How much authority do school nurses have?

[flashpoint]

Please don't take this question wrong, I'm certainly not trying to stir up trouble, I'd just like some answers and advice. Under what circumstances can a school nurse say a student cannot return to school? I understand completely for things like chicken pox or pink eye or anything else that is highly contagious, but what about other things?

I work in an ER / Urgent Care setting and we are forever having parents present with their children saying things like, "The school nurse says he need a throat culture." or "The school nurse says he can't come back to school until he's been on an antibiotic for 24 hours." One of the school nurses even sent a note with a patient saying, "Has been coughing, c/o sore throat for three days - needs z-pak." So, the doctor looks at the patient and really sees no reason to do a throat culture or we do lab which indicates everything is viral...and the kid can't go back to school unless we do a culture or prescribe an antibiotic? I understand the need to protect all of the other student and teachers and other staff, but how can they tell someone they can't go back to school unless they have labs or take an antibiotic that they really don't need? And sending us a note telling us the kid needs a z-pak? What up with that? I have no problem with them saying the kid can't be in school until they've seen a doctor, or why don't you call you doctor and ask about a throat culture or an antibiotic, but I think this is going a little too far...am I out of line? Are they just being a little overly aggresive or are they out of line? Can they really keep a kid out of school if we don't give the them an antibiotic? For how long? One of or doctors wrote the nurse a note saying the kid had a virus and couldn't return to school until he was afebrile, but that he didn't need an antibiotic and the kid ended up in his regular clinic two days later, still asking for an antibiotic at the direction of the school nurse.

Like I said before, I understand for things like chicken pox, pink eye, things like that, but what about the rest of the stuff that is going around?

Also, we have confirmed these statements with the school nurse...she told us she is just protecting her students...

[bergren]

I think you have raised a valid point. School nurses can exclude someone until they see a physician (to establish that a rash is not contagious, etc). The physician makes the diagnosis (unless the school nurses is a PNP - some are).

The treatment and exclusion is based on the physician's diagnosis. Once the physician makes the diagnosis, some states are very specific about when a child can return. Minnesota publishes an entire directory of when to exclude and when a child can return to school. But if the physician states the child has a virus, the nurse can say the child cannot return to school until the child's status meets the school's protocol: Able to particpate fully in class, fever under 100 degrees, not actively vomiting, etc, etc. If a child does need an antibiotic for say, strept, diagnosed by the MD, the state or the school can say that the child cannot return until the antibiotic has been taken for 24 hours, and then if the child has no fever etc.

School nurses, unless they are PNPs, cannot demand a specific treatment. Maybe this nurse is just geting ahead of herself a little assuming the child has something specific. I know I have on occasion asked kids to see their doctors for strept or conjunctivitus, only to have them come back with a negative strept test or allergies. As the years go byu, I have fewer false positives.

You can check with your state health department for the school exclusion policies (if they have any). They may be on the web - look at this staes school nurse web site. You could also ask for the school's policy on exclusions.

[MomNRN, BSN, RN]

As a school nurse, I have never demanded treatment. I work at a school for children who have developmental and/or behavioral disabilities. Often the parent is not more higher functioning than the student or they live in a seriously dysfunctional home setting. When these children become ill and it is apparent they need to see a doctor, we may exclude or threaten to exclude until they bring a note from the doctor stating they may return.

These are extreme cases and usually based on definite, grossly abnormal symptoms. One example is a young man who had a temp of 103 and brown, purulent drainage running from his ear. If we didn't threaten exclusion, chances are he might not have seen the doctor. Turned out he had a perforated ear drum.

We see many red eyes, throats, and ears. We suggest treatment as needed, but never make diagnoses.

[cpgrn]

I only resort to this in extreme circumstanses. It has to be a child that I have been following for days and then I will tell them that they need a physician's note to return. It depends on the circumstances.

[DeeDee71]

I rarely ask for a physician's note, in most cases the parents do pretty good at keeping their kids home when needed. I never demand treatemnts or testing to be done, that is up to the physician. The main area we exclude student's for is fever and we do require they be fever free, with out the use of fever reducing meds for 24 hours before returning to school.

[bergren]

This came up in another thread and it bears mentioning here. It is NOT unusual for a health aide to misrepresent themselves as a school nurse. Many many schools no longer have a school nurse. The poarent may use the term school nurse, but in actuality, it is a unlicensed aide with no formal training. There is often one nurse covering anywhere for 3 - 12 schools, and a health aide or secretary in each school working under their license. There are great health aides who totally understand the limits of their education and their role, but others, a few, often do not realize that they do not have assesment skills and think nothing of "diagnosing". To read more, go to the thread: UAP's in our school clinic.

I rarely ask for a physician's note, in most cases the parents do pretty good at keeping their kids home when needed. I never demand treatemnts or testing to be done, that is up to the physician. The main area we exclude student's for is fever and we do require they be fever free, with out the use of fever reducing meds for 24 hours before returning to school.