I am the only nurse for a 2 school district (approx 800 students). We have a high mobility rate and are in a low income community. Prior to my hire last year, the district had never employeed a professional nurse. I have spent the last 2 years getting the district compliant as well as advocating for a second nurse. Our BOE does not see the necessity of hiring a second nurse, while the sup states that she does, but she tells me that her hands are tied.
Currently, I am in charge of mantaining all district wide state mandated paperwork (physicals, immunizations, dentals, eye exams), health plans district wide, IEP/504s district wide, recovering our failed hearing and vision screening program district wide, coordinating mobile health clinics district wide, maintaining emergency medications district wide, as well as maintaining the health office/stuent visits of 1 school. There is a health aid/secretary who is in the health office of the other school, whose respnosibility consists of student visits (which includes giving medications, care of a diabetic, and health assessments, which is not a part of her job description) and secretarial duties. I have to run much of what I do past administration before I do so (including self advocating to get a lunch break).
Although I am professionally responsible for both schools, I am aloted an hour a week to be at the other school unless I have a substitute nurse available to sit in my office at my main school. I have been named on documents and received calls from parents stating they have talked to me, when it was truly the health aid at the other school.
When I met with my administration regarding my concerns a few months back, we brainstromed some ideas to take some some of the load off of my plate. For example, the clearical stuff, like having someone else enter in the physical/immunization data into the computer for me and tag teaming with a secretary who is certified in hearing and vision (we would work together to complete the screenings, but I would take over the lead and follow up of the program). Both of those things were agreed upon during that meeting. They have recently been put back on my plate "to keep things accurate and consistent." More recently, I've started to get the "this needs to be done in a more timely manner next year" comments.
I feel like I am drowning and I also feel that the district is putting the student's health at risk as well as myself and the health aid at legal risk (although I'm constantly reassured that admin is assuming that liability). I can't decide if they just don't get it or if they are setting me up for failure. Do I stand a chance on convincing them somehow that I can't do it alone? I do enjoy the school where I am located at, but I am reaching my breaking point. I don't know where to go from here. Does anyone have any advice or thoughts for me?
Following this thread and sending you my deepest understanding. I am the ONLY nurse for all 4 of our schools (~1600 students) and I do not have subs or health aides. I am the lone provider, responsible for everything. I am to stay at my K-2 school unless there is an emergency. I am allowed to leave for an hour a day, at the end of the day to complete any of the millions of things that need to be done at the other buildings. I have been to board meetings and met with administrators, unsuccessfully. It's unsafe and unpractical and I dread the day that the roof comes caving in. Hopefully our colleagues will have some good advice!
I'm sorry that we are in the same unfortunate boat.
Do the parents KNOW that a non licensed person is giving their child medication? Does this person get a training by you or who each year?
I would NOT trust them about the liability issue, get your own extra insurance to cover your a$$.
Do you have a school committee? I would present my ideas to whomever you can, and the highest level you can, I know you said you went to the superintendent, keep pushing!!!!
Last year, I had brought this very topic up (medication adminsitration and health interventions should be conducted by an administrator) to the principal, vice principal, superintendant, and our board president. This year, I also have brought the same concerns up with our new superintendant. I've even gone as far as printing up my entire nurse practice act (I'm in IL) and highlighting the exact print within the document backs me up. They still claim that they as administrators will take the chance of the liabilty to have the health aid/secretary continue to administer the medication and health interventions.
I'm not too confident I can succeed, but I can try to do more research and figure out a different means to approach things.
I understand your dilemma...maybe approach it from the angle that by you simply "introducing" a task that must be performed on that campus places you in a professional de facto supervisory position; which the nurse practice act prohibits. In other words, even though the district says they would take responsibility (which I would demand in writing in general), that pledge to you doesn't excuse you from the requirements of your nursing license. In other, other, words, you can supervise the custodial staff while being employed as a RN but you can't supervise unlicensed personnel performing nursing tasks without violating the nurse practice act. One thing for sure, if YOU don't continue the effort, no one else will. Very best of luck to you.
I agree with everyone before me, and that a "we take liability" paper trail drawn up by the fancy district lawyers should be insisted upon. They get paid the big bucks to say "oh crap we are breaking the nurse practice act, we should tell someone..." and people actually listen to them.
Educators are ignorant of the NPA, tell them that their word does not relinquish you of anything. It would be like the Principal saying you can murder someone and they are responsible. The NPA is law, they are basically breaking the law. Unlicensed people don't get it.
1:800 ratio isn't bad. However, I've had similar problems with administrators not understanding the responsibility nurses take on in a position such as this. I've gone head to head with a principal over sending a trained, but unlicensed diabetic care assistant (State of Texas requires one for schools with a nurse and three for school without a full time nurse) on a field trip with our diabetic kid. He didn't want to send them and wouldn't. Kid got a little too much insulin on the field trip. Fortunately, she was okay, but did that incident change anything with my admin? Nope!
Basically, educators often just don't get it and in Texas, medication administration in school is an administrative task, not a medical one. Principals are free to delegate whoever they want to (the only training required is for UDCAs). If I were in your position, I would work on isolating your duties to strictly one school. You could also potentially still be responsible for care plans, shots, screenings, etc at the other school. However, implementation (and thus delegation) of care plans would not be your responsibility. Plop them on the desk of the administrator with a place for them to delegate the person carrying out said plan and their signature. If you can't sever yourself from "delegating" then I would get out as soon as you can.
jess11RN
291 Posts
I'm sorry that we are in the same unfortunate boat.