Appropriate assignment/caseload

Here's my opinion.  You cannot do both.  A medically fragile child needs a 1:1 Private Duty Nurse (PDN).  You can't be both a school nurse, responsible for 1200 students and a PDN.  If your district is insisting you can, you need to run - I don't mean walk - RUN away.  Your license is on the line.  Read that again - YOUR license.  Not the district's, not the head of health services, YOURS.  When there is a bad outcome, neither the lawyers or the BON in your state are going to accept that the school district is responsible.  And, if you think the district lawyers will help you, think again.  They are there for the district and will throw you under the bus if it means saving them.

Asking for clarification - are you going to be responsible for the 1:1 student all the time, and then called away to cover the other kids OR are you saying you are covering the 1:1 kiddo when their normal nurse is on break? 

If the latter, then it would be doable, but I would be cautious.... If you are only covering for short periods of time, then get it in writing, that during that time, you are then solely responsible for the 1:1 student and would not be expected to leave the student to attend to other school nurse duties. 

I worked in a school where they had 2 school nurses and a 1:1 nurse. One of the school nurses would cover the 1:1 student during his nurse's lunch break. Of course, they were lucky enough to still have an office nurse covering the remainder of the school.

So I would still have my 2 buildings and 1200 kids, but any time the primary agency nurse called off, I would be expected to care for the 1:1 student.  I would not be able to do anything else when I am with that student.  Another nurse would take emergency calls and questions for my buildings. My fear is since he is so complicated, jumping in randomly and whenever would be really difficult and possibly a dangerous risk to him and my license.  I feel like this is too much for one nurse but I wasn't sure what others have been asked to do.  I decided and communicated that I cannot do this.  

MountainRN said:

So I would still have my 2 buildings and 1200 kids, but any time the primary agency nurse called off, I would be expected to care for the 1:1 student.  I would not be able to do anything else when I am with that student.  Another nurse would take emergency calls and questions for my buildings. My fear is since he is so complicated, jumping in randomly and whenever would be really difficult and possibly a dangerous risk to him and my license.  I feel like this is too much for one nurse but I wasn't sure what others have been asked to do.  I decided and communicated that I cannot do this.  

That is a big fat no and you need to get your school lawyers involved. They need to have a  backup plan or the child stays home. Or they need to pay a sub to cover you and you cover the child. You cannot do both a with any fidelity.

@MountainRN  how did this turn out?

My district agreed and we hired a nurse for the student! Yay!  I'm so happy to have the support.  I am so super busy and the agency nurse called in sick just today and thankfully we had our back up district nurse there to provide safe care.  I would have been so swamped otherwise!  

In our district the agency is responsible for coverage.  If the agency nurse is out, they must find a sub.  If no sub available the student cannot attend.  Up to the agency

My district has said this would be a violation of FAPE laws but I would think safety of the student should take precedent.  I have another student starting next week in that same classroom that will require a nurse and doesn't have one so trying to figure it out another solution again! 

MountainRN said:

My district has said this would be a violation of FAPE laws but I would think safety of the student should take precedent.  I have another student starting next week in that same classroom that will require a nurse and doesn't have one so trying to figure it out another solution again! 

In districts I know of, agency stuff does the 1:1 but the office nurse (if there is an LPN or LVN) or the RN covers during short staffing. The understanding is they can not do anything else at all while 1:1 so all the duties they're actually paying the RN for they can't do. No calls or IEPs or anything. 
 

Safety always takes priority. It's tough though since we can't deny them education due to medical needs, but most parents are understanding.