I am a school RN in California. My district has been getting a lot of students switching from Diastat to Ativan orders for seizures. We are able to train ULPs for Diastat with parental consent. Ativan, on the other hand, can ONLY be administered by an RN/LVN because it is not FDA approved for people under 18. We are having so many problems trying to figure out coverage for all of the Ativan scattered around our district!
My question is this, how are other schools (especially in CA) handling this? I see only three solutions:
1. We just hire more LVNs (obviously that is not even up to us and extremely difficult)
2. We tell the parents that their child can either move to a different school that already has a nurse (is that legal?)
3. Have some kind of LEGAL document that states the school will call 911 immediately at onset of seizure if nurse is not on campus. And is that even legal?
I would LOVE it if anyone has any legal documentation or resources regarding this issue.
California keeps passing these crazy laws that make it ok for trained lay people to do medical stuff. They can give insulin, glucagon, diastat, narcs, ativan, etc.
I'll tell ya, the office staff are really getting fed up with having to be trained to treat medical issues. They have their own job to do. When I had to train them for stock epi-pens because no one would volunteer, they were peeved! (The office staff could have refused - they didn't realize that of course but I have a feeling they will soon).
The law in CA stated that the Superintendents had to send out an email asking for 2 volunteers per campus. In our school nurse meeting last week, we talked about how if no one will get trained, then we don't have to abide by the law.
in my state, laypeople can be trained to give epi and glucagon - (personally i'm not thrilled with the glucagon one as it doesn't have lay people doing fingerstick too - its based on what they see only - anyway.. that's a whole other diatribe for a different day) so we'd need a nurse to give diastat anyhow. If a student with a seizure action plan were to go on a field trip, i would have to secure a nurse or have that student's parent go on the trip. I've never given ativan buccally - so i've got no reference point for it.
I'm in NY so I understand the situations are different in the fact that we all have nurses in our buildings here but can't the parent require the district to have a Nurse on site at all times or claim that their child is being discriminated against because of their disability? I would think there's no way for the state to get around the ADA by saying no one volunteered to be trained.
I have trained my preschool teacher to give to a student with Absence seizure. The order is for 0.5 ml in the buccal area for a seizure lasting longer than 5 min. If the seizure lasts 1 more minute...call 911.
I cover 4 buildings.. 3 different districts. I feel pretty confident with this arrangement.
I have trained my preschool teacher to give to a student with Absence seizure. The order is for 0.5 ml in the buccal area for a seizure lasting longer than 5 min. If the seizure lasts 1 more minute...call 911.
I cover 4 buildings.. 3 different districts. I feel pretty confident with this arrangement.
Is that legal for her to do in your state? Did the mom have to sign consent?
Is she practicing under your license?
What if she messes up and says this is how huffmannurse trained me?
Ohio Law allows for the administration of Diastat by unlicensed personnel who are trained to do so. The law was challenged back in 2006 by the Lancaster School District Support Association, who sued the Board of Education and the Ohio Board of Nursing. The rationale behind the lawsuit was that the administration of Diastat by unlicensed personnel was a violation of the Nurse Practice Act and that staff rights were being violated by requiring them to engage in the unauthorized practice of nursing. The court ruled in favor of the Board of Education and the OBN and the decision was held up on appeal.
Is that legal for her to do in your state? Did the mom have to sign consent?
Is she practicing under your license?
What if she messes up and says this is how huffmannurse trained me?
Thanks. Those are all really good questions. In Missouri, anything can be delegated. It is up to the school nurse to provide the training and deem it safe. I am responsible if she gives this medicine. Do I wish it didn't have to be that way? Somewhat. But, it is how is has to be in good old Missouri - the Show Me state, especially in small districts, where it isn't feasible to have a nurse in every building. I have well documented training. We are good to go. The parent always gives signed consent before this would ever happen.
Spidey's mom, ADN, BSN, RN
11,305 Posts
California keeps passing these crazy laws that make it ok for trained lay people to do medical stuff. They can give insulin, glucagon, diastat, narcs, ativan, etc.
I'll tell ya, the office staff are really getting fed up with having to be trained to treat medical issues. They have their own job to do. When I had to train them for stock epi-pens because no one would volunteer, they were peeved! (The office staff could have refused - they didn't realize that of course but I have a feeling they will soon).
The law in CA stated that the Superintendents had to send out an email asking for 2 volunteers per campus. In our school nurse meeting last week, we talked about how if no one will get trained, then we don't have to abide by the law.
Crazy crazy stuff . . .glad I'm a short-termer.