not getting the info I need

[jess11RN]

OK all..I got a little situation here...please reassure me that I'm not over reacting...

I cover multiple schools. In one of the schools, a person without any medical background maintains the health office. I am professionally responsible for the health office, but am not this person's supervisor. Recently, this person has been getting very lax about things and has been making errors, some significant (admin is aware).

This week, I have found emergency medications for several students accepted by this person, which I would expect. However, I was not informed that these students have emergency meds at school and this person did not get any paperwork for the emergency medications. One is an epi pen and I have no documentation on what the student is allergic to. This person is well aware that these are my expectations.

I'm in the process of now putting out these fires and getting what we need. I'll also report it to admin, although I feel awful doing it because I really do like this person. But, I can't help to feel irate at the idea that these things that I'm responsible for were not communicated to me, I'm missing vital information, communication from me to teachers/necessary staff has not taken place, and policies have not been adhered to. I am worried about what else is being neglected over there-I also reported 2 additional issues 2 weeks ago. If something happens, it's my license. I'm not over reacting, am I?

[UrbanHealthRN, BSN, RN]

Oooh this is a hot mess. I don't think you're overreacting- this is exactly the sort of thing that happens when people who don't have backgrounds in healthcare are put into healthcare-related positions, and it stinks. While I'm not dealing with exactly the same issue as you, jess11RN, I can definitely see where you're coming from, because I work in an educational setting where I am the only healthcare person, and health-related work is often delegated to non-health staff per state guidelines and agency policy (I'm early childhood- sometimes it feels like we're the wild west of education!).

Who is the supervisor for this person? You, or somebody else? Even if you're not the direct supervisor, have you at least been able to sit down with this person and review your expectations for student health services, like reporting all new meds to you, obtaining MD documentation, etc.? How has this person responded to your concerns?

I would definitely keep reporting each and every student health or safety concern to admin, and accompany my reports with district policy, state law, or whatever else is in place that this person is violating. I would also remind my admin of my nursing license and any nurse practice act guidelines in your state that pertain to your situation. Quite frankly, I'd also remind admin of all the parents in that school who would be horrified to hear their children weren't being kept safe during school hours.

I understand wanting to keep a good working relationship with this person, but if you're truly in a position where this is reflecting on your nursing license, then I'd find ways to be at that school as much as possible and personally handle all health matters until I see evidence that the other person can do their job.

Maybe these ideas sound harsh, but when it comes to things like emergency meds and allergies, I don't mess around. I don't really care to break my back by being thrown under a bus if god forbid something should happen as a result of another person's negligence.

[Supernrse01, BSN]

You are not overreacting and here is why...

"these things that I'm responsible for were not communicated to me, I'm missing vital information, communication from me to teachers/necessary staff has not taken place, and policies have not been adhered to. I am worried about what else is being neglected over there-I also reported 2 additional issues 2 weeks ago. If something happens, it's my license."

Have you addressed these issues with the person too?

[jess11RN]

I haven't directly addressed the extent of my concerns with the person, but I did address it in a means of saying, we need this paperwork. I'm not good at confronting people at all and I fear like confronting them would destroy any positive relationship that we have, therefore perpetuating more issues like this and even less communication down the road. Plus, I am not their supervisor, so it's a fine line that I walk. I have spoken with administration about concerns in the past, so this is where I'm going at this point as well.

Maybe I SHOULD take this more into my own hands?

Unfortunately, I maintain my own health office too, so the expectation on me is that I stay here unless I have something specific going on over there. It really is a catch 22.

[Supernrse01, BSN]

I should have added:

I know you mentioned that you like this person, and that is perfectly fine, but in this case, liking them, or even not, has nothing to do with what is going on. Liking them should be your catalyst for approaching them to help them see what is happening could lead to some pretty serious mistakes and consequences.

[jess11RN]

8 minutes ago, Supernrse01 said:

I should have added:

I know you mentioned that you like this person, and that is perfectly fine, but in this case, liking them, or even not, has nothing to do with what is going on. Liking them should be your catalyst for approaching them to help them see what is happening could lead to some pretty serious mistakes and consequences.

Very good point. Thanks!

[BeckyESRN]

Can you come up with a system for ensuring you have the correct paper from the parent and for communicating this info to you? Like a check list for accepting medication/medical forms. medication in original packaging, label with student's name, DOB , and prescriber's name present, medication administration signed by parent and physician, condition listed, nurse notified. something simple that can be used every time something health related is brought in

[UrbanHealthRN, BSN, RN]

1 hour ago, jess11RN said:

Unfortunately, I maintain my own health office too, so the expectation on me is that I stay here unless I have something specific going on over there. It really is a catch 22.

Sounds like you have more than plenty going on over there! If admin wants you stay at your own school, too bad. They're just gonna have to miss you and cover their bums while you go put out the fires that they should be putting out in the first place.

[AutumnDraidean]

I don't think you are overreacting, The other advantage of a checklist is that it serves as proof that either A, all steps are taking place or B, something is missing and needs to be addressed.

If you implement the same checklists for your office then you are not singling this person out, but instead you are adding a layer of cross checks to prevent problems. It's also handy for subs like me so I can make sure I've done all the steps you need me to in order to start a new med or recieve an emergency med.

As my nursing school director frequently reminded us "When the rubber meets the road it's the RN who's responsible!"

[Katillac, RN]

I love the idea of automating in the form of checklists as much as possible. Then you can have a matter of fact conversation with her that goes, "I took a look at the checklists, and X and X aren't complete. I'll need to let so-and-so know we aren't in compliance just yet so WE can keep them in the loop. Please let me know when you receive X so I can update them on OUR progress." It's not a confrontation, it's a way of talking about a joint response to a joint problem, but setting yourself up as the one in charge of the process, even if not in charge of (supervising) her. You can even be sympathetic to how challenging it is to be expected to know how to prioritize all of the pieces of the job, and follow it up with how you hope the checklists will help. That way you aren't saying, "You did bad and I'm telling," you're saying here's a way to support what we all want - a job well done providing a safe environment for our kids.

Reporting factually to the PTB on the problems will also show the interventions you supplied in an effort to be compliant in case the excrement ever does hit the air mover. In a way, it's better you aren't her supervisor. That way you haven't delegated tasks to someone who is a sub-performer. Full disclosure, I don't know the ins and outs of the school nurse role. But I do know the spine tingling fear and anger that comes from someone with a different knowledge base and limited motivation putting me and mine at risk. However, in order to put your mind at ease and bring down your emotional response, I might look into how much risk your license is in due to her sub-optimal performance. That may help you in your interactions with her and in representing a need for change to the PTB from a calmly informed stance.

[jess11RN]

1 hour ago, Katillac said:

I love the idea of automating in the form of checklists as much as possible. Then you can have a matter of fact conversation with her that goes, "I took a look at the checklists, and X and X aren't complete. I'll need to let so-and-so know we aren't in compliance just yet so WE can keep them in the loop. Please let me know when you receive X so I can update them on OUR progress." It's not a confrontation, it's a way of talking about a joint response to a joint problem, but setting yourself up as the one in charge of the process, even if not in charge of (supervising) her. You can even be sympathetic to how challenging it is to be expected to know how to prioritize all of the pieces of the job, and follow it up with how you hope the checklists will help. That way you aren't saying, "You did bad and I'm telling," you're saying here's a way to support what we all want - a job well done providing a safe environment for our kids.

Reporting factually to the PTB on the problems will also show the interventions you supplied in an effort to be compliant in case the excrement ever does hit the air mover. In a way, it's better you aren't her supervisor. That way you haven't delegated tasks to someone who is a sub-performer. Full disclosure, I don't know the ins and outs of the school nurse role. But I do know the spine tingling fear and anger that comes from someone with a different knowledge base and limited motivation putting me and mine at risk. However, in order to put your mind at ease and bring down your emotional response, I might look into how much risk your license is in due to her sub-optimal performance. That may help you in your interactions with her and in representing a need for change to the PTB from a calmly informed stance.

This is extremely helpful. I don't have a great way with words, but you put it so well. Thank you so much!

[Katillac, RN]

Thanks! It comes from working with volunteers, AKA herding cats. When you have the responsibility but not necessarily the authority, you have to get creative.

I'll bet when you try it you'll find out it comes out naturally - I can tell from your OP you want a win/win. It's not so much the words as that attitude of we're in this together and we both want a good outcome, but I've noticed this part isn't working. Then you follow it with what do you think we should do differently, or this is what I think we need to do differently or this is what we're going to do instead, depending on how forceful you need to be. Then you let the higher ups know how you addressed it - they love it when you come with a problem in one hand and your action plan in the other. Then if you still don't get results, you can say to her that the plan you made isn't working - the information isn't getting where it needs to - so you're going to involve the PTBs in making a new plan. If she has any sense, she'll fall into line, recognizing that it's in her best interests. But if not, you then you tell them that in spite of numerous attempts on your part, she isn't completing the agreed on work which is putting the district at risk, and ask for their response. It's respectful CYA - you educated and empowered her to do better, but if she elects not to, you need to protect your kids, yourself and your employer in that order.