Is it the responsibility of the school nurse to do clothing changes for pee and poop?

[Nurse Beth, MSN]

That's a real and challenging situation. Based on what you described, there are several concerns and potential approaches to address them.

Key points to consider

• Scope of practice: In most jurisdictions, school nurses provide clinical care, health assessments, management of medications, and emergency response. Routine, ongoing clothing changes for students without a medical diagnosis or clear medical need fall into custodial care. Assigning this duty to a nurse could divert time from medically necessary care.
• Paraprofessional support: Many districts employ health clerks, health assistants, or patient care technicians to handle non-clinical tasks (changing clothes, toileting assistance, basic hygiene) under supervision, freeing the nurse to focus on clinical care and emergencies. This arrangement is usually defined by policy and job descriptions. Who changes clothes when you are not there?

Practical steps and questions to discuss with the district

• What is the official job description for the school nurse(s) and any paraprofessionals?
• Clarify the role and policies about custodial duties vs. clinical duties for nurses.

Assess patient care needs and safety

• Are there students with medical diagnoses (e.g., incontinence, mobility impairment) requiring nursing involvement?
• Is there a plan for those students that minimizes unnecessary nurse time for routine tasks (e.g., assistive care provided by trained assistants under nurse supervision)?

Staffing and logistics

• Can the district hire or designate enough health aides/paras to handle non-clinical tasks (diapering, toileting, cleanup) with clear boundaries and training?
• Are there contingency plans for medical emergencies when a nurse is tied up with non-clinical tasks?

Training and protocols

• Implement infection control procedures for spills, including PPE, cleaning products, disposal, and hand hygiene.
• Create clear criteria for when a staff member (not the nurse) should handle routine toileting or clothing changes, and when the nurse's involvement is medically necessary.
• Training should be grounded in policy and include safeguards for staff against sexual allegations, clear guidelines on when to contact parents, and procedures for obtaining any necessary witnesses when touching a child is involved.

Legal and regulatory review

• Confirm compliance with state or country nurse practice acts, school health policies, and child protection/privacy laws.
• Check worker safety guidelines for staff performing assistive care tasks.

Possible interim recommendations

• Reallocate non-clinical duties: Move routine clothing-change and cleaning tasks to trained health aides/paraprofessionals under nurse supervision, not to the nurse as a primary duty.
• Develop a triage system: Use standard screening to determine which issues require nurse involvement (e.g., acute illness, injury, medication administration) and which can be handled by trained staff.
• Build a resource pool: Hire or designate a pool of per-diem health aides to cover peak times or multiple sites, so the nurse can focus on clinical care.

Also check out the School Nurse Forum for reference and reality check. They are an active, helpful group.

Best wishes,

Nurse Beth

[JustBeachyNurse, LPN]

Depends on the state and the school.  Some districts pay a "toileting stipend" to individual or classroom aids/paraprofessionals if a student is known to be incontinent (generally a special education student) and similar for preschool programs.   An older student may be expected to clean themselves up as much as possible or call a parent to assist if it is a one time unexpected accident.