy school year! PS--I do not think bypassing "rules" to save or improve a student condition using your professional judgment could ever be criticized.
  5. by   sunny1973
    Thanks for your ideas. I feel a little better about my situation. In nursing school, we learned that "Standards of Care" or "What a prudent nurse would do" includes your training, education, standards of care for nurses as well as your specialty & also your job description. All these things can be used in a court of law. This is why I often feel I am on shaky ground for acting in line with my conscience. I may be acting within a standard of care (ANA) yet out of the boundaries of my job description - which is highly beaurocratic & regulated. I'm certain the people who make all these little rules & regulations do not actually work in schools. Most of them are just not practical!

    Thanks for your thoughts! I plan to continue gathering info!
  6. by   Jane Zakrzewski
    In reply to sunny 1973 I am a school nurse in NY (since 1983) and I am unaware of any protocol that insists a 504 for students needing medication/treatment in schools in NY. Is this something your school district has a policy on? Frankly, it's hard enough for the nurse to procure all the paperwork for med administration/treatments without the hassel of going through a 504. My school district (nurses) send home forms(or fax forms to doctors offices) for parents and physicians to complete in order for me to administer medication in school, but we don't do this
    via a 504......I think you should be proactive here and approach your school superintendent or committee on special education and at least ask why this particular procedure NEEDS to take place!! Also, re-read anything you can about 504's and anything you can about medicaid re-imbursement for health care services in schools....I think you'll find some interesting information. You
    must be very busy in committee meetings with all the 504's generated (just from kids on meds). Good Luck !
  7. by   sunny1973
    Jane & others -
    Thanks for you input. It turns out that the picky 504 policy only exists in New York City. Frankly, it makes me sick. It prevents me from giving medications to children who may need a prescription medication for a limited time. Recently, I was heartbroken to turn away a 2nd grade Chinese immigrant recently adopted to the USA who needed a rigorous course of antibiotics (1 month) TID with meals. The mother had to give the child a snack when she got home from school & administer the medication at that time. There are so many more stories like that - it would make your stomach churn.
    I always wanted to provide public health but I'm not sure if my conscience will let me continue in my current environment after my contract is up! It encourages me somewhat to hear that it is not this way everywhere!

    Sunny
  8. by   Jane Zakrzewski
    Hey Sunny ---Let me start by hailing you and all you must be struggling with in the aftermath of Sept. 11th....By the way, Buffalo New York is also one of those cities who have certain procedures and exemptions (in regard to health services), similar to NYC....I understand and sympathize with you in your dilemma.
    If I can encourage you to stick it out with your service as a school nurse, please take a moment to think it through...Your students need you,,,,it sounds like they have a consiencious nurse on their side,,,,willing to fight to keep the students health and wellness on the priority list of the board of education. In order for students to learn(to the best of their ability), they must be at their healthiest both physically, and emotionally. Who better to ensure that these kids are being taken care of then YOU!
    My prayers are with you..... Jane

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