RN School Nurse replaced with LPN. When will NYS mandate an RN in every school?!

  1. 1 I have been an RN since 1991. I finally achieved my "Dream Job" of becoming a School Nurse, and worked at an elementary school for over 10 years, only to be laid off and replaced with an LPN this past June.

    I had finally gotten to a point where I felt like all my doubts about being a nurse were because I just wasn't in the right area of nursing, because as a School Nurse, I LOVED my job and truly felt like it was my calling in life. I tried everything to educate our board of education--even contacting the State Education Department and showing the board all the regulations, scopes of practice, and statements from the state against what they were doing...but to no avail. It made no difference, and I lost my job along with another RN.

    Now an LPN is in my office, taking care of over 550 students and over 100 staff members---students with extreme special needs---and she is not qualified to do the job (no assessment or triage privileges as an LPN!) Don't get me wrong, I have a lot of respect for LPN's---I worked as an LPN before I got my RN---but I also knew my scope of practice.

    I am shocked that EVERYTHING School Nurses do is mandated by the state....but School Nurses themselves are NOT mandated. Are you kidding me? There doesn't seem to be any urgency to remedy this either!

    With more and more students with chronic & serious medical issues attending schools, why isn't this on the very forefront of legislation? I have written several senators & congressmen only to be told that they "understand" the importance and it is something they take seriously....but that is it. I think RN's (School Nurses) across the state of NY...heck--it should be this way across the country in EVERY state--need to stand up and do something about this!

    As School Nurses....we are independent practitioners that make a HUGE difference in the lives of the students & communities we serve...we are necessary, important....and we should be STATE MANDATED IN EVERY SINGLE SCHOOL BUILDING!!!!! Thoughts? Suggestions? I feel alone, abandoned, scared, and so very uncertain of my future. Losing my dream job was so much harder on me that I could have ever imagined it would be.
    Last edit by JustBeachyNurse on Sep 20, '12 : Reason: formatting/spacing
  2. Poll: Should New York mandate an RN for every school building?

    • Absolutely! They are crazy not to!

      71.43% 5
    • I don't see the difference between and RN or LPN as a School Nurse

      28.57% 2
    • Schools don't need nurses

      0% 0
    7 Votes
  3. Visit  jhendoRN profile page

    About jhendoRN

    Joined Aug '12; Posts: 4; Likes: 6.

    5 Comments so far...

  4. Visit  Artistyc1 profile page
    0
    I am a little confused about this post. Is there an RN that oversees the LPN that replaced you? I am in NY as well. I believe that a district is NOT mandated to have a nurse of any kind. However, if there IS a school nurse, it must be an RN. I think some get around this by having an RN "supervise", but with as busy as many offices and schools are, this may be supervision by phone only.
  5. Visit  jhendoRN profile page
    0
    You are right....NYS does not mandate nurses at schools, and if a school chooses to have one, it must be at least 1 RN. As for "overseeing the LPN"....you should go to our state board site & look up the scopes of practice--I was stunned. LPN's can not assess or triage--which is 90% of what a school nurse does. They are "dependent practitioners" where an RN is an "independent practitioner". The LPN must be under the direction of an RN at all times for every single student & staff member that comes into the medical office with a medical issue. According to Karen Hollowood RN/BSN/MSEd from State Ed, the LPN should not be in a building by herself..and if she is...she should be calling that RN for every single visit to get the RN's direction! How can this be done, honestly, when the RN has over 1000 students, and the LPN has a building of over 500...including medically fragile children. It is irresponsible and risky of districts to do this. Niagara Wheatfield school revoked their decision to lay off an RN and use the LPN instead after they researched the scopes of practice and liabilities involved. My other thought is...what RN that cares about her license would want to make medical decisions over a telephone without her own personal assessment of the student?! Supervision by phone only is absolutely insane...we might as well just start calling our personal physicians and let them treat us over the phone without seeing us! Insane! It will never change until NYS FINALLY mandates an RN in every school....and I am not holding my breath! HA!
  6. Visit  mc3 profile page
    2
    Just so you're aware, I'm an LPN in Florida, and I work at an elementary school of 950+ students and 60+ staff. I was taught to assess in nursing school (yes, head to toe assessment), and interpreting information, implementing care plans, giving meds,provide holistic nursing care etc. Call it what you will, but every LPN does assess and apply nursing interventions. Just like RN's. Just ask them. The state of FL has LPN's in their elementary schools, with RN's in oversight positions. I saw the District nurse RN about 5 weeks ago for maybe 10 minutes and we chatted about her sons the whole time. I'm very independent, have assessed and handled emergencies for brittle diabetics, children with severe allergies, children needing Epipens and glucagon, children who have broken their arms/feet, colostomies, behavior/emotional issues, adults who have broken bones and cardiac arrest, and been involved with 504's and more. How could I have done all this without assessing? I am involved in the immunization program and work directly with the Health Dept. on issues. The suspected abuse cases are seen by me first. Some of our nurses have been in their jobs 20+ years. Some of our schools have LPN's who do catherizations, tube feedings, suctioning, and more..we have our share of medically fragile students, and have never had a problem with an LPN's versus RN's care.

    It's odd to me that LPN's are mostly in charge positions at SNF's, yet you don't hear anybody having an issues about their "assessing" versus "evaluating" skills. Why is that? Do they have finer "evaluating" skills in LTC's, and they're full of folks who are medically fragile and unstable. And, no, I'm going going out of my scope of practice, either. If I am, then every school nurse, dialysis nurse, clinic nurse, LTC nurse, etc etc in this country is out of compliance.

    I am not saying I think LPN's are equal to RN's. I know that! I understand RN's have a greater depth of knowledge, have more years in school, etc . I think each has it's own strengths. Unfortunately, it seems some of our RN friends have no use for us, or don't really understand what we're taught in school.
    mc3
    Last edit by mc3 on Oct 3, '12 : Reason: because I wanted to
    loveoverpride and loriangel14 like this.
  7. Visit  mc3 profile page
    0
    Quote from jhendoRN
    You are right....NYS does not mandate nurses at schools, and if a school chooses to have one, it must be at least 1 RN. As for "overseeing the LPN"....you should go to our state board site & look up the scopes of practice--I was stunned. LPN's can not assess or triage--which is 90% of what a school nurse does. They are "dependent practitioners" where an RN is an "independent practitioner". The LPN must be under the direction of an RN at all times for every single student & staff member that comes into the medical office with a medical issue. According to Karen Hollowood RN/BSN/MSEd from State Ed, the LPN should not be in a building by herself..and if she is...she should be calling that RN for every single visit to get the RN's direction! How can this be done, honestly, when the RN has over 1000 students, and the LPN has a building of over 500...including medically fragile children. It is irresponsible and risky of districts to do this. Niagara Wheatfield school revoked their decision to lay off an RN and use the LPN instead after they researched the scopes of practice and liabilities involved. My other thought is...what RN that cares about her license would want to make medical decisions over a telephone without her own personal assessment of the student?! Supervision by phone only is absolutely insane...we might as well just start calling our personal physicians and let them treat us over the phone without seeing us! Insane! It will never change until NYS FINALLY mandates an RN in every school....and I am not holding my breath! HA!
    Shows you just how things vary from state to state. I worked in Massachusetts and Florida, and oversight did not mandate an RN be in the building, they could be anywhere...see my posting..

    mc3
  8. Visit  HazelLPN profile page
    0
    I am a retired LPN and I work as a substitute assistant school nurse.

    Every state has a different scope of practice for LPNs. Where I work, the scope of practice is very vague on purpose, leaving much up to the particular facility as to what an LPN can legally do under her/his license.

    I retired three years ago after a long career in various ICUs..most recently PICU and NICU. None of the patients I took care of in these units were "stable with predictable outcomes". I took care of intubated patients on vents, HFO and ECMO. I titrated my own pressors and gave my own IV pushes. I gave blood products (after checking with an RN). I was limited in that I didn't do the initial assessment on admission, I didn't give any IV chemotherapy, I didn't serve as a pts primary nurse and write the careplan, and I couldn't push propofol or other anesthics. I also didn't take charge or carry the code beeper Otherwise, I mangaged my own patients and I did so very well for many years.

    New York has one of the most restrictive scopes for LPNs. Even though all LPNs assess patients, some states reserve the term "assessment" for RNs only, and assessments performed by an LPN are referred to as "data collections". The idea is that the RN then will assess the LPNs patients, with input from that LPNs data. In reality, 99% of the time the RN will write "read and agree" and sign her/his name after the LPNs.

    In the state where I work, only BSN educated RNs who have a certificate from the state department of education can work as certified school nurses. As an LPN, I can work as an assistant school nurse. I generally care for special needs students who the regular school RN simply would not have the time to care for. Our certified school nurses are represented by the teachers union and are all members of the National Education Association. Our nurses have their own bargaining unit and it is in the contract between the teachers union and the school board that each high school have a full time certified school RN. If there is an MH unit at that school with many special needs/medically fragile children, that school RN is assigned as assistant....which are LPNs or RNs who don't have the certification from the state department.

    If your school nurses are members of the teachers union, they should go to bat for you. If they are not members of the teachers union, they should be. Our teachers are very supportive of our school nurses and vice versa.

    Best to you,
    Mrs H.


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