School nurse denies inhaler

Specialties School

Published

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Before replying, please google this and watch some of the other stories about this-for example, this one:

http://www.wesh.com/news/31109650/detail.html#ixzz1vsd2cwFv

There are always 2 sides to every story and the yahoo story does not even come close to being an unbiased account.

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Specializes in School Nursing.

I agree the media is not reporting the whole story, and I tend to believe that the parent is probably blowing the symptoms out of proportion. I have a hard time believing that the nurse would not have called 911 had it been a severe acute asthma attack...and if that was the case there is no way admin and the district would be standing behind her.

We had a recent situation where a parent was claiming our staff members who are trained to cover my office in my absence were negligent in their care of her child. She went to the media, who was all set to run the story until they got the other side of the story and realized the care was appropriate. It seems the media in the above case are not being quite as responsible.

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Specializes in kids.

I'm sure we do not have the whole story to start with.... And it is now a third hand story as this is a YAHOO writer reporting on TV story so....

I wonder if she had a pulse oximeter on that read 99?

Was he retracting?

Did she use the rule of 9's?

Was he cyanotic?

Did he have a history that has not been shared in the article?

Did it look like anxiety?

Where there wheezes either audible or present on auscultation?

Was there a behaviour history with this kid?

Did the reporter ask HER side of the story? Even if sh/e did, she would be violating HIPAA and FERPA to share that info s we dont have her side.

I personally would have given him the MDI and called 911 if I thought there was an emergent situation. If it was not deemed an EMS type emergency I would have called for verbal permission and then sent the form home with the 17 year old or asked the parent to come in and sign. If I was concerned enough about the parents response I would have had someone witness the phone call to the parent.

However, all that said.....

If it is as reported, then it is a shameful act of neglect and irresponsibility. While rules are rules (re the need for a parent permission form), the greater good is served by meeting the emergent needs of the student.

Too many unknowns....

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I have watched and read several accounts of what happened and from what is out there already I have to beleive this LPN did not do her job properly.

As far as the form not being on file, the mother recently posted on facebook that she has photocopies that are time and date stamped from when the Doctors office faxed the school the authorization AFTER the school reportedly lost the first one.

In one report the school spokesperson said that the student became aggressive because he didn't have his inhaler and the nurse felt threatened and locked the door, the school admin. held the boy in his office where he was visible through a glass door. The spokesman said that the nurse and the school admin agreed that the boy wasn't having a genuine asthma attack and thus would not call 911 either. Spokeperson never said that the nurse monitored vital signs, only that they observed the Pt through a glass door. I just don't see how a proper assessment of the Pt can be done through a glass door.

The school did in fact have the inhaler that was legally prescribed to the patient in their possession but witheld it from him. Medication aside once the student was controlled by the admin why didnt the nurse conduct a follow up assessment of the patient to ensure that nothing was wrong?

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Specializes in school nursing, ortho, trauma.

I've already said my piece about this several times. Order or no order, if a student is having an exacerbation of their asthma and has their inhaler on them, i'm giving the inhaler if i think it's truly warranted. Of course this is followed up by a lecture from me - i've even gone as far as to state that the student may not return until i have that order (i don't know that i really have the authority to do that, but it has worked, and i have gotten an asthma action plan immediately when i have crowed like that).

If the student was not in any danger, lungs clear, spo2 wnl, etc then no - i would not give the student the inhaler either. I would have made a call to the parent to advise what was going on, let her know that i needed an order and so forth. If the parent or student insisted that it was an emergent situation(parent not being there, mind you) then i would tell teh parent to come into mendicate him or would have gladly called an ambulance for the student and would have sent the inhaler with EMS. I'd hate to abuse ems in such a way, but people sometimes don't get the message unless you do something bold (and i would hope it wouldn't come to that!)

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

FL cracker....Welcome to AN! The largest online nursing community!

I believe that There are always two sides to every story. The mother failed to sign the proper paperwork to allow the child to have the asthma medication. Faxing the order is not the parental consent. If the student was having a "full asthma attack"and "turning blue/blue finger tips" it would be difficult if not impossible to be escorted anywhere without being carried on a stretcher. It sounds like the staff were familiar with this young man and knew he would be alright until MOM got there. Did Mom Then take him to the ED to be evaluated? If his finger tips were blue then she should have......Too many variables to judge.

There is no way to know whether a followup assessment was or was not carried out by the news reports but observing an angry teenager who is not in respiratory distress with labored breathing through a glass door can be sufficient enough to know that the child is in no acute distress.

I have triaged thousands of patients and from the moment they walk on the door. When a patient is in real distress, you know it the moment you look at them and think your self......man, this guy's in TROUBLE....and rush to their side. I find it difficult to believe the Yahoo article as 100% unbiased and true.

The attorney that represented the Anthony's? Now there's someone I believe....not. Man, there is still something, that for me.....stinks about that whole case. I think they ALL know what happened. Nurse Mom and cop DAD helped cover it up.

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Specializes in Med Surg - Renal.

My thoughts are the same as others. The story is so absurd it doesn't sound like it is being reported properly.

I once had a patient call security screaming I was "withholding his inhaler from him." He was mad that I took too long (about a half minute) to get the inhaler from his med bin. I was standing next to him with the inhaler as he continued his 5 minute screaming rant, uninterrupted, that he had COPD, he was dying, and I was withholding his medication.

I'm sure the person on the other end of the phone line surely would think I was an incompetent, negligent nurse if he believed the story he was being told. This particular patient had a tendency to go a little scooters when he was on steroids; by lunch he was profusely apologizing.

In any case, anyone with an acute asthma attack is going to get their inhaler if I have anything to do with it, regardless of signatures.

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As everyone as stated, if any child was having symptoms of asthma attack, I would be the first to call 911. Just today, I had a student come up and tell me he couldn't breathe. Was talking fine, 0 s/sx respiratory distress, lungs clear, HR normal. No history of allergies or asthma. Not allowed to keep an oximeter at school. Should I have called 911 for him? No, I called Mom and was told (and I quote) "yes, he's just a little actor, isn't he? Send him back". After this story, I will call 911 the next time something like this happens. Then Mom can pay the ambulance bill and it won't be so funny.

mc3:paw:

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Specializes in Emergency, Telemetry, Transplant.

At first I though this was serious reporting, they I realized it was an op-ed piece (and not a very good one at that). For example, the writer used her father as her 'expert witness'--and I'm guessing he would say whatever this opinion "writer" wanted him to say.

Just go over to the "She got fired..." threat and you can see that following policy actually is more important than 'save a life at all cost.' If the nurse truly did nothing other than lock the door when the student was having major difficulties breathing, yes, she did not do her duty, but it is not as simple as just giving the kid the inhaler....

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Specializes in Med-Surg; Telemetry; School Nurse pk-8.

I agree that there is more to this than meets the eye. For example the kid's inhaler was found during a backpack search. Odd that a backpack search was done at the same time that a severe asthmatic attack occurred. And if the backpack was searched in desperation to get that inahaler, odd that once it was found it was confiscated... I mean with the kid's lips and nails blue and all that...

My BS sensor is bleeping like crazy right now....

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I went to the district web site. There are only 5 RNs for 61,000 students. That is about 1:12,222 students. The clinics are staffed with LPNs and health assistants. The med policy online says med administration is up to the principal or designee. It further states that the School Nurse is responsible for checking the authorizations every 3 months. Thati is the only reference to a nurse by title in the entire online procedure. Each RN supervises 13-14schools. Hopefully this districts as learned something from all of this and rethinks how they look out for kids. If we were working in that professional hell I am not sure we could say how the outcome would end up. I think these delegation issue always scare me to death.

Have a wonderful weekend off...for most of us the light is in the middle of the tunnel lol

Terry

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