This is my first year as a school nurse so I'm still trying to figure out all of the legal stuff that surrounds our job. I work at a Charter School with no other nurse available. I do have two sub nurses who have a contract with our school but they both have hospital jobs making it difficult for me to find coverage.
Anyways, I have 2 field trips coming up involving three different grades (a school nurses worst nightmare). I also have two diabetic students, one going on each trip. One of the diabetic students is going on a four hour long hiking field trip. The other diabetic student is going to a science museum. Neither of the parents can accompany their student on the trip. One parent demanded that I specifically be on her son's trip because "you know him best and he is the worst off diabetic".
My question is: Can a sub nurse go on one of the field trips with a diabetic student? I do have my certificate for field trip delegation but I didn't think I could delegate emergency glucagon to another nurse.
First off...yuck! I agree that your director should be the one to talk to the parents as this was his decision.
What grade are these students in? I only ask because I am wandering if the diabetic child going to the museum has ever gone anywhere without either a nurse or his/her parent before. Or can recognize feeling "low." (I have one student that knows the second he hits below 70.)
Does his/her teacher know him/her well enough to recognize something might be wrong (i.e. hypoglycemia)? I work at a charter school as well, don't have any subs on payroll (though we have two school buildings and each has a nurse), and have one diabetic whose teacher is awesome and picks up the symptoms of hypoglycemia well once taught what to look for. A trip to the museum seems less likely to result in a diabetic crisis...can the school allow this student to go if the parent signs off on his/her teacher (educated by you, of course) being the one with emergency glucagon?
(Side note, when I subbed for the public school system, I went on a few field trips; as someone else said, that was what the subs were there for :).
Sorry to leave you all hanging. This is what happened. After I called both parents to inform them that their child would not be allowed to attend if they did not have a parent or guardian with them they were furious. One of the parents asked to speak with the direct which I gladly transferred the call. She was threatening to call ADA and DPH (to name a few). A few minutes later my director told me he would be providing sub nurses for the trips. However, he asked ME to find the sub nurses. We do have two that have a contract with our school but I get frustrated asking because I feel it is not part of my job description. In other schools, is it your job to find your own coverage?
As for the students, one is in 9th grade and one is in 8th. They are both on insulin pumps and they are both very unpredicatable and difficult to control. They will come in with bg in the 50s, give them some carbs, wait 15mins, and they will drop even further into the 40s! So now I'm left with the decision, should I stay in my office, or attend a trip? I know I'm responsible for 300 some odd other students in the school but it's very difficult to explain to a nurse exactly how these diabetics work when she has never met them before. I will gladly be looking forward to your opinons!
Also, I have a very difficult time sticking up for myself when it comes to my director. I get so initimidated I usually end up doing whatever he asks of me despite whether or not it is in my job description (like requiring me to find a school phyisian at the beginning of the year). Do you guys have any tips on how I can become more confident knowing I am the only healthcare provider in this school full of administrators? In a charter school, my manger is the director. I am the only nurse.
I used to have to get my subs but thankfully not any more.....can you be in touch via cell with the field trip subs? That might make it easier to help coordinate their care. The musuem may be easier than the hike based on cell service ability-that might help. (Of course you KNOW your office will be full anytime the sub calls with a question re the diabetes!)
Good Luck and maybe after this is all over would be the time to sit down and explain the difficulty of getting a sub. Our district hires them (we interview them to make sure they will workout in the school setting) but the sub coordinator calls when one of us are out. Maybe offer to help interview a pool of them so you are not making "Cold calls".
Besides, who is gonna call for a sub if you are unable to? (illness or injury)
Specializes in School Nursing, Public Health, Home Care.
If I was your sub nurse, I would rather take on one student than stay back and be responsible for the whole school. As long as you give the sub the parameters and equipment, they should be fine. There's always the advantage of a cell phone as well!
As far as dealing with the principal or director, one way to answer those "requests" is to say "I don't feel comfortable doing that because the teaching staff are not required to.....get their own subs......whatever" Follow up with a comment about your job description if you need more. But sometimes saying less is enough. Then you don't look foolish saying twenty reasons why. When you say you aren't comfortable doing item x, it's sometimes difficult for the other person to say "well you have to do it" and they can't easily negate your statement, because they can't tell you how to feel. Finally, there is the "pick your battles" concept. Some things we do above and beyond and suck it up but sometimes you have to say enough!
Even though you have to contact then, you at least have two subs to start with (the office manager steps in for me when I am out). You mentioned that both your subs work in a hospital setting...if they are both available, how is their diabetes knowledge? Have either subbed in the school for you before/handled a patient with an insulin pump? I feel the museum trip is definitely easier, so a sub could handle that. If your diabetic is that fragile on a pump, you may to accompany on the hiking trip and have a sub at the school. But again that decision, for me, would depend if the subs you have are available and if either of them had ever subbed in for a day at the school.
As I mentioned, I work in a charter school where my manager is the director and non-medical, so I understand that can be hard in stating your medical case and know you often have to do it all yourself. It may not mean much, but you get a ::hug:: from me.
Specializes in family practice and school nursing.
In NYS schools must provide coverage for field trips unless the student is self directed in taking their own meds or the parent or their designee goes along. Things can get complicated in my setting as we have many students with special needs who cannot be self directed. We have 3 sites that 2 of us cover, so when we add a field trip to the mix it gets very difficult. There are a couple subs but if they are not available then the school must pay an agency nurse to go on the trip. In NYS state it is ILLEGAL to exclude a student from a field trip based on their disability. Worse case scenerio; if no nurse can be found and the parents can't go, rather than exclude the child the whole trip would need to be canceled. Luckily, this has not happened.
Specializes in family practice and school nursing.
Oh , I forgot to add that with the many different programs we have in our bulidings, sometimes the nurses don't even know about the field trip until the day before and sometimes even on the morning of the trip! Makes figuring the logistics even more fun
I have 7th and 8th grade diabetic males; one on a pump, one not. Both manage their own diabetes. The 8th grader on his own and the 7th grader with someone to oversee. They each give their own insulin. The goal with diabetics is to get them to the point where they can manage their own diabetes.
Only nurses can give insulin in CA although there is a lawsuit going on now about that. The parent can come in or send in a delegate but no other school employee can do this. Not the health clerk or a paraprofessional (aka teacher's aide).
When our diabetic kids went to science camp though - a parent had to go. An entire week of monitoring the boys was too much.
And yes, it is NOT your duty to find the sub nurses or talk to the parents. That's the district's duty.
JenTheSchoolRN, BSN, RN
3,035 Posts
First off...yuck! I agree that your director should be the one to talk to the parents as this was his decision.
What grade are these students in? I only ask because I am wandering if the diabetic child going to the museum has ever gone anywhere without either a nurse or his/her parent before. Or can recognize feeling "low." (I have one student that knows the second he hits below 70.)
Does his/her teacher know him/her well enough to recognize something might be wrong (i.e. hypoglycemia)? I work at a charter school as well, don't have any subs on payroll (though we have two school buildings and each has a nurse), and have one diabetic whose teacher is awesome and picks up the symptoms of hypoglycemia well once taught what to look for. A trip to the museum seems less likely to result in a diabetic crisis...can the school allow this student to go if the parent signs off on his/her teacher (educated by you, of course) being the one with emergency glucagon?
(Side note, when I subbed for the public school system, I went on a few field trips; as someone else said, that was what the subs were there for :).