Can you do me a favor and violate the nurse practice act?

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Specializes in med-surg, IMC, school nursing, NICU.

I don't expect teachers or administrators to know a nurse's scope of practice inside and out. I don't. But I DO expect them to remember when I tell them that I legally can't do something and stop acting annoyed when I refuse. The most popular one...

We have a referral-only behavior program at my school. These are the violent kids with multiple behavioral diagnoses. There is a seclusion room and all the staff are CPI trained to help maintain safety when the kids are in crisis. All of these kids are on multiple behavioral medications and it becomes evident VERY quickly when one of them didn't get their AM dose at home. The teachers in this program, as well as some administrators, constantly ask me to administer meds without an order. For example, I have one student who takes a 12 PM dose of Ritalin. He also takes it in the AM at home. If he comes in and immediately starts acting out, I always get a call "I don't think Jimmy John was medicated? Can you call mom and find out and if not can you just give him one of his lunchtime pills now?"

No matter HOW many times I explain that I cannot administer the medication without an order, they still get all huffy when I say no. This isn't really scope of practice related but another time, I called a mom to discover that yes, she did forget to give Little Darling his medication but she was 2 hours away for a conference and dad was unable to come administer the AM dose. When I reported back to the AP and teacher, I was asked "Well why can't dad come?"

I said "I didn't ask. She said he couldn't, I wasn't going to grill her about why." Again, I was met with exasperation from the teachers. I'm sorry, but I think it would be rude to question this mom about why her husband couldn't come. She is a very "with it" parent and truly wants what is best for her son. If she says nobody can come, nobody can come.

Does anybody else experience this?

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Specializes in School Nurse.

I did have this happen to me at my previous school. I would explain that LEGALLY I cannot give an unscheduled dose of medication, and I was not going to risk losing my license over this. Since we do have a little latitude of when we can give the medication, I would tell the teacher that I could admin the medication a little earlier then usual. Teachers are always looking for a quick fix, medication is not always going to calm a student down who is having a crisis.

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Specializes in school nursing, ortho, trauma.

Yes! I have been there! The staff has said to me that they don't understand why i can't just give the dose because i have the pills RIGHT THERE. Well yes, but i do enjoy being employed. and i'm pretty sure that the rest of the staff isn't going to take up a yearly collection for my "early retirement" when i'm shown the door for my actions.

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My first year I had a teacher tell me "I have an important observation this afternoon, so I need you to give little Timmy a "heavy" dose of his lunchtime medication, so that he doesn't mess it up for me"

Last year one told me that little Susie takes the same ADD med as her daughter and she had a few extra in her purse, so I could give one to Susie "because she is acting like she forgot it"

This year it's been "Why can't you just repeat a dose when he's acting up, that's what I did when my son took that med"

Seriously, they have NO CLUE! If you know that I can't give a kid a cough drop, why do you think I just double a dose of a medication?!

Breathe and repeat I love my job, I love my job, I love my job

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In our state, we are not required to have a physician note to administer medications, the pharmacy label and parent signature are all we need. Many of our students have a PRN bottle of their AM meds here in the clinic, with only 4-5 pills in it. We are able to give that if they forget at home. I don't know if that would be an option for you or not.

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Specializes in School Nurse.
My first year I had a teacher tell me "I have an important observation this afternoon, so I need you to give little Timmy a "heavy" dose of his lunchtime medication, so that he doesn't mess it up for me"

Last year one told me that little Susie takes the same ADD med as her daughter and she had a few extra in her purse, so I could give one to Susie "because she is acting like she forgot it"

This year it's been "Why can't you just repeat a dose when he's acting up, that's what I did when my son took that med"

Seriously, they have NO CLUE! If you know that I can't give a kid a cough drop, why do you think I just double a dose of a medication?!

Breathe and repeat I love my job, I love my job, I love my job

^^^There are no words

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In our state, we are not required to have a physician note to administer medications, the pharmacy label and parent signature are all we need. Many of our students have a PRN bottle of their AM meds here in the clinic, with only 4-5 pills in it. We are able to give that if they forget at home. I don't know if that would be an option for you or not.

The first time a kid sees me to say that he/she forgot their morning med, I call home and let the parent know that if they get me an order, we can keep 2-3 tablets here, just in case. I've had a few parents do this and it works out nicely for everyone!

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Specializes in med-surg, IMC, school nursing, NICU.
In our state, we are not required to have a physician note to administer medications, the pharmacy label and parent signature are all we need. Many of our students have a PRN bottle of their AM meds here in the clinic, with only 4-5 pills in it. We are able to give that if they forget at home. I don't know if that would be an option for you or not.

I actually obtained an order for this very situation for the same student to which I was referring earlier. Mom never brought the meds in though.

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I actually obtained an order for this very situation for the same student to which I was referring earlier. Mom never brought the meds in though.

Heh, go figure......

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The first time a kid sees me to say that he/she forgot their morning med, I call home and let the parent know that if they get me an order, we can keep 2-3 tablets here, just in case. I've had a few parents do this and it works out nicely for everyone!

this is what I have done too. Sometimes a student will come to the office and say they forgot so I make sure to always confirm with the parent before administering so I don't' accidentally over medicate a kid who forgot they took it.

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Specializes in School nursing.
The first time a kid sees me to say that he/she forgot their morning med, I call home and let the parent know that if they get me an order, we can keep 2-3 tablets here, just in case. I've had a few parents do this and it works out nicely for everyone!

I do this as well - the order is actually pretty easy if they are willing and I tell them that when they refill the prescription to ask the pharmacist to make an extra labeled bottle for school for them, so that I can get the meds in the prescription bottle. It works very well.

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Teachers have a license too...they should understand the concept of protecting it. :angrybird1:

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