Jump to content

I need your advise please

Specializes in ER. Has 33 years experience.

Hello Everybody

I am an LPN working for a home health care company.

I'm taking care of a special needs child. I go to school with him.

My problem is the school nurse. She demands me to chart for the school or give a copy from my charting and MAR.

I feel that it would violate the HIPPA and could jeopardize my license because of the double charting.

My employer stated that it is ok to do it and it would be done for billing purposes.

The school nurse is not involved in direct patient care and I don't work for the school either.

I expressed my concern to my employer and I did not received any reliable response i.e. legal reference etc. other then saying it is ok.

I am hesitating to escalate this issue to the corporate compliance team fearing that my boss would just take me off this case.

We all work on PRN base and it is hard to get 40 hours as I have now with this case. Also they could just not giving me anything because of my "defiance"

So my question is that would you chart for a company who you don't work for or would you give a copy of your documentation including MAR out of your hand to the school?

Thank you for reading this long thread....

Been there,done that, ASN, RN

Has 33 years experience.

My employer encourages the use of the compliance committee. They are there to reviews policies and procedures specific to the organization. What makes you feel you are being "defiant"?

Guest862922, LPN, RN

Specializes in ER. Has 33 years experience.

I don't feel that way but I feel that they could come up with this conclusion after multiple phone calls and I'm still resisting.

The nurse keep harassing me so I keep calling my boss then the answer is oh its ok...I found in our Code of contact that I need written permission from my boss to give a copy...not sure anymore

Been there,done that, ASN, RN

Has 33 years experience.

Why not just point out what you found in the code of conduct manual? I would be concerned about giving progress notes to anyone not involved in the patient's care. Permission from the employer would not protect you anyway. Fail to see what that has to do with billing purposes. Seems like all you would need you be a time slip from the school.

What did the school nurse say when you brought up your concern for a possible HIPAA breach?

Do you carry malpractice insurance?

Guest862922, LPN, RN

Specializes in ER. Has 33 years experience.

Well the Code of Conduct says that I can not give out info or show documents unless I have the written permission from my boss or from our HIPPA Officer... I still think it is not right...

The school nurse treats me like I work for her and said that my boss said it is ok..She is actually works on a complain against me full with slander... she forgot her paper in my folder ... I got a copy from the secretary and the nurse came to me and ripoed out of my hand... I reported this as an incident... it happened yesterday... she also demanded to have access to the Diastat I carry with me... she seems power hungry to me...

Guest862922, LPN, RN

Specializes in ER. Has 33 years experience.

I am not sure about the billing but that is my boss told me. I said to him that in that case they should provide the info such as what skills I do i.e. tube feeding, medicating.It is something about that the school get paid after those skills too.

My company has malpractice insurance on us.I am seriously considering renew mine I had before because the insurance company could provide legal information as well.

Been there,done that, ASN, RN

Has 33 years experience.

What's a diastat? Your employer needs to be present with you during a discussion with the school nurse.

No job is worth being pushed around for.

Guest862922, LPN, RN

Specializes in ER. Has 33 years experience.

Valium suppository with the set dose and waste amount i.e. 10 mg syringe with the set lower dose

Controlled substance I sign for and sealed by the pharmacy. She wanted to open the seal too...I do agree with you I feel that we need a meeting but my employer doesn't feel that way...

Guest862922, LPN, RN

Specializes in ER. Has 33 years experience.

I have to medicate the pt. She wants access to the med I carry stated" if you are incapacitated or incompetent"...

Your company should have a written policy which describes how you should interact with school employees and policy (including school nurses). You share some objectives with these people in the care of the child. It is important that you discover a collaborative pathway to provide the needed safe and effective care for the child while in the school building. They have requirements and regulations which you may not be familiar with, please ask them for clarification so that you can determine how or if you can assist in achieving.

It sounds to me like you are feeling uncertain and pushed and are therefore, sort of digging in your heels. That is a pretty normal reaction, but it will not (in the long run) be good for your career.

I recommend that you get as much information as possible, take the mystery out of the questions or requests, and find ways to work together.

OCNRN63, RN

Specializes in Oncology; medical specialty website.

Well the Code of Conduct says that I can not give out info or show documents unless I have the written permission from my boss or from our HIPPA Officer... I still think it is not right...

The school nurse treats me like I work for her and said that my boss said it is ok..She is actually works on a complain against me full with slander... she forgot her paper in my folder ... I got a copy from the secretary and the nurse came to me and ripoed out of my hand... I reported this as an incident... it happened yesterday... she also demanded to have access to the Diastat I carry with me... she seems power hungry to me...

Don't get into a power struggle with this nurse. You will lose, without question.

​FYI, it's HIPAA, not HIPPA.

Jolie, BSN

Specializes in Maternal - Child Health. Has 34 years experience.

I'd like to offer some information from the perspective of a school nurse.

First and foremost, everyone's goal is to enable this child to safely attend school and participate as fully as possible.

I believe the tension arises from lack of clarity regarding your and the school nurse's responsibilities in reaching that goal. It would be helpful to know the organizational structure of the school and how you fit into that. It is ultimately the principal's duty to provide (or enable others to provide) for the safety and well-being of every child and adult present in the building. Where health matters are concerned, the school nurse is the person to whom the principal delegates this responsibility. She is well within her bounds to ask and have a good understanding of what the child's condition and needs are, what the plan of care is, how it is being carried out, and whether it is effective or not. She is also responsible for ensuring that safety, infection control and hygiene practices are being followed, especially since these impact not only your 1:1 student, but also every other person in the building.

For example, Diastat is a controlled substance. Most State Boards of Nursing/Pharmacy or Departments of Public Health issue strict guidelines on how this medication may be held and administered in the school setting, not only to ensure that it is safely given to your 1:1 student, but also to ensure that it does not fall into the hands of a child or adult who may be sickened by it. This is just one of many considerations that don't necessarily apply when you care for this child in the home setting, but become an issue when you accompany the child to school, where you must comply with state and school district policies and procedures. While you may have the right to essentially act as this child's substitute parent in the school setting, you are not excused from following school district rules, or state laws.

To an extent, your actions may be determined by who hired and pays you. If you are paid by the school or district, then they can and should require you to document according to their instructions. If you are paid by the family, you may keep your notes confidential, but the school is within reason to ask you to document pertinent information in the school record to demonstrate that the child received appropriate care and supervision in school, which is everyone's goal.

Please request a meeting with your agency, the child's parents and school officials so these concerns can be worked out in a professional manner. Failure to do so will foster even greater tension, which will only harm your student in the long run.

Edited by Jolie

TriciaJ, RN

Specializes in Psych, Corrections, Med-Surg, Ambulatory. Has 39 years experience.

I'd like to offer some information from the perspective of a school nurse.

First and foremost, everyone's goal is to enable this child to safely attend school and participate as fully as possible.

I believe the tension arises from lack of clarity regarding your and the school nurse's responsibilities in reaching that goal. It would be helpful to know the organizational structure of the school and how you fit into that. It is ultimately the principal's duty to provide (or enable others to provide) for the safety and well-being of every child and adult present in the building. Where health matters are concerned, the school nurse is the person to whom the principal delegates this responsibility. She is well within her bounds to ask and have a good understanding of what the child's condition and needs are, what the plan of care is, how it is being carried out, and whether it is effective or not. She is also responsible for ensuring that safety, infection control and hygiene practices are being followed, especially since these impact not only your 1:1 student, but also every other person in the building.

For example, Diastat is a controlled substance. Most State Boards of Nursing/Pharmacy or Departments of Public Health issue strict guidelines on how this medication may be held and administered in the school setting, not only to ensure that it is safely given to your 1:1 student, but also to ensure that it does not fall into the hands of a child or adult who may be sickened by it. This is just one of many considerations that don't necessarily apply when you care for this child in the home setting, but become an issue when you accompany the child to school, where you must comply with state and school district policies and procedures. While you may have the right to essentially act as this child's substitute parent in the school setting, you are not excused from following school district rules, or state laws.

To an extent, your actions may be determined by who hired and pays you. If you are paid by the school or district, then they can and should require you to document according to their instructions. If you are paid by the family, you may keep your notes confidential, but the school is within reason to ask you to document pertinent information in the school record to demonstrate that the child received appropriate care and supervision in school, which is everyone's goal.

Please request a meeting with your agency, the child's parents and school officials so these concerns can be worked out in a professional manner. Failure to do so will foster even greater tension, which will only harm your student in the long run.

Yes, I think these are excellent points raised. Rather than get into what you think is a turf war, try to find out how much responsibility the school board bears for every child's well-being. There must be a legal way to keep each other informed for the benefit of the child. You may also want to seek guidance from your State Board of Nursing on this issue. This can't be the first time anyone has encountered this situation.

BuckyBadgerRN, ASN, RN

Specializes in HH, Peds, Rehab, Clinical. Has 4 years experience.

HIPAA! For the love of Mike, it's HIPAA!

It really seems like you are determined to engage in a power struggle with the school nurse. Knock it off. There is a special needs child attending the school, she DOES potentially have to care for this child, it would be in everyone's best interest if she were in the loop regarding her medications, needs, cares, etc.

You say the agencies guidelines say you can share information if they give written permission. Just get it already and move on. I can certainly see why you've gotten a label with your agency and they'd be reluctant to assign other cases to you. Sorry for the bluntness, but by your own words I can see why they'd think that.

Why not call your malpractice carrier, pass this by them for some direction?

Or ask your boss for a written letter stating that you are allowed to give copies to the school nurse?

Sounds to me like there's a reason that this seems to be the only 40 hour position available......

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

Public schools in the United States of America are obligated to provide for all eligible children in their district to attend school. If this means paying for a 1:1 nurse for a vent dependent child, they must do it. The school is probably paying for this child's nursing services and the services are probably outlined in either his IEP or 504 plan. Even though you are present with this child, the school nurse is the healthcare professional employed by the school who has ultimate responsibility for the health and safety of all children in the school. Given that the school is likely paying for this child's service and HIPAA comes into play with health insurance, it may not apply at all. FERPA would apply.

I don't see the issue with the school nurse knowing where the Diastat is. What if the child has a severe seizure in which he needs to be bagged? While you're doing that, she can grab and administer the Diastat. Sometimes you need 2 people when a child is seizing.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

I'd like to offer some information from the perspective of a school nurse.

I was hoping a school nurse would chime in on this. I read this the other day, didn't respond at the time, but was thinking that it's reasonable that the school nurse would need to know what's going on treatment-wise with this child. Not want to know, need to know. She's the school nurse, this medically fragile child is a student in the school that employs her, thus she bears responsibility for this child...and it's her license, too.

Since your employer does not provide definitive guidance that countermands the school nurse's instructions, do what you are told and document accordingly. Or, make arrangements for another job. My employer emphasized to me that I was subordinate to the school nurse.

BuckyBadgerRN, ASN, RN

Specializes in HH, Peds, Rehab, Clinical. Has 4 years experience.

Op? Coming back?

×

By using the site you agree to our Privacy, Cookies, and Terms of Service Policies.

OK